Naturopathic Medicine for Improved Health Care within Canadian Aboriginal Communities

Abstract

Abstract
Aboriginal communities in Canada are plagued by chronic illness despite significant financial investment to increase access to primary health care facilities. The government has recognized that a new Aboriginal-driven health care approach must be developed and must respect traditional Aboriginal medicine. This can be a difficult challenge due to significant philosophical differences between the Western medical model and Aboriginal medicine, as well as logistical barriers. Naturopathic medicine has the tools to bridge the gap between traditional and modern medicine and supports a holistic view of health that is more closely aligned with the Aboriginal view of health. Through partnerships with Aboriginal people and health care practitioners, the direct involvement of naturopathic doctors in Aboriginal health care delivery would serve a key role in achieving improved health of Aboriginal people across Canada.
Addressing the health needs of Aboriginal people in Canada and uncovering ways to close the disparity gap between Aboriginal and non-Aboriginal people’s health lie at the heart of this report. In looking at this issue, four investigations were completed: 1) a systematic review of the literature to explore the use of naturopathic or other types of complementary medicine used within the Aboriginal context; 2) a qualitative study on the impact and conduct of naturopathic medicine at a community clinic dedicated to serving Aboriginal people; 3) a telephone survey of Aboriginal Health Centres across Ontario; and 4) a comparison of the similarities and differences of the philosophical approaches within naturopathic and traditional Aboriginal medicine.
The systematic review did not yield any reports related to the implementation of naturopathic medicine nor any form of complementary medicine within Aboriginal communities. Findings from the qualitative research study indicate that the naturopathic clinic at Anishnawbe Health Toronto (AHT) is achieving positive patient outcomes and addressing the specific health needs of this population in a way that is not met by other traditional or conventional health care providers. Upon evaluation and analysis of common themes at Aboriginal Health Access Centres and after comparison with actual delivery of care, a clear imbalance between the desire for and accessibility to health promotion and prevention programs and the provision of holistic care was revealed. This imbalance could be corrected through the implementation of naturopathic medicine.
From a philosophical and practical viewpoint, there is a clear alignment between the Aboriginal view of health and the approach used by naturopathic medicine as both perspectives believe a holistic view of health is fundamental to care. The importance of treatments that address not only the physical, but also the mental, emotional and spiritual aspects of health are stressed within both traditional Aboriginal and naturopathic approaches to health and wellness.

Full text

Naturopathic Medicine for
Improved Health Care within
Canadian Aboriginal
Communities
Conducted by the Department of Research &
Clinical Epidemiology at the Canadian College
of Naturopathic Medicine
A project supported by the First Nations and Inuit Health
Branch of Health Canada

Visionary Circle
~ Ian Potter ~ Bob Dickson ~ Bob Bernhardt ~
~ Dugald Seely ~ Simon Brascoupé ~ Johanne McCarthy ~
~ Deborah Kennedy ~ Kieran Cooley ~ Rishma Walji ~ Sigrid Grobys ~
Executive Team
Project Leader
Dugald Seely ND, MSc
Team Coordinators
Deborah Kennedy MBA, ND
Rishma Walji ND, PhD (c)
Johanne McCarthy ND
Synthesis Research Team
Deborah Kennedy MBA, ND
Sigrid Grobys ND
Johanne McCarthy ND
Qualitative Research Team
Rishma Walji ND, PhD (c)
Kieran Cooley ND, MSc (c)
Laura Weeks, PhD (c)
Field Research Team
Johanne McCarthy ND
Dugald Seely ND, MSc
Deborah Kennedy MBA, ND
Sigrid Grobys ND

Acknowledgments
This project was made possible through a funding grant from the First Nations and
Inuit Health Branch of Health Canada (FNIHB) and would not have been possible
without the support of Ian Potter, and Simon Brascoupé.
Thank you to Bob Dickson, Vice-president of the Canadian Executive Service
Organization (CESO) for his involvement and in bringing key partners together to allow
this work to move forward.
Thank you to the Aboriginal people, in particular, patients at Anishnawbe Health
Toronto. Without your cooperation and willingness to share your experiences,
support for naturopathic medicine within the aboriginal communities would not have
been possible.
Thank you to Joe Hester, Executive Director and the staff of Anishnawbe Health
Toronto (AHT) for opening your doors to the research staff and supporting
naturopathic medicine at AHT.
Thank you to naturopathic doctors and AHT Clinic Supervisors, Jennifer Hillier and
Masina Wright and AHT Student Interns, past and present, for sharing your
experiences of working within AHT and for the continued patient care that you provide
to the Aboriginal community served by AHT.
Thank you to CCNM Students Rochelle Fernandes and Adrian Nasager for the
transcription of the interviews for the qualitative research completed at AHT.
Thank you to the Aboriginal Health Access Centres for participation in the telephone
survey. In some instances, several people were contacted to obtain the necessary
information for the survey and we’d like to thank them for their time and assistance
during our field research. Thank you to the people at the following clinics:
• Kanonkwa/tesheio: Social
• N’Mninowyaa: Community
Health Access
• Gizhewaadiziwin Access Centre
• De dwa da dehs nyes Aboriginal
Health Access Centre
• Wassay-Gezhig Na-Hahn-Dah-
We-Igamig
• Anishnawbe-Mushkiki
• Noojmowin Teg Health Access
Centre
• Ganaan De We O Dis Yethi
Yenahwahse - SOAHAC
• Wabano Centre for Aboriginal
Health
• Shkagamik-Kwe Health Centre
• Misiway Eniniwuk Health Centre
- ii -

Abstract
Aboriginal communities in Canada are plagued by chronic illness despite significant
financial investment to increase access to primary health care facilities. The
government has recognized that a new Aboriginal-driven health care approach must
be developed and must respect traditional Aboriginal medicine. This can be a difficult
challenge due to significant philosophical differences between the Western medical
model and Aboriginal medicine, as well as logistical barriers. Naturopathic medicine
has the tools to bridge the gap between traditional and modern medicine and
supports a holistic view of health that is more closely aligned with the Aboriginal view
of health. Through partnerships with Aboriginal people and health care practitioners,
the direct involvement of naturopathic doctors in Aboriginal health care delivery would
serve a key role in achieving improved health of Aboriginal people across Canada.
Addressing the health needs of Aboriginal people in Canada and uncovering ways to
close the disparity gap between Aboriginal and non-Aboriginal people’s health lie at
the heart of this report. In looking at this issue, four investigations were completed:
1) a systematic review of the literature to explore the use of naturopathic or other
types of complementary medicine used within the Aboriginal context; 2) a qualitative
study on the impact and conduct of naturopathic medicine at a community clinic
dedicated to serving Aboriginal people; 3) a telephone survey of Aboriginal Health
Centres across Ontario; and 4) a comparison of the similarities and differences of the
philosophical approaches within naturopathic and traditional Aboriginal medicine.
The systematic review did not yield any reports related to the implementation of
naturopathic medicine nor any form of complementary medicine within Aboriginal
communities. Findings from the qualitative research study indicate that the
naturopathic clinic at Anishnawbe Health Toronto (AHT) is achieving positive patient
outcomes and addressing the specific health needs of this population in a way that is
not met by other traditional or conventional health care providers. Upon evaluation
and analysis of common themes at Aboriginal Health Access Centres and after
comparison with actual delivery of care, a clear imbalance between the desire for and
accessibility to health promotion and prevention programs and the provision of
holistic care was revealed. This imbalance could be corrected through the
implementation of naturopathic medicine.
From a philosophical and practical viewpoint, there is a clear alignment between the
Aboriginal view of health and the approach used by naturopathic medicine as both
perspectives believe a holistic view of health is fundamental to care. The importance
of treatments that address not only the physical, but also the mental, emotional and
spiritual aspects of health are stressed within both traditional Aboriginal and
naturopathic approaches to health and wellness.
- iii -

Table of Contents
Acknowledgments ...................................................................................... ii
Abstract.................................................................................................... iii
Table of Contents...................................................................................... iv
List of Figures ........................................................................................... vi
List of Tables ............................................................................................ vi
1. Introduction ...........................................................................................1
Clarifying terms used in this document ...................................................................................2
Health Status of Aboriginal People in Canada ..........................................................................3
2. Systematic Review .................................................................................5
Methodology...............................................................................................................5
Results .......................................................................................................................7
Discussion..................................................................................................................7
3. Qualitative Research Study at the Anishnawbe Health Clinic ....................9
Project Description and Background .............................................................................9
Methodology...............................................................................................................9
Participants..........................................................................................................................9
Results .....................................................................................................................10
Strengths of Naturopathic Medicine in Aboriginal Communities...............................................10
Challenges and Limitations Identified ....................................................................................13
Recommendations.....................................................................................................15
Conclusions ..............................................................................................................16
4. Telephone Survey of Aboriginal Health Access Centres .........................18
Introduction ..............................................................................................................18
Methodology.............................................................................................................18
Data Collection and Assessment..........................................................................................18
Results .....................................................................................................................19
Evaluation of Aboriginal Health Access Centres Mission/ Values/ Goals...................................19
- iv -

Themes Assessed ..............................................................................................................19
Holism...........................................................................................................................19
Inclusiveness..................................................................................................................20
Quality Care ...................................................................................................................20
Community determined Agenda .......................................................................................21
Education and Advocacy .................................................................................................21
Culture/Context..............................................................................................................22
Analysis of Services Provided ..........................................................................................22
Discussion................................................................................................................23
Conclusion................................................................................................................25
5. Health Care Needs of Aboriginal People................................................26
Government Recommendations ..................................................................................26
First Nations Recommendations .................................................................................28
Cultural Competency .................................................................................................28
Limitations and Discussion .........................................................................................29
6. Aboriginal Health Care Needs and Naturopathic Medicine .....................31
Bridging the Gap with Naturopathic Medicine ...............................................................31
Naturopathic Doctors and Traditional Healers ..............................................................32
Naturopathic Education and Practice...........................................................................34
Summary..................................................................................................................36
7. Future Directions .................................................................................37
8. Conclusion...........................................................................................39
Appendix A: Qualitative Research Study: Semi-structured Interview Questions
...............................................................................................................40
Appendix B: Qualitative Research Study: Coding themes ...........................41
Appendix C: Qualitative Research Study: Participant Characteristics .........43
Appendix D: Telephone Survey: List of Aboriginal Health Access Centres ...44
References ..............................................................................................46
- v -

