Team Up! Team-based primary and community care in action

In this episode Morgan and Sarah explore Indigenous Advocate and Indigenous liaison roles in Primary Care. Indigenous Liaisons and Advocates work across the primary care system to support Indigenous people in accessing care. This can also include supporting system transformation towards more culturally safe care, providing education to healthcare colleagues, and working alongside Indigenous Nations, elders, and community to design care for local needs. We will hear from two people who work in advocacy and liaison roles about what they do, how they work, and what they enjoy about working in primary care.
The key takeaways from this episode include:
  1. Indigenous support roles might span the whole system of care and are responsive to the unique needs of each community and Nation they serve - they won’t ever look the same and that’s a good thing!
  2. The approaches, decisions, and changes to care must be guided by community, elders and Indigenous people.
  3. Care practice between Indigenous support roles and patients needs to: be grounded in relational care, have a deep understanding of history, take careful consideration of space, and allow the process to unfold with Indigenous patients setting the pace.
A huge thank-you to our guests from this episode for sharing their knowledge and experience with us. In this episode you heard from:
  • Reina Thurmer: Reina was born and raised in Whitehorse, Yukon, and she is a member of the Wikwemikong First Nation on her mother’s side and German on her father’s side. When interviewed for this episode, she held the role of Indigenous Wellness Advocate with the Comox Valley PCN, working on the K’ómoks First Nation supporting patients in receiving culturally appropriate care from family doctors, nurse practitioners and other healthcare team members. She has since left that role and started med school!
  • Gracie Kelly: Gracie’s family roots are with the Soowahlie/Xaxlip First Nations and she is a Cultural Safety and Humility facilitator, an educator, enjoys sharing traditional teachings and is an advocate of supporting Indigenous communities. Gracie works with the Chilliwack Division of Family Practice, a non-profit society that represents Family Physicians in Chilliwack, Agassiz, Seabird Island and Hope. Their members provide primary care services from Chilliwack to Boothroyd and strive to improve health care services for patients by supporting an engaged and collegial medical community.
Resources and Links :

What is Team Up! Team-based primary and community care in action?

A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.

Morgan: Are you interested in
learning more about what Indigenous

wellness liaisons and advocates do?

Are you considering adding
an Indigenous health focused

role in your team or your pcn?

Yeah, me too.

Sarah: Morgan, we're now over halfway
through our roll call season and

it seems like people are really
enjoying this deep dive into roles.

We had our most downloaded month ever.

Morgan: Yes.

It seems like people are
really enjoying this and it's

resonating, which is great to hear.

Sarah: Well, I think I was really
excited that, we're talking about the

Indigenous wellness Liaison role today
because in our own team, we're just

wrapping up an eight week reflective
process focused on different aspects

of justice, equity, diversity,
and inclusion, what we call JEDI.

Morgan: Yeah, the timing
couldn't be better.

We've just finished this one, I
think this is our fourth that we've

done as a group and, we continue to
do these, throughout our ISU work.

But today's episode we're gonna
highlight the Indigenous specific

primary care roles, and I'm really
interested in learning and hearing from

our guests who have a lot to share.

They've got really different
experiences and have shared a lot

of wisdom for us for the podcast.

Sarah: Yeah, and I think this episode
is gonna feel a little bit different,

than some of our previous episodes
as we're gonna be taking on much

more of an active learner role here.

I have limited experience with Indigenous
focused primary care roles and was really

just so humbled during our interviews
with our guests about their work.

I think we're gonna be doing more
listening than talking in this episode.

Morgan: That sounds good.

And who are we gonna hear from today?

Sarah: So we spoke with two
people for today's episode.

First, Gracie Kelly, whose family
roots are with the Soowahlie

and Xaxlip First Nations.

She's a cultural safety and humility
facilitator, educator and Indigenous

advocate who works with the Chilliwack
Division of Family Practice as an

Indigenous Relations Manager for the PCN.

Gracie: So I'm Gracie Kelly,
Indigenous Relations Manager with the

Chilliwack Division of Family Practice
and also the Primary Care Network

region from Boothroyd to Chilliwack
supporting Indigenous communities.

So welcome everybody.

I am on the traditional territory of
the Soowahlie community which is one

of the We also include Metis my role
is to support health and integration

promoting traditional wellness practices,
integrating Ministry of Health funding

to support the Indigenous communities.

