Interviewee: Well, so I think any person needs to really be looked at from a holistic lens and that's not something we do well in healthcare either. Yeah, now I'm throwing a bunch of stuff at you and it looks like you're writing some notes so I don't know if you want to clarify anything I said or any questions so far?

Hailey: No, I think you've been pretty clear. Yeah, and don't worry about just throwing a lot of things out there because I know you've limited time so since I'm taking notes I can just go back and like really delve into any terms that I don't get. 

Interviewee: Yeah, and I'm curious what kind of reading or information you found specifically on what trauma informed means.

Hailey: I think for trauma informed, the reading I've done is kind of  firstly  that you need to  recognize  our colonial history and then secondly to  kind of ask people what trauma informed means. People  who they are, where they're from, that sort of thing to  understand  background, heritage,  their life story, our big parts and then I think  just to then carry out  whatever you do in a manner that's informed by that. Yeah, I don't think there was  anything  super concrete,  in our policy right now, but  I'm curious if  at your organization, they have , I don't know  specific  the definition or  their specific.

Interviewee: You know, I think there's such a range in people's understanding. By and large, it's still something that we, I think, have quite a bit of work to do. In the evolution of health care, really appreciating trauma and the results of that. It is fairly new, right? I mean, maybe it's been around for, I'm just throwing out a number, but 20 years, but in the evolution of health care that that's really quite new and it takes quite a long time for things to get embedded and for us to really get caught up. So I think that somewhere, I think I probably already said this, but that I think our health care systems still really have a lot of work to do. There is like trauma informed courses that are developed, especially for places like mental health and substance use and even emerge, but it's still an ongoing education at this point. I mean, you were mentioning some of the ways of being with people that come with being trauma informed, which I think you hit on some important pieces and then I might also add, really trying to explain what you're doing as you're doing it. That's both a respectful thing to do because you're often working with other people's bodies and stuff, right? And not knowing their history, especially if they went to residential school and how that trauma stays with them. Always really important to explain what you're going to do and see if they have any questions and get their permission. You know, as I mentioned that things are often really rushed, we don't have lots of time, but it doesn't take long to say, is it okay if I do such and such or I am going to do such and such, is that okay with you?

Hailey: Right.

Interviewee: So explaining what you're going to do because you don't want to catch people off guard or make them feel violated and ask them if they have any questions. Just giving people that space to be where they're at and that permission almost to be where they're at. Yeah, that level of understanding. Some, I don't know if you've been directed to the National Collaborating Center of Indigenous Health. They have some amazing webinars on there, really quite a broad range and I seem to recall some trauma informed there. And also the UBC Indigenous Health Center of Excellence or Burning and Excellence, I can't remember exactly what it's called. I've attended some of their trauma informed webinars. They're really good.

So I would recommend those. And then if you're looking at stories, like we don't want to just ask people their stories and people's, especially Indigenous teachings and people's stories are theirs to own and we don't share others' stories without their permission. So one place when I used to teach, because I used to teach Indigenous health at UVic and a couple of other universities, a resource that I would use with the students is, I can see if I can find the link and send it to you, but it's some residential school survivors sharing a little bit on their stories and their experiences. And they are sharing those stories because they want them to be heard. They've gifted them to people despite it being often traumatic for them to tell it. And it's, yeah, I'll find you the link because I can't remember the name offhand, but they're little vignettes, if you will, maybe three to five minutes each or something and they don't get into a lot of the horrific details.

So definitely the traumaticness or the awfulness of those experiences comes through without them using a lot of graphic detail. So they're very much sanitized in a way, but I'm sure you've probably heard some of the horrors of the residential school systems. And I spent quite a bit of time with Indigenous community members and elders and heard their stories directly. And yeah, they're pretty bad. But these ones are, you know, I don't think they would traumatize you hearing them.

