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Indigenous Healthcare (HLST ARTICLE)

Indigenous healthcare: Caterpillars
to butterflies, case study supporting
Healthcare Management Forum
2019, Vol. 32(1) 40-43
ª 2018 The Canadian College of
Health Leaders. All rights reserved.
Article reuse guidelines:
DOI: 10.1177/0840470418809395
Roger A. Boyer II, CHE, IA, PhD, FCCHL (Cand.)1
The Canadian Government released a document to aid in the relationships between the Government of Canada and First Nations
around the ratification and redesign of the Indian Act of 1876. The name of this document was the “White Paper.” The Federal
Government’s “White Paper, statement of Government of Canada on Indian Policy of 1969,” rejected the concept of special status
for First Nations within confederation—they should have the same rights and responsibilities as other Canadians. The Federal
Government argued treaty rights were irrelevant in today’s society; the important issues demanding attention included economic,
educational, and social problems. In Canada’s assessment of the “savage” situation, the government could not see wellness
wholistically addressing the poverty, social crises, and bleak future faced by most First Peoples was rooted in the very denial of
treaty rights and humanness. This article pushes to educate health leaders about current circumstances contributing to racism.
Where are the butterflies? Over the past 168 years of this
colonial relationship, mino-biimaadiziwin (note 1) has been the
focal point of the weapons used to assimilate the children and
annihilate the Indigenous soul. The sour historical relationship
between Canadians and Indigenous Peoples can be experienced
as a primary school fight blaming each other for mutually
harmful actions. These unresolved actions and attitudes enter
through the doors of our clinics, hospitals, and meetings. These
caterpillar-like relationships attribute to the need for this article
which provides recommendations to help transform these relationships and lead us towards butterflies. The author will take
the reader through the historical policies that contributed to this
present reality: the conception of the caterpillars. The understanding of these policies will move the author to discuss some
of the activities supporting the cocoon approach and silos used
to deal with unique Indigenous complexities—both historical
and present. Compounding this historical and silo experience,
Indigenous Peoples have been cycling through adaptations to
more adaptions with limited amounts of equitable access to
health and systems support their need for mino-biimaadiziwin.
Finally, the author will provide a challenge to current health
leaders to take meaningful and growing steps to create more
Conception of the caterpillars: Historical
experience with Indigenous Peoples
The Indian Act of 1876 was constructed by Parliament through
obligation to the Constitution Act of 1867. The Indian Act was
written into two sections and applied equally to all Registered
Indians within the boundary lines of Canada. This included
Indians on-reserve and those in the urban centres. One section
covered five to seven regulations regarding the “Indians
Register” or “Indian Agent” and another section outlined the
regulations as per band membership. The responsibility of the
Indian registration was on the shoulders of the Federal Minister. The purpose of the Indians Act was to define who was an
“Indian.” Indian whose name or mark appeared on the register
were considered to have Indian status or treaty status which
allowed them legal rights supported by the signatures
of relatives who signed the treaty with the Queen and the
Government of Canada. During the 1960s, when First Nation
activism became prevalent in the political realm, Pierre Elliott
Trudeau, the Liberal-democrat, was elected as Prime Minister
of Canada.
The 1960s began a decade where Canadian bureaucratic
arrogance attached to ignorance about their “Indian” wards.
The progressive policy was to culturally assimilate all First
Nations peoples. Many of the bureaucrats and politicians were
optimistic and pleased with the progress being made with those
“Indians.” Statistics supported this optimism by reporting an
increase of Indian children who were being educated through
the Federal Government’s post elementary facilities called
Indian Residential Schools.1 These federally-funded programs
relocated native children from their homes on reserve to urban
institutionalized buildings. While natives were located on
reserve, the responsibility for their wellbeing lay within federal
policy, but during the relocation to the urban placement, provincial jurisdiction created space for confusion and subjective
interpretation of the law. This situation factored into the current
state of accessibility gaps in healthcare for First Nations related
to the responsible party financial payee obligation. Brian Sinclair’s incident brought this circumstance to reality.2
Makwa Wise, Toronto, Ontario, Canada.
