ARCHIVED: Appendix G: Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse – Working with Aboriginal individuals


Appendix G: Working with Aboriginal Individuals, by Dr. Rose Roberts, RN, PhD

A brief history of Aboriginal Peoples

Abundant literature describes the history of the First Nations, Métis and Inuit in Canada. An abbreviated list of recommended readings is found in the bibliography. The purpose here is to provide an overview as a starting point for health care practitioners working with First Nations, Métis, and Inuit peoples in the area of Sensitive Practice.

Aboriginal Peoples constitute a diverse population in Canada. There are several terms that have been introduced in the literature in an attempt to categorize these populations into one group, such as aboriginal, native, Indian, and indigenous. The Constitution of Canada uses the term Aboriginal to include Status and Non-Status Indians, Métis and Inuit. Status Indians are those whose ancestors signed treaties; Non-Status Indians are those whose ancestors refused to sign treaties or were absent at the time of the signing. A subpopulation of Non-Status Indians was also created through loss of treaty rights for various reasons such as serving in the armed forces, voting, obtaining a postsecondary degree, and, for Status Indian women, marrying non-Aboriginal men. For the most part, members of this subpopulation have regained their treaty rights through a revision in the Indian Act in 1984 (Bill C-31).

Our knowledge of the history of indigenous people in Canada prior to the arrival of the Europeans is very limited. The majority of information has been gleaned through the sciences of archaeology and anthropology. The most commonly held theory in the Western world is that the ancestors of the First Nations came from Asia over the Bering Strait. Time immemorial, a phrase often used by First Nations to describe how long they have been here, has been roughly translated to mean between 50,000 and 15,000 BC.50 There have been three separate times when the Bering Strait could have been used as a land bridge, and there are theories arguing that there were three distinct migrations.50 On the basis of archaeological findings, it appears that, through multiple generations, the first wave of people travelled down the Pacific coast into South America. As the glaciers retreated, some headed back up north. The second wave, the Athapascans (Dene), stayed in the north, but began to move south following a volcanic eruption. The third wave, the Inuit, spread eastward through the north.50

There have been several attempts to categorize the First Nations people of Canada. Linguistics is one common method, and there are 11 different language families: Algonquian, Athapaskan, Eskimo-Aleut, Haida, Tlingit, Siouan, Tsimshian, Wakashan, Salishan, Kutenai, and Iroquoian.175 It has been hypothesized that around the time of European contact there were between 50 and 60 languages, but the most commonly spoken languages today are Cree, Ojibway, and Inuktitut. Many First Nations are diligently working to save their languages.175 Another method of categorization is culture areas, and these areas are based on geography and a group of people sharing similar cultures. These culture areas are: Arctic, Western Subarctic, Eastern Subarctic, Northeastern Woodlands, Plains, Plateau, and Northwest Coast.175 It is interesting that these geographical culture areas closely resemble the geographical separation according to linguistics. Today there are more than 610 First Nations communities in Canada, and the total population, living both on and off reserve, is more than 733,000.13

The time following contact with Europeans brought many changes to First Nations peoples in Canada, including the creation of an entirely different people: the Métis. The Métis were primarily the offspring of First Nations women and French men. The term half-breed was more often used to describe children of First Nations women and Scottish or English men. The Métis of today define themselves according to the following definition adopted by the Métis National Council, the national governmental organization representing the Métis: "Métis means a person who self identifies as Métis, is of Historic Métis Nation ancestry, is distinct from other Aboriginal peoples and is accepted by the Métis Nation."106 The "Historic Métis Nation" means the Aboriginal people then known as Métis or Half-Breeds who resided in the Historic Métis Nation Homeland, the area of land in west central North America used and occupied as the traditional territory of the Métis or Half-Breeds. The Métis National Council estimates that there are between 350,000 and 400,000 Métis in Canada.106

The Inuit are peoples who live in the Arctic regions of Canada, Alaska, and Greenland. They have very similar cultural and physical characteristics despite the wide geographical area in which they live. The Inuit have survived in one of the world's harshest environments for more than 5,000 years.90 The areas are mostly coastal, consisting of shallow basins with rivers flowing through and many islands covered with permanent ice and mountain glaciers. The treeless shores provide no wind protection, temperatures are below freezing for eight or nine months of the year, and total precipitation is so slight that the area nearly qualifies as desert. According to the 2001 census, there are more than 45,000 Inuit in Canada, representing about 5% of the Aboriginal population.160 They are represented nationally by the Inuit Tapiriit Kanatami.

The residential school legacy

Between 1892 and 1969, approximately 135 residential schools were established to meet 1 the treaty right to education. Although First Nations leaders wanted schools built on the reserves, the federal government decided that residential schools would be cheaper and entered agreements with the Roman Catholic Church, the Church of England, the Methodist Church, and the Presbyterian Church to operate the schools. The vast majority of these schools were in the western provinces and it is estimated that more than 150,000 students attended them. The Assembly of First Nations estimates that more than 105,000 survivors of residential schools are still alive today.14

The premise of the residential schools was assimilation through education, religious indoctrination, and cultural degradation (teaching the children to be ashamed of their heritage). Physical, emotional, and sexual abuses were rampant and living conditions were often substandard. Former residents say that they were often hungry and that their parents brought them food on their weekend visits;72 others report being forced to steal food from the kitchens. The education the children received was also substandard. As late as the 1950s, more than 40% of the teaching staff at the schools had no professional training.1 Cultural degradation practices included physical and emotional abuse for speaking a traditional language, cutting students' hair (hair has strong cultural and spiritual implications), imposing foreign religious practices, and intentionally separating students from visiting parents.

