Early Death A mong M embers of Toronto’s Aboriginal Community Walking in Their S hoes

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Early Death A mong M embers of Toronto’s Aboriginal Community Walking in Their S hoes . Anishnawbe Health Toronto. Dr . R. Klair, Dr. C.P. Shah, Dr. A. Reeves . Background. - PowerPoint PPT Presentation

Transcript of Early Death A mong M embers of Toronto’s Aboriginal Community Walking in Their S hoes

Early death among members of Torontos Aboriginal Community: Walking in their shoes

Early Death Among Members of Torontos Aboriginal CommunityWalking in Their Shoes

Thank you for being here today. This project came about as the result of observations made by Dr. Chandrakant Shah while working at Anishnawbe Health Toronto. He has been working there as a family physician for a number of years now. Over this time he has attended the funerals of many of his patients. One thing he frequently observed was the fact that many were dying at a very young age. He was curious what the average age of death was for the aboriginal population not only in the center where he works but also in comparison to other social centers in Toronto. Secondly we wanted to know really what were the possible root causes of these deaths at such a early age. I will be taking you on a journey of these individuals who have died prematurely through their life experiences to better understand what happened to them.

1Anishnawbe Health TorontoDr. R. Klair, Dr. C.P. Shah, Dr. A. Reeves

The study was conducted at Anishnawbe Health Toronto with the help of 3 other social service centers. Dr. Shah is also here today. Also we would like to thank Mr. Harvey Manning who was responsible for conducting the interviews.2BackgroundOur clinical observations at Anishnawbe Health Toronto & three other Aboriginal health and social service centres suggest that a large number of Aboriginal individuals in Toronto are dying prematurelymeaning, they are passing away long before would be expected for the average Canadian citizen. This study conducted at Anishnawbe Health Toronto looks at premature deaths in the aboriginal community using a mixed methods research study. These deaths were examined using a quantitative medical chart review and a narrative analysis of qualitative interviews. Interviews were carried out with aboriginal community members who were close to the deceased to offer insight into the social determinants of health for the deceased throughout the course of their life. There are numerous other studies which outline the medical causes of deaths in aboriginal people. Our interest was much deeper than this. We wanted to know what had happened to these individuals in their lives to succumb to death at a relatively young age. The aim of our study was to attempt to identify the root causes of premature deaths among aboriginal service users at four urban health and social centers in Toronto.

3Historical ContextIn both developing and developed countries alike, Indigenous peoples face some of the heaviest burdens of ill health, due to this history it results in:loss of identity, culture, unstable housing and homelessnesslack of education and stable jobs lack of social supports.Aboriginals or Indigenous people in many countries not just Canada face some of the heaviest burdens of ill health. Much of this is due to a history of colonization and post colonial policies which have resulted in discrimination and racism. Research suggests that more and more aboriginal people are living off the reserve and in urban areas . They arrive in cities with the same dreams all young Canadians have of building a better future for themselves. The transition from rural to urban setting can be very challenging for anyone. This challenge is further compounded for aboriginals due to a multitude of obstacles, which they face.

4MethodsRoot Cause Analysis:Quantitative chart review of deathsAHT data between 2010-2012: 43 DeathsOther three agencies: 66 DeathsTotal Deaths reviewed: 109Narrative analysis of qualitative interviews20 interviews were carried out with community members close to the deceased The quantitative aspect looked at 109 total cases 43 of which were from Anishnawbe Health Toronto and 66 from 3 other social services agencies in Toronto.What we really wanted though was to go back and look at the life events which led to their early demise. From these 109 cases we conducted twenty interviews with either close family members or friends who knew the deceased intimately. Their stories formed the qualitative analysis aspect of this paper. When we conducted these interviews it gave us an abundance of information to decipher through. After reviewing these stories and comments the main overarching themes related to this root cause analysis were 1) impact of colonial and post colonial policies in social determinants of health and 2) Chronic stress as a result of these historical policies.

