Engaging for Indigenous cultural safety in the emergency department

Penticton Regional Hospital Emergency Department (ED) Head Dr Mike Bergunder recognizes that the ED can be a daunting first point of contact in the health care system for many local Indigenous community members.

In fact, says Jacki McPherson, Health Director for the Penticton Indian Band (PIB), this experience can have an impact on their care and health outcomes.

As a key step towards strengthening cultural safety in the ED, they worked together to organize two pivotal learning events with Interior Health and Snpink’tn (the Penticton Indian Band/PIB). The initiative aimed to build greater understanding between health care providers and Indigenous community members as a foundation for change.

With more than 30 years of experience in Indigenous health, Jacki McPherson welcomed the opportunity to start addressing a long-standing gap in access to emergency care for Indigenous community members, many of whom have had negative experiences in the ED.

She highlights that hesitation and mistrust often prevent some community members from seeking timely access to emergency care, which can negatively impact health outcomes.

“The ED is often the first place my people go to in the hospital. Unfortunately, so many times they delay seeking care, and wait for another choice,” she says.

Dr Bergunder was inspired to take action. “As an Indigenous emergency physician, I want to create a safe environment for Indigenous patients visiting our hospital, and combat the systemic racism that persists in hospital settings, as highlighted by the findings in the In Plain Sight report,” he explains.

Together with hospital ED managers and the Indigenous Patient Navigator, they organized the two sessions.

Funding was provided by Interior Health and the Penticton Medical Staff Association through Facility Engagement, an initiative of the Specialist Services Committee, a joint effort of Doctors of BC and the Government of BC.

Listening and learning for health care providers

The first session was a ‘listening and learning’ townhall hosted by the PIB for ED physicians, nurse leaders, medical office assistants, and mental health and substance use care managers.

Held on the PIB reserve, the townhall allowed for dialogue over a shared meal. Elders shared personal stories about their culture, experiences in residential schools and Indian hospitals, and the impact of those experiences on their interactions with the health care system today.

Jacki McPherson explains that ED doctors and nurses gained insight into historical trauma and the challenges faced by Indigenous Peoples – including why some are reluctant to go to the ED, why there is a lack of trust in providers, and why they may be resistant upon arrival or to follow discharge instructions after leaving.

Participants committed to sharing the valuable insights they gained with their teams and programs.

Emergency Department orientation for Indigenous community members

The second event focused on helping Indigenous community members better understand and navigate the ED and related services.

"I brought my people into the community hall to meet with ED staff so they could discuss what triage means and learn about policies and procedures. It’s information they will bring back to their families,” Jacki McPherson explains.

The session was well-attended, and community members' feedback was positive. "Many said that it was really good, and long overdue, she says. “It would have also made my work much easier if this had happened years ago," she adds, optimistic that meaningful change is finally starting.

The seeds of change

Jacki McPherson emphasizes the significance of the partners’ willingness to collaborate with her people. She believes the effort has already made an impact, observing that health care providers making changes in their approaches to patients. 

"These changes, and working together, have made a big difference for my people. I tell them, ‘We are improving relationships. You will be treated with respect, listened to, you will be heard.’" – Jacki McPherson, Health Director, Penticton Indian Band, Okanagan Nation

She further notes that this cultural safety work has the support of her leadership. “My Chief and Council want this work to continue because it’s for their people.”

Dr Bergunder echoes this, highlighting the importance of addressing systemic issues: “This partnership comes from a genuine desire to correct the systemic wrongs that persist within our health care system, in a way that is specific to our community.”

“The journey towards cultural safety is a lifelong process, but with the support of Indigenous communities, Interior Health, hospital leadership, and health care workers, there is hope for meaningful and lasting change,” says Dr Bergunder.

“My hope is that this will be the first of many opportunities to engage with our Indigenous community members and ensure we are providing culturally safe care.”  – Dr Mike Bergunder, Emergency Physician and Department Head