There are perhaps fifty million Indigenous people in North and South America, almost everywhere dispossessed, poor and powerless either today or in the past. In the past they refused to die; today they will not be assimilated or ignored. They insist that we must address the issues of colonization, racism and inequity that have pursued us since Columbus made his landfall in the West Indies (Boyer, 2000). (1) In recent years Indigenous peoples have been gaining their own voice in the western academic world and have developed methodologies of their own to facilitate the appropriate collection, analysis and dissemination of knowledge (Tuhiwai Smith, 1999,Smylie et al. 2003, Snarch 2004).
In Canada in 2001 there were approximately 976,310 aboriginal people living in Canada, about half of whom live on reserves and half off(Statistics Canada 2001). This population includes First Nations, Inuit and Metis,whose relative proportions are shown in Chart 1. By many standards,life for Aboriginal Canadians is much more difficult than for non-Aboriginals. They are younger (Fig 2.2 from Health Canada, Statistical Profile of the Health of First Nations, 2001), more likely to live in rural or remote parts of the country (although many live in urban areas as well) and less likely to enjoy many of the privileges and amenities the majority of Canadians take for granted. In 1986 forty five percent of Status Indians were without any high school education (compared with seventeen percent for Canada as a whole) (4) . A federal 1984 study of housing documented that forty seven percent of housing were inadequate; thirty eight percent lacked one or more of the following basic amenities: running water, indoor toilet and bath or shower, and thirty six percent were overcrowded (compared with less than three percent for Canada). (5) Twenty years later, little has changed. The prelimary results of the First Nations Regional Longitudinal Health Survey, the first major survey of the health of Aboriginal Canadians by an Aboriginally controlled organization (NAHO) found that 32% of Aboriginal Canadians participating rated their water supply as unsafe, 24.6% reported overcrowded living conditions (vs 1% of the general population)and 32.9% were living in housing requiring major repairs (vs 8.2% of the general population)(NAHO 2004).
Health indices all clearly indicate that Aboriginal Canadians are not as healthy as other Canadians (although many of these are likely inaccurate given the lack of a uniform and standard process for collecting and linking data on ethnic group status to the health information databases generally used for generating these statistics). In 2000 status First Nations men had a life expectancy 7.4 years shorter and women 5.4 years shorter than other Canadians(Health Canada, 2001). Aboriginal Canadians have a higher incidence of such infectious diseases as gastroenteritis, tuberculosis, diptheria, pertussis, rheumatic fever, respiratory problems, STIs, and infectious hepatitis, many of which are preventable(Health Canada, 2001). Chronic diseases are also becoming an increasing problem with an epidemic of diabetes(3-4 times the national average), obesity (up to 90-95% of people over the age of 50 in some studies), metabolic syndrome and the subsequent cardiovascular(2-3 times higher) and renal complications of these diseases hitting many aboriginal people and communities with devastating results(Howard et al 1999, Shaw et al 2000, Young et al 2000, Ananad et al 2001, Green 2003, Tonelli et al 2004). Even more concerning than the prevalence of infectious and chronic diseases are the problems of intentional and unintentional injury, which are the number one causes of potential years of life lost for Aboriginal people in Canada (Figure 3.8 from Health Canada, 2001).
This category includes a number of sub-categories, including motor vehicle accidents, fire and flames, drownings and suicides, all of which are major contributors to the category. It is the number one cause of death for all age groups under 45, with all of the 3 top causes of death in these age groups being sub-categories of injury(Health Canada, 2001). The young ages of the victims is a major factor in its major contribution to the potential year of life lost. Within the general category of injury, that of suicide warrants particular attention. It results in more potential years of life lost than all cancers, and over 50% more than all circulatory diseases. Rates of suicide overall are about twice the national average, but in the younger age groups they are much higher (in the neighbourhood of 4-5 times the national average for 25-39 year olds and 5-8 times for those 15-24)(Health Canada, 2001). Social, cultural, economic and environmental influences are all important in this area, with some communities being relatively unaffected, while others experience rates of suicide up to 50X higher than the national average (Health Canada, 2001, Chandler and Lalonde, 1998). Both suicide and other unintentional injuries have at least some relationship to substance abuse, which is also an issue that is more prevalent in the aboriginal population (Health Canada, 2001).