Also ensuring both urban and away
from home are being taken care of.

So my work is supporting Indigenous
ensuring cultural safety and humility

practices have been integrated
from the voices of the Indigenous

of what they would like to see and
change and really promote Indigenous

coming into receiving healthcare.

Sarah: And we also spoke with Reina
Thurmer, who was born and raised in

Whitehorse Yukon, and is a member
of the Wikwemikong First Nation of

Manitoulin Island in Northern Ontario.

Now, Reina has since left this position to
go back to school, and this is exciting,

she's been accepted into medical school.

but when we spoke, she was the Indigenous
Wellness Advocate with the Comox

Valley PCN, working out of her office
located on the K'omoks First Nation.

Reina: So my name's Reina Nokomis Thurmer.

I'm born and raised in Whitehorse Yukon
on the traditional territory of the

Kwanlin Dün First Nation, and the Ta'an
Kwäch'än Council and I'm currently

working for Island Health and the local
primary care network as the Indigenous

wellness advocate, and I'm working on
the traditional unceded territory of the

K'omoks First Nation, and supporting,
I believe it's nine clinics that we

have in the Valley that are working
with the primary care network here.

So I'm working with those clinics as
well as a local health connections

clinic, and then also with kind
of the greater community here.

The scope of the work is quite large.

it can be anything from helping someone
navigate non-insured health benefits or

First Nations Health Authority to, you
know, we get a lot of people reaching out,

asking for support with helping them find,
counseling supports and maybe they don't

feel comfortable reaching out to A social
worker or a mental health clinician right

away, that might feel like a barrier.

It could be anything from helping someone
access Red Cross equipment to connecting

with their physician about questions
they may have or they don't understand,

helping complete status card applications
or Metis citizenship applications.

And then also, the more difficult side
with the advocacy piece for people

that are experiencing very real and
challenging barriers in accessing their

healthcare, whether it be discrimination,
not feeling safe, or welcome in

spaces, the overwhelming emotions and
experiences that can come with accessing

Western healthcare in institutionalized
settings can be very challenging,

understandably for a lot of people.

And trying to see how we can really
integrate culture, cultural competency,

traditional learning, traditional
supports, traditional medicine, spiritual

care into their healthcare and their
western healthcare approach because

for a lot of people, that isn't even
something they know how to ask for

because it's never been offered to them.

Morgan: Now I wanna acknowledge the
important work F N H A and many of the

people from across the whole system
are doing to support all healthcare

providers to provide more culturally
safe care for Indigenous patients.

We'll link to some of these efforts
in the show notes for this episode.

Sarah: And today we really wanted to
focus in on roles that are created

specifically to support Indigenous
health and wellness, and that are held

by Indigenous people within primary care.

Morgan: In my own experience working
with different Indigenous support

roles, I know they can be quite varied.

So what's the scope for
these type of roles, Sarah?

Sarah: what We learned, the
scope is really, really broad.

as you heard from both Reina and Gracie,
as they introduced themselves and talked

about their work spanning the whole system
from supporting individuals to accessing

care, to embedding kind of cultural
safety and humility into care practice,

to ensuring appropriate consultation with
Indigenous communities is happening when

care is being designed and also thinking
about, how traditional cultural practices

of Indigenous nations are considered
or included in these broader systems.

They also, I think, do a lot of work
supporting providers and teams in

the learning that needs to happen to
create cultural safety in primary care.

Reina: This is not a role that I see
myself solely being able to fill.

It is a huge collaboration with
the local nations and, seeing it

also as an opportunity to educate.

It's a very interesting balance that this
role, I think specifically plays because

I'm a part of a primary care network team.

I'm a team member in these clinics,
in these professional settings.

But my role is also there to not only
support my team, but also support people

that don't feel safe in our team setting.

Playing both sides of that role comes
with its challenges, but I think

that's kind of the point you know.

how can we support from within
while also helping our team with

that learning journey as well.

Morgan: So these roles are both oriented
towards the patient, but also very outward

facing, too bridging to community, and
probably really like multiple communities.

And that added layer of supporting the
learning journey of our colleagues makes

this a really complex role to hold.

And it reminds me a lot of that
social worker role in terms

of where it sits in the team.

Sarah: That's so true.

You know, that kind of , community
bridge and anchor sort of idea that

we heard in the social work episode.

