Meaningful end-of-life care: Integrating Mi’kmaw knowledge and traditions into east coast health care
News & Updates | June 23, 2023 | Sarah Dobec
Paulina Meader is a Licensed Practical Nurse (LPN) and the Health Director at Wije’winen Health Centre in Halifax. She is from Membertou First Nation, a Mi’kmaw reserve located in the traditional district of Unama’ki – Cape Breton Island. From birth, Paulina has been in the health care system. She was diagnosed with Cystic Fibrosis (CF) when she was just two days old.
“I have had both positive and negative experiences navigating the health care system which have shaped my involvement and desire to change health care for Mi’kmaq… and everyone. My early CF diagnosis was due to having a strong advocate who, despite preconceived notions of Indigenous health care and the needs of Indigenous people, fought for me to be transferred to a pediatric facility where a proper diagnosis could be made. This theme has continued throughout my life where I am the voice of Indigenous patients. Often being told (as a patient) this is the first time a physician has cared for an Indigenous person with CF, and I end up doing quite a bit of education work for my own care providers.”
In addition to her primary care role as an LPN, Paulina has recently taken on the role of Health Director at the Wije’winen Health Centre managing partnerships, communication, advocacy, education, policy work, and funding.
“This is my first time being in a role where I can make decisions to implement practices, change policy and change the narrative around Indigenous health care, and Mi’kmaw-specific health care in Nova Scotia and the Halifax Regional Municipality. It’s been amazing to have the authority to say, ‘Yes, this works’, ‘no, this does not work’, or ‘This is how we can make this better’ and work with other Indigenous and Mi’kmaw health care professionals to find the best way to support our communities.”
I’m feeling very fulfilled. It’s really beautiful work to be in community, be part of a community and provide care for that community.
“It’s a very different kind of satisfaction in my work; it’s all-encompassing because I feel good emotionally, physically, mentally, and spiritually. The clinic is growing rapidly with the goal of having a well-rounded, well-supported family medicine practice that can support the urban Indigenous community in a multitude of ways.”
There are still some obvious and easily addressed gaps from Paulina’s perspective. For example, the language and translation services that the Nova Scotia Health Authority (NSH) uses has approximately 170 languages offered, but it does not include Mi’kmaw. It’s actually one of the three official languages of the province, but it’s not being implemented in actionable ways where it’s included in this health care service.
Educating health care professionals in the NSH about Mi’kmaw traditions is something that Paulina integrates in her work whenever possible.
“Resilience is a strong observation that I have made about Mi’kmaw people and our traditions. Due to colonization, many Mi’kmaw people practice Catholicism, but we have still integrated many of our traditions into day-to-day life, including prayer cloths. Once a year, women and children will wash a statue of St Anne with a white cloth. The Mi’kmaw are known for honouring children, women, and feminine people for their love, wisdom, and teachings. We had clan mothers who were responsible for their families, so St. Anne, the mother of Mary and grandmother of Jesus, became celebrated by our people. She was and is a clan mother. The white cloths are then cut into strips and distributed to people in the community who are sick or frail. The cloths are rich in meaning and carry the love and prayers of women and children, so I tell health care workers, whenever possible, not to remove them from a patient who is in their care. This is an example of an important Mi’kmaw tradition that can easily be respected and honoured if people are aware.”
Very recently, Paulina had the opportunity to provide traditional end-of-life care for a Dene person who had lived in Mi’kmaw communities for most of their life. “I was able to smudge and brush them down with an eagle feather and pray with them while they were still coherent. After they passed, with the help of community, we were able to give them a cedar bath and braid their hair. The facility gave us the time and space to provide this traditional care which was very special. I believe this is thanks to those who are educating health care professionals in our region about our practices.”
Educating health care professionals in the NSH about Mi’kmaw traditions is something that I integrate in my work whenever possible.
Paulina acknowledges that there is still lots of education and work to do in order to provide meaningful end-of-life care, and it comes from people being willing to learn and to ask questions. “People are often afraid to ask questions about culture and needs. I suggest to my students that they make it part of their assessment because they are already asking so many personal questions. You can just add in, ‘Are there any specific spiritual or culture practices that you would like me to be aware of?’ It’s that simple. It opens the door, and it helps create a safer space.”
Paulina ended our conversation with these final thoughts. “Death is a very individual experience, but it always has the opportunity to be transformative for the people who are experiencing it at the secondary level. While a person is dying, our focus is on them, but after death, we need to embrace our own mourning and grieving. There is room to improve how we process death in our communities and in health care.”