Bridging Gaps: Indigenous Navigators Enhance Emergency Services at University Health Network
Photo courtesy of UHN Foundation
By
Amy Noise
Emergency departments are a critical health access point for many Indigenous people but are often not viewed as safe spaces by community members. In the University Health Network emergency department, Indigenous patient navigators are helping to overcome some of the barriers Indigenous people face when seeking urgent care.
“You tell me when you are coming, you tell me what you need, and I'll be that person to support your health-care journey.”
Naaniibwid genoozid zhingwaak kwe, whose given name is Victoria Manitowabi, is one of the Indigenous patient navigators in the University Health Network (UHN) emergency department. An Anishinaabe Kwe from Wiikwemkoong Unceded Territory on Manitoulin Island, she had a long history of working in health care as a personal support worker for Elders and an auntie helper at the Toronto Birth Centre before becoming a navigator.
“I am here as a shkaabewis (helper). The community members coming in have their own voices. They can self-refer to our program, or emergency department staff can inform them about our services. My role is to support community in navigating the health system, help with communication with the health-care team, and creating a safe space where they can feel supported and a little bit safer.”
According to data from Our Health Counts Toronto, more than one in four Indigenous adults reported being treated unfairly by health-care professionals due to their Indigenous identity, with 71 per cent stating that experiences of racism prevented, stopped or delayed them from returning to health services.
“You tell me when you are coming, you tell me what you need, and I'll be that person to support your health-care journey.”
With up to 37 per cent of Indigenous people in the city lacking a regular primary care provider, emergency departments are a critical health access point. But community members often avoid seeking care because of previous negative experiences, the experiences of others and the ongoing impact of colonialism and systemic racism in Canadian health systems.
The Indigenous Patient Navigator program, part of UHN’s broader Indigenous Health Program, seeks to create healthier spaces for Indigenous patients in the emergency department by embracing the Medicine Wheel model of care.
It is supported by Drs. Jennifer Hulme and Marcella Jones, emergency physicians, health equity co-leads for the UHN emergency department, and assistant professors in the University of Toronto Department of Family and Community Medicine.
“While training in family medicine, I was drawn to working in the emergency department because our door is always open; we’re here for any person at any time,” says Dr. Jones. “But for that to be a reality for everyone, it needs to be a safe space, particularly for those from systemically marginalized communities.”
The program has three core components: supporting Indigenous community members in the emergency department, building relationships with the Indigenous community outside the hospital, and education for hospital staff.
Launched in May 2023, this combination of emergency department support, community engagement and education is already making a difference for community programs like Sagatay, which offers transitional housing in a safe, supportive and culture-based learning environment.
“I want to thank you for doing the work you do. It has already made enough of a difference that word is spreading. Sagatay community members are becoming aware that they have people to advocate for them and receive them with kindness at the hospitals, and as a result, most do not avoid the hospital as they used to. This is a new experience for our guys; residents and staff are extremely grateful to have you [Indigenous patient navigators] there,” says Jane Roy, Sagatay program manager.
For Dr. Hulme, the difference is symbolic as well as practical. “Too often, health equity interventions are one way. Why is this working well? Because we have the emergency department working hand-in-hand with the patient navigators, the Indigenous Health Program at UHN and community partners to address more than just Indigenous patients’ physical health, but also their emotional, mental and spiritual health through access to traditional medicines and ceremony.”
Looking ahead, the team hopes to expand the program to allow for more navigators, more of the time.