And so much of the work that these
roles do is also guided by what

individual Indigenous patients and
communities need, and I think something

really foundational to these types
of roles is the depths of connection

with local Indigenous communities.

Gracie: It's really important
that Indigenous teachings or

perspectives don't sit in a square
box or in a colonial structure.

It really is that evolving
circle of communication within

Indigenous to kind of come back.

I may share some ideas of what it is
that I'm planning or a conversation

that a Indigenous health rep has
identified and then network back with

traditional wellness mentors that I have.

I have one so far that offers
traditional wellness practices

within the sacred space room.

I also have a very important team of a
traditional teachings advisory, a small

group of Indigenous reps and or people
supporting Indigenous within our region.

These people, I'm very honored to share
and network and hear guidance, hear

thoughtful words of how to continue
on with the work in a good way.

Sarah: And what really stood out to
me from what Gracie said here is, this

strong sense of responsibility to how
they approach care, meeting every patient

at whatever point they're at, to ensure
that they feel safe, and that this is

grounded in an understanding of history
and past experiences with care, which

you know, have often been traumatic,
culturally unsafe, racist, and potentially

even resulting in further harm.

Morgan: Sarah, the view into this is
it's not just patient-centric, but

then it becomes patient and community.

And nation centric.

And so there's this whole
systems approach to what they're

thinking about in their work.

And this sort of echoes from the In
Plain Site Report, the widespread

systemic racism that has been
faced by Indigenous peoples in

BC across the healthcare system.

So it's great to see these roles,
thinking about many of those aspects.

Sarah: And we'll put a link to those
resources and the In Plain Site

Report, into the show notes as well.

And I think what these roles are doing
is they're really helping to ensure

that Indigenous people can access care
that understands history and works to

provide really greater safety and care.

Gracie shared an example of an individual
who was really reluctant to seek

care, and through her encouragement
was able to kind of find that space

where she could access care safely.

Gracie: I can share an example
of somebody who was a little bit

reluctant into receiving healthcare
and then I shared with them how there

are many foundation training and
ongoing cultural safety training.

and I shared that please bring any
concerns that you have and here's my

card, and if there's a challenge that
comes up, please just let me know.

And so, with her knowing that there
has been so much change throughout

all of the health agencies.

She went to her appointment,
she said with new perspective, new

thinking, and she said from the very
beginning from the MOA approach with

the questions, to the care of the
health professional, she said, I now

continue to return and I now continue
to share that we are safe and that

it's okay to go now to get healthcare.

Morgan: Reina has a story about
providing more ways, to access care.

And patients may not be
comfortable in a clinic setting.

Reina: So I am able to travel between
the clinics as needed based on

bookings, but also based on preference
for the clientele that we work with.

It is really great to offer
virtual, over the phone or at my

office at the K'omox First Nation.

Recognizing that clinic spaces may be an
area where they require support or feel

uncomfortable accessing at sometimes.

So giving them other options to meet
and convene has been really great.

And I am finding that when presented with
the option to meet outside of clinic, a

lot of people are choosing that option.

Morgan: We all need to consider how
clinics can actually be structural

barriers to care and also critical
to think about our relationships.

And I think Indigenous support workers
actively build trust through the

relationship building that they do.

And this is true as I was
reflecting both that individual

and across the whole system.

Sarah: You know, Morgan, this really
reminds me of something that happened

to me early on in my research career.

I was working, with the Council of
Yukon First Nations and gathering some

feedback around access to care and
what the challenges were for community

members and hearing a story about,
you know, they'd built this new health

center, it was super shiny, it had
all the things, and nobody was coming.

And going out and connecting with
community and realizing, it was a

very medical building, you walked
in and there was a plexiglass sheet

that separated the MOA sitting at
the front desk from the waiting room.

There was like all of these barriers
that were actually, very real.

And there was a whole bunch
of cultural reasons why people

were just really feeling unsafe.

And then it was so wonderful to see what
kind of small changes they were able to

make to this clinical setting, to make
it feel less clinical, to make it more

accessible, to really intentionally think
about what are those cultural barriers,

and then work on dismantling them.

Morgan: Small changes can
have a big difference.

Big changes are needed too.

But I think we also saw in our,
immunization project, the immPACC

project, where communities were
finding small ways to reduce structural

barriers for different marginalized
groups, including Indigenous peoples

to allow better access to vaccine.

Sarah: And then there's also
the relationship building

side of things, right?