List of Figures
Figure 1: Life expectancy, 1980 through 2001 ..................................................... 3
Figure 2: Flow chart of studies excluded and selected for final review ..................... 7
List of Tables
Table 1: Difference in Life Expectancy by Year and Gender .................................... 4
Table 2: Search terms and number of citations returned for each search. ............... 5
Table 3: Themes found in each respective Aboriginal Health Access Centre........... 19
Table 4: Accessibility to Health Care Professional at the Aboriginal Health Access
Centres .................................................................................................... 24
Table 5: Excerpt of Key findings and suggestions from the 1996 Royal Commission
Report ...................................................................................................... 27
Table 6: Comparison of the Different Perspectives of Traditional Aboriginal Medicine,
Naturopathic Medicine and Conventional / Western Medicine......................... 33
- vi -

- 1 -
1. Introduction
Addressing the health care needs of Aboriginal people in Canada and uncovering
ways to close the disparity gap between Aboriginal and non-Aboriginal people’s health
lie at the heart of this report. The four principal goals of this project were to:
1. Establish a base of evidence on how naturopathic medicine or any other type
of holistic and complementary medicine has been used to improve health
within Aboriginal communities and clinics.
2. Assess the needs of Aboriginals to improve health care and explore how
naturopathic medicine addresses or could address these needs.
3. Explore and document the commonalities and differences that exist between
naturopathic medicine and Aboriginal people’s perspectives with respect to
health.
4. Determine the mechanisms and opportunities available to facilitate the
application of naturopathic medicine within Aboriginal communities.
The report is divided into eight sections:
~ Section One provides an introduction to the report by laying out the broad goals,
structural layout of the report and important background information for the reader.
~ Section Two describes the process and results of a systematic review to identify
how naturopathic medicine and other types of holistic and complementary medicine
are used within Aboriginal communities to improve health. In addition to identifying
how naturopathic medicine is used in other communities, the systematic review
addressed a second objective, that of highlighting critical components that must be in
place to ensure successful implementation of naturopathic medicine within Aboriginal
communities.
~ Section Three describes the use of and experience with naturopathic medicine at
the Anishnawbe Health Toronto (AHT) clinic. This work was done using a formal
qualitative research study design that employed semi-structured interviews to
document the experiences of patients and naturopathic interns at AHT.
~ Section Four provides the results of a telephone survey to better understand the
current context of twelve Aboriginal Health Access Centers with respect to their
mission, values and goals. Results of the survey emphasize the community’s desire
for the incorporation of a holistic health approach and also provide information on the
health care practitioners available within each centre.

~ Section Five reports on various government and Aboriginal health resources
available and identifies essential elements that must be in place to support
improvements in Aboriginal health.
~ Section Six discusses how the principles of naturopathic medicine and the view of
health from an Aboriginal perspective are aligned.
~ Section Seven provides a discussion of what future directions may be necessary to
take the findings of this report and convert them to further action.
~ Section Eight provides a conclusion to the report with an emphasis on the
strengths naturopathic medicine has to offer in the context of improving Aboriginal
health.
Clarifying terms used in this document
The terms “Native” and “Aboriginal” are used to refer to people whose ancestors are
indigenous to North America. These terms encompass a large variety of different
Aboriginal nations and populations, each with their own unique language, culture, and
traditions.1 Within Canada, the term Aboriginal is generally used to refer to people
whose ancestors are indigenous to North America and refers to First Nations, Inuit,
and Métis collectively. There are different government recognized categories of these
Aboriginal populations which include: Status or registered Indians (According to the
Indian Act), Non-Status Indians, Métis people, and Inuit people. Beyond these
categories, Aboriginal people self-identify based on their own criteria of heritage and
the many Nations and sub-cultural categories within each of these designations.
The term First Nations refers to status and non-status people of First Nations
ancestry as set out in the rules of the Indian Act.1 Métis refers to people of mixed
First Nations and European lineage with their own distinct language and culture. The
Inuit are Aboriginal people from or with ancestry from Arctic Canada who traditionally
share a common language and live in 53 communities located in one of Nunavut,
Inuvialuit (Western Arctic), Nunavik (Northern Quebec), and Nunatsiavut (Northern
Labrador). Responsibility for the provision of health care to First Nations and Inuit
people is not well defined with direct and indirect involvement coming from federal,
provincial and/or territorial levels of governments. There is a clear understanding
amongst First Nations and Inuit people that health care is to be provided by the
federal government rather than provincial or territorial governments as a treaty right
as reimbursement for the use of land and resources.1 Métis obtain health care
services from provincial or territorial sources.1
- 2 -

Health Status of Aboriginal People in Canada
The high rates of health problems experienced by Aboriginal people in Canada have
been documented extensively over the last few decades. Aboriginal people
consistently score lower on virtually every measure of health and well-being
compared to non-Aboriginals. “In the early 1900’s the health and social conditions of
Aboriginal people was so appalling that the federal government appointed a physician
to help improve the health status of the First Nations, Métis and Inuit people.”1 Since
that time, various agencies and organizations have been involved in improving the
health of, and health care delivery to Aboriginal people. These issues are shared by
many populations worldwide, particularly those who have been victims of colonization
and the systematic suppression of their traditional lifestyles. Canada stands out in the
sense that it provides relatively advanced primary healthcare services and financial
support to Aboriginal communities. For example, in 1992, the per capita ratio of
total expenditures for Aboriginals in comparison to non-natives was 1.6 for healthcare
alone. Nevertheless, the rates of social dysfunction and ill health in Aboriginal
communities have remained exceedingly high despite these financial investments.2
The following information on life expectancy and Infant mortality rate was published in
2005 by the Treasury Board of Canada. Data indicates that discrepancies continue
to exist between First Nations People and non-native Canadians on important
measures of population health despite a positive trend over the last 25 years.
Figure 1: Life expectancy, 1980 through 20013
- 3 -

Table 1: Difference in Life Expectancy by Year and Gender
Year Aboriginal Men vs
Canadian Men
Aboriginal Women vs
Canadian Women
1980 10.2 10.9
1990 7.5 6.8
2001 6.7 6.7
Life expectancy
Life expectancy is a broad measure of overall health and is affected by a multitude of
measures including: genetics, obesity, access to health care, diet, tobacco smoking,
mental health, socioeconomic status, rates of HIV infection, education, cardiovascular
disease, and drug and alcohol use.4
Infant mortality
Infant mortality within First Nations communities has been declining steadily. The rate
of deaths per 1,000 births dropped from 23.7 in 1980, to 12.3 in 1991, to 6.4 in
2000. Although declining, the infant mortality rate for First Nations communities
continues to be higher than the rate amongst non-native Canadians, which currently
stands at 5.2 deaths per 1,000 live births.5
Progress is being made to close the gap between the health of First Nation and non-
Aboriginal Canadians as evidenced by the trends shown in the tables above, however;
there is still a considerable way to go in order to achieve parity. In addition, the
prevalence of both lifestyle-related illness and mental conditions such as diabetes,
major depressive episodes, obesity, and alcoholism is 2-3 times that of non-
Aboriginal Canadians.6 Family violence, addictions, suicide, and fetal alcohol
syndrome have also emerged as prominent health concerns in Aboriginal
communities. Overall, Aboriginal people are experiencing a disproportionate measure
of illness, mental and psychological ill health, and both physical and sexual violence.
- 4 -

2. Systematic Review
A systematic review exploring the use of naturopathic medicine in any and all
Aboriginal communities was conducted to better understand the role that
naturopathic medicine plays in the health of Aboriginal Canadians. The primary
objective of this systematic review was to complete a comprehensive literature
search for any previous work done by naturopathic doctors or any other practitioners
of complementary medicine within Aboriginal communities. The secondary objective
was to synthesize and summarize the findings with respect to the components that
must be in place to achieve successful implementation of these kinds of non
conventional care in Aboriginal communities. In addition to a concise picture of
previously published work, a goal of the synthesis research was to provide a
framework and a direction for future work in this area.
Methodology
The following medical databases were searched independently by DK and SG: Alt
HealthWatch, AMED, Biomedical Reference Collection (Basic), Psychology and
Behavior Sciences Collection, CINAHL, MEDLINE, and the Cochrane Library. The
search strategy was refined by testing several search terms and incorporating new
terms as relevant citations were identified (see Table 2 for a list of search terms
used). The “related articles” feature of PubMed was also used to broaden our search
as well as checking reference lists within relevant publications to capture any other
resources not revealed by our initial searches.
In order to capture therapeutic approaches that are used by naturopathic doctors,
search strings with content overlap to “naturopathic medicine” were used.
Terminology used during the database searches is summarized in Table 2. Without a
significant yield of pertinent results, we expanded our search to other terms relevant
to naturopathic modalities such as “acupuncture” and “nutrition”. All searches were
completed by February 10th 2008.
Table 2: Search terms and number of citations returned for each search
Search terms Number of Citations
Returned
Search Terms Number of Citations
Returned
Aboriginal + holistic 38 Holistic healthcare
Native American
19
Aboriginal + integrated 48 Holistic approach Native
American
17
Aboriginal + multi-
disciplinary
2 Native integrated health
services
31
Native + multi- 6 CAM integrated health 2
- 5 -

