Interviewee: All right, perfect.

Hailey: Okay.

Interviewee: All good?

Hailey: Okay, so before I start asking the questions I prepared, could you do  a little introduction of  your role at BC Cancer so I can kind of get a better idea before I start?

Interviewee: Who I am and what I'm about, yeah, for sure. So my name's <<>>. I am Scottish on my mother's side and I'm Cree on my dad's side from the Satellite Cree Nation, which is up in Northeastern Alberta. I live in Victoria,the traditional territory of the Lithuanian people. I've been a really grateful visitor here for the last 15 years. It's a fairly new position. I've been in my role for just over a year now. And my role has kind of two tracks. So in half of my work, I work with our Indigenous Cancer Control Team. So BC Cancer does have an Indigenous team. And in that role, I support the development and implementation of cultural safety plans for our assisting six cancer centers. And those cultural safety plans have a whole range of actions and priorities, all relating to really wanting to improve the care experience and improve the patient experience for Indigenous patients and their families as they receive treatment at BC Cancer. And a big chunk of that work is related to the facilities themselves. So lots of work to make the facilities more culturally safe. So bringing Indigenous artwork into facilities, including territorial acknowledgement signage. And creating or building sacred care spaces, so spaces for Indigenous patients to go for ceremony before or after treatment. So that's kind of half of my work with our existing cancer centers. The other half of my work, I'm supporting Indigenous engagement across four new cancer centers we're building right now, which are in Burnaby, Surrey, Kamloops, and Nanaimo. So yeah, it's a dual role.

Hailey: Great. Okay. Thank you for that. I think you already touched on it a little bit, but how do you integrate cultural practices and traditions into  a healing health approach? 

Interviewee: Yeah, a lot of that work is done through our Indigenous patient navigators. So at BC Cancer, we have a physician called Indigenous Patient Navigator, and their role is to support Indigenous patients and their families throughout their whole cancer journey. So ensuring that they feel welcomed into the cancer center, often going with them to appointments who support that process, providing access to cultural services or ceremonial services. So if somebody wants to go for a smudging or be brushed off or have any kind of other access to ceremony, the Indigenous Patient Navigators, IPNs, can help connect those patients to those services. And also providing access to all kinds of other logistical support, so whether that's supporting transportation to treatment or accommodation while they're there, meal support. So our Indigenous Patient Navigators really lead that work in terms of supporting patients while they're there receiving treatment. And then again, in my role, yeah, so doing things like incorporating Indigenous artwork into space so that folks can see themselves reflected in the cancer centers, whether that's through artwork or design. And then also, like I mentioned, building actual physical spaces for spiritual care. We just completed a new spiritual and outdoor spiritual care space at the Abbotsford Cancer Center, working with a Coast Salish builder who created that space for us. So yeah, just looking for ways to incorporate those opportunities for culture and ceremony and connection within the centers themselves.

Hailey: Okay. So on a similar note, what strategies do you use to address cultural safety and humility and potentially address discrimination in your organization in order to create empowering environments? 

Interviewee: Yeah, for sure. Well, at BC Cancer, and BC Cancer is part of PHSA, the Provincial Services Authority, there's certainly a really large focus on cultural safety. There's required training for all PHSA staff, so BC Cancer being part of that, as a required cultural safety training, which really helps to broaden the understanding for staff around the history of colonization and residential schools, understand cultural safety, understand how to provide more culturally safe services for patients and their families. So yeah, training is definitely a big emphasis in the work that we're doing to really create better care and better services for patients and families when they come and access treatment at our centers. 

Hailey: Let's see.  So what community resources are then available to save those with trauma or people that might not feel safe or that sort of thing?

Interviewee: Yeah, great question. I mean, it really depends on the individual and where they're from and where they live. So if it's somebody, let's say in the Vancouver area, who's from the Musqueam First Nation and lives on reserve and they're accessing services at our cancer center, that nation may have, usually will have health services available for members. And so if it's a First Nations person living on reserve in their home community, there could be some services available for them. There are counseling supports available through the First Nations Health Authority. Again, you have to have First Nations status in order to access those services. If you are an urban Indigenous people, most large urban communities in B.C. have something called the Friendship Center. I don't know if you've heard of Friendship Centers before. So I think there's 25 in the province and they provide a really wide range of services for Indigenous people who are living in urban areas, so living away from their home community. So those centers really have a wide range of services for folks from counseling to connection back to culture or language to health supports. Again, depending on the community, definitely lots of other service providers. So I'm based in Victoria, so I'm more familiar with what exists in Victoria. In Vancouver, I know there are a large range of services for Indigenous people. Vancouver has the largest urban Indigenous population in B.C. and so there are a lot of urban service providers.

Hailey: I'm actually curious because I haven't learned much about this, but in order to have First Nations status, you would have to live with your community? 