Thus, there are many significant health and social issues facing Aboriginal communities and their health care providers. Physicians interested in serving Aboriginal populations need to be better prepared; not only should they be clinically competent, but also culturally sensitive and politically aware of the variety of issues that impact on the health of Canada's Aboriginal peoples.
While Queen's University has trained health science students in Aboriginal contexts for some time, (in particular through the Queen's University Weeneebayko program in Moose Factory), this optional third year of training for physicians in Aboriginal Health is unique. The resident will have the opportunity to explore the historical roots of the health issues facing Aboriginal communities as well as participate in the delivery of care in different Aboriginal settings in Canada today. The potential benefits of this third year program are many. Firstly, family physicians who are specially trained in Aboriginal health issues will be better prepared to serve Aboriginal communities and provide more culturally sensitive care. Secondly, the existence of a unique program devoted to Aboriginal Health will provide enhanced educational opportunities in crosscultural medicine for both the core two year residency program in Family Medicine as well as the undergraduate medical curriculum. The sensitization of all physicians to the broad social determinants of health should be a recognized educational objective. The knowledge base and skills developed in working with Aboriginal people will be of use to physicians practicing in many areas of Canada among people of different cultures than themselves.
The following pages describe the objectives and curriculum of this unique third year program in Aboriginal Health. One of the principle objectives of this program is to increase the number of well-trained and culturally attuned family physicians available and interested in establishing practices in Aboriginal communities. Through this year of postgraduate education, residents will contribute their clinical expertise to communities in which they choose to do their clinical placements. Thus, commitment to Aboriginal Canadians as well as resident educational needs, is a focus of the program. In summary, it is hoped that this document will stimulate thought and dialogue about Aboriginal health issues and the appropriate education of physicians to deal with these issues.
.
The following are the specific objectives of the Aboriginal Health program. For an overview of the informational and conceptual content that residents will acquire during the year in order to meet these objectives, see section 3. Historical and Cultural Context
To develop an understanding of the culture of Aboriginal people prior to contact with the Europeans, and what the impact of contact was.
To provide a context to the current political struggles of Aboriginal people by examining them in light of the historical relationship (Indian Act) and agreements (treaties) with the federal government.
Encourage recognition and change of negative stereotypes of Aboriginal peoples and greater appreciation of Aboriginal Canadian cultures, including an understanding of the importance of traditional Aboriginal medicine in the process of healing Aboriginal individuals and communities.
To gain an understanding of current theories on the impacts of colonization and racism for Indigenous peoples in Canada and internationally. Determinants of Health
To encourage an understanding of the variety and breadth of issues that affect the health of Aboriginal people (including biological, psychological, social, economic, and political factors), in order to begin to address the inequalities in health between Aboriginal and non-Aboriginal Canadians.
To develop an understanding of how social conditions (e.g. inadequate water supply,housing, and sewage; under- or unemployment; lack of access to education) contribute to a sense of powerlessness and poor self esteem, and ultimately impact on the health of the people.
To assist in the recognition of how these problems may be resolved (through improved health promotion, political lobbying, increased Aboriginal control, etc.) Knowledge and Clinical Skills Acquisition
To provide opportunities for the residents to improve their cross-cultural communication skills.
To encourage awareness of the special health care and social needs of Aboriginal communities.
To assist in developing sensitivity and skill in dealing with mental health issues such as family violence, child sexual abuse, substance abuse, and suicide.
To encourage both respect and understanding of the skills of other health care professionals working with Aboriginal people, such as nurses, Community Health Represenatives (CHRs), and mental health workers, as well as traditional healers.
To enhance residents' clinical skills in order to function comfortably and competently in northern or isolated communities Research and Community Development
To provide residents with a framework for understanding both the role of communitybased participatory action research (AHRQ, 2003) and the means to implement it.
To give residents opportunities to participate in community-based research projects with appropriate consultation from community leaders and workers, Aboriginal political bodies, and academics in the field.
To provide opportunities to observe/ participate in other on-going community development projects. Medical Education
To encourage and facilitate the integration of Aboriginal health issues and cross-cultural sensitivity in both the core two year Family Medicine Residency Program as well as the undergraduate medical curriculum at Queen's University, to the benefit of all trainees.
