Watch the videos before you start working on your case study: 1. How to talk about Indigenous people 2. What non-Indigenous Canadians need to know 3. Indigenous Knowledge to Close Gaps in Indigenous Health | Marcia Anderson-DeCoteau | 4. Greenwood, M., de Leeuw, S., & Lindsay, N. (2018). Challenges in health equity for Indigenous peoples in Canada. Lancet, 391, 1718-35 This case focuses on a low-income, non-English speaking Indigenous Anishinaabe people, one of Canada’s First Nations patient and family which uses the Ojibway language. As you read through this story, pay special attention to issues involved in medical decision-making such as gender roles and values, and interest in treatments outside of traditional western medicine based on Indigenous health knowledge. Background When Binesi was born, his parents were ecstatic and very proud. Binesi was their first child born into their family. It is four years after Binesi birth, and the family has grown even larger. There are now 5 children (3 older than Binesi, one 20-month-old) and Binesi grandmother living in the same small house in Sheguiandah First Nation Reserve. Binesi mother, Ishkode, takes care of her family as best she can, and she feels lucky to have her mother there to give her advice and a helping hand. Makwa, his father works very hard as a custodian at a local school to provide his family with enough income. He has picked up a little English at work, but only Ojibwe is spoken at home. Serious asthma problems run in the family, and Binesi is no exception. Although he looks healthy, Binesi has had severe asthma for several years. When he was 2, a series of awful wheezing episodes sent him to the hospital multiple times. His parents do their best to care for him, but they are both spread pretty thin. To help with all the Binesi’s asthma problems, the parents recently relocated to a new house that has no carpeting, and Makwa has limited his smoking to outside. The house still has poor ventilation and has some water leaks from the roof. The family has two dogs, which could be a problem, but they just couldn’t see getting rid of two loved members of their family. Binesi takes a lot of medications for his asthma symptoms. His parents have been taught a little bit about asthma when they visited the clinic 1 year ago. Travel there is difficult and requires a 1000 km journey by plane. Despite these actions, Binesi continues to have heavy wheezing and a tight cough, especially at night. They are having difficulty arranging for him to be seen by the doctor, as the waiting list is 6 months long. Age: 4y. weight: 20kg Current Medications: Albuterol MDI 2 puffs TID Flovent MDI 2 puffs daily Montelukast 5mg chewable tablet daily Theophylline 300mg PO every 8 hours With Binesi continuing to have asthma problems, the family became skeptical that the medications weren’t working. Under the guidance of her mother, she took Binesi to their clan’s Medicine Person. At the Medicine Person’s advice, the family began giving him an herbal tea made of black tea leaves, licorice root and capsicum and began to use a topical salve made from milk thistle on his chest twice a day to help with the coughing. 1. Identify the challenges in the environment that largely define the Aboriginal situation. 2. Identify 6 social determinates of health that may be critical for this community. How do they impact your patient assessment and the care you provide? 2.Identify the healing practices suggested by the Medicine Person. 3. Research potential interactions with Binesi’s medication regime. 4. How would you share this information with the family? 5. How can you incorporate healing practices into Binesi’s care? 6. Identify potential interactions of various healing practices with any prescribed medications. 7. Describe how nurses can advocate for the inclusion of traditional healing practices.