Search terms Number of Citations
Returned
Search Terms Number of Citations
Returned
disciplinary services policy
development
First Nations + multi-
disciplinary
2 Integrated health
services policy
development
99
First Nations + holistic 12 First Nations integrated
health services policy
7
Aboriginal + acupuncture 2 First Nations integrated
health services
26
Aboriginal + nutrition 232 Indigenous integrated
holistic health services
2
Native American +
holistic
66 Aboriginal integrated
health services
36
First Nations +
acupuncture
0 Traditional healing
delivery of healthcare
366
Articles were included in our review if they reported initiatives in which any form of
alternative, complementary, or naturopathic medicine was implemented in Aboriginal
communities. There were no limitations imposed based on language nor geographic
region allowing access to reports from anywhere in the world. The initial search
yielded 2110 unique citations. Of those, 2077 were rejected as they did not fit our
search criteria and 16 articles were selected for full analysis. After careful review, all
16 of these articles were also rejected. Of these final ones rejected; ten reported on
Aboriginal-driven community programs; two summarized cultural differences between
Aboriginal and Western approaches to health in nursing practices; and four outlined
the healthcare needs of Aboriginal communities. Figure 1 provides a summary flow
schematic of the articles found, reviewed, and rejected during the systematic
searches performed.
To augment the formal medical literature database search, we broadened our scope
to include Canadian Aboriginal websites such as NAHO (National Aboriginal Health
Organization), AHWS (Aboriginal Health and Wellness Strategy) Ontario, and
Government of Canada websites related to Aboriginal Health or Health in general
(Health Canada, Indian and Northern affairs).
- 6 -

Figure 2: Flow chart of studies excluded and selected for final review
2110 articles found through
s
y
stematic searches
Results
Our search yielded no articles reporting on the implementation or assessment of
holistic models of care including alternative, complementary, or naturopathic
medicine in Aboriginal communities. As no relevant journal articles could be
identified, it was impossible to collate successful components for the integration of
naturopathic medicine within both traditional healing practices and western/
biomedical models of healing.
Discussion
Prior to commencing the systematic review our assumption was that we would find at
least a handful of manuscripts to analyze. It was a surprise to all involved that
consistent and broad based searches did not uncover anything that directly fit our
inclusion criteria. The systematic review did however provide an abundance of
material that spoke to the need for research in exactly the area we were considering
and provided rich content to fulfill the other goals of the project.
33 abstracts screened for
inclusion
2077 rejected outright
17 articles rejected, as they did not fit
the inclusion criteria
16 articles retrieved for full
anal
y
sis
16 articles excluded
• 10 included aboriginal-driven community
programs that did not include alternative
medicine
• 2 summarized cultural differences between
aboriginal and western approaches to health
in nursing practices
• 4 focused only on the health-care needs of
aboriginal communities
0 articles included in
s
y
stematic review
- 7 -

What was found from the literature review included a wealth of articles addressing the
needs of Aboriginal people with respect to health care and the delivery of health care
in general. An important theme that arose from a review of this literature was the
urgent need for change in the way medicine is delivered within Aboriginal
communities.6,7 A message that consistently appeared was the need for a new way
of supporting health for Aboriginal people.
Characteristics of this ‘new way’ included a desire for a whole system of care that
includes the community, the environment, and the spirit as well as the need to
correct overt pathology in the diseased state. Issues regarding the latter were well
addressed via conventional western medicine, however, the former issues, those
outside the normal physiological understanding of disease, were too often ignored.
This is no surprise given that the framework for Aboriginal health care delivery
resides within the context of another culture’s authority.
In conducting the systematic review it was also valuable to realize the paucity of any
attempt to implement, research, and/or report on the use of naturopathic or other
holistic and complementary systems of health within Aboriginal communities. This
lack of evidence provided the impetus for our working group to explore and
document work being done in the community by naturopathic doctors. Specifically,
two areas of inquiry were followed. In the first, a qualitative research study was
conducted on the application and impact of naturopathic interns working at a clinic
for Aboriginal people, and in the second a telephone survey was used to explore and
document the use of naturopathic medicine at Aboriginal health care clinics.
- 8 -

3. Qualitative Research Study at the Anishnawbe Health
Clinic
Project Description and Background
The purpose of this study was to explore the role of naturopathic medicine in health
and healing in Aboriginal communities, by focusing on the various ‘user’ experiences
with naturopathic care at Anishnawbe Health Toronto (AHT). This exploratory study
used data from semi-structured interviews with seven interns, three supervisors, and
seven patients at the Anishnawbe Health Toronto (AHT) Naturopathic Clinic. The
interns and supervisors were either currently placed at AHT or had been placed there
within the past five years. All patients were current patients of AHT when the
interviews were conducted. We achieved a maximum variation sample that included
participants from a range of backgrounds, varied experience with AHT and both male
and female participants. This section outlines the strengths and weaknesses of
naturopathic medicine in Aboriginal communities and the provision of naturopathic
care at the AHT specifically. Based on the results, recommendations are provided
regarding implementing naturopathic initiatives in other First Nations communities or
clinics.
Methodology
The design for this study is an applied ethnography, which is a qualitative research
approach that seeks to determine the meanings of beliefs and behaviors in the
context of an individual’s culture.8
The methods for this study included semi-structured interviews, which were
conducted with naturopathic interns, naturopathic supervisors and patients in order to
gain an appreciation of their understandings of naturopathic medicine and Aboriginal
health.9 As a second form of data collection, participant observation was also used
for this study.10 Such observation enables insight into the social context of the
participants at AHT, presenting a fuller overall picture and context for the data.
Participants
A total of 17 interviews were conducted, 7 with interns, 7 with patients, and 3 with
supervisors. This number was enough to reach theoretical saturation of key emergent
themes.9
Inclusion criteria were as follows:
• Adequate exposure to AHT
- 9 -

o patients – at least 3 patient visits to AHT with a naturopathic doctor
(ND) within the last 3 years (all but one had over 3 months of
patient experience with NDs at AHT)
o interns – at least 3 full days of experience interning at AHT within
the last 3 years (all interviewed had over 2 months of experience, 1
visit per week)
o supervisors – at least 1 month of supervisory experience at AHT
within the last 3 years (all had over 4 months of experience working
at AHT specifically);
• Ability to participate in an interview conducted in English (or willing to
participate if a Native speaking translator is present, although a translator
was not needed)
All supervisors and interns that were approached were willing and able to participate,
five patients did not participate due to time constraints or other coinciding surveys at
AHT (see Appendix C for participant characteristics).
Informed consent was received in writing by all participants. Interviews lasted
between 20 minutes and one hour and were recorded following consent. The
interviews were semi-structured, meaning that topics not on the list of questions were
explored if they were deemed relevant to the interviewee (see Appendix A for a list of
interview questions). Data collected from the interviews were transcribed verbatim
and coded by at least two researchers (RW and KC). Meetings were held regularly to
discuss coding, emerging issues from the data, and key themes (RW, KC, LW).11
After coding meetings, data was entered in the qualitative software program, NVivo,
in order to organize the data (see Appendix B for coding themes).12 One non-ND, non-
CCNM affiliate, also reviewed the data to ensure quality of the analysis (LW).10,13,14
Results
Strengths of Naturopathic Medicine in Aboriginal Communities
Analysis of the interviews provided clear evidence that naturopathic medicine fits well
with native perspectives, traditions, and beliefs regarding the nature of health and
healing. Many patients stressed the similarities between naturopathic philosophy and
their personal need for health care that emphasized not only the physical but also the
spiritual, mental, and emotional aspects of health. Further, the importance of
individualized care offered by naturopathic doctors resonated with the needs of the
patients at AHT. Patients were very pleased to have a practitioner who took the time
to listen to their health concerns and respect their cultural traditions. The care
received by NDs at the clinic helped build a level of rapport and trust necessary for
- 10 -

healing and ultimately helped their treatment success. In the words of one native
patient:
It all goes back to the very word itself, respect, they are willing to listen
without intervening without contradicting you and contradictions in that
respect would be disrespectful and degrading, pushing down its like
saying we do not really know what you are talking about, which would
make you very angry which has made me angry very much. I deal with
a lot of discrimination, I deal with a lot of inaccessibility, I deal with a lot
of lying and tossing of the buck and it does not happen here. That’s
gold, but not my gold, but its gold you can’t cash it in but hopefully I
will and I got good advice with regards to a conscious diet and natural
supplements… They want to teach you they do not make you feel
stupid. (Patient #3)
They didn’t try and patch things up. They got to the core issue of stuff.
They helped me look at my emotional and psychological issues as well
as my physical issues. And they didn’t just treat it they went in there
and looked at where it came from and how to address it and to view it
from a more holistic approach. (Patient #6)
[Naturopathic philosophy is] totally in-line with my own. Ya totally. It’s
the connectivity. The reliance of all parts, all the parts are used to
make the whole but the whole is reliant on every single part. So it’s all
of the parts: your emotional, your spiritual, your intellectual. If any part
is ill then you need to recover that part so it can be of any use to
yourself or your family or you can pass the healing on but you have to
heal yourself. (Patient #4)
In general patients were very happy with the care they were receiving from the
naturopathic clinic at AHT. Not only were they positive about the opportunity to
access naturopathic care, perceiving it to be more in-line with their personal
philosophies of health and healing than conventional approaches, but they reported
many positive outcomes. Further, they stressed the benefits of the open attitude of
the interns and the ability to easily communicate not only about physical aspects of
health, but also the emotional layer of their health care needs.
I think [naturopathic medicine has] been a huge part. I’ve been working
very, very vigilant(ly) for the last nine years through chiropractic,
through naturopathic, through psychiatry, through the different things
that are available here at the centre. And they’ve all played a huge part
- 11 -

