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The research article entitled “End of Life Care in Nunavik, Quebec: Inuit Experiences, Current Realities and Way Forward” explores the the barriers between Inuit peoples and their healthcare providers, as well as possible strategies to develop a sustainable and culturally sensitive care model that is congruent with their traditional end of life care. The authors Shawn Hordyk, PhD and his colleagues seek to identify the challenges facing a specific group of Inuits in Nunavik, Quebec and develop a plan to create culturally appropriate education and forge relationships between medical institutions and their Inuit patients. The tradition of providing end of life care in a home setting is deeply ingrained within Inuit culture; in the article an elder is quoted saying “If you don’t care for the person [in passing of life], your heart is going to suffer.” (Hordyk et al, 2016). However, Hordyk (2016) asserts that sociocultural, geographic and medical factors are inhibiting this practice, stating that Inuit people are often dying in hospitals which are sometimes outside of their community. This often allows for minimal access to cultural practices and limits time spent with family. Furthermore, the separation of patients from family and community places further strain on the traditional, communal Inuit dying traditions. Traditionally, the home of person nearing the end of their life will fill with family of all ages as they come to offer support the in the form of conversation, prayer and silences, among a variety of other customary comforts.
The authors state that “health institutions in Nunavik have a history of disregarding interventions and traditional Inuit cultural values”(Hordyk et al, 2016 pg. 650). It can be inferred that the lack of partnership between traditional care practitioners and institutional caregivers is a primary challenge for Nunavik Inuits in the late stages of life. In the defence of healthcare providers the author states that when possible, arrangements have been made to accommodate in home end of life care. However, the decline in Inuits dying at home can also be attributed to factors outside of medical institutions.
Hordyk describes how care methods can be lost in translation over time leaving family inadequately prepared to care for the dying person. In addition, the author discusses the “intergenerational trauma rooted in colonial practices resulted in social suffering” (Hordyk et al, 2016 pg. 650). The latter is briefly touched on in the course of the article but is an important factor in the development of a suitable healthcare solution for Inuit peoples due to the instability it has caused within communities. Hordyk (2016) suggests that in order to cultivate an appropriate end of life care model there must be trust between healthcare professionals and the Inuit, more exchanging of knowledge between the two and seeking to understand the depth of the Inuit’s collective social suffering due to prior colonial practices.
The article looks to “better understand the factors shaping end of life care in Nunavik to support the development of a sustainable model of care” (Hordyk et al, 2016 pg. 647) These factors have been identified through a range of methods, some scientific and some not.
Interviewing, which is non-scientific and anecdotal in nature, was one half of their data collection methods. The use of informal and semi-formal interviews suggest that the questions are inconsistent and open for interpretation based on the individual being interviewed. The responses given during the interview will be heavily based upon personal opinion and would be very difficult to generalize. Interviews were held with subjects recruited via snowball sampling; this technique works by accepting referrals from subjects already involved in the study. It is used when attempting to reach hidden populations; populations that would otherwise be difficult to reach. The primary drawback to this recruitment approach is that it this allows for heavy bias. In addition to interviews, they used the qualitative research method known as participant observation. Throughout their 14 total weeks spent in the field they observed various community events and funeral practices. They also made regular visits to elder’s homes and nursing homes. Qualitative research is the scientific method of research that works by obtaining data in non-numerical formats.
There is, to some degree, macro-level analysis in this article as there are descriptions of the effects of healthcare institution on the individual. However, the main level of analysis addressed would be micro-level. This is stated through the emphasis on interactions between the Qallunaat (non-Inuit medical staff) and the Inuit people. “Reduce risk of errors in communication leading to breakdowns in trust, some of which are described in the literature as microaggressions.’’ (Hordyk et al, 2016 pg. 653) The author stresses the importance of effective, culturally correct communication and an increase in trust between Qallunaat and the Inuit at several points throughout the article. This is further evidence on Hordyk’s focus on micro level orientation.
It has been concluded by the author that there are three imperative elements to be building a sustainable end of life care model for the Inuits in Nunavik. First being, adequate training for medical professions “concerning the historical, social, and cultural realities that underlie relationships” (Hordyk et al, 2016 pg. 652). In order to give culturally appropriate care, caregivers must understand the challenges brought by colonialism to the indigenous community. He then suggests that communities must work to build upon their pre-existing means of addressing that suffering. As well as effective education for Inuits on their traditional end of life care practices and how to perform them, this will reduce the risk of family being left improperly informed on caring for dying person in the home environment.