And this is something that
Reina really emphasized.

Reina: Well, I'm a huge people person.

And I think that's probably why I
crave being in clinics being able to

build relationships with the physicians
as they come in and out and, meeting

with people in group settings as well.

Relationship building is huge.

So meeting people, getting to know them,
getting a sense of where they're at, what

they might have questions about, what
they might need, where the gaps might be.

And usually in that time we find two or
three other things that they didn't even

know they could ask for support with.

And then moving forward, we have
this ongoing communication, they

don't need to get their physician to
reach out to me to connect with them.

They have my number, my email,
they know how to get ahold of me.

The part that I love the most about this
job is that it feels really relationship

based and it feels like continuous care.

Sarah: Those relationships are so
important across the system, and I

think the connection of relationships to
creating spaces that are culturally safe

Morgan: yeah, relationships
are central in primary care.

And with space, improving space,
improving the connection to

the land are really important.

And if you design space, it
can better communicate care or

conversely, the lack of caring.

It can communicate the belonging
or the lack thereof of belonging,

It can communicate an understanding
of truth and reconciliation or not.

And both Reina and Gracie's spaces
encourage both that connection to the

land and to the Indigenous identity
while working to maintain safety.

Reina: Something that I recently
noticed about a newly renovated

clinic that I really appreciate and,
and love and wouldn't have thought

of before, are spaces for us to meet
and have our appointments without

medical equipment in the room.

it really changes the mood of the
appointment and it makes it feel

less clinical, it makes it feel maybe
less intimidating or scary for people

that have those challenges accessing
healthcare and we just have a space

where we can sit and we can connect.

even the lighting, the artwork, the mood
of the space, I think is really important

but I would've never thought about that
until I had access to a space that allowed

me, to just have those appointments.

Sarah: And I think, you know, those
little things like the artwork,

the mood, it's so important to
think about the full impact of

how those small changes can really
influence how people feel in a space.

Gracie's also been instrumental in
the creation of a sacred space in a

new primary care clinic in Chilliwack,
which opened in May of 2022.

So the Chillowak and Fraser Health rural
Primary care center Momíyelhtelaxwt,

which means helping one another
has a specific focus on coordinated

and culturally safe primary care,
including traditional wellness mentors.

Gracie: In the beginning when I came on
board there was announcement of, this

new building and they said, Gracie, can
you create a cultural teachings for us?

I actually went in front of the building
to help give me a little bit of a vision.

And from there creating a
cultural considerations document.

And what they shared was we have space
for a sacred space room in the building,

and this is a design we have that has
been vetted, this is what a sacred

space we would like it to be a vision of.

So when you walk in the building,
it's public and open to anybody

who would like to come in.

Within this sacred space room is a
beautiful vent and the vent is to assist

with providing smudging so there'd
be no problems with the air system.

So we just close the doors and turn on
the vent and do some holistic teachings.

With the Sacred Space Room, it's
also very inviting because we have

boxes of archeology artifacts can
be put in these display windows.

And there will be a map of
the 22 communities showcasing

them along the Fraser River.

Throughout the whole building
we have some Indigenous artwork.

Fred Meyerink did some amazing
photography and in the entrance

he has pictures of Indigenous.

The theme of these pictures are
all talking together and it's

just, it's just beautiful work.

And there's beautiful images of the Fraser
River and the mountains the waters and

so it's just such a welcoming space.

People are in awe when they come in and
it just really encourages that cultural

identity, the connection to the land on
how we really want it to be highlighted.

We are fortunate to have Chief
Angie George Bailey of Aitchelitz.

First Nations participate in the
blessing of the grounds before anything

started, very, very important following
cultural teachings to do that.

Laura Wheelock our special Elder
and community advisor and a very

wonderful mentor who also assisted
with the HUL’QUMI’NUM' language.

So we, we all gathered together and did
the ground blessing and also ensured

of, you know, when these names of these
rooms were incorporated, that they were

really well identified to the people
that are gonna be using these rooms.

So ensuring that all cultural
aspects were taken care of.

When I connect back with Elders and
hear a little bit of their vision and

uphold some of their teachings, or all
of their teachings, I should say It's

really humbling to hear, when we had
our sacred space opening, my mom of

93 said, I never thought this would
ever happen to have a sacred space

connected with primary care services.

It was really blessed to hear those
words and see Indigenous Elders

come into the room and be welcomed,
be appreciative that this exists.