So that's why I think the storytellers have been very careful in how the wording that they use and whatnot. So and I don't know where else you were thinking of for stories or narratives, but did you have any other ideas for that?

Hailey: Yeah, you know, for those sort of things, because  my last interview, he pointed me to a speaker series he'd done with  Indigenous health care leaders or  just Indigenous leaders in general. And then another one of my interviewees pointed me to this report with  stories that they use for qualitative feedback on  the trauma-informed care they'd done. So  those sorts of resources are kind of what I'm looking for as well. So yeah, that link would be really helpful to me, obviously, if you have  a personal story, that could work. But that's kind of the resources are kind of what I'm looking for as well. To be able to pull the stories that have already been  shared willingly. 

Interviewee: Yeah. And I'm curious how you envision turning it into an art representation, which I think is great. I know I would always encourage my students to be creative and find ways of expressing their learning. And they did some amazing work. So, yeah, I'm just curious. You don't mind sharing a bit more?

Hailey: It's  in the beginning stages of brainstorming,  I'm trying to. Because I've been doing the interviews  the past two weeks of them. So I'm trying to  pull whatever I can from there and incorporate it into my art. And I'll have  kind of some writing as well this side to  explain, but  I'm still in the drafting. I'll probably be working with this indigenous artist that has you know, been a partner with our school for a while to  ideate and  see what elements they can incorporate. And I think  each piece will kind of I don't want to just have a literal drawing of  kind of someone's story. So I kind of take  certain symbolic elements probably and  create that and  use different symbols that in my research, you know, represent  certain experiences. And  they're meaningful also to  the local community, I really want it to be rooted in local culture and their idiosyncrasies. Yeah. Yeah. Let me know if you have  any ideas  or advice. I'm always open to that. 

Interviewee: Yeah. You know, I think it's really important to be able to allow that creativity and recognize what speaks to you. Right. I think if you're able to really tap into your own creative self, that that is how it's going to be the best.

So I guess I'm hesitant to recommend when I really want to see you be able to surface what how you envision and how it's really meaningful for you. One thing that did come to mind when you were speaking is have you ever heard of there's a movie called Making of the Witness Blanket or have you heard of the Witness Blanket? It was done by an Indigenous artist who I think it was his father went to residential school and he wanted to find some way of honoring him and he went across Canada and heard stories. And so the movie Making of the Witness Blanket is all about his interviews with people and he gathered one thing from every person. And it's it's now this huge blanket or mural that's in I think it's the Center for Truth and Reconciliation or something in Winnipeg. I had the opportunity to go to a pre-screening where him and his father were in attendance in person at the BC Museum in Victoria right when they had finished making it. And so it was very powerful being in attendance with a bunch of elders and him talking about it himself and the father talking about it. But the movie is really well done. You might find it valuable as well as really interesting. They did a lovely job. So there's some stories in there as well as you can see how he created a piece of art out of those stories and to really honor the people. So I guess my only recommendation is thinking about honoring the people as you're doing it to give that meaning because stories belong to that person. Right. So we're sharing a piece of them. Yeah. Yeah. So that's something I would recommend. 

Yeah. Any more specific questions?

Hailey:  I kind of want to hear about what you guys, you know, have  in practice at VCH  strategies to address cultural safety and humility to create  an empowering environment, a safe environment.

Interviewee: Sure. And I mean, as you're probably aware with the in plain sight report and the truth and reconciliation calls to action, there is a fair bit of work in all the health authorities because the need was already always there. But we're being held accountable a little bit more, which is, of course, a great thing, but it's very much overdue. So we were trying to separate out, including everything under cultural safety and if there's indigenous specific racism that is very much part of our society in Canada, mainly because it was perpetuated for land disposition and oppression of indigenous people to be able to take advantage of resources like the land that this narrative around inferiority and I don't know how much work you've done into racism and racism theory and things like colonization. Right. Racism as a means of colonization and white supremacy and all that. Those aspects, I'm not sure how much you've done delved into that, but it's very much a part of what we need to undo within health care.