Corresponding author:
Roger A. Boyer II, Makwa Wise, Toronto, Ontario, Canada.
E-mail: roger.boyerii@makwawise.care
On June 24, 1969, Jean Chrétien, Minister of the Department of Indian Affairs and Northern Development and future
Prime Minister of Canada, collaborated with the Former
Prime Minister of Canada; Pierre Trudeau3 released a document to aid in the relationships between the Government of
Canada and First Nations around the ratification and redesign
of the Indian Act of 1876. The name of this document was the
“White Paper.” The Federal Government’s “White Paper,”
rejected the concept of special status for native people
within confederation—“they should have the same rights and
responsibilities as other Canadians”. The Federal Government
argued that Aboriginal and treaty rights were irrelevant in
today’s society; the important issues demanding attention
included economic, educational, and social problems. In their
assessment of the native situation, the Federal Government
could not see that the poverty, social crises, and bleak future
faced by most First Peoples were rooted in the very denial of
Aboriginal and treaty rights. In addition, it addressed provincial responsibility and called for the end of treaties. The
Federal Government argued that this was the only way for
First Nations to fully and equally participate in economic,
political, and cultural life in Canada. The “White Paper”
policy called for First Nation members to have no distinction
from the general Canadian society. First Nations leaders
rejected the “White Paper” for two irrevocable reasons: it did
not address the problems plaguing the First Nations’ local
communities, and the First Nations leaders, who represented
the very people who would be most affected by its mandates,
were not properly consulted regarding the details of this new
In November 1969, 144 delegates of the bands of British
Columbia met at Kamloops Indian Residential School. This
5-day meeting allowed for the voices of the delegates to be
heard by their represented leaders.5 Another aid to this
counter attack came from the Union of BC Chiefs. This 39page document became foundational in the formation of
Canadian legal terminology and ideology regarding First
Nation policies. This policy’s focus was to “whitewash”
culture, language, and identity from First Nations members
across Canada allowing them to move from a “bad” life on the
reserve, which was oppressive, to a “better” life among the
anthropological “other” with unchanged feelings, emotions,
beliefs, or negative consequence. The Government of Canada
turned a deaf ear on the voice and worldview of these effected
First Nations members regardless. Paul Hiebert explains,
“Our worldview gives us emotional security . . . [and] our
fundamental beliefs with emotional reinforcements so that
they are not easily destroyed . . . provid[ing] psychological
reassurance that the world is truly as we see it and a sense of
peace.”6 The First Nations worldview has not been able to
understand nor construct an assumption of peace because of
the entire “brainwashing” event conducted by the Federal
Government. The foundation of security and safety has never
National Indian Brotherhood (NIB) was created behind the
lines of war. The NIB reacted to “White Paper” policy in 1970.
The NIB, now known as the Assembly of First Nations, consisted of First Nations leaders and influential individuals of the
time such as George Manuel, Walter Dieter, Noel Star blanket,
Delbert Riley, Dr. David Ahenakew, Georges Erasmus, Ovide
Mercredi, Phil Fontaine, and Matthew Coon Come. These
leaders chose to present a counter policy to the “White
Paper” calling it the “Red Paper.” This “Red Paper” policy,
which was presented to Prime Minister Trudeau and his
cabinet, was a counter attack which called for First Nations
Treaty rights. The foundation for this argument laid in their
beliefs that, “there is nothing more important than our treaties, our lands and the wellbeing of our future generations.”