To promote the attraction of Aboriginal medical students and residents to Queen's University.
Post Graduate Training in Aboriginal Halth Topics and Themes
The following is a list of broad topics and themes outlining some of the important issues that residents should become familiar with during their year of training. While some education will come through readings, the resident should also reflect on the impact of these issues during core and elective rotations. In addition, particular topics are appropriate for discussion in rounds and seminars for the education of all health care workers.
Historical and Cultural Context
Aboriginal life before contact with Europeans, including health status
the nature and consequences of contact and colonization (on lifestyle, culture,
health of the people, etc.)
the Indian Act and treaties with the government, and their relationship to the current political (social/economic) struggles of Aboriginal peoples
the destructive role of the church and its residential schools on Aboriginal selfidentity
the important cultural norms of traditional Aboriginal society (including respect of elders, community consensus, etc.)
the impacts of racism, past and present
Health Status
differences in health status between Aboriginal Canadians and non-Aboriginals
current measures of health status (e.g. infant mortality rates) and their limitations
the social, political, and economic determinants of health (e.g. poverty, unemployment, poor housing, etc.), the strength of their impact on the health of Aboriginal peoples, and the reasons for their existence.
the specific conditions common to Aboriginal populations: e.g. community and personal mental health problems (substance abuse, family violence, child sexual abuse, suicide, depression), dental disease, infectious diseases including tuberculosis, non-insulin dependent diabetes, obesity, culture-bound syndromes, etc.
the reasons for the prevalence, incidence, and perpetuation of the conditions above (including genetic and acquired vulnerability); assessment and culturally appropriate management of these health problems
the connection between lack of control over one's life and poor self-esteem to poor health
the commonality of the issues facing various Aboriginal communities, and reasons for specific differences
the role of traditional Aboriginal medicine and spirituality in Aboriginal communities in the recovery of their health as a people (including an understanding of their need to heal mind, body and spirit, and hence the lack of effectiveness of Western medicine to "cure" them)
the global connections (ie. residents should develop some understanding of how Aboriginal Canadian health compares with the health status of Indigenous peoples
elsewhere in the world)
Delivery of Health Care
impact and role of high technology medicine in isolated communities (e.g. evacuation of women for childbirth, relocation for dialysis)
viable alternatives to high tech approaches that Aboriginal communities find unacceptable
political and economic approaches to Aboriginal health issues (e.g. management of health resources, "transfer of control" from federal government to Aboriginal communities)
what does transfer of health care to Aboriginal control mean practically, how can it be accomplished in the best interests of the people (ie. the community, the family, and the individual), and what are the problems of transfer
The Role of Health Care Providers
the importance and means of recognizing one's own cultural norms and values, in order to see another's
finding the balance between treating the symptoms and curing the disease (i.e. trying to have an effect on the roots of poor health)
awareness of the importance of the holistic approach, and the differences in perspectives and understanding this often entails (e.g. healing is very important in First Nations traditions, but is not the same as Western notions of "treatment")
the importance of working together with other health professionals (e.g. CHR's, nurses, mental health workers, Aboriginal medicine men/women), and how to do
it effectively
the role of family and community as health care providers
the importance and means of demystifying professional practices for Aboriginal patients
strategies for culturally appropriate health promotion on a variety of issues (e.g. safe sex, prenatal care, nutrition, etc.)
the use of research for the benefit of the community: how to go about it, whom to consult, who develops the idea and has access to the results (community-based/ participatory research)
what is community development, and how should physicians be involved
means of encouraging Aboriginal Canadians to empower themselves to be a part of their own healing (individually and as a community), and ultimately take responsibility for it
The following is a brief outline of the twelve month curriculum in Aboriginal health. For a
description of each rotation see sections five and six
CORE COMPONENT
As this program is only filled periodically and the learning needs of each participant are unique,
the following is a suggested outline only. Each resident will have an individualized curriculum
tailored to their particular needs.
Directed reading of historical/cultural context: 12 month course.
Rural and remote On-Reserve clinical rotations: 4 months or more (this will generally include a period of time at the Queen’s University Weeneebayko Program in Moose
Factory and may also include other rural or remote aboriginal heath teaching centres
(Manitoulin Island (Wikwemikong) or Sioux Lookout Zone in Ontario) as indiciated by
resident needs and preceptor availability.