in my healing. The naturopaths are the only medical doctors I have.
They’ve helped heal me. (Patient #2)
I’m thrilled [about the ND services]. I’m thrilled that we have these
services available to myself and all Aboriginals as well. I don’t think that
many of us would have access because of financial constraints I don’t
think we would have access to the quality of care. Definitely physical
improvement … And the other one is emotional. I… my practitioner
and myself as a team, tapped into some really huge emotional issues.
(Patient #4)
Supervisors and interns echoed the strong philosophical fit between naturopathic
medicine and Aboriginal health perspectives. For example one intern stated:
I think naturopathic medicine is very suited for First Nations because of
their connection to the earth and really looking, I think that they look at
chief concerns from a root cause point of view as well. They just put a
different spin on it than us. They have a great respect for their bodies,
as our culture does a great respect for the earth. They want to use
things that are sustainable. I think naturopathic medicine can address
that philosophy. (Intern #4)
Supervisors and interns also expressed that working at AHT was a rewarding
experience, in terms of education and also personal development. They welcomed
the opportunity to have a positive impact on a unique population with strong cultural
beliefs and values and felt that they learned as much from their patients as their
patients did from them. AHT was described as a unique and dynamic health care
centre that provides naturopathic care within an integrative health care model. They
were enthusiastic about the exposure to a variety of clinical needs and the
opportunity to develop a good rapport with their patients. Further, they felt they were
having a positive impact on their patients and that their patients seemed to enjoy and
appreciate the care that they were receiving.
Very (x3) rewarding at (Anish). I find that when I go home, I am struck
by the experience. I see so much in practice, and I heard a lot from
the beginning about getting those results. And you are going to have
results. This experience is invaluable, even four months is all I need and
it’s going to stick with me for a long time. (Intern #3)
I like the sensation after leaving, once I calm myself down after
whatever intensity of the day. I do feel invaluable, like there is that real
- 12 -

sense of appreciation and some the gratitude there, which you don’t
always get everywhere. (Intern #6)
Challenges and Limitations Identified
Although there is a clear compatibility between naturopathic medicine and aboriginal
beliefs, challenges and limitations were identified to the way in which naturopathic
medicine is provided to Aboriginal patients at AHT. For instance, the physical
infrastructure of the naturopathic clinic at AHT posed some barriers to care in the
practice of naturopathic medicine. A primary concern that arose was the lack of
privacy afforded to patients during their consultations, as the four consultation rooms
are divided by curtains only. Patients, supervisors and interns all stressed that this
was an obstacle to care in that patients were inhibited from sharing the personal
information necessary to develop suitable treatment plans in a confidential manner.
This problem is compounded by the fact that the Aboriginal community is small and
intimately connected. There is a strong likelihood that one patient will know another in
the next ‘room’ thus further compromising patient’s confidence in the confidentiality of
the visit.
I think that they need more privacy. When I‘m trying to talk to them
about my problem everyone else can hear what I’m saying or
everybody has these things going on in their lives that are kind of
personal I don’t really like to hear that when I come. When I’m going
through my feelings I really don’t want anybody knowing. Even though I
may not know who they might be, there might come a time when I
might know somebody that comes in here. And I don’t want them to
know that part of me because that’s my healing. (Patient #5)
Although there is a sense that the clinic itself both represents and provides a means
for the community as a whole to move towards health and healing from a holistic or
social perspective, healing at an individual level requires a space where confidentiality
and privacy are assured.
Other aspects of the organizational and physical structure of the clinic were
mentioned by all participants. For example, patients, interns and supervisors alike
were concerned with the lack of continuous access to supplements prescribed to
patients. Supplements are donated to the clinic and made available at no cost to
patients, which is a huge benefit for patient care; however, the lack of a continuous
supply hampers the ability to develop appropriate treatment plans. Many interns
however viewed this as a surmountable challenge that forced them to be creative in
the provision of care.
- 13 -

I…feel like it’s teaching me how to work within stricter limits, with less
resources and with people who have more severe issues. (Intern #4)
Working conditions are below reasonable standards with a lack of air circulation and
windows in the basement. Interns frequently take breaks outside (regardless of the
weather) to get some fresh air during the day. The air quality was also mentioned as
being an obstacle to ideal care, as with naturopathic medicine the healing
environment is an integral part of care. Further, the office space is cramped and
unable to well accommodate all interns, supervisors, and student observers at the
same time. Another issue that arose is the fact that there are limited reference
resources (i.e. books and computerized databases) available to assist with the
development of treatment plans. The interns felt these limitations restricted but did
not compromise the care they were able to provide, recognizing these as areas for
improvement to allow the provision of optimal care.
One theme that arose during analysis is that limited access to naturopathic care in
this community is a real obstacle to achieving good community care. Supervisors
mentioned difficulties in meeting the demand for care and a lack of time for accepting
new patients. The inability to provide levels of accessible care in accordance with
demand resulted in the implementation of policies to limit access to a certain number
of days per month. As a result of these issues, it is evident that not all those who
wish to make use of the naturopathic care services provided at AHT may effectively
do so.
Some interns mentioned difficulties building rapport due to racial differences that
resulted in hostility from some patients. It was understood that this was not a
personal problem but rather a historical one. Several interns indicated that it would
have been helpful to receive additional training regarding culturally specific issues
before working at AHT. They often felt seriously challenged by, and sometimes
unprepared for, the mental health cases that they saw. The seemingly short four-
month term internship at AHT was also frequently mentioned as an obstacle to
developing adequate rapport and trust with patients.
So that is where the learning curve is more also on an energetic front
because you are dealing with a totally different type of community, you
are dealing with homelessness. I really felt that I wasn’t that prepared
for it, it was just something that was mentioned. Now that I have gone
through a lot of that I know how to handle myself in a situation. It can
be really overwhelming to hear really sad stories. To have patients
come through that have bugs crawling off them, to have patients who
don’t eat, how do you do naturopathic medicine in a population that
doesn’t have money, that doesn’t have access to a lot of the basic
- 14 -

things that that a person with a nine to five job would have. So it’s
really a different practice of medicine. (Intern #6)
All practitioners at the AHT, which includes medical doctors, physiotherapists,
psychiatrists, naturopathic interns, social workers, traditional healers, and elders
work in a ‘circle of care’ meaning all practitioners have mutual access to all patient
records, electronically. The circle of care promotes continuity of care and facilitates
referral to various practitioners as needed. Although recognized as a potential
strength of the clinic, the interns felt they had very little communication with other
practitioners due to a lack of time, effort, and an effective venue for communication.
Some interns mentioned that their efforts to connect with others at AHT with a
respectful and open-mind proved to be useful in developing relationships. However,
as the naturopathic clinic is physically separate from the rest of AHT, coupled with a
frequent rotation of new interns, it was often seen to be difficult to maintain the open
communication within the circle of care that would have been ideal.
The naturopaths were pretty much separate from the medical doctors.
There was generally no area or venue for that open discourse between
the naturopath and the physician and the nurse practitioner. The
recommendations that are being made by the people are never taken
to heart. (Intern #1)
In addition, there is a sharp learning curve associated with the shared computer
system, resulting in more time taken than necessary filling out what the interns
perceived as cumbersome computer forms. Furthermore, there were practical
limitations due to a limited number of computers and frequent malfunctioning of
software, all of which were mentioned by several participants.
There are no windows in the basement… the facility itself doesn’t allow
for privacy, you can hear what’s going on in the other room… the one
little office is extremely small [for all of us] … we don’t have any linens.
There are no sheets, no gowns, no towels... They require that we do
the notes on the computer, but often the laptop computers are missing
um the powerbars, or they don’t have the mouse that goes with the
computer, or when we go on to the network it disconnects us… I feel
that it has to do with the facility... there is a lack of supplements…
(Intern #3)
Recommendations
Despite the physical limitations outlined above, the naturopathic clinic at AHT can
boast numerous positive patient outcomes. Each patient participant mentioned their
- 15 -

health had improved specifically as a result of the naturopathic care they received.
They were very positive about their experiences, although they were concerned about
the manner in which care was provided, especially with regards to the lack of privacy.
The positive outcomes observed in the face of the physical limitations strongly
suggest that the provision of naturopathic care at AHT is well worth it and would
serve a real benefit in other Aboriginal communities. In order to provide viable and
high quality health care, however, changes at AHT are required with respect to how
naturopathic services are delivered. Access to care, availability of resources,
continuity of care, delivery of culturally appropriate care and space/privacy issues
are key elements to address.
An important aspect to effective integration of naturopathic care at AHT is the
relationship between the naturopathic practitioners and other health care
practitioners including the willingness to communicate and respect cultural
differences. Further, there needs to be a common understanding of the current and
historical difficulties that Aboriginal people have faced and the resultant reluctance to
accept and trust health care providers. Patients, interns, and supervisors all agreed
that the similar healing philosophies and practices between naturopathic medicine
and traditional Aboriginal healers helped facilitate trust, openness, and effective
healing relationships; however, additional cultural education would be beneficial.
In order to develop rapport and build trust within a circle of care, it is necessary for
interns and supervisors to participate in and fully understand traditional healing
practices. Without this interaction, it may be difficult to gain complete trust, insight,
and respect from the Aboriginal community. Further, continuity of care between
different health care practitioners, as well as within the naturopathic clinic should be
reinforced in the delivery of care.
Conclusions
Our preliminary analysis indicates that the naturopathic clinic at AHT is achieving
positive patient outcomes and is addressing the specific health needs of this
population; needs that are not apparently being met by other traditional or
conventional health care providers. Naturopathic care is highly regarded by patients.
However, physical limitations exist that interfere with the quality and effectiveness of
care. Practical solutions to space and resource issues should be respected and
changes implemented in order to improve the care that these patients receive. The
clinical environment could be improved for the interns and supervisors who work
there so that they can provide optimal care to their patients, as opposed to being
distracted by organizational and space concerns.
Naturopathic interns and supervisors need to make a concerted effort to understand
the needs, culture and practices of the community as a whole and not just their
- 16 -

patients. The degree of integration between health care practitioners is less than
ideal, with communication being the greatest barrier to full integration. While it is a
great learning opportunity for the interns at AHT, there must be a greater focus on
how patients can benefit from the experience. Although many of the issues reported
here are specific to the AHT, the experience and recommendations are applicable to
many models of health care delivery for Aboriginal health and provide guidelines for
future involvement of naturopathic medicine in Aboriginal communities.
- 17 -