Hailey: Yeah. For sure, these things have been taught to us in school, but it still feels quite censored and shallow so if you have any resources that I could use for some deeper reading, I would really appreciate it. We're not really educated on, you know, the modern repercussions and rhetoric we learn about. 

Interviewee: I'm sending you a resource, the in plain sight report via email. That if you haven't had a look at that, I strongly recommend it because it's stories of 4,000 indigenous people and their experiences of racism in health care. I think we need to very explicitly name the indigenous specific racism and not just include it within the term cultural safety because it's not really about culture and somebody being able to practice their culture or not being held against somebody for their culture. Indigenous specific racism is very much a purposeful act of colonization so really trying to build that understanding in our health care system, explore and help people understand where things like racism come from so that we're not shaming people. I really want to take a supportive and educational approach and that we're all in this together, right? This has been a progression of the last couple of hundred years that have got us to where we are, but also holding people responsible and building the expectation that racism and in my case in work I do, indigenous specific racism will not be tolerated. So we're trying to build what we call a speak up culture where everybody feels comfortable calling out what they might witness and perceive as racialized acts or ways of being of speaking to somebody. And so we're also creating an indigenous cultural safety policy and out of that is the work in how we go about educating and communicating that so I'm in my role just trying to start with some leadership development around it. So for example a manager on a nursing unit, how does she approach her staff in doing this learning, what does it look like for their work because it can be very different depending on the different roles that people play, right? And so beyond the education what accountabilities do we have because that's also something that was identified in the in plain sight report is that right now there really isn't any accountability. People aren't held accountable even if they are recognized for racialized behavior so there's the education side and the accountability side. And this is very much work that we're actively engaging in so it's not implemented, it's not fully done, we're not there yet, we're very much in progress. 

Hailey: Are you pushing for  policy updates or is it just  social accountability as in  other people?

Interviewee: Well I mentioned the indigenous cultural safety policy, it's very extensive, it's like a 10 page policy that includes different aspects so within the indigenous health team we're just going through some of the final edits of that so hopefully it will be implemented as an organization wide policy very soon. And then have you heard of the HSO cultural safety standards which is health standards organization, you might want to look that up. So that's a federal organization that is responsible for their linked with accreditation Canada who accredits all hospitals and health authorities to essentially allow them to be able to operate within Canada. So they're implementing standards that all health authorities are going to have to meet.

Hailey: So that's another way of holding accountability and evaluating the success or how much we're actually accomplishing that right? And then  what community resources are available for people that come with trauma for example or in need of  mental health support?

Interviewee: You know I haven't worked in mental health specifically and that tends to be more at the community level so probably best to ask somebody who works in that area, apologies. If I were to offer a couple of examples, there would be so much I would miss out on. Yeah, I just don't feel like I could do a good job of that. But you could definitely ask some of the, especially sites that work in the downtown east side for example. Yeah, and explore our website is probably a really good way to understand a bit more about the structural organization and supports because there's many different sites and programs and departments within Vancouver Coastal Health. We have 31,000 employees so we're very very large. Yeah, and I do have a 930 meeting so I just want to give you a minute for any last question that you might have. 

Hailey: Maybe do you have  a feedback collection mechanism as well to see?

Interviewee: We're in the process of developing Inter health authorities so the health authorities getting together and something that's called cultural safety indicators. So we're trying to determine what those are right now because it's complex.

So there's everything from how many neonatal classes somebody's attended to delays waiting for surgery, how many people have left without being seen in the emergency department because of the wait times and potential for racialized treatment.

Right, you're all over and so we're really trying to narrow those down.

Hailey: Okay, yeah. Thank you so much.

Interviewee: Good luck with it all. Thank you so much. I'd love to be able to see your final result.

Hailey: For sure.

Interviewee: Good day. Bye. Bye. 

Hailey: Thank you.