5Average Age of Death in Years We were quite shocked to find that the average age of death of our sample was 37 years old compared to the average age of death in Toronto is approximately 75.

Life expectancy however for the aboriginal population in general is about 7-8 years less than the average Canadian. This is quite striking as we know we have a plethora of health and social services here in Toronto, aboriginal and non-aboriginal which are available.

6Qualitative Results The findings from interviews are organized around two overarching themes within this root cause analysis:Impact of colonial & post-colonial policies on social determinants of health:Assimilation PolicySystemic Discrimination Cultural Disruption Reviewing the interviews we noticed a couple themes which were emerging. The most prevalent themes among them were related to colonial and post-colonial policies with subthemes of assimilation policy, systemic discrimination, and cultural disruption.7Impact of Colonial & Post-Colonial Policies on Health Determinants[The deceased told me], I went to residential school and the things that happened thereI cant even talk aboutthats why I drank so much. I just couldnt be a father. (P.193)

It wasnt [the deceaseds] faultbecause the history of colonialism, and the historic trauma transmission delivered over the last 500 years has impacted Aboriginal people in many different ways. And I think its caused a lot of different levels of posttraumatic stress disorder, and its caused Aboriginal people to suffer spiritually, mentally emotionally, physically. So when you take them from their land, their spirit becomes damaged. (P.201)

This next slide here shows a couple examples of the quotes from interviews we conducted.For many people who experience some form of trauma in their lives it is often very difficult to discuss. Let me describe a reality of the situation as it exists today. Dr. Shah recently saw a patient who typifies this theme. The patient was a 56 year old aboriginal female with a long standing history of diabetes. He had known her as one of his family medicine patients for a number of years. Something about her always just didnt fit he felt something was missing. Finally one day she opened up and told him about her past and how she had been in residential school very early on in her childhood. For a number of years during this time she had been sexually abused almost every other night. Until this time she had never discussed it before with anyone else including her family. Im using this example since often these questions are not asked when a patient history is taken. Many dont realize that the last of the residential schools closed in the 1990 so it isnt that distant part of Canadian history. The legacies of these schools persist in the children of children who attended these schools. Children who were denied the opportunity to observe and receive positive parenting from their own parents.

8Qualitative Results The findings from interviews are organized around two overarching themes within this root cause analysis:Chronic stress as a result of these historical policies resulting in: Violence towards self and other Identity Issues Mental Health Challenges Addiction Social Isolation So what these post-colonial polices, assimilation policies did was rob people of their culture their language, their way of life, and their identity. This in turn leads to a form of chronic stress for individuals, which can have a significant impact on their lives. This chronic stress may manifest in many different ways such as violence toward themselves and others, identity issues, mental health issues, problems with addictions, social isolation and may exacerbate numerous preexisting medical conditions. Recent biomedical and psychological literature offers ties between early and chronic stress in an individual and adverse neurobiological changes in the brain. Individuals who experience adverse childhood experiences and chronic stress early in life may go on to struggle with in relationships and intimacy, have difficulty controlling impulses, and adopt health-risk behaviours.9Chronic Stress[The deceased] fought a lot becauseyou knowhe never picked a fight but never backed down from one. And it was all really racist stuff that went on. (P.121)

Well, [the deceased] was shy, you know? Wouldnt ask anybody for help. [] I think that [because of] residential schools or whatever, things that she had that she was dealing withshe couldnt really go out and try to get therapy or try to rise above and better herself. She was just stuck. (P.282)

In addition to the chronic stress brought on by these postcolonial policies aboriginals often suffer additional stressors brought on by systemic discrimination. This happens in schools workforces and even our hospitals. One prominent example which comes to mind and many of you may be aware of is the death of Brian Sinclair in 2008. This man was an aboriginal man who was a double amputee. Brian was sent by his family doctor to the emergency department due to urinary retention. Unfortunately Brian died in the waiting room before being seen likely secondary to sepsis from a bladder infection, which possibly could have been treated. Brian waited there in his wheelchair for approximately 34 hours without being seen. M