The residential school experiences continue to have a detrimental impact on Aboriginal communities today. These "intergenerational impacts refer to the effects of physical and sexual abuse that were passed on to the children, grandchildren, and great-grandchildren of Aboriginal people who attended the residential school system."2 Some of these effects include:

  • Alcohol and drug abuse;
  • Past and ongoing physical, emotional, and sexual abuse;
  • Low self-esteem;
  • Dysfunctional families and interpersonal relationships;
  • Parenting issues;
  • Suicide;
  • Teen pregnancy.

The Aboriginal Healing Foundation (AHF) was established in 1998 in response to the Royal Commission on Aboriginal Peoples. The AHF's mandate is to fund and support Aboriginal healing initiatives. As of November 2005, the federal government had committed $378 million to 1,346 community-based grants and has pledged another $125 million over the next five years. The AHF has received more than $1.3 billion in funding proposals and estimates that $600 million is required over the next 30 years to fully address the residential school legacy. For more information, interested readers are encouraged to visit the AHF website ( The Indian Residential School Survivors' Society is another organization that offers resources to survivors as well as those that work within the healing field ( Among other services, it provides a national 24- hour toll-free crisis line (1-866-925-4419).

With respect to Sensitive Practice, health care practitioners working with Aboriginal clients should be aware of the following personality characteristics that may indicate past residential school trauma: (a) unconscious internalization of residential school behaviours (e.g., false politeness, not speaking out, passive compliance, excessive neatness, or obedience without thought); (b) flashbacks and associative trauma (e.g., certain smells, foods, sounds, sights, and people trigger flashbacks and memories, anxiety attacks, physical symptoms, or fear); (c) internalized sense of inferiority or aversion in relation to white people and especially white people in power.2

Health care practitioners are strongly encouraged to approach individuals of Aboriginal heritage with respect and openness, allowing more time than usual for introductions and the development of a trusting relationship. The Sensitive Practice protocols presented in this Handbook are appropriate to use when working with Aboriginal clients, especially when they are accompanied by concerted efforts to increase one's awareness and understanding of Aboriginal cultures.

Recommended Readings and Resources Aboriginal Peoples: Readings (especially the policy statements by Dr. Janet Smylie)

Health care systems

Health care is not a provision specifically addressed in the treaties between Canada and First Nations and Inuit. The only direct mention of health care can be found in Treaty 6 which was signed in the mid-prairies of Saskatchewan and Alberta in 1876 and reads, "That a medicine chest shall be kept at the house of each Indian Agent for the use and benefit of the Indians at the direction of such agent."39 Subsequent court proceedings involving Treaty 6 have ruled that at the time the treaties were signed, the Chiefs were looking for the best possible agreement for their members, and within that understanding, the clause could mean the provision of any and all services necessary for continued health for First Nations.112 The intent of the medicine chest clause has been applied to all First Nations and Inuit peoples.

The federal government provides comprehensive health care services to First Nations and the Inuit through the First Nations and Inuit Health Branch (FNIHB). FNIHB provides direct care to on-reserve populations and reimburses the provincial and other health care agencies for services provided to off-reserve populations. There has been a recent shift in responsibility as First Nations are reclaiming some aspects of self-government. Health transfer payments to individual First Nations or Tribal Councils has allowed First Nations to administer the funding and given them the freedom to determine their own health needs and plan their programs accordingly. Non-Status and Métis people are left out of these arrangements and receive their health care within the provincial or territorial health system.

Aboriginal health beliefs

The most common health model found in the literature and the oral tradition of Aboriginal peoples is the medicine wheel model (see Figure 2). Actual medicine wheels are circular stone formations found in all parts of North America. The term medicine wheel has been borrowed from these stone structures and applied to the theory of health and other areas of Aboriginal traditions. The medicine wheel is a circle, which means there is no end and no beginning. The same could be said for one's health status. The four areas of the wheel are intellectual, emotional, spiritual, and physical. Some Aboriginal people believe that all four areas have to be in balance if one is to be in an optimum state of health; in other words, if any of the four areas are out of balance, then the individual becomes ill. All four areas are also connected and interrelated, so that there is no distinction such as the separation between mind and body that is often found in Western health paradigms. Specific programs have been developed in many Aboriginal communities and organizations using the medicine wheel as the framework. An Internet search of the term medicine wheel reveals the diverse situations and disease entities to which this framework has been applied.

FIGURE 2 Medicine Wheel
Figure 2 - Text Equivalent
  • Physical
  • Spiritual
  • Emotional
  • Intellectual

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