Interviewee: Nope. But you have to have a status connection back. So it's kind of a complex structure, but basically the Government of Canada through the Indian Act, which is the piece of legislation that governs First Nations people, they have a system where they identify who is eligible for First Nations status, so generally it means you have to have at least one parent who had status as well. And so it passes down, like if your parent has full status, then your child would have status. And so if you have full status from a band, you would have a status number that identifies you as what's called a status Indian, not a term that we would use anymore. And so I, for example, have status. My nation, like I said, is in Northern Alberta. I live in B.C., but as a status Indian, I have access to those benefits through the nation. And again, each nation is different in how services are provided to their members, whether they live on reserve or off reserve. If you have First Nations status and you live on reserve, there are generally more services available to you when you live away from your community, you're more disconnected to those resources. But again, that's where things like friendship centers play a really big role in providing services to Indigenous folks living in urban areas. 

Hailey: Thank you. How do you or do you involve Indigenous elders or  knowledge keepers in your program?

Interviewee: For sure. So for me and my role, if we are building, let's say, so for the Abbotsford Cancer Center, we just built a sacred space. So we consulted with an elder around the naming for the space and also brought elders and knowledge keepers in to do a ceremony to open the space. We have, so for example, the Victoria Cancer Center, our Indigenous patient navigator is connected to an elder in the community. So when patients ask for ceremonial support, our IPN is able to connect the patient to that elder who can either come to the center and provide services or the patients can go to where the elder is. So for sure, we connect with them in that way. Also, other examples, if we're building a new facility, often we'll try, we'll ensure that we consult with community around what type of design we would want to use or how we would want to deliver that service. It's definitely important to have that consultation happening.

Hailey: I love that there's all these resources available. I wanted to ask on the flip side what  perhaps improvements could there be or what obstacles still exist in receiving  safe care?

Interviewee: Well, I mean, the unfortunate reality is that the health care system in BC is still really, there are still, there's still a lot of racism that exists. And so for a lot of Indigenous patients, they're fearful to come and receive treatment at centers or to go to any kind of health care facilities because of the history of racism that has existed in those facilities and that continues to exist. And so folks will either belong coming in for treatment or not come in for treatment at all because they're fearful of what their experience would be. And so just from a BC Cancer lens, there's certainly a lot of work that we're doing, like I said, cultural safety training for staff so staff can provide better services and building, creating safer physically spaces that are more culturally safer patients. So there's lots of work that we're trying to do. But certainly racism is a reality still in our health care system and it creates big challenges for Indigenous people when they're coming to access care. 

Hailey: Do you then  have or are you working on  an accountability mechanism? 

Interviewee: Yeah, so PHSA has a fairly robust complaints process and so if a patient has a complaint about the care that they've received, Indigenous or not, there is a whole protocol and process that happens to ensure that that complaint is heard and responded to. And there are then, I don't have a full background in the complaints world, but yeah, there's a process where complaints can be escalated through the complaint system so that the patient is heard. And then on the other side of that there's a response to that complaint. So whether that's additional training for staff or a healing circle where folks can come together and share about their experience. So there's a complaints process and then lots of mechanisms in place to try and address that change moving forward.

Hailey: Thank you. Could you either maybe share someone's story of healing and resilience within your organization or maybe if there's a resource where people have publicly told their stories, is there any you know of since I'm focusing on a kind of narrative style?

Interviewee: I wouldn't say that I have a specific story to share. Publicly available resources. On the BC Cancer site we have an Indigenous Cancer Strategy and within that Cancer Strategy I think we do have stories from survivors about their journey with cancer care and so I think that could be a good resource. I think we also have several short videos. I'm just going to pull it up right now and then if it's what I remember I can put the link in the chat for you. So I would definitely recommend checking out this page. There's the Cancer Strategy document. There's lots of resources there for folks living with cancer. There's several videos, Joanna's story, Marion's story, data, so yeah lots of I think good starting points there.

Hailey: Thank you so much. Just to  learn a little bit more about trauma informed care specifically since I know it's a little bit different from  culturally sensitive kind of care. What are some specific  practices or interventions that fall under or  that can make a difference for someone?  what would be your definition?

Interviewee: Yeah that is not my level of expertise or yeah so I don't think that I could really speak to that specifically in terms of a definition or examples. I mean I think for me just personally from an Indigenous lens like seeing the person as a whole person, understanding their story and their background and their you know what they've been through and how that impacts the person that they are today. So if they're behaving in a specific way when they're in an appointment seeking services you wouldn't judge them you know on their current behaviour. You would understand where they're coming from and what their experience has been or past traumas that they may have had and how that impacts their current life scenario. So I would say that again that's just me and my own opinion. I couldn't provide a better or more specific definition.

Hailey: Okay actually I was wondering if I could hear about  why or how you  decided to work in this field?  your reasoning, motivation I  to think. 