The NIB’s action against the legislation incited the First
Nations community to take a renewed sense of pride in their
heritage and culture. First Nations groups demonstrated that
they could initiate positive action, form a united front of the
nation, and successfully create political organizations from
coast to coast. This marked the beginning of the First Nation
movement and strong political activism. The following
year in 1971, the Federal Government quietly put aside the
“White Paper.” The controversial policy was silenced by the
Supreme Court of Canada’s decision of Calder v Attorney
General of British Columbia in 19737; however, native title
was reaffirmed common law, and in response, the Federal
Government took responsibility for the health and wellness of
First Nations.
Fast forward from these activities to the Canadian government under the leadership to Stephen Harper; he pushes
for an apology for this trauma-filled past of Indigenous
populations. This apology began the dialogue around reconciliation and healing both for Canadians and Indigenous
leading to the need to know how to reconcile these relationships. This directional and need for guidance gave birth
to the July 23, 2015, document entitled Honoring the Truth,
Reconciling for the Future Summary of the Final Report of
the Truth and Reconciliation Commission of Canada. This
report explains that the Federal Government had never provided the funding and support needed to improve Indigenous
health and wellbeing. There are 94 Calls to Action. These
Calls to Action need to be reviewed by all health leaders and
applied within their systems, structures, and cultures.
The cocoon: Silos and struggle
The “White Paper” was all about assimilation citizenship, and
new white identity where as First Nations’ values consist of
harmony, stewardship, and wholistic identity with Creator
and Creation. The First Nation past experiences with the
Government of Canada would support this incompatibility
with any government policy with the words “assimilate” or
“white”. These homogeneous acts to systems and structure
are designed to help Canadians, but not Indigenous Peoples.
This is called the “round peg into the square hole” approach
to healthcare. This tug of war to make Indigenous Peoples
conform to the silo approach of the Canadian health system
demonstrates a lack of insight and innovation. There is a
jurisdictional black hole for Indigenous Peoples, the
responsibility of healthcare being a federal or provincial
responsibility and only recently resolved when five-year-old,
Jordon River Anderson, died in a Winnipeg hospital while
administrators were fighting about who was going to pay
for the treatment. For further information about the Jordon’s
Principle, please review Jordon’s Principle and Public
Health (note 2).
These imperial policies answer some of the needs but at a
tremendous cost to the Indigenous. Each Nation lost their land,
liberty, and law for education, citizenship, and employment
causing great trauma. Within the western perspectives, those
three elements would be an exchange for and fulfillment of
some of the testing needs on the reserve but worldview points
us back into the direction of connectedness with the land as
paramount not only as a physical variable but also hold a
spiritual ramification. These conflicting degrees of compatibility, this policy would be deemed an incompatible innovation. The Government of Canada committed the “empty vessel
fallacy”8 by imposing a policy of freedom upon the First
Nations. The Federal Government takes the First Nations for
granted and continue to think we are an ill-legitimate child
being passed back and forth by Canadian policies or procedures
supporting Canadian superior education, and powerful ideas to
continue the assimilation process of filling the blank slates of
the First Nations’ mind. Due to this assumption, the compatibility of this innovation was quickly rejected by the First
Nations. Nations are not seen as apart of the solution instead
problem. This Indian problem persists today within our
healthcare settings. The value system of the First Nations is
unique and sacred because of its connectivity of wholistic
spirituality. Limited models of healthcare support this
intrinsic need. The increase rate of diffusion of the “White
Paper” along communication channels continues to support
this inequity of care across your home on native land. There is
a real call for decisions and directions to be built on the
worldview of First Nation decision-making of consensus. The
opinions of First Nations leaders and collectivistic culture
were able to come together from coast to coast and voice their
reaction to this “White Paper.”9 This inclusive action is a start
to investing into butterflies—real transformation.
Investing in butterflies: Challenge to
health leaders
In a fiscally restrictive environment, investing in reconciliation
seems to be far from the essential operational needs of your
healthcare system, right? Reconciliation and its norms have the
ability to transform not only your patient experience but
empower your practitioners toward fulfillment. The health
leadership challenges are to adopt or adapt a transformational
leadership framework of reconciliation. The author will discuss
this four-piece framework below.