4. Telephone Survey of Aboriginal Health Access Centres
Introduction
A review of the 12 Aboriginal Health Access Centres in Ontario was undertaken to
provide more information about Integrative health in an Aboriginal setting. The
Aboriginal Health Access Centres were chosen for review because these centres
claim to foster participative health care of the communities within which they are
located. The organization of these centres has been “guided by a careful analysis of
what Aboriginal people said to them (government partners) in a province wide
consultation about their health and well-being”.15 Over 7,000 aboriginal participants
communicated the importance of the recognition of their own health program
planning structures with a more active role in the directing of regional health
services.16 These health access centres were established with the recognition that
specific recommendations for practice guidelines are best determined by Native
people themselves.17 Thus these centres should exemplify a model of health care
that more accurately reflects the values and ideals of health care delivery for
Aboriginal communities.
Methodology
Data Collection and Assessment
Internet websites for 11 of the 12 Aboriginal Access Centres were used to identify
material pertaining to each centre’s mission statement, values, goals and services
offered. Each Centre was contacted and asked to forward a copy of their most
recent annual report; however, only 4 of the 12 Centres responded by the time of
publication. For the Centres that did not have relevant information either published on
a website or accessible in their current reports, the Executive Director of each facility
was contacted initially by e-mail and then by telephone. In some instances, calls were
forwarded to either reception or assistant staff and questions were answered by
these individuals.
Information regarding each centre’s mission statement, values, goals and services
were collected and categorized into common themes. The services offered,
including accessibility to various types of health care professionals and health
specific programs offered were also categorized for analysis. Services were roughly
classified based mainly on differences in perspective of treatment. Three broad
categories were identified for the purposes of analysis: physical therapies;
mental/emotional therapies; and holistic therapies. It is important to note that
categorization of services was based upon what is known about the various
- 18 -

professions and not based on how any of the individual service providers actually
practices.
Results
Evaluation of Aboriginal Health Access Centres Mission/ Values/ Goals
In evaluating and understanding the ideal philosophical perspective pertaining to
health care delivery for Aboriginal people, an exploration of the 12 Aboriginal Health
Access Centres in Ontario was undertaken.
Commonly recurring themes include:
• a recognition of the importance of culture and context in healing;
• care that is inclusive of all Aboriginal populations;
• holism in health care;
• a community determined health agenda;
• quality care; and
• a recognition of the importance of education and health advocacy.
Table 3: Themes found in each respective Aboriginal Health Access Centre
Aboriginal Health Access Centres
Common Themes 1 2 3 4 5 6 7 8 9 10 11 12
Holism X X X X X X X
Inclusiveness X X X X
Quality Care X X X
Community determined agenda X X
Education and Health advocacy X X X X X X X
Cultural context X X X X X X
Note: Please refer to Appendix D for a cross reference table that identifies the number associated to each
Aboriginal Health Access Centre.
Themes Assessed
Holism
The most common theme embraced by the Aboriginal Health Access Centres is the
idea of a holistic health care model that offers physical, mental, emotional and
spiritual health and wellness (centres: 1,4,5,8,10,11,12). This model is in contrast
to the biomedical model of medicine that focuses on a reductionist view of medical
problems and treatment that predominantly focuses on physical health and disease
pathology. The term holistic stresses the emphasis Aboriginal people place on
- 19 -

maintaining harmony and balance between not only aspects of their own health but
between individuals and the environment. The many traditional forms of Aboriginal
medicine and healing, all stress this essential concept of balance.
One of the centres acknowledged the importance of a balanced relationship between
the health care staff and a “commitment to working as a team at implementing a
holistic model of health care” (centre: 5). Other centres recognized the importance of
a combination of traditional, and contemporary care and the promotion of an
Aboriginal perspective integrated with Western medical technology (centres:
4,5,6,8,10,11). Three centres recognized the importance of including
complementary care into this integrative model (centres: 4,10,12). Proposed models
of health care delivery demonstrate how Western medicine could be included into a
new holistic model of care that would include a balanced level of accessibility to both
technological medical advances, and to traditional ways of treatment delivery in
general.
Inclusiveness
Value statements of the Aboriginal Health Access Centres commonly express a need
for the inclusion of all Aboriginal populations regardless of what system of health care
is used (centres: 4,8,10,12). This inclusiveness is linked to an understanding that
even though Aboriginal people have a shared historical experience, there is great
variability between individual values and beliefs and that these are to be considered in
the provision of care. For example: an individual may be categorized as belonging to
First Nation’s clan, yet was not raised within that culture and thus is currently in the
process of learning their Native culture. In this situation, a range of different
therapies to reflect the spectrum of individual beliefs and values may be most
appropriate to provide optimal care.
The theme of inclusive health care also implies that health is interpreted from a
broader perspective that includes the health of the individual, family, and community
rather than merely focusing on health at an individual level (centres: 1,6,8,9,12). This
notion flows from the cultural belief that everything is connected. Therefore, in order
to improve the health of the individual, it is also essential to address the health of the
community.
Quality Care
The goal of the Canadian Health Care system is to provide “the highest standard of
health and health care for all patients”.18 The Aboriginal Health Access Centres strive
to provide quality service, and value this as a common theme (centres: 1,8,11).
- 20 -

Quality service means providing culturally appropriate, inclusive, accessible, holistic,
preventative care based on an Aboriginal community-determined agenda.
Community determined Agenda
An important component of delivering culturally appropriate, holistic care involves
listening to and valuing the Aboriginal community’s self-determined needs. A failure of
caregivers and provincial policy makers “to understand social and cultural differences
leads to dissatisfaction among Aboriginal clients, who then tend not to follow plans
for their care and don’t do as well as a result”.19 Two centres identified the need for
an individual, family and community health agenda with a collaborative approach to
planning, service delivery and evaluation of care (centres: 1,8). The dominant
biomedical system’s reluctance to appreciate that Aboriginal clients make decisions
by consensus, involving family and other community members in their care is
attributed as a possible source of tension and miscommunication in the delivery of
care to Aboriginal populations.19 Opening the lines of communication and control
over the planning of service delivery at a community level is thought to be one
solution to the discrepancy in the health of Aboriginal people in Canada.19 There is
evidence however that the positive effects of transferring health service resources to
Aboriginal organizations, although effective, are limited if program funding is short-
term or inflexible and inconsiderate of the socio-economic or historical conditions that
contextualize the health of Aboriginal people.19
Education and Advocacy
It is recognized that health care delivery is not just about treating sickness, but
should also serve to prevent illness and promote health.19 The lack of a preventative
approach to health care was stated as one of the obstacles to primary health care in
the 2002 Royal Commission on the Future of Health Care in Canada.20 Ontario’s
Aboriginal Healing and Wellness Strategy, a major funding provider for 10 of the 12
Aboriginal Health Access Centres in the province of Ontario was designed to make
prevention a top priority in the delivery of health care in Aboriginal Communities.19
This common theme is expressed in the mission and values statements of almost
every Aboriginal Health Access Centre surveyed (centres: 4,5,8,9,10,11,12).
Education focuses on shifting the belief that health is a responsibility of the service
providers to encouraging an increased level of personal responsibility for health,
thereby changing dependency attitudes and empowering individuals to make healthy
lifestyle choices (centres: 9,10,11,12).
Health promotion and education do not merely entail educating the client or the
community for whom the Aboriginal Health Access Centres service, but also serves to
enhance patient advocacy and the education of non-Aboriginal care providers.
- 21 -

Ultimately this should be reflected in health care policies and future plans so that high
quality and relevant care can be delivered effectively (centres: 1,8).
Culture/Context
Access to culturally appropriate health care is enormously important to Aboriginal
communities (centres: 4,6,8,9,11,12). In order to understand what is meant by
‘culturally appropriate care’ we must first understand the notion of culture. The basic
definition of a culture “encompasses the beliefs and behaviors that are learned and
shared by members of a group”.21 A culture is considered a minority if it contrasts
with the white, European culture which is the “largest and most powerful subgroup of
the Canadian population”.22 The majority culture is distinct in the amount of economic
and political power it holds and therefore the policies that are institutionalized
generally reflect the majority culture’s system of values and beliefs. In contrast, a
minority culture’s beliefs and less powerful social position are reflected in the
problems of the division of mutually satisfactory health care.
Values are considered as concepts and ideals that are held as integral components
within a culture. A person’s system of values and beliefs are passed down from
generation to generation and reflect, and are modified by our unique historical
context. Different cultures promote different values and have different shared
histories. A desire to return to Traditional Aboriginal Medicine and ideals is another
common theme expressed in the mission statements of the various health centres
(centres: 1,8,10,12). A number of Aboriginal Health Access Centres acknowledge
the need to respect Aboriginal people as individuals with clear values and beliefs and
who hold a distinct cultural identity (centres: 4,11,12). Another issue identified in the
survey was an acknowledgement of current discrepancies in the health and well-being
of Aboriginal populations such that there was no adherance to a health determinants
model but rather to a biomedical model of health (centres: 5,8).
Analysis of Services Provided
Information about the services offered by each of the 12 Aboriginal Health Access
Centres was accessed by their websites, e-mail, or through personal conversation
with the Executive Director of each facility or his/her referred staff. Out of the 12
Centres, two centres were not included in this analysis due to a lack of specific
information on the types and numbers of health professionals working at their facility.
For the purposes of analysis, service providers’ were categorized based on the basis
of practice their specific title advocates. For example, Traditional Healers, Traditional
Coordinators, and Naturopathic Doctors were categorized to offer services based on
a holistic basis of treatment (see Table 4: Accessibility to Health Care Professionals).
General Practitioners, Nurse Practitioners, Registered Nurses, Chiropractors,
- 22 -