Urban Aboriginal Health Care: To be based out of a suitable urban aboriginal heath
access centre/health centre (ie. Ottawa [Wabano], Toronto[Anishnabwe Health], Sudbury,
Timmins): 2 or more months
Aboriginal Public Health (May be separate or concurrent with Moose Factory or another
Rotation) – 2 months or more
ELECTIVES
Residents choose from some combination of the following, or pursue other appropriate training
(in consultation with the program co-ordinator).
Further clinical training (e.g. obstetrics, pediatrics, acute care/ emergency medicine,
infectious diseases, mental health).
Community-based/ participatory research project.
Community development involvement.
Native Studies courses (Trent Native Studies, U of T, Johns Hopkins Distance Ed Online
or Onsite are all viable alternatives).
More experience in other Aboriginal communities.
Arctic experience.
Regional or National level public health experience with First Nations and Inuit Health
Branch
International experience in the United States, Australia, or New Zealand.
The goal of the core component of the Aboriginal health program is to familiarize the resident
with the historical and cultural context of Aboriginal Canadian life experiences both in readings,
and in different clinical and cultural settings. This section of the program will normally occupy
the resident for the first six months of the year (i.e. July to December), though flexibility is
possible. The resident's time will be equally divided between clinical work, readings, mental
health work, and public health/health promotion. Each of these areas are deemed to be important,
and hence the resident's time will be protected for them.
Directed Reading Course - Horizontal learning (throughout the year)
Dr. Michael Green is the program co-ordinator and a recognized expert on aboriginal
health. He practiced full time in the Moose Factory area for 8 years, 4 of those as Chief
of Staff. Following completion of his MPH at the Bloomberg School of Public Health at
Johns Hopkins University and his move to Queen's University he began a part time
consulting position as a Zone Medical Officer (Public Health) for the Ontario Region of
Health Canada's First Nations and Inuit Health Branch. He represents the University
regularly at forums on aboriginal health issues, provides lectures in Aboriginal Health at
the undergraduate(MD program) and graduate levels(Masters Program) at Queen's and is
involved in research in this field. He will offer the residents a reading course throughout
the program. One or two half days per week will be set aside for the residents to partake
in this coursework regardless of their rotation.
Depending on the residents' previous experience, and their interest, the course will cover
such topics as:
Basic overview of historical factors relevant to Aboriginal issues including the
French Regime, the fur trade era (contact through to the reservation period), and
the disparate groups and their territorial locations throughout Canada and the
North.
An outline history of Canada's policy towards First Nations and other Aboriginal
groups.
Treaties and reserves.
Contemporary disputes.
Demographic and medical issues; past and present.
Specific regional issues.
Other opportunities for didactic studies in Aboriginal issues include courses
offered at the University of Toronto, the Native Studies program at Trent
University, Peterborough, and the American Indian Health Course at John's
Hopkins (offered distance ed via the internet as well as on site)
2. Rural and/or remote On-Reserve Experience: Queen's University Weeneebayko
Program, Wikwimekong, Manitoulin Island and/or others
Queen's University has a well-established program to deliver health care services to
Aboriginal Canadians living in Moose Factory and along the west coast of James Bay.
This relationship is longstanding (almost 40 years in 2005) and has afforded many
opportunities for Queen's students from health disciplines to develop a greater
understanding of issues affecting Aboriginal people in the north. The major objectives of
this rotation are to introduce the resident to the broad determinants of health for people
living on isolated reserves and how these impact on their health care, in addition to the
practice of medicine in a cross-cultural context, as part of a multi-disciplinary team. The
resident will be involved in health care delivery at the main hospital and in outlying
communities, and be expected to assist in the public health work done in the Zone. In
addition to their clinical work, residents are encouraged to partake in a community-based
research project (i.e. of interest and use to the community) for this region, and may
choose to begin their work during this visit. Aboriginal leaders have suggested that the
residents visit the Zone during hunting season (fall and spring) in order to experience this
important tradition with the people. Moose Factory is the most obvious site for this
northern experience because of the well-established link with Queen's University,
however, other locations can be arranged if desired (e.g. Sioux Lookout Zone).