So honestly, traditional wellness
practices being recognized that's a true

and special gift to be able to uphold.

Sarah: It was just so inspiring
to hear Gracie talk about how

important the opening of this
center and the space has been to

the nations and people in the area.

There was such care and intention taken
in the design of the space, but also

the protocols and the cultural practices
that were part of opening the space.

Morgan: I think that process, when
we're rushed, we can often miss.

And so it's so good to hear how impactful
that is in the opening of the new space.

So let's shift and think about the person
focused, care portions of the role.

What does that look like for an
Indigenous liaison role in practice?

Sarah: And we had some
great conversations here.

Reina talked about the pacing of
care, how her approach to support is

to create the space in the experience
for Indigenous people to set the pace.

So much about healthcare is about
speed and efficiency, increasing

access, it's about increasing numbers.

this comes from the reality of needing
to care for huge panels of patients.

But then it means it can be really
hard to slow things down to allow

for the time that might be needed
for different kinds of patients

to access the services they need.

Reina: A lot of the things that I'm
helping with, you know, we go through the

bureaucratic processes and things, take
time and support needs to be ongoing.

But also I think the feedback that I
get from people is just wanting to have

a team that genuinely feels like they
care, and that they're not just another

person that comes in, gets seen, gets
a problem solved and then they leave.

I like to tell people when they come in,
this is paced based on what you want to

do, what works for you in your timeline.

There's no rush to get things done.

I don't close files and your discharged
and you have to start all over again.

We work at the pace of the person because
we also need to consider that the nature

of the work that we're talking about
is usually very sensitive, can be very

challenging to discuss, challenging
to work on, and it can't be rushed.

I like to give an hour every appointment
when I can, and we sit and we chat

and we connect and it feels really
personal, which I think is what people

are experiencing not to be the case
potentially in other areas of healthcare.

Morgan: are there any specific things
that Gracie or Reina do to support

the system, and their colleagues
around providing culturally safe care?

Sarah: I think there's so much here.

So Gracie talked about a
couple of initiatives that

she led to help with this.

One was sharing the Seven Caring Teachings
on a card that all healthcare staff

carry and another was you know, how
she introduces new staff to the region.

Gracie: I think a highlight of promoting
the Seven Caring Teachings is really

important in all the work that I do.

What was really a great connection
was that "Gracie, we would like to

add your seven caring teachings to a
little card that goes with all the

staff within Fraser Health, with all
the division staff, with everybody

throughout our region and beyond.

Can we put those words on a little card?

and on the back have the
healing hands of friendship."

And I was like, oh, wow, that sounds
awesome, You know, so that it's a

little reminder that every time a
health professional is in connection

with an Indigenous person, that
they follow the caring teachings.

That was a really big highlight to
hear that these words are so important,

we wanna share with everybody.

what I've done as well is when we
get new hire on board I'll take three

people in my car and do a driving
tour of the communities right.

Get to know who and where indigenous
are, we are all neighbors to each

other very close neighbors so it's
really capturing that building of

relationships in as many ways as I can.

Knowing that we're actually on Soowahlie
territory, people will go through a

bit of a growing phase of that being
comfortable just like learning how

to say the traditional territories.

I'm not sure how to say the words of
the communities, and then I'll say I

had a challenge in first starting to
learn the words of Ng-khla-kap-muhx

in the Fraser Canyon communities.

So I too had to go through that learning
process and continue to practice.

My mom says we all learn from each other
and just kind of hold each other up

the best way we can and ensuring that
these respectful teachings are offered.

Morgan: I really appreciate Gracie's
approach to taking new hires out to

see the lands of those communities.

I wish I had done that when I moved here.

It definitely connects you to the place,
and it helps moving beyond that sort

of intellectual knowledge about the
different Indigenous communities.

And then understanding the landscape and
the geography, which is so important.

Sarah: And I think when you're living
in the kind of spaces that we get to

live in, where the seasons have such a
big influence on things like people's

mood, you really start to appreciate
the environment in a different

way when you have opportunities
to learn, from people like Gracie.

Morgan: Sarah, with the breadth, what are
some of the trickier parts of these roles?

What did we hear were
some of the challenges?

Sarah: There's been some really
important learning, that

these roles have come across as
they've taken shape in the PCNs.

These roles are new, they didn't
exist, two years ago even.