Dieticians, Occupational Therapists, Physical Therapists, and Clinic Aids were all
categorized as providing a more physical treatment perspective. The
mental/emotional perspective of treatment included the services provided by
Psychologists, Psychiatrists, Social Workers, and Mental Health Coordinators and/or
Workers.
A fourth and unique category separated the services provided by either Health
Promotions Coordinators or Health Promotions Workers responsible for running
condition specific health promotions programs. Prevention programs offered ranged
from facility to facility with more common ones including: the Fetal Alcohol Spectrum
Disorder Program, Child Nutrition Program, Asthma Programs, Diabetes Prevention
Programs, and various Natural Health Workshops.
Categorization based on the various treatment perspectives of each profession is a
limiting factor in this analysis as it does not acknowledge how each individual
program is run nor does it acknowledge the perspective of practice of the individual
service provider.
Discussion
Based on the results of the broad based field survey conducted as summarized in
Table 4, it is evident that the majority of Aboriginal Health Access Centres provide
services geared towards improving the physical health of their patients served.
Rather than the subtler mental/emotional and other holistic treatment approaches,
these centres focus primarily on treating pathologies according to a biomedical
perspective consistent with the dominant culture of health care delivery. All of the
Centres have services provided by General Practitioners with only one Centre without
access to a Nurse practitioner. There are much fewer of the providers that practice
based on a mental/emotional perspective and only three of the ten centres have even
one service provider with a predominantly mental/emotional scope of practice
(centres: 2,8,11).
- 23 -

ABORIGINAL HEALTH ACCESS CENTRE
General Practitioner
Nurse Practioner
Registered Nurse
Chiropractic Doctor
Dietician
Registered Massage Therapist
Occupational Therapist
Physical Therapist
Clinic Aid
Health Promotions
Coordinator (runs FASD; Child
Nutrition Programs)
Health Promotions Worker
(runs Asthma Program;
Prevention of diabetes;
Natural health workshops)
Psychologist
Psychiatrist
Social Worker
Mental Health Coordinator or
Worker
Naturopathic Doctor
Traditional Coordinator (TC) or
Traditional Elder (TE)
1. Kanonkwa'tesheio:io Social information unavailable
2. N'Mninoeyaa: Community Health Access 3 p/t 6 2 1 1
3. Gizhewaadiziwin Access Centre 2 p/t 2 1 1 1 2 1 TC
4. De dwa da dehs nye>s Aboriginal Health Access Centre 2 3 2 2 1 1 1 p/t 1 TC; 1 TE
5. Wassay-Gezhig Na-Nahn-Dah-We-Igamig 2 p/t 4 3 1
6. Noojmowin-Teg Health Access Centre 8 p/t 3 2 2 2 1 1
7. Ganaan De We O Dis^Yethi Yenahwahse (SOAHAC) 3 2 3 1 1 1* 1 1 1
8. Wabano Centre for Aboriginal Health 2 4 1 1 1 1
9. Shkagamik-Kwe Health Centre 4 1 2 1 1 1 1 1 1
10. Anishnawbe-Mushkiki 2 3 1 5 1†1
11. Misiway Eniniwuk Health Centre 1 ½ 2 1 1
12. Anishnawbe Health Toronto information unavailable 1 p/t
† 1 Naturopathic Doctor on staff i n 2002, not currently
* Nurse Practitions with special tra ining in psychiatry
TREATMENT PERSPECTIVE
A Comparison of the 12 Ontario Aboriginal Health Access Centres
Accessibility to Health Care Professionals:
PHYSICAL THERAPIES
CONDITION
SPECIFIC
PROGRAMS BASED ON
FUNDING
MENTAL/ EMOTIONAL
THERAPIES
WHOLISTIC
THERAPIES
Table 4: Accessibility to Health Care Professionals at the Aboriginal Health Access Centres
- 24 -

- 25 -
Despite many of the centres having clearly worded mission and vision statements
that attest to providing care from a holistic perspective, there are a
disproportionately low number of practitioners with an educational background
geared towards the provision of this kind of holistic care. For instance, only two of
the 12 Aboriginal Health Access Centres have part time services offered by
Naturopathic Doctors (centres: 4,12). Traditional Healers and Traditional
Coordinators are also under-represented in comparison to the number of
practitioners providing services based on the biomedical/physical perspective of
healing.Two of the Centres have no access to either a Traditional Coordinator or a
Traditional Healer/Elder. Many of the Health Care Centres expressed concern about
this stating that the majority of the problem results from funding that is either
inflexible or inadequate. Further, the overwhelming need for primary care combined
with deficient resources has limited the transition to a more holistic and preventative
model of care (centre: 10). The programs provided by the Health Promotions
Coordinators and Health Promotions workers were also felt to be restricted by lack of
funding. These programs were said to run on a contract by contract basis received
from various government agencies and condition specific organizations. A number of
the Centres expressed frustration in having to re-apply for funding for certain
preventative programs on a yearly basis (centres: 2,3,4,6,8,9,10).
Conclusion
In evaluating common themes linking the mission, values, and goals of the various
Health Access Centres and comparing these ideals with the actual delivery of care at
these facilities, there is a clear imbalance between the desire for and accessibility to
health care programs and the actual provision of holistic care. Access to
mental/emotional services is under-represented at many of the Centres with the
majority of treatment being administered from a physical/biomedical perspective.
For the Centres that do have access to the various holistic service providers, it is
difficult to tell in this rudimentary analysis if there is collaboration between service
providers to offer less fragmented care.

5. Health Care Needs of Aboriginal People
There have been many task forces, meetings, roundtable discussions, policy papers,
commissions, and blueprints written and published on strategies to address the gaps
in providing access and suitable health care to Aboriginal people. A review of these
documents reveals a number of themes. The first theme is that the health of the
Aboriginal people will be improved if they are given the responsibility to determine
how best to deliver health care to the members of the Aboriginal community. The
second theme emphasizes that the health of Aboriginal people needs to focus not just
on the delivery of healthcare, but also across all of the determinants of health. The
third theme is the need for the provision of culturally relevant health care to Aboriginal
people across Canada, one that is aligned with the Aboriginal perspective and
definition of health.
Government Recommendations
The Royal Commission on Aboriginal health (1996) recognized that “substantial
improvements in the health and welfare of Aboriginal people will not be accomplished
by tinkering with existing programs and services. Commissioners believe that to
restore well-being to Aboriginal people — and their communities and nations — a
major departure from current practice is needed”.2 The last 15 years have shown
that the current health care approach for Aboriginal People does not adequately
address the causes of ill health in their communities. It has become evident that
providing greater access to primary care facilities without concern for the broader
social, political, environmental, and cultural determinants of health will not have a
significant positive impact on Aboriginal health.
“The [Royal] Commission proposes that new Aboriginal health and healing
systems should embody four essential characteristics:
• pursuit of equity in access to health and healing services and in health
status outcomes;
• holism in approaches to problems and their treatment and prevention;
• Aboriginal authority over health systems and, where feasible,
community control over services; and
• Diversity in the design of systems and services to accommodate
differences in culture and community realities.”2
“Restoring health and well-being to Aboriginal people requires services and programs
founded on an integrated, or holistic, view of human health.”2
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The Royal Commission report also completed a comparison of current and proposed
approaches to community health care.2 The following table provides an excerpt of
key findings from the report:
Table 5: Excerpt of Key findings and suggestions from the 1996 Royal
Commission Report 2
Current Approach to Community Health
care
Proposed Approach to Community
Healing and Wellness
• Dominated by biomedical approach to
treatment and care
• Program-specific funding within that
narrow definition of health
• Based on holistic, culturally appropriate
understanding of illness
• Block funding of healing centres under
federal or provincial jurisdiction;
intergovernmental transfers for centres
under Aboriginal jurisdiction; permits
program activity based on holistic
understanding of health
The 1999 Aboriginal Health Policy for Ontario set out a conceptual framework for
understanding Aboriginal health and how to improve it. The following points outline
this framework:
• “The Aboriginal life cycle explains life through the passage of stages which are
celebrated and correspond to the four directions, seasons, elements and gift.
It reflects the interdependence of individuals, families and communities and
their responsibilities to each other.
• (W)holistic health incorporates the physical, mental, emotional and spiritual
needs of the individual, family and community
• The continuum of care, or healing continuum, incorporates health promotion,
prevention, treatment and curative programs and services and
rehabilitation.”23
The Commission on the Future of Health Care in Canada made the following
recommendations:
1. Current funding for Aboriginal health services should be pooled into a single
consolidated budget in each province and territory to be used to integrate
Aboriginal health care service, improve access and provide adequate, stable
and predictable funding.
2. The consolidated budgets should be used to fund new Aboriginal Health
Partnerships that would be responsible for developing policies, providing
services, and improving the health of Aboriginal people.20
- 27 -