Despite the weakness of biased and limited empirical evidence, the article does effectively accomplish what it sets out to. Hordyk (2016) began his research with the goal of identifying challenges and suggesting effective ways to overcome them, and he was successful. There is no doubt that the suggestions for change are congruent with the information that was obtained by Hordyk and his colleagues. Moreover, all of his suggestions are supported by information gathered from interviews and observations done with Inuits as well as the Qallunaat. One can infer that there must be equal efforts on the part of both Inuit peoples and Qallunaat to work towards a sustainable means of end of life care planning.
From my perspective the author’s solutions are well supported by his findings. The descriptions of mistrust and miscommunications in the article support that his solution centers around effective communication, education and general understanding by both parties. However, I think these ideas will need to be implemented over many generations to fully observe the possible benefits of the presented solutions. Furthermore, this is a multifaceted problem that will need multiple constantly evolving solutions that are revised as new information is gathered. His three elements would work well as a preliminary foundation upon which new methods of care planning could be established, however it will take much more research and deliberation to engineer a completed framework for positive and sustainable change.
When considering the issues being examined, especially the lasting impacts of colonialism and healthcare institution on the Inuit population, the life course perspective can be easily applied to the article. “Bridges the macro and micro level of analysis by recognizing social structures, historical context, individual experiences and meanings” (Novak et al, 2014 pg. 26). That is a very fitting description of the life course perspective, coincidentally is also a very fitting description for the perspective in this article. The bridging of the institution of healthcare, effects of colonial practices and interactions between the two groups mentioned in the article is the summary of how the life course perspective relates closely the perspective of the author. The life course perspective is a multifaceted one, as is the array of social issues outlined in this article. This perspective has the ability to address many areas of one’s life, ranging from effects of historical events to the individual experiences of a person. If we consider from this perspective, it can be reasonably suggested that the key to improving relations between healthcare is in the social interactions between individuals. In addition, education on end of life care in the family setting must be provided early in each family members life so that they will be better prepared when their loved ones need care. It is critical that they are comfortable with the practices so they can be able caregivers to their elders and avoid becoming overwhelmed by the task. Education and involvement of younger generations before it is their responsibility to be a sole caregiver will help ease them in changing roles. This perspective can also account for the individual’s desire to die at home, with traditional practices surrounded by family. It supports the continuity of aging and the link between earlier life and later life. If a person has spent their entire life in an environment surrounded by family through the majority of transitions over their years, it is natural that is where they will feel most at ease in their end of life stages.
It’s likely that many elders in the community would have been raised by people directly affected by colonial practices. This has caused extensive social suffering among the Inuit community that will be passed down for generations to come. This accounts for their inherent mistrust of the Qallunaat when taking into account one’s personal biography. This in particular, is an intergenerational issue that will take many generations to end.
An article retrieved from the The Starphoenix entitled “Cultural Respect Identified as Key to Better Cancer Outcomes Among” written by C. Bains describes how medical institutions approach marketing prevention-focused models of healthcare to indigenous people, such as the dangers of drinking and smoking. The delivery of information must be culturally appropriate in order to reach the target audience. Bains (2018) states the importance of marketing it from a health and wellness perspective. Cindy Martin, CEO of the Canadian Partnership Against Cancer, was quoted saying, “They do not feel safe in their cancer journey, they don’t feel respected in the healthcare system, they don’t feel understood” (Bains, 2018).
The feelings relayed by Martin relate directly to the issues expressed in Hordyk’s article. Culturally sensitive care is an important aspect of effective healthcare that is often being overlooked in modern practices. The article also states that cancer is on the rise for Inuit, Aboriginal and Metis peoples, further highlighting the importance of educating our healthcare providers on culturally sensitive care and prevention methods. It is every Canadian’s right to receive health care based on their individual needs. That not only includes their medical and treatment needs, but also their emotional needs. The need to feel safe, understood and respected in the healthcare environment should be strictly protected. Unfortunately, our current system sometimes fails to uphold the those rights. Hordyk’s article supports the assumption that it is not only isolated communities facing these challenges, and that this is a very real and widespread problem plaguing our healthcare system.
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