HAVE A HEALTH CONCERN? CALL AUNTIE

By Alicia Fung

When you have a health issue, whom do you go to for help?

You might turn to your family doctor—a trusted primary care provider with whom you have built a relationship over time and knows your specific health needs. But what happens when you don’t have a family doctor you trust? Or crucially, what happens when you can’t trust the health care system as a whole? This is the case for many Indigenous people in Canada.

Indigenous people regularly experience racism, stigma, stereotyping, and discrimination in health care. An independent investigation performed in the B.C. health care system in 2020 found that 84% of Indigenous people surveyed reported experiencing some form of discrimination in health care. The same investigation also found more than one-half of the Indigenous health care workers surveyed reported they had personally experienced racism in their work environment because of their Indigenous identity.

But this isn’t unique to B.C. According to the Our Health Counts Toronto research project, more than one in four Indigenous adults reported that they have been treated unfairly by health care professionals because of their Indigenous identity. Of the Indigenous adults who have reported unfair treatment, 72 per cent indicated that it had occurred more than once in the past five years.

These harmful experiences have turned many Indigenous people away from accessing the health care they need, says Dr. Suzanne Shoush, a First Nations and Black family physician, and the inaugural Indigenous Health Faculty Lead at the University of Toronto Department of Family and Community Medicine. “We know that anti-Indigenous racism is prevalent. The Our Health Counts data shows that 71% of Indigenous adults in Toronto have said that experiences of racism from a health care provider have either stopped, prevented, or delayed them from seeking follow-up health care,” she explains.

But this comes as no surprise—when negative experiences in the health care system outweigh positive ones, it’s unlikely that you will go to get the care you deserve.

“Primary health care is a great concept and model, but the way that it currently exists can be very uncomfortable for people who have been treated poorly by institutions— which is a common experience for Indigenous people,” says Cheryllee Bourgeois, a Métis midwife at Seventh Generation Midwives Toronto.

All of these negative experiences accumulate over time, inducing the systemic exclusion of Indigenous people from the health care system—an exclusion that became much clearer and more profound when COVID-19 hit. But that’s not all. Health disparities experienced by Indigenous communities were also magnified in the pandemic, and it was clear that this was a group who would face more dire consequences from COVID than others.

“Whenever there are gaps in health care or a crisis impacting health care, it will always impact Indigenous communities disproportionately. So, when there was an abrupt shutdown of public health care services due to COVID, we were very worried. These are communities that already have less access to primary care than others and often have no health care provider whatsoever. So, we were worried about the disproportionate exclusion, about stigma, about barriers to accessing testing and information, about social isolation—the list goes on. And there was this heightened fear among the Indigenous community during the pandemic about where it was safe to go, what to do, and who to turn to,” says Dr. Shoush.

Data from the Our Health Counts survey speak to inequitable access to primary care. Results show 63% of Indigenous adults in Toronto have a regular family doctor or nurse practitioner compared to 90% of adults in Toronto who have a regular physician.

To address this exclusion during a critical time, Ms. Bourgeois and Dr. Shoush started the Call Auntie COVID-19 Indigenous Pathways Hotline in April 2020, a COVID information hotline focused on supporting Indigenous communities staffed by Indigenous health experts called “aunties.” The hotline’s name comes from the cultural concept of calling your auntie: a trusted relative —whether blood-related or not—who you can turn to whenever you’re facing difficulty.

“In the Indigenous community, when you’re in trouble, trying to figure something out, or just don’t know what to do next, you call your auntie—somebody you can actually trust. Somebody you know is reliable, consistent, available, and will drop everything to help you,” says Ms. Bourgeois.

Initially, the hotline was meant to be a COVID information resource for Indigenous people and their families who were having trouble navigating the healthcare system. They could “Call Auntie,” and the aunties would provide expert advice about COVID and how they could protect their health and that of their families. But soon, people began calling the aunties for more than just pandemic information.

“People started calling us for things like, ‘I can’t get birth control,’ ‘I can’t get my blood pressure medication,’ or ‘I’m having a mental health crisis’—things that were so bread and butter primary care, that we ended up saying, ‘Ok, let’s open an in-person clinic,’” says Dr. Shoush.

In September 2020, Call Auntie expanded their services to include the full scope of primary care for Indigenous people and their families. But, unlike other primary care clinics in the city, the Call Auntie Clinic takes an Indigenous kinship approach to providing primary care.

“This idea of kinship care pulls from teachings and kinship systems that already exist in Indigenous communities to support community wellbeing. It’s this idea of shared responsibility for caring for the community because it doesn’t always make sense to have one person who is the expert at meeting the needs of every other person,” says Ms. Bourgeois.

This shared responsibility of care means that the Call Auntie Clinic is a truly team-based model: every auntie on the team is an equal provider and patients can choose who they feel safest with as their pathway to care. Patients can come to receive any primary health care service including reproductive health, harm reduction, pregnancy and postpartum support; they can also come in for food, traditional medicines or for advice around difficult family or community situations.

“The lack of culturally safe care is the largest barrier to healthcare for Indigenous people, so creating these community-based Indigenous-led safe spaces as entry points to care are essential in lowering barriers and creating a for-us, by-us existence within medicine. With Call Auntie, you could come into a very safe space that was very different from hospital spaces and hospital clinics—different from a lot of the way primary care exists in the city. The centre of care is the patient, and they can come in and speak to anyone on the team as an entry point into care. Patients can come at a time that works for them and they’re not turned away if they’re ‘late.’ They can come and get traditional medicine. They can come just to get food or a drink if they want—because care doesn’t only mean caring for physical health,” Dr. Shoush explains.

Two years later, the Call Auntie Clinic has a small but mighty team of nine aunties and continues to provide culturally safe care to Indigenous communities across Toronto, improving access to primary health care for a group that has great unmet need.

“By using the systems of culture we know and are used to, we can create entryways and lower barriers to access for a community that we know doesn’t engage in health care in the same way,” says Ms. Bourgeois. “It’s not enough to assume that people don’t have family doctors and having one is the solution. You have to get people to the point where they’re even willing to consider having a relationship with a family doctor—and sometimes that can take a little work. So, our goal is to try and create spaces where people can practice being involved in primary care in a way where they feel comfortable.”