The report also included comments from the Canadian Public Health Association
(2001) which call for culturally based healthcare. A telling excerpt reads: “Only by
designing programs that respect the culture of the nation’s people and communities
and by celebrating Canada’s diversity, can health professionals help improve the
health of vulnerable populations and reduce the demand on the health system as a
whole.”20
First Nations Recommendations
A background paper provided by First Nations on Canada – Aboriginal Peoples
Roundtable in 2004 articulated the overall goal of a “First nations controlled and
sustainable health system that adopts a holistic, culturally appropriate approach.”24
The First Nations’ collective vision for First Nations people is to be served by their
own distinct yet coordinated health system which ensures a continuum of services, a
holistic approach to health and the integrity of traditional healing practices.25,27
“… the term “health” embraces a (w)holistic approach encompassing
the physical, emotional, intellectual and spiritual well-being of people
living in harmony with well functioning social system …” (Blueprint on
Aboriginal Health: A 10 – year transformative Plan, 2005)
“First Nations, Inuit and Métis concepts of health incorporate the
mental, physical, spiritual emotional and social aspects of health”26
Cultural Competency
In 2000, the Society of Obstetrician and Gynaecologists of Canada (SOGC) developed
guidelines for Health Professionals Working with Aboriginal people. These guidelines
were developed from the results of a Medline search from the period 1966 to
February 1999. These recommendations cover four distinct areas: the sociocultural
context, health concerns, cross-cultural understanding, and aboriginal health
resources. Some of the specific recommendations from the SOGC’s study included:
1. Health professionals should appreciate holistic definitions of health as defined
by Aboriginal people.
2. Health professionals should work with Aboriginal individuals and communities
to provide culturally appropriate health care.
3. Health professionals should respect traditional medicine and work with
Aboriginal healers to seek ways to integrate traditional and western
medicine.28
- 28 -

Through the various important and often nationally scoped documents that we
appraised, there is a consistent call for culturally relevant health care by Aboriginal
people and a definition of health that is holistic. Although the need for the
incorporation of traditional Aboriginal medicine in clinical settings has been
recognized, few Aboriginal-specific health-care centres actually offer such services.
This finding is supported by the results of the telephone survey summarized in
Section Four.
It is generally acknowledged that cultural bias or a failure to understand how culture
affects health and illness can contribute to inadequate care.29 In the late 1800’s,
Aboriginal people were forbidden by law to practice their healing rituals and traditions
28 and according to Elder Denise Thorne ‘by the 1960’s traditional spiritual people
were almost extinct”.2 As a result, Aboriginal people were forced to accept the
healthcare provided to them by the Government. Clearly this has resulted in the
deteriorating health of the Aboriginal people through the centuries. It is written that
one needs to go back 300 years to find a point in time where Aboriginal and
European people’s health has equivalent status.30 Over the past 20 years, while there
have been improvements in health care delivery to Aboriginal people, there are still
enormous gaps in care and a continuing legacy of discrepancy across most health
measures between Aboriginal and non-Aboriginal Canadians.
Cultural competence with respect to health care, describes the ability of a system to
provide care to patients with diverse values, beliefs and behaviors.31 The delivery of
culturally competent health care is seen as a means to provide quality in health care
delivery and the elimination of racial disparities.31-33 It is clear that governmental
agencies recognize the need for cultural competence within the health care delivery
model for Aboriginal people and that Aboriginal people are also calling for cultural
competence as a means to improve their own health. The problem is recognized,
and the remaining requirement is to provide effective delivery of culturally competent
and relevant care. Within Aboriginal communities, culturally appropriate care means
incorporating the entire picture of a person including physical, spiritual, emotional and
mental aspects.
Limitations and Discussion
The results of this report were derived from either journal articles or resources that
could be obtained from internet sources. There was insufficient time to delve into the
entire breadth of research written on Aboriginal health and traditional medicine in all
scholarly works.
- 29 -

The references on the articulated needs of Aboriginal people were taken from
National websites or from Ontario health policy initiatives. While other provincial
sources were quickly reviewed for consistency of content, the scope of this project
did not allow us to incorporate all potential resources.
The authors do not claim to be health policy experts, nor do we feel that within the
allotted time, we have uncovered all of the various documents that discuss the
Aboriginal view and definition of health. We have attempted to highlight the various
components that surfaced in our review, consolidate these and to present the
information without bias to be best of our ability. In summary of our findings, there is
consistency across governmental and aboriginal documents. The underlying theme
identified is the requirement for an Aboriginal controlled and sustainable health
system that adopts a holistic, culturally appropriate approach in the implementation
and delivery of health care to Aboriginal people.
- 30 -

6. Aboriginal Health Care Needs and Naturopathic
Medicine
In the previous sections of this document there were a number of requirements that
were identified in order to provide for culturally competent health care. Specifically,
health care for Aboriginal people needs to:
• be delivered within a culturally-relevant context
• be holistic
• be integrated with traditional medicine
• celebrate native culture
It is clear that while efforts have been made to move in this direction there are still
gaps that negatively impact the health of Aboriginal people.
Bridging the Gap with Naturopathic Medicine
Naturopathic doctors (NDs) are in a unique position to bridge the gap between
Western and traditional Aboriginal medicine. NDs have the education to understand
and respect both Western and Traditional Aboriginal medical philosophies and
treatments by virtue of their guiding principles of practice. Outlined in the Textbook of
Complementary and Alternative Medicine:
Naturopathic medicine is a primary health-care system. Its purpose
includes the prevention and treatment of disease and the optimization
of health through the use of natural agents and therapies that
encourage the body’s innate ability to heal. The practice of
naturopathic medicine incorporates traditional approaches with current
evidence to treat the whole person in the least invasive yet effective
manner (…) The emphasis is on holistic treatment, with attention paid
to achieving harmony in the mental, emotional, physical, social and
spiritual planes.34
As discussed, concepts of health amongst Aboriginal people incorporate the mental,
physical, spiritual, emotional, and social aspects of health.26 Naturopathic medicine
shares a number of philosophical principles with Aboriginal medicine and their
worldview of health. Primary to both approaches is the belief in the healing power of
nature, or the assumption that the body exhibits self-intelligence with the ability to
self-heal. In this manner, the job of the health practitioner is to assist the body’s
innate ability to fix itself by removing causes of illness and supporting various organs
in an attempt to restore internal conditions conducive to health. This is different from
conventional medicine, in which there is a core belief that mechanisms of illness can
- 31 -

be reduced to understandable discrete units, such that targeted interventions can be
used to “correct” dysfunctional bodily processes.35
The belief in the healing power of nature, a tenet of both naturopathic medicine and
the Aboriginal worldview of health, implies that the cause of illness must be removed
for health to be restored. This cause may be found on several different planes;
physical, mental, emotional or spiritual. Aboriginal healers and naturopathic doctors
alike may provide treatments on any of these levels affected. In fact, spiritual
practice is central to both naturopathic and Aboriginal medical philosophy. Aboriginal
Elders are often consulted by patients who are struggling to find a place for tradition
in the modern world, and many interventions require ceremony, examination and
counseling. Naturopathic doctors draw on traditional medical systems such as
traditional Chinese medicine in order to treat modern ailments. Counseling and the
role of spiritual needs for health are integrated into the curriculum of naturopathic
medical training. This approach represents a significant departure from Western
medicine, in which matters of the spirit are referred to a psychiatric subspecialty for
select patients with clearly defined mental pathologies.
Important to health within the Aboriginal and naturopathic perspective, the spirit
needs to be addressed in all patients, no matter what the presenting condition, in
order for health to be achieved. Aboriginal Elders have identified these parallels and
made the recommendation of creating a space for Western medicine, naturopathic
and Traditional medicine to learn together so that the three models can function
collaboratively and efficiently in health centres catering to Aboriginal communities. In
fact, several Elders we spoke with identified naturopathic medicine as more
compatible with traditional medicine and stressed the fact that alternative medicine
takes into account mental-emotional as well as physical trauma.
Naturopathic approaches hold promise for improving the quality of life
of Aboriginal People because they incorporate the holistic model and
do not just “medicate the problem”.36
Naturopathic Doctors and Traditional Healers
Naturopathic doctors and traditional healers also share some commonalities in the
way they practice. NDs are trained in botanical medicine, clinical nutrition, lifestyle
counseling, hydrotherapy, physical medicine, homeopathy, and traditional Chinese
medicine. Lifestyle modifications are at the root of most naturopathic interventions
and other modalities are used depending on the needs and concerns of the patient.
Similarly, traditional healers regard diet and nutrition as the primary basis for
sustaining or restoring health and advocate abundant water drinking, physical
exercise, and deep breathing. They also prescribe a number of herbal and
- 32 -

hydrotherapeutic treatments that include such therapeutic processes as sweat baths,
mud, clay and charcoal poultices as well as the use of enemas.37 A further similarity
between naturopathic and Aboriginal approaches to health is that several different
types of interventions can be applied to restore health and this is done within a highly
individualized therapeutic approach.
Although significant overlap exists in the philosophy and practice of naturopathic and
Traditional Aboriginal medicine, important differences remain. The following table
summarizes some of the similarities and the differences in perspectives between
Traditional, Naturopathic and Conventional medicine.
Table 6: Comparison of the Different Perspectives of Traditional Aboriginal
Medicine, Naturopathic Medicine and Conventional / Western Medicine38
Traditional Aboriginal
Perspective
Naturopathic Perspective Conventional Perspective
Interaction Multiple causes interact Cause and effect
Co-operation Co-operation Authoritarian
Symbiotic relationships Symbiotic relationships Competitiveness
Harmony in diversity Harmony in diversity Unity by similarity and
repetition
Contextual analyses Contextual analyses with
categorization to facilitate
explanation
Categorization
Multiple truths to be
considered
Multiple truths to be
considered
One truth
Information could be non
redundantly generated
Somewhere in-between Past and Future information
is inferable from the present
Dynamic Dynamic Static
Holistic including everything
external
Holistic including everything
internal
Reductionist / focus on
parts of the whole
Broadly speaking, Aboriginal philosophy encompasses all aspects of the individual
(mental, physical, and spiritual elements of health) yet also encompasses the
environment in a spiritual and intuitive way. Naturopathic medicine certainly concerns
itself with the individual components of health and includes the social and physical
environment, however local events such as weather changes, coincidence, and even
what may be described as situational ‘lucky or unlucky’ events are not emphasized.
Traditional Aboriginal thought can subscribe to the idea that elements within the
‘universe’ are in a delicate state of balance that can be easily upset. When a person,
place, thing or event is out of balance, it will become dysfunctional. Thus, an
- 33 -

