InFocus Magazine

On June 19, 2015 a hand-made button blanket wall hanging was presented to the staff at the St. Joseph’s maternity ward.  The impressively large and brightly colored wall hanging was placed in a prominent position directly facing the entrance to the ward—and as a result, is almost impossible to miss.  Though the button blanket wall hanging is a beautiful addition to the maternity ward, it is more than just a decoration—it is a symbol of the ongoing journey toward a shared understanding between medical care providers and Aboriginal people.

Laurel Anderson, the Aboriginal Liaison Nurse for St. Joseph’s Hospital, is one of the key individuals who initiated the button blanket wall hanging project. Anderson has an important job at St. Joseph’s Hospital. She provides advocacy and connects Aboriginal people to services and support. Anderson also works with hospital staff to create awareness of the difficulties Aboriginal people may face when they enter the hospital.

“It’s about how we as health professionals engage with people,” Anderson says.  “The goal is to improve the overall patient experience in the hospital, and the broader goal is to change the culture of the institution—to make the hospital more culturally safe.”

The concept of cultural safety is one that has been around for more than three decades.  The term was developed by Irihapeti Ramsden, a Maori nurse in New Zealand, in response to the Maori people’s discontent with the nursing care they were receiving.  Cultural safety education is now included in most nursing curricula, not just in New Zealand but around the world.

According to Canada’s National Aboriginal Health Organization’s fact sheet on cultural safety, “Cultural safety requires that nurses become respectful of nationality, culture, age, sex, political and religious beliefs. The key element of culturally safe practice is establishing trust with the patient.  Culturally safe care empowers people because it reinforces the idea that each person’s knowledge and reality is valid and valuable. It facilitates open communication and allows the patient to voice concerns about nursing care that he or she many deem unsafe.”

Soon after Anderson became the Aboriginal Liaison Nurse for St. Joseph’s Hospital she approached Kelly Phillips, the Clinical Coordinator for the Maternal Care Unit at St. Joseph’s.  Anderson inquired if Phillips would be willing to examine the care Aboriginal women were receiving at the maternity unit and to explore ways in which their care could be improved.  Phillips agreed to work with Anderson, and from there steps were taken to improve the level of cultural safety at the maternity ward.

“The question we asked was, ‘How can we serve Aboriginal patients better,’ with the understanding that any improvements we made would not only improve the care we gave Aboriginal patients, but would increase the quality of care for everyone who entered the hospital,” says Phillips. Anderson and Phillips arranged education seminars where nursing staff, doctors and other health care providers were invited to come together and learn the concepts to cultural safety.

“Learning to create an environment in our hospital that is culturally safe has been an incredible experience,” Phillips says. “Actually, it has created a real shift for us. We’ve become more aware of the power we have as nurses when we are tracking with a patient—the power of the relationship between us. If a person isn’t feeling comfortable they will shut down.  Sometimes Aboriginal people don’t trust institutions, so we need to be that much more cognizant and cautious when we support them.”

It’s interesting to note that a number of Aboriginal people find it difficult to trust their caregivers when they are in an institutional environment.  This lack of trust sometimes causes Aboriginal people to avoid the hospital and other sources of health care.  And this is a problem, because when Aboriginal people avoid hospitals and other sources of care, their health could be compromised. According to the Island Health website, Aboriginal people don’t access health care services at the same rate as non-Aboriginal people.

To understand why some Aboriginal people distrust institutional environments one must first understand the impact that past events have had on the Aboriginal person’s mindset.  In the book titled Maya ‘Xl La – Highest Respect – A Journey to Cultural Safety, written to tell the story of the button blanket wall hanging project, Dr. Evelyn Voyageur-Savoie, Elder in Residence at North Island College, says, “First, one must fully understand past historic colonialism and laws such as enforced residential schooling and its effects on the lives of Aboriginal people.

“Because of the many abuses Aboriginal people received in schools, this has made them leery about workers and service providers.  Many Aboriginal people lost their ability to trust because the people who were supposed to keep them safe were the perpetrators.”

Phillips agrees. “You can’t understand a perspective if you don’t understand the history and how it impacts them.”

According to Voyageur-Savoie, a large part of working toward rebuilding the trust that was lost is to look at ways to improve communication.  For example, the care provider must ask questions, be empathetic and listen well.  Voyageur-Savoie explains, “I am advising anyone who works with Aboriginal people to learn more by talking with them. It is very important so service providers can understand where their clients are coming from. It will also help them to understand, be empathetic and be a good listener.”

Anderson agrees that building relationships is the first order of business.  “Relationships and relationship building is one of the core foundations of all things Aboriginal,” says Anderson.  “The button blanket wall hanging project was created as a way to encourage dialogue and improve relationships and understanding between health care professionals and Aboriginal people.”

The wall hanging is comprised of 20 small squares surrounding a large centre square, which depicts the Tree of Life.  According to Edna Leask, Elder and key individual in the wall hanging project, “The Tree of Life is symbolic of many things in many cultures, but to the coastal First Nations, it represents the Cedar tree, a tree which has nurtured and sustained coastal First Nations for thousands of years.”

Each of the smaller squares was created by Elders and community members, particularly Aboriginal women who’d had a baby at the St. Joseph’s Hospital maternity ward.  For six months the Elders gathered with the women and Anderson to create these squares.

The individual squares are beautiful and rich in personal detail.  One square depicts an Aboriginal woman holding her child.  Another square is a gorgeous picture of a salmon with eggs.  And another square, sewn by eight year old Bianca Wagner, is filled with fabric hearts that symbolize the love that is shared between family members.

Once the squares were completed they were sewn together by Naomi Coutts, Elder worker at Wachiay Friendship Centre, who also designed the tree in the centre of the blanket. Then, over a period of several months, the wall hanging was brought to the maternity ward by the Elders, who welcomed maternity ward staff, doctors, midwives, doulas, as well as patients and their family members to sit a while and sew on the buttons and the beads that would embellish the beautiful fabric art.

It was another opportunity for the Elders, health care workers and community members to talk and understand each other.  While sitting around the squares and sewing on the beads the Elders shared stories and traditions—and the health care workers and community members listened, asked questions and shared stories of their own.
It was an opportunity for each party to build a relationship with each other.  “When the hands are busy, the mind opens up, and allows people to become more comfortable with each other,” says Anderson.

After the wall hanging was finished it was gifted to the maternity ward at St. Joseph’s—a symbol of acknowledgement to the staff for the work they had done in making the maternity unit a more culturally safe place.

According to Phillips, the wall hanging is a constant reminder to staff that they have a huge responsibility. “The impact of this project has been much greater and far reaching than we could have ever anticipated.  Our success story is about a shift in how maternal child staff are interacting with and supporting women and their families.  This may not sound like such a monumental story but it speaks to a willingness to do business differently, to build relationships and provide culturally safe care.”

Perhaps Leask summed up the project best when she wrote, “We are all special and unique.  I believe we all come to Mother Earth with special gifts to carry us through life. We are all intertwined and connected together in this circle of life with our ancestors, the land, water and animals.  We have to listen to each other and learn from each other; trust, love, respect, responsibility, be compassionate and build relationships with our loved ones, our families, our communities and Mother Earth.”

Anderson and Phillips are now working to use the wall hanging as a fundraising tool.  Toward that goal, photographer James Peacock has volunteered to take photos of all the squares, which will be made into greeting cards.  Money raised from the sale of the cards will support vulnerable women and families, of any nationality, in times of crisis.  Look for the cards around the Valley in the months to come.