Reina shared how to navigate
things like sharing in an emr.

how data is collected, stored, and shared,
is complicated by the fact that EMRs are

not built with Indigenous people in mind.

Reina: What this year has been is trying
to establish the uniqueness of this

role and what that looks like, because
when I'm charting in the electronic

medical records of all these clinics
and this role is new and there's no

procedure of how even charting goes.

it's so easy to fit into the way that
social work is charting, the different

ways notes are being taken, what's
being included in those notes and

if I'm just coming in and following
suit and doing those things, what

is the uniqueness of this role?

What is the extra piece that's being
provided if I'm simply just doing that?

So being sure to include in my
notes things that maybe aren't

normal social work notes.

You know, I include cultural pieces, I
make sure their status number is listed

in their top information at the header.

There's no space for a status number
in a lot of those electronic medical

records, which is huge because that
should be utilized all the time.

And without it being there often
it's overlooked or people

even forget to consider it.

So maybe my notes are a bit longer
than social work notes because

I'm including cultural pieces.

But, also, the Catch 22 is having
to rewrite my notes and tailoring

them to choose what is appropriate.

If I have someone who has a difficult
relationship with their physician issues

with accessing healthcare, the last thing
I wanna do is include something in my

notes that could impact the relationship
with their physician, impact how they

feel about coming into the space.

So trying to be clear with the people
that I work with saying I do chart in

the medical record notes of your doctor.

We will include whatever is
important for them to know and what

you would like for them to know.

Morgan: There's so much
uniqueness between the various

communities, groups, and nations.

I mean, just from a resourcing perspective
alone, the differing amounts of resource

and therefore, access can vary so much.

And it's not well known across the
system how variable it is even within one

larger community or part of the region.

Reina has been working through
some of these system complexities,

as they create these challenging
situations for access to care.

Reina: Being from the Yukon, a lot of the
culture and knowledge that I know is very

Yukon First Nation, community specific.

And a lot of this year moving
here and being new to the Valley,

I have to include that time for
me to know the community as well.

I find that if you're doing this
work, it's really important to not

just set up shop and get to work.

Because the people that are accessing
the care have been impacted by the

unique specifics to their community.

but also wanting to acknowledge that
a lot of people we work with are also

similar to me, and they're new to
the valley, they're new to the area.

There can sometimes be a gap
in understanding the resources

that people can access.

I find that there seems to be a lot of
blanket statement or blanket understanding

of resources and what people can access
and maybe not acknowledging or seeing

the uniqueness of every community.

for example, if someone is from a northern
community and they have, as opposed to a

status number, it's called an N number,
and physicians refer them to First

Nations Health Authority for coverage.

I had a patient who was submitting
reimbursement for prescription or glasses

and was submitted to First Nations Health
Authority, sent back, not approved.

They have an N number, which means
they have to access non-insured health

benefits, but that wasn't known.

So we submitted to
non-insured health benefits.

It bounced back because non-insured
health benefits saw them as a BC

resident, said that what they were
seeking reimbursement for was covered.

BC healthcare doesn't cover that,
so we had to resubmit it again, and

we have this Elder sitting waiting
for reimbursement for four months.

And so those are the things, the barriers,
the gaps, and this person living in a

remote area without access to an email
address, a fax machine, it's things I

see all the time where people are just
falling through the cracks because there's

these little things that are being missed.

Morgan: I really think this is an
important reminder for all of us.

There are systems behind the scenes that
are making potentially dangerous decisions

based on assumptions about eligibility.

and we know that Indigenous people
accessing healthcare in BC come

from so many different backgrounds
and these layers of bureaucracy.

Sarah, I mean, they're provincial,
they're federal, they're local.

This all slows down and
impedes access to care.

So there's a very valuable navigation
component here too that the

Indigenous workers are often doing.

Sarah: and that navigation piece
just comes up time and again, right?

Additional supports, anything that
can help a patient navigate the

system has so much value but I think
particularly for Indigenous patients,

that navigation support, because
there's additional systems that they're

navigating is just so important.

We also talked a bit about how these
roles might connect with other roles

in teams, and Reina had this to say.

Reina: There are many instances where,
if one of the social workers shares

a client or a patient that I'm also
working with, we will meet together

if the client is interested and we
can do a collaborative, appointment.