Wikwemikong Reserve, Manitoulin Island: This rotation has been chosen as being
appropriate for the residents because it provides the opportunity to live on a reserve in the
"near north", and integrate as best they can into a community that is very likely different
from their past experience. While in the community they will participate in the work of
the mental health office and its community development projects. They will also assist in
the medical clinics, and take call on a limited basis. They will have the opportunity to
meet the medicine man and elders in the community and thus can learn from them some
of the local traditions and customs.
Urban Aboriginal Health
All residents, regardless of their eventual choice of practice, need to be aware of the
issues faced by Aboriginal people who leave their reserves to live in larger urban centres,
or who have grown up in the city. In Toronto there are a number of services for
Aboriginals in which the resident can participate. Anishnawbe Health offers clinics both
in their centre, and at other more accessible locations for particular groups. The resident
may be involved in these as well as Anishnawbe's work with street people. In addition,
the resident may spend some time at the Community Crisis Centre (with Aboriginal
counsellors as well as the non-Aboriginal psychologist), and the healing circles at the
Native Women's Resource Centre. There are similar opportunities in Ottawa (Wabano
Aboriginal Health Centre), and Sudbury and Timmins offer options for mid-small size
urban areas as alternatives.
Aboriginal Public Health
Population and public health issues for aboriginal populations in Canada are of particular
importance. Each resident will have an opportunity to spend time working with one or
more Medical Officers working with First Nations and Inuit Health Branch. Depending
on the resident's individual interests or needs this could be done with the program coordinator
Dr Green, at the Regional Headquarters for FNIHB Ontario Region or with the
Office of Community Medicine at FNIHB's National Headquarters in Ottawa.
NOTE: It is recognized that two months in any single community is hardly sufficient
time to develop a genuine appreciation of the community's spirit, concerns, conflicts, etc.
Residents may wish to enhance their continuity of care, continuity of research, continuity
of development processes, etc. by spending four or six months in one setting, either in a
single block or by return visits to the same community. This may be most readily
accomplished in the Moose Factory/ James Bay area.
The third year in Aboriginal Health is intended to be very flexible, in order to provide each resident with appropriate, individualized training. Residents will come to the program with a variety of experiences and skills, and the communities in which they will work have differing needs. Some residents, particularly those who wish to work in northern and isolated communities, will need to strengthen their clinical base and may therefore choose to pursue more specific clinical training during this year. In addition, some research experience is strongly encouraged. The following ideas are suggested for the use of elective time, however, residents are encouraged to consult with the program co-ordinator if they wish to pursue other appropriate training.
1. Further Clinical Experience:
Those residents who intend to practise in isolated regions and have just completed their CCFP may find it prudent to acquire further clinical training during this year
(if not at another time), before relocating in the north. Additional training in obstetrics, pediatrics, and acute care/ emergency medicine may be obtained through rotations in a location that services northern Aboriginal communities such as Timmins, or, for specific objectives, in teaching hospitals in Kingston or elsewhere. Residents may also wish to consider their need for extra experience in conditions common to Aboriginal populations such as diabetes, infectious diseases, and mental health problems (e.g. counselling, psychosocial assessment, crisis intervention and case management for such problems as substance abuse, family violence, and suicide). Residents may choose to spend up to six months of the year in settings which will enhance their base clinical knowledge and skills.
2. Community-based/ participatory research project:
Opportunities are available to become involved in research projects through the Queen's University Weeneebayko Factory Program. Such community-based research will be of use to the communities. Residents should consult with community leaders and appropriate Aboriginal political organizations when developing their projects, and collaborate with Aboriginal service providers, professionals, and community-based agencies. This process should begin early in the year. It is expected that research may be integrated into some of the other rotations (i.e. not be full time), and potential publication would be a goal. Other opportunities to develop skills in conducting research in Aboriginal Communitiesinclude linkages to the ACADRE centres in Ottawa, Toronto or Saskatoon, all ofwhich have some linkages to faculty at Queen’s who would be able to facilitatethe establishment of specific linkages for interested residents.
