Nadine Caron, MD [1]
There are some troubling facts when it comes to health care for Canada’s Aboriginal population. First, despite great efforts, health reports continue to demonstrate a concerning difference in health statistics between Aboriginal and non-Aboriginal Canadians. Second, these statistics are primarily determined by genetic, social, or environmental factors that lie outside of our health care system. Once a patient steps into our health care system, his or her diagnosis and ongoing care becomes the responsibility of the health care professionals. Despite this important role, most physicians in British Columbia are not adequately trained to develop the complex understanding that is required to meet the health care needs of our First Nations population.
As physicians, we are aware of the long list of disparities facing Aboriginal populations. When Canadian Aboriginals are compared to non-Aboriginals, we find the following:
• Suicide rates are 5 to 8 times higher
• Diabetes rates are 3 to 5 times higher
• Fetal alcohol syndrome rates are at least 25 times higher
• Traumatic injury rates are 4 times higher
• Tuberculosis is 10 times more prevalent
To name just a few health factors.
The suggested causes for these discrepancies are complex and varied. These causes include genetic predisposition, environmental factors, lifestyle, and/or access to health care. For decades we have struggled to eliminate the disparities between Aboriginal and non-Aboriginal populations, yet the problem persists today. Perhaps part of the solution is to better understand the determinants of health behind the statistics for our Aboriginal patients and to acknowledge the limits of our health care system in addressing their complete health care needs that are based on these factors.
What is our understanding of Aboriginal health and health care? Can you really help an individual without understanding the basics of his or her history, culture, and perspective on these health issues? The standard patient history and physical examination we were taught in medical school does not provide us with the full breadth of information we need to optimally care for an Aboriginal patient.
But as physicians there is little access to this cultural, social, and professional knowledge. Even doctors with the best intentions will struggle to acquire this knowledge base if they are trying to gain it while working in the emergency room on a Friday night or in a busy family practice during the day. Is there any source that can help bridge the gap in this understanding?
The Council on Health Promotion subcommittee on Aboriginal Health has discussed this in great detail. Our committee is a mixture of Aboriginal and non-Aboriginal individuals who are clinically active physicians (specialists and generalists), government representatives, and academic leaders.
The committee has determined that there is lack of access to educational opportunities for physicians to learn more about caring for First Nations patients. Through our search, we found lectures and weekend courses for nurses and hospital personnel that address some of these issues, but there are limited sources of information and education for physicians. We know that UBC has struggled with integrating First Nations health issues in their Doctor, Patient, and Society course. There is one course for physicians put on by Vancouver Coastal Health that is not well known and is only available in Vancouver.
We propose to develop a course that would:
• Describe the history of First Nations people in British Columbia.
• Introduce current social, economic, and environmental issues that have an impact on their health status.
• Openly describe the expectations and wishes of First Nations patients when communicating with their physicians (and how to optimize that communication).
• Briefly introduce some of the major health concerns and options for care available within British Columbia.
We anticipate this course would be open to medical students and physicians from British Columbia. If you have any thoughts or ideas regarding this potential educational opportunity or would be interested in such an opportunity, please contact the Aboriginal Health Committee at aboriginal@bcma.bc.ca [2].
—Nadine Caron, MD
Chair, Aboriginal Health Committee