Dialogue Volume 15, Issue 3 2019 - Page 23

OPIOIDS "Data will enable First Nations in telling a story of the inequities that must also be addressed for First Nations communities to survive the opioid crisis." The goal is to inform the development and evaluation of local interventions. At the time of the funding announcement, Carol Hopkins, Thunderbird’s Executive Director, said that “Data will enable First Nations in telling a story of the inequities that must also be addressed for First Nations communities to survive the opioid crisis.” There’s no shortage of ideas around preven- tion, prescribing practices, outreach, educa- tion, coordination, crisis response, treatment and wraparound care. That’s on top of efforts to deal with the diversion from legitimate prescriptions, and thwart the illicit flow of substances into the community. Beyond the specific solutions, focus is on the model of health. Hopkins has talked about how action to address the crisis must be measured. You can track things like access to therapies, overdoses and child welfare cases due to addictions. That all matters. But success rests too on the extent to which actions create mental wellness among First Na- tions. That means Indigenous-based outcomes like hope, belonging, meaning and purpose. A strength-based approach also respects the core belief that everyone has inherent strengths, and that the community is re- sourceful and capable of solving its problems. A 2018 session at TOPHC (the Ontario public health convention) dealt with the First Nations opioids epidemic in northwestern Ontario. Francine Pellerin, Health Director for Matawa First Nations in Thunder Bay, mentioned the chi kee way meno biimadeseyung strategy. In Oji-Cree, that’s a back-to-our-roots idea of walking in a good, healthy life. Practice patient-centred medicine While many solutions are unique to First Na- tions, Dr. Robinson says that in a few respects opioid addiction there should be viewed as it would anywhere. First, see it for what it is. Dr. Robinson says that society, and the medical community too, has been slow to recognize that addiction isn’t a moral problem. It’s a chronic illness. She hopes family doctors will view this as a disease they can treat, like diabetes. “Helping people overcome addictions is the most rewarding work I’ve ever done. If you just leave it to the specialists to manage this, there will be an awful lot of people who can’t access care.” Second, hold off on assumptions and be curious. That’s true for all patient-centred medicine. “Consider all of the contextual factors for your patient,” says Dr. Robinson. “If you work with one particular culture, learn as much as you can to be informed about where the patient is situated. Ultimately, you’re engaging with the patient as an individual. But you want the background to have a broader view.” The kind of mindset that works for opioid response in First Nations can have broad ap- plications, suggests Dr. Chase. “We learned something that would work all across the province: approach the commu- nity,” she says. “Decolonize your thinking, to feel you always know best. Ask how you can help. Is advocacy needed? The doctor can be a voice. Start listening, and say to Indigenous people, ‘How might I support you?’ That’s the kind of transformation we need.” MD ISSUE 3, 2019 DIALOGUE 23