3. Community development involvement:
Residents may have the opportunity to participate in ongoing community development projects, in order to familiarize themselves with the processinvolved. Those who chose to use their elective time in this way would be encouraged to participate at the local level, working with individuals in the community who can identify community priorities and the methodology of community development to suit the context of the cultural values, beliefs and customs of their people. The program coordinator will assist the resident in establishing the appropriate linkages for these projects.
4. Native Studies courses:
Trent University in Peterbourogh has a strong native studies program that has many courses which would be appropriate for residents in this program. Residents should note that if they choose not to enroll in a course, it may still be possible to arrange workshops with the Aboriginal faculty of Trent University on topics of relevance to physicians. As Peterborough is also a site for clinical rotations in the department, co-ordination of the two may be possible. Residents may also wish to choose courses from Laurentian University's Native Studies Program (they could participate by correspondence through the "Contact North" network), the University of Toronto, or the online course in Native American Health at Johns Hopkins University.
5. More experience in Aboriginal communities:
Residents who are interested may choose to spend their elective time in other health care systems in order to broaden their experience. The program coordinator
will provide specific suggestions of useful rotations.
6. Far North Experience
Should an individual resident desire to include some educational time in Canada's far north, arrangements will be made to spend two months in an Arctic setting. Dr. Sandy MacDonald is the Medical Director for Nunavut and is one possible contact for such a rotation. An important part of this experience will be exposure to isolated Inuit communities. It is expected that residents will appreciate the common health care needs and problems of delivery of health care services, for isolated Aboriginal communities across Canada (i.e. the political and geographic factors, among others, that influence the process of change).
7. International Experiences in Indigenous Health:
The experience of Indigenous peoples around the world can provide important insights into both the causes and solutions to many of the health related issues facing Aboriginal Canadians. The program co-ordinator has linkages with centres in the United States, Australia and New Zealand that may be able to provide interested residents with clinical and/or research opportunities should they wish to pursue them. Please note that due to licensing and visa requirements there is a need to provide considerable notice for interest in these opportunities and that in most instances specific funding to support these electives is NOT available.
Applications to the program will be reviewed and decisions on acceptance made by the
Enhanced Skills Post-Graduate Program Committee in the same manner as applications to
other programs, however input may be obtained from key partner organizations (ie.
Weeneebayko Health) or other appropriate outside individuals at the discretion of the
committee. The residents will receive supervision from a number of both medical and
non-medical personnel during their year. The following people may be asked to contribute
to the development of learning contracts and the evaluation of residents in order to assess
knowledge, skills and attitudes objectively and comprehensively:
1. Supervising physicians in core and elective rotations.
2. Other health care personnel with whom the resident works such as public health
and mental health care workers, nurses, CHR's, and the patient representative.
3. Directed reading course professor.
4. Appropriate supervisors of research and community development projects.
Residents will receive documentation of their completion of the Aboriginal Health
program from Queen's University Department of Family Medicine.
Over time, educational needs will change, both as community issues evolve, and as
residents entering the program have been previously sensitized to Aboriginal Canadian's
health care needs. In creating this document, a variety of individuals have been consulted
and have been exceedingly helpful. Ongoing consultation in the development of this
program will be required. Both the health care service to Aboriginal communities and the
medical/ cultural education of residents will be enhanced by a consultation group chaired
by the program co-ordinator, and consisting of Aboriginal representatives from
appropriate groups. Hopefully such a group will prove to have other benefits in the larger
university context, particularly with respect to Aboriginal access to medical education.
Dr. Liz Roberts, a physician who has worked with Aboriginal people for much of her
career, challenges us to consider the role educational institutions should play in assisting
community development through training and education:
A major goal of Canada's First Nations is to regain Self-Government and assert
Self-Determination within all areas of life. One of the priorities that repeatedly
emerges as initiatives develop in all fields is that of the need for Training and
Education.
As various Institutions, structures or administrative arrangements are defined and
developed by First Nations, needs are identified for Human resources to be available at all levels. Increasingly Non-Native Educational Institutions are
becoming involved in the development and delivery of Programs which impact on this goal of First Nations.
Because of this impact it becomes crucial for Educational Institutions to consider
whether they have a role in assisting Community Development as well as
delivering Education and Training Programs and if they do, to further consider
how they can define and carry out this role in a helpful and constructive manner.