I've had appointments where it's
myself, the patient, and their family

doctor in the room, and we're talking
together . and I have people that I work

with, that maybe struggle a bit with the
relationship with their physician and even

to just have me on the phone listening,
I don't even say anything , they just

know that there's a support there.

And it feels like, with this broad open
role and having access to the other

primary care network team members, being
able to reach out to them, get a social

worker's perspective, a mental health
clinician's perspective, a pharmacist.

That team piece has been so essential.

I feel so supported in being able to
connect with those other professions

that have expertise that I don't, and
we're able to provide, you know, a

really well-rounded support network for
the people that are reaching out for

care, which is a really great feeling.

Morgan: It's so encouraging to know
that these supportive roles are

becoming more common for patients,
and I know it's early days.

I've worked with an outreach team a
couple of years ago and had the privilege

of working with an Indigenous support
worker in the team and that we were able

to collaborate to provide more fulsome
care was a very large part due to the

trust developed through the Indigenous
support worker with our clients.

His early connection, Sarah built that
trust and then there was this umbrella

of trust that extended across the team,
and he was able to bring patients to

us or invite us to come out with him
and then that umbrella of trust would

allow us to then start building our own
relationships with clients and patients.

Sarah: That kind of bridging
role I think is so important.

We also asked Gracie and Reina what
advice they would give to PCNs who

are considering adding an Indigenous
specific wellness focused role.

Here's what they had to say.

Reina: My advice would be acknowledging
the need for more support in that

area, but also diverse support.

And if you're able to access funding for
more than one position that is catering

towards the Indigenous population in
the community, I would say go for it.

It would be great to see maybe a Metis
individual providing support to Metis

people because they experience different
circumstances for accessing healthcare

than maybe someone who has their status.

And for people that, have none of
those supports, due to colonization

and issues around getting
certification and the Indian Act.

But I would say that for my
role, there's a huge need.

And I often find myself like wishing
that there were more of me there's

so many people that would benefit
from this kind of support because

managing and navigating the healthcare
system, especially the extra

steps , that is a learning curve.

And for a lot of people,
support is so needed.

And you know, someone to remind people
that you still can access cultural

support and Indigenous support no
matter what stage of your exploration

of your cultural identity is.

You know people that feel maybe that
they can't access support because they

don't have their status, or they're maybe
not as cultural or they don't really

know how they identify, or it feels
inappropriate for them to access support.

Just to be a support that reminds anyone
that no matter where you are in that

cultural exploration journey, you have a
right and you can access those supports.

They're there for you no
matter what stage you're at.

Gracie: It's very important to ensure
that our Elders really have a voice

when we talk about health and wellness
within our Indigenous communities.

You know, we hear of
no decision without us.

I also hear the words of common
approaches, create those common approaches

to Indigenous health and wellness to
gather and then you'll come up with

solutions that will work, that are
realistic that can really identify, the

ways and means of supporting everybody.

Morgan: I am hopeful as a system
that we are and will continue to

recognize just how much value these
roles can bring into primary care.

Sarah, I hope we can continue to make
these investments and fund different

approaches to care that are led by
the unique needs of Indigenous peoples

and focused on culturally safe care.

Sarah: I think that's just so important
where we are right now, both in kind of

the transformation of primary care, and
then also if we think more broadly about

reconciliation and the steps that I think
need to be taken in BC and in Canada to

really, move forward in that direction.

So let's do a quick summary
of what we learned today.

First Indigenous support roles might
span the whole system of care and

are responsive to the unique needs of
each community and nation they serve.

So they won't ever look the same
and I think that's a good thing.

Morgan: And second, and related to
that is, that not only does it need

to be unique to the community, but
designed and guided by the community,

engaging Elders and Indigenous people
to discuss what's needed while things

are being planned and implemented.

Sarah: And third, I think care
practice between Indigenous

support roles and patients needs
to be grounded in relational care.

So people need to have this deep
understanding of history, careful

consideration of space, to really
allow, the care processes to unfold with

Indigenous patients setting the pace.

Morgan: And if there's a small
first thing that a provider can

do today, I think it's to listen.

And ask people's history and
listen to what stories you're told.

So thanks for joining us
today on this episode.

We'll be back next week when we talk
about some primary care unicorns.

Sarah: That sounds exciting, doesn't it?

Until then, we'd love to hear from
you, so please drop us a line

at with any
thoughts about today's episode or

what you'd like to see next season.

Thanks for listening.