Interviewee: Great question. I have spent my whole career working within Indigenous organizations and Indigenous nonprofits and as an Indigenous person myself I think always having the opportunity to work for our communities and to create better outcomes. I for sure have a personal connection in this work. I lost my lung cancer when I was young and so you know I think between my own family experience and sorry I don't know if you could hear the song in the background yeah I think that I'm really drawn to that. I think it's it can be really especially you know working as an Indigenous person in a large organization like BC Cancer it can be really daunting but it's important to try and be able to help make change especially for me for Indigenous people and so the opportunity to do that through this work is powerful. If we can create a better experience of care for Indigenous patients and their families in the future then I think that we've been successful in our work and I feel a lot of gratitude to be able to be part of that. So you'd say that like it was healthcare like always like what you oh so you were like? No this is my first time working in a healthcare field. Until now I've worked for mostly well I worked for the Friendship Centre, the Provincial Friendship Centre office working mostly with youth services and with child and family services and after I was transitioned from that position I worked for an organization called the Moose Eye Campaign which is a campaign that addresses gender-based violence against Indigenous women and girls and so that was the world that I was coming from so healthcare is a new field and there's so much learning for me in this space but I think it's an area where there's still so much racism that exists and so being able to make a difference in this field is important.

Hailey: I've actually I think our school is  doing something with the Moose Eye. Moose Eye probably yeah they're in lots of schools. How do you know there's  the complaints but in general how do you collect feedback from  clients, patients,  community members about their experiences and  whether   how they feel about you know  is it working that sort of thing?

Interviewee: Yeah BC Cancer as a whole does a lot of work in collecting patient feedback so they have patient feedback surveys that they run really frequently. You'll see if you look at the Indigenous Cancer Strategy document that there's a patient journey map so we've done patient journey mapping sessions where we'll come with a graphic recorder, sit in circle with patients, hear their experience and then represent it in a graphic and so that's something those kind of engagement sessions are stuff that we plan fairly regularly. Also really through our Indigenous patient navigators we get to hear a lot of first-hand experience through them because those navigators are working every day on the front line with patients and so they're able to really relay that feedback back to our team about what's working or not working or challenges that patients are experiencing or positive experiences that they've had within the system so yeah our IPNs are really important there. 

Hailey: So the navigator acts as a bridge? do they work with  an individual patient on one-to-one?

Interviewee: yeah the Indigenous patient navigators are really there to be the bridge between the patients and the care system so they support patients in any way that patients need help so it could be  I said arranging organizing travel and accommodation while the patient has to come for treatment often many Indigenous patients live in remote communities and so they're having to travel you know five to ten hours to the closest cancer center to get treatment and so there's lots of support that can be provided for travel and accommodation often going to appointments with patients both you know just to take notes for the patient it can be overwhelming when you're in appointment but also to advocate for them if the doctors maybe you know if there's questions about care that they're receiving they can be there as an advocate and they help connect patients to spiritual care access or supports so they're really there to help a patient in any way that they need help and again they're the bridge so often as well you know maybe an oncologist has questions for a patient and they're having trouble getting connected to the patient then the oncologist could go to the patient navigator and say can you help me connect with the patient or I have these questions maybe help me get those answers so they're the bridge It's really important all the time.

Hailey: yeah I'm  right now I'm shadowing at  a dentist office and I see that  a lot of the patients come in with  someone who takes notes for them. Sometimes they're elderly. so it's interesting I see that within this role there is a position specifically delegated to best serve indigenous patients. I think it's a great idea seeing how interpersonal relationships are so important to wellbeing.

Interviewee: the indigenous patient navigator position yes specifically for indigenous patients there are definitely a lot of other supportive care services that exist within the cancer centers but the navigator position has been created specifically for indigenous patients and so they're like trained on how to like are they I don't know like trained in like mental health care yeah a lot of them have social work backgrounds so they have a lot of that experience already through social work degrees or experience in that field almost all of them I think all of them are indigenous so they have lived experience and background so that's kind of the field that they're coming from.

Hailey: okay lastly kind of  for my project are there any specific  symbols or  I don't know is there any art out there that I could look at to  draw inspiration from.

Interviewee: yeah publicly facing is the question but they just did a story I'll see if I can find it on the BC Cancer website on some of the projects that I've just undertaken oh here we go yeah so this is a public space and story so I can share this with you so you can see yeah see some of the work so there's murals art, territorial acknowledgement so lots of lots of options and looking.

Hailey: yeah because  I'm wondering  what sort of art style I should emulate I  one material so I'm trying to brainstorm and draw inspiration so I can  represent what I learn so these are I love the color schemes used here okay thank you for sharing that with me. That kind of concludes most of the questions I have prepared is there  any additional  comments or  information you want to leave with me or  something important.

Interviewee: I think that that's I think that's all of the kind of key pieces again I don't have a huge background in trauma informed care that's not my area of expertise so I can answer questions as much in that area but um yeah I think I've provided as much as I can always it was really informative like yeah I think I got a better idea of kind of you know the services available.

Hailey: it's really helpful thank you for taking the time to do this yeah for sure happy to help really appreciate it. That's kind of all I have prepared. So I love the short meeting but I think it's because you're really concise with your answers and I appreciate that as well.