This document has outlined an optional, flexible, third year of training for family physicians interested in working with Aboriginal populations. A draft of the program description was presented to the board members of the National Native Physicians Association in 1992 and was received with support and interest. It was hoped that this program will also impact on the curricula of the core family medicine residency and undergraduate medical years. A further positive by-product enunciated in 1992 was the the establishment of a more active policy of attracting Aboriginal medical students to Queen's University.
This has happened, and since 1999 Queen's University has had an Aboriginal medical student admissions policy in place which has been successful in increasing the numbers of offers of admission to aboriginal students The establishment of postgraduate medical education in Aboriginal Health is a significant step, but certainly not sufficient in itself. Berger reminds us that we must be a part of the healing process for Aboriginal peoples:
A history of disease and death permeates relations between Whites and Natives today. Down the long passageways of time the memories of fire and epidemic occurring and recurring, manifesting themselves today in marginalization and despair, form a chain, linking the past to the present. If we are ever to break that chain, or to forge durable links in a new, stronger and healthier one, we must be willing to come to grips with the past that we share with the Native people, a past of which we are hardly aware but which they know too well. The cure for the pathology afflicting Native communities lies in acknowledging this - such would be "the treatment of the whole community."
POSTGRADUATE TRAINING IN ABORIGINAL HEALTH
References for Update
Seven Years Later: An inventory of population health policy since the Royal Commission on Aboriginal Peoples. Canadian Institute for Health Information, Ottawa, 2004.
Anand, SS, Yusuf, S, Jacobs R. et al. Risk factors, atherosclerosis, and cardiovascular disease among Aboriginal people in Canada: the Study of Health Assessment and Risk Evaluation in Aboriginal Peoples (SHARE-AP). Lancet 2001; 358: 1147-53.
Chandler MJ and Lalonde, C.E. ‘Cultural continuity as a hedge against suicide in Canada’s First Nations ’. Transcultural Psychiatry 1998; 35(2): 191-219.
Howard BV, Lee ET, Cowan LD et al. Rising Tide of Cardiovascular Disease in American Indians: The Strong Heart Study. Circulation 1999; 99:2389-2395.
Shah BR, Hux JE, and Zinman B. Increasing Rates of Ischemic Heart Disease in the Native Population of Ontario, Canada. Arch Intern Med 2000; 160:1862-1866.
Young TK, Reading J, Elias B, and O’Neil JD. Type 2 diabetes mellitus in Canada’s First
Nations: status of an epidemic in progress. CMAJ 2000; 163(5): 61-6.
Tuhiwai Smith, Linda. Decolonizing Methodologies: Research and Indigenous Peoples. University of Otago Press, Dunedin, New Zealand, 1999.
Boyer, Y. The International Right to Health for Indigenous Peoples in Canada. NAHO Discussion Paper Series in Aboriginal Health: Legal Issues No 3. NAHO, Ottawa, 2004
Tonelli, M, Hemmelgarn B, Manns B, Pylypchuk G, Bohm, C, Yeates K, Gourishankar S,
and Gill JS. Death and renal transplantation among Aboriginal people undergoing dialysis. CMAJ 2004; 171(6): 577-82.
Agency for Healthcare Research and Quality. Creating Partnerships, Improving Health: The role of Community-Based Participatory Research. AHRQ, washington, 2003.
Schnarch, Brian. Ownership, Control, Access, and Possession (OCAP) or Self-
Determination Applied to Research: A Critical Analysis of Contemporary First Nations
Research and Some Options for First Nations Communities. First Nations Centre,
NAHO, Ottawa, 2004.
Smylie, J, Martin, CM, Kaplan-Myrth, N, Steele, L, Tait, C, and Hogg, W. Knowledge translation and indigenous knowledge. Circumpolar Health 2003;139-143.
Green, ME, Dialysis, Diabetes and Canada’s Aboriginal Peoples. Can J Rural Med 2003;
8(1): 14-15.
Michael E. Green, BSc, MD, MPH, CCFP
Assistant Professor
Departments of Family Medicine and Community Health and Epidemiology
Queen's University
Family Medicine Centre
P.O. Bag 8888
220 Bagot Street
Kingston, ON
K7L 5E9