The majority of Canadian health leaders focus on two frameworks: LEAN or LEADS. The author’s critique of these
starting point would be self-actualization, not service and
Healthcare Management Forum
support of staff and patients. To take this a step further, these
streams lead to our focus as being performance and point
achievement. These sterile, means to an end have pushed us
into high rates of burnout and significant turnover in our middle
to senior management positions. So, what is a solution? The
author would like to suggest a transformative framework to
leadership focused on empathy, authenticity, transparency, and
CARE; or as the author coined the term E.A.T. CARE. This
understanding is a transformation in leadership versus another
measurement or target to achieve. One needs to be able to look
in the mirror day-in and day-out to realize their staff are
looking for someone to show them empathy to empower the
impossible or miraculous. When this reality is achieved,
authenticity and transparency support the evolution of CARE
into all areas of the system including the water cooler conversations. So, I know you’re thinking, Roger, you have to give
me more than this for a framework. However, this will not
happen because in a world who seek the easy way or route from
point A to B, the calling to this type of leadership will make
you and take you to a co-creation of these values with your
teams, families, and ultimately your patients spreading into the
communities you call home. This is how you invest in butterflies: by not taking the easy way but the transformative way to
co-creation of the E.A.T. CARE framework. So, the author
challenges you to “get your Legos out” with your teams and
start building your unique E.A.T. CARE Leadership framework interwoven with the values of your unique culture and
community. Enjoy!
The author started this article with a question to the reader:
where are the butterflies? The historical past of trauma,
homogenization, and pure assimilation support the silos of the
Indigenous relationship with Canada. The sour historical relationship between Canadians and Indigenous Peoples needs
transformation from blaming each other to collaboration. These
butterfly-like relationships will take a tremendous amount of
mutual respect and risk. However, the author has challenged
health leaders with a great framework of transformationalempathetic leadership entitled E.A.T. CARE which will provide the guide along this road less travelled in reconciling the
trauma. The author would like to leave you with this thought:
can we afford to not create a system to support the most traumaimpacted populations in order for mino-biimaadizwin, the
good life, to be realized? The oaths of the healer, to do no harm,
should be the foundation for all health systems.
1. Mino-Biimaadiziwin is a conceptual reality to Indigenous, in particular Anishinabek, of the wholistic systems and structures an
individual, families, and Nations connect to in order to live a good
life on Mother Earth. This multifaceted norm is foundational to
living the balanced Indigenous life.
2. https://www.cpha.ca/sites/default/files/uploads/policy/posi
1. Menno B. Surviving as Indians: The Challenge of Self-Government. Toronto, Ontario, Canada: University of Toronto Press;
2. Daniel NP. First Nations History: We Were Not the Savages: Collision between European and Native American Civilizations.
3rd ed. Halifax, Nova Scotia, Canada: Fernwood; 2006:264.
3. Pierre Trudeau Personal Web site. Available at: http://www.clever
net.net/pierre_trudeau/. Accessed May 1, 2018.
4. Assembly of First Nations. Available at: http://www.afn.ca/article.
asp?id¼59. Accessed April 30, 2018].
5. Canada. Indian and Northern Affairs Canada. Statement of the
Government of Canada on Indian Policy, 1969. Ottawa,
Ontario, Canada: Indian and Northern Affairs Canada; 1969.
No. R32-2469.
Paul GH. Transforming Worldviews: An Anthropological Understanding of How People Change. Grand Rapids, MI: Baker Academic; 2008:29-30.
Calder V. Attorney-General of British Columbia. Available at:
www.library2.usask.ca/native/cnic/vol07/091.html. Accessed
April 30, 2018.
Everett MR. Diffusion of Innovations. 5th ed. New York, NY: Free
Press; 2003:254.
First Nations Governance Act moves Forward. INAC. Available at:
Accessed May 21, 2018.