Report on Needs for Aboriginal Wellness at Stanton Territorial Hospital Authority

The purpose of this report is to identify the needs for continued Aboriginal wellness programs at the Stanton Territorial Health Authority (STHA) within the existing hospital structure, and to highlight services which may be delivered in a new Aboriginal wellness building beside the hospital. We explored what is currently underway for Aboriginal wellness services at STHA, what are some of the best practices for Aboriginal wellness in Canada, and we worked with territorial knowledge holders to identify priorities for Aboriginal wellness services at Stanton hospital.

This needs assessment brought together a number of resources on Aboriginal wellness in Canada and gathered expert opinions from Elders, care providers, policy makers and researchers in the Northwest Territories. The sources of information included: (1) a review of best practices in hospital-based Aboriginal wellness services, (2) a review the Stanton Elders Council’s meeting minutes, (3) a series of interviews with the Stanton Elders’ Council members, regional health representatives, and community stakeholders, and (4) a community engagement and priority setting workshop to get input on findings and key program components. The findings told us which programs within STHA could benefit from an Aboriginal wellness approach.  We describe program features of Aboriginal Wellness and introduce the programs/services that could be delivered in the main hospital building, and programs/services that would need to be developed in an adjacent building (as it would not be suitable to have those services in a hospital).

Priority areas for program enhancements at STHA included palliative care, wellness promotion, midwifery services, traditional medicine, complimentary medicine, mental health, and childhood and family development. Specifics were provided in relation to the services that could be provided in the STHA and in an adjacent structure. For activities in the STHA it was recommended that programs follow a holistic model of wellness, support specialized and experienced patient escorts, include culturally-responsive Elder care services, have an on site traditional healer and referrals for community based care, provide access to traditional foods, cultural liaison, accommodation for families, and deliver orientation and education in Aboriginal cultural competencies for staff. Services that were recommended within a stand alone structure included an Elder in residence, rooms for traditional healers, referrals, outreach and support for community healers and land based programs, outdoor sweat lodge, sitting area and cook fire, kitchen for non-inspected meats, overnight suite for families of inpatients, space for language services, space for workshops, lecture hall/space for teachings that includes a ceremonial fire. How the two structures might connect was discussed with suggestions about physical connections (walkway), electronic (connected charts and care provider communication between buildings), and policy development with a strategy linking aspects of Aboriginal wellness. Other administrative elements were mentioned, including the need for culturally appropriate measures for quality improvement, clinical standards for Aboriginal Wellness, human resources development and a functional plan for infrastructure development. Figure 1 provides a picture of how the elements of programs, services in Stanton, and outside of Stanton connect and supported by administrative levers.

Given the interconnectedness of sectors working for Aboriginal wellness, the broader context for Aboriginal wellness in the NWT was mentioned on numerous occasions. Currently the Northwest Territories is undergoing a health reform with the amalgamation of health authorities, and STHA is undergoing redevelopment. The changes will influence both the governance and building structure at Stanton hospital and provide an opportunity to consider sustainable and responsive programs for Aboriginal Wellness not only in STHA, but also within the amalgamated health authority. Some recommendations made were at a higher systems level and could have implications within the amalgamated health authority.

These included the need for a mission and vision statement that acknowledges and supports underlying values of holism, family orientation, community engagement, respect, compassion for and inclusivity of all cultures and the need for consultation on the best approach for governance and supporting partnerships in the oversight of Aboriginal wellness programs. It is evident that the relationships and partnerships supporting Aboriginal wellness initiatives are complex both within Stanton and the territory. The mechanism of using a territory wide strategy for Aboriginal wellness to support governance models and partnerships, maximize resources, and provide quality care was highlighted as a consideration for the NWT. 

The overall mood of the consultation was hopeful. Thoughtful consideration was given to the recommendations brought forward by those who contributed to this report. In Canada and the Northwest Territories there is a supportive environment and a keen interest to improve and develop Aboriginal wellness programs. The participants recognized Treaty rights, the Calls to Action for health by the Truth & Reconciliation Commission, and the UN Declaration on the Rights of Indigenous Peoples. The report is detailed and contains the data that was collected. Chapter 1 introduces the approach taken for the assessment. Chapter 2 highlights the scope of Aboriginal wellness services currently offered and being explored at STHA, chapter 3 provides some information on who is currently accessing services at STHA, chapter 4 shares findings on best practices for hospital based programs on Aboriginal wellness in Canada, chapter 5 describes the areas for development in STHA, and in the adjacent building and chapter 6 concludes with final recommendations and action items.