In September 1996, following the completion of my Bachelor of Science in Nursing degree, I started my (second) career as a Community Health Nurse (CHN) working with First Nations communities in British Columbia (BC). My experiences with the people on these reserves have led me to study health promotion in more depth and have affected every aspect of my life, including my own approach to family and work.
In my first uncertain and overwhelming week, I had the great fortune of meeting my new colleague and now friend, a First Nations Health Nurse, who had just returned home to work in the area she grew up in. She and her family took me under their wing, and I began to understand the inner workings and priorities of the First Nations communities in a way that would not have been possible using literature or books. Throughout this experience I attended cultural celebrations, feasts, weddings and funerals. I learned a great deal from the strengths of the First Nations families and communities I had the opportunity to work with.
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A Lessons Learned
Once immersed in my job, I quickly discovered the art and science of community nursing wasn't something I learned at school. In fact, my greatest assets turned out to be my personality and interpersonal skills as opposed to my nursing skills. Working with three communities of approximately 1,200 people, a crisis of one sort or another became priority on many occasions and I rarely accomplished what I intended on any given day. With this experience came some important lessons (that to many may appear as common sense) that still guide my practice today, regardless of the group or community I work with.
i Work with First Nations people must be built on relationships of trust, which means you must be explicit about your reasons for wanting to work with them.
Initially, the people I was hired to work with had difficulty trusting me and were therefore reluctant to work with me. They had seen many people come to help them, or attempt to help them for short periods of time, and then leave. Not only did some feel that these short visits were of little use to them, some felt they were harmful. To earn their trust, I had to begin by trusting and leap outside of the traditional professional-client relationship, which generally does not include self-disclosure of any kind.
One of the first requirements of my job was to publish a newsletter about myself that was distributed to the entire community! It included a photo, explained where I came from, what my job was about, and why it I was that I was there (and not with my own family). The newsletter was a step in the right direction, but working with them for a full two years (often day and night) was the important factor in earning their trust. My willingness to stick with them through many trials demonstrated the commitment I felt to those who had supported me through my many challenges as an outsider. It was only because I had demonstrated that commitment and ensured that there were known people to replace me when I left, that I was able to feel good about leaving.
Unfortunately, the reality is that two years is only enough time for changes to begin to take place. For the people in the communities, life didn't change much, another person simply came and then moved out of their lives. My life, however, changed forever.
ii If you want to make services more accessible to First Nations communities, you must go to them.
Hired as the First Nations community health nurse, it was imperative for me to have a presence within the communities. Most health professionals are used to having people come to them. I learned that this is not always the best way to provide service. A local physician and his wife (a nurse with a passion for moms and babies) began to work with me in building partnerships between the local health community and the reserves. We found that by working on the reserves with someone the community members had grown to recognize and trust (for example the Community Health Representatives, local community members), community members became more interested in their health regardless of the health issue (prenatal health, child health, diabetes or heart health amongst the elder population) and were more willing to attempt healthy behaviour changes. With the help of existing resources in the communities, such as alcohol and drug workers and other band employees, I served as a link to many professionals (doctors, home care nurses, social workers, etc.) who were mandated to provide service to the three communities.
iii When working with First Nations people, you must be flexible and accommodate their reality, priorities and values.
Though the list of duties on my job description was enormous, ranging from vaccinations to lifestyle counseling to community development, I found that in practice it was even larger. Being a nurse for rural isolated communities meant that regardless of whether I was getting groceries or attending a social function, I was still 'The Nurse.' This meant that crises situations also fell within the domain of what community members expected of me and I felt it was my responsibility to help deal with these situations since there were few people around to do so.
There were many other examples of times when I had to be flexible and account for priorities and values that I didn't (yet) entirely understand. For example, funerals (an unfortunately frequent occurrence at the time) were very important. It didn't matter what else was going on, when someone died all three communities would virtually shut down and the only real priority became to pay ones respects and provide support to their families.
Although at first this ritual seemed strange to me, it is these experiences through which I learned the tremendous value of social support and bonded with the community members. Not surprisingly, every new experience I had, and contact I made in these communities, slightly altered my course. I still feel that this kind of ongoing evaluation and adjusting is essential to being a good practitioner working with any group.
When it comes to improving the health of First Nations communities, it is not possible to make good decisions without their involvement. In fact, it is not possible to do anything without their involvement. Collaboration and accountability are required if you want community participation in any initiative since they (rightfully) are the experts on what they need and what will work for them (as with any group).
Though the bands I worked for hired me, the Federal Government who paid for my position developed my job description. I was accountable to both and felt challenged, straddling the priorities of each. According to my (government) job description, communicable disease control was my number one, non-negotiable priority (to protect the health of the people). When I reported to band members (an experience that involved quarterly reports presented orally to approximately 200 people who were allowed to ask questions, provide feedback and help choose the direction of my job!), my priority was to be home visits and coordination of services to the chronically ill and community elders. The reality of the situation was that I would simply not have been able to do one of the priorities without tackling the other. I tried to do both, within the confines of a 24 hour day and many other priorities and distractions.
What I realized is that I had to work with all the stakeholders in the community. The people in the region I was hired to cover were not interested in my 'help' in the way that my job description dictated. They were, however, interested in a partnership that would address their priority health issues IF I was willing to carefully listen (one community member told me that I had two ears and one mouth for a reason), watch and participate in their way of doing things.
Though many professionals have expressed frustration at trying to 'get things done' on reserves, in fact these are communities with great capacity to come together and accomplish things when they are motivated and feel something is a priority. I am still amazed at how quickly they could pull together a feast for 500 people!
B Closing Thoughts
A question I was frequently asked was "When are you leaving?" This is ironic because although I have since returned to my home community, part of me will always remain with them. It is this experience that taught me the essence of ethics and social responsibility, along with the importance of family. It is a rare opportunity to be able to share in the experiences of a cultural group that is not your own and I will always be grateful for the many relationships that made this experience so enriching to my life. I learned foremost that life is very precious and we all share the responsibility for building a better tomorrow. The challenge is in building bridges between the past, present and future. Together we can make a difference!
If you have any comments, questions, or feedback, please contract Tracy at firstname.lastname@example.org