individual will become ill if he/she upsets the rules of the universe. This observation
also applies to natural phenomena such as earthquakes, hurricanes, and the
occurrence of a bad crop, as they are all viewed as the same manifestation of some
kind of spiritual imbalance. In this way, both the environment and the person can be
considered “ill” or out of balance simultaneously.
The Traditional healer fits in this Aboriginal model of complete interconnectedness in
that he/she has an above average ability to control the exertion of spiritual forces and
is said to have a special spiritual connection with the plants he/she prescribes for
healing patients.39 The traditional healer’s responsibility is not so much curing illness,
but rather, facilitating the patient’s understanding of the world and where he/she fits
within it. Ceremonies are central to Aboriginal culture and healing because they
reaffirm the relationship of humans with the Creator. The traditional healer may
prescribe medicinal herbs, ceremonies, or relationship-building events in order to
bring about healing. Naturopathic doctors, however, concern themselves more with
attempting to cure the patient’s illness within the context of holistic yet non-
metaphysical issues.
Further to this important difference between traditional Aboriginal medicine and
naturopathic medicine is the place of intuition and supernatural influences:
Parallels between Western scientists and Indigenous healers break
down, however, in the roles of intuition, vision, and other “internal”
forces, which Indigenous science honors as essential aspects of any
human endeavor. Western scientists refuse to acknowledge such
elements of knowing, even though they are affected by them.40
Although naturopathic medicine does not inherently reject the power of intuition and
prayer, it is neither taught nor central to the practice of naturopathy. Aboriginal
healers, however, rely heavily on intuition and prayer to diagnose and treat illness
respectively.
Naturopathic Education and Practice
Despite certain differences, the overlap between naturopathic and Aboriginal
approaches to health remains considerable. Naturopathic doctors are well equipped
to understand Aboriginal concepts in a clinical yet still holistic context. Naturopathic
doctors are fluent in the language of Western biomedicine and can provide a powerful
interface between Aboriginal and Western medicine. Just like their conventional
counterparts, NDs understand the value and need for objective assessment including
laboratory based tests and imaging for both diagnostic and prognostic purposes.
- 34 -

NDs are trained to interpret such findings and are able to arrive at a diagnosis
according to the International Classification of Disease (ICD-10) criteria.34
In their four-year post graduate full-time training, naturopathic doctors attend basic
science classes including anatomy, physiology and pathology and also learn to
perform routine screening procedures such as gynecological exams, full physical
exams and blood draws. Naturopathic clinical decisions are made with respect to a
broad based body of knowledge that respects and is shaped by the tenets of
evidence based medicine. More and more research geared specifically towards
naturopathic interventions is being produced and being published in respected
medical journals. In this manner, naturopathic medicine as a system uses modes of
transmission similar to Western medicine and recognizes the value of formal research
and standardized practice when it is appropriate and clearly indicated.
A large proportion of Aboriginal people in Canada present with chronic disease that
often stems from an unhealthy lifestyle. More than half of the Aboriginal population
smokes, 24% are obese, and the prevalence of diabetes and alcoholism is 2-3 times
that of non-Aboriginal Canadians.6 The need for primary prevention among Aboriginal
people has been identified as being especially urgent given their high prevalence of
chronic diseases and the complications that ensue.41 Lifestyle habits are ingrained in
adults, such that making modifications can be difficult. Successful lifestyle
interventions require perseverance and patience using tools such as frequent follow-
up visits, intensive telephone counseling, and print material for a comprehensive
program of patient education. On average, a typical visit with a medical doctor in
North America lasts 17 minutes with only one minute spent on educating patients
about the need for nutrition and physical activity.42 A study has shown that time
constraints limit the ability of physicians to comply with preventive recommendations
made by the US Preventive Services Task Force.43 In contrast, one of the principal
strengths of the naturopathic medical profession is that NDs typically spend 30 to 45
minutes with patients during follow-up visits, giving them the time to teach patients
how to engage in a healthy lifestyle and to implement effective habits to achieve
better health.34 With information delivered in a culturally-sensitive manner,
naturopathic medicine would significantly contribute to positively impacting unhealthy
lifestyles in Aboriginal communities and help reverse some of the epidemic of chronic
disease suffered by so many members of this population.
Naturopathic medicine is a regulated profession in four of Canada’s ten provinces
since the mid 1950’s. [Laws regulating naturopathic practice were enacted in Ontario
by 1925, British Columbia in 1936, Manitoba in 1943 and Saskatchewan in 1952.]
The scope of practice of naturopathic doctors is clearly established and in each
province where naturopathic medicine is regulated, a regulatory board similar to the
College of Doctors and Surgeons exists for public protection. The title “naturopathic
- 35 -

doctor” is protected and can only be used after completing an accredited four-year
full-time training in one of the six accredited colleges that teach naturopathic
medicine in North America.
Summary
In summary, naturopathic doctors, with their holistic view of health and illness and
their knowledge of evidence-based medical tools are currently in the position to
bridge the gap between Traditional Aboriginal medicine and the Western medical
model. The inclusion of naturopathic doctors into the circle of care in Aboriginal
driven health centres can answer the need for preventative medicine focus and
provide an essential link between Traditional Aboriginal practitioners and Western
medical doctors. This inclusion would ensure comprehensive health care delivery to
Aboriginals.
- 36 -

7. Future Directions
There are many opportunities that have been identified in the conduct of this project.
The following identify some of the future directions that could be undertaken with
respect to the application of naturopathic medicine within Aboriginal communities.
Despite the logistical challenges faced by the patients, and naturopathic doctors at
Anishnawbe Health Toronto, the inclusion of naturopathic medicine as a service has
demonstrated a positive impact on the health of individuals that avail themselves of
naturopathic medicine. An opportunity exists to engage with the administration to
explore solutions to these challenges and provide a more supportive and conducive
environment for the practice of naturopathic medicine at AHT. Furthermore,
outcomes based research to test and document the effectiveness of naturopathic
medicine using quantitative data could and should be engaged at this site.
Given the paucity of information on the integration of naturopathic medicine with
Aboriginal Traditional medicine and Western medicine, both AHT and De dwa da dehs
nye are currently Aboriginal Health Access Centres where further research into this
integration can occur as each of these centres have naturopathic doctors on staff.
There are many questions to explore:
• What has made the implementation of naturopathic medicine possible at these
two centres?
• What are the factors that have facilitated this implementation? What barriers
need to be overcome?
• What further opportunities are there to enhance the implementation and
further the integration of naturopathic medicine within Aboriginal Health
centres?
• What are the essential components that support cultural competency within
these Aboriginal health centres and how can this be extended to other
organizations?
• What are the best ways to allow further integration of naturopathic medicine
with Traditional Aboriginal healers – how can these two areas work together to
support and deepen the healing within not only the individual, but the family,
the community, and the environment?
• How can we evaluate the internal dynamics of the individual Health Access
centres to determine if services provided are reflective of each centre’s goals
of health care provision?
• How can we evaluate the services provided at the various centres with time
and funding allotted for personal meetings and discussion about ethical
research requirements including achieving possible benefits for the research
- 37 -

centre and the community it services? These benefits may include extended
funding for programs that Aboriginal communities feel they are lacking or that
need evaluation.
Perhaps the greatest opportunity for collaboration exists in sharing knowledge, cross
training of naturopathic doctors, traditional healers, and medical doctors. Means to
achieve this could include educational units or learning opportunities embedded within
the curriculum of study for these various health care practitioners.
There were several centres that expressed the desire to incorporate naturopathic
medicine as one of the services offered. Further discussions with the administration
of these centres regarding the integration of naturopathic medicine would need to be
pursued in order to allow any inclusion of naturopathic care. Furthermore, Aboriginal
community agreement is necessary to achieve real traction of naturopathic medicine.
This could best be realized by enlisting the aid and advice of Elders and Traditional
healers within the community approached.
The delivery of culturally competent health care to people is paramount to supporting
healing. The SOGC explored those components that support cultural competency
within Aboriginal communities. Opportunities exist to extend this information further
towards the development of training programs that provide the information and
training necessary to ensure cultural competency in those individuals that work with
Aboriginal health centres.
Funding models used for Aboriginal health Access Centres are still program based.
This is despite the recognition and recommendations from both the Royal
Commission on Aboriginal Peoples2 and Commission on the Future of Health Care in
Canada20 for block funding and/or pooled funding for Aboriginal Health services.
Opportunities exist to further research and implement funding models that would
support the provision of holistic health providers fairly.
Sources of potential funding include the Canadian Institute of Health Research,
Institute of Aboriginal Peoples’ Health and the First Nations and Inuit Health Branch of
Health Canada. These institutions as well as charitable foundations could provide
support for further research on the health benefits of involving naturopathic medicine
within Aboriginal communities.
- 38 -

8. Conclusion
Aboriginal communities in Canada are plagued by chronic illness despite significant
financial investment to increase access to primary care facilities. The government
has recognized that a new Aboriginal-driven health care approach must be developed
and must respect traditional Aboriginal medicine. This can be a difficult challenge due
to significant philosophical differences between the Western medical model and
Aboriginal medicine, as well as logistical barriers. The unique position of naturopathic
medicine is that it is founded in a philosophy that respects both traditional practice
and modern medicine. Thus, naturopathic doctors may provide an effective interface
to enhance collaboration between Western and Aboriginal health practitioners.
Including naturopathic doctors in Aboriginal-driven health centres would answer the
urgent need for lifestyle modification and chronic illness prevention in the
communities. One can imagine a centre catering to Aboriginal People in which
patients work simultaneously with their traditional healer, medical doctor,
naturopathic doctor, and other healthcare providers. This schematic fits perfectly with
the current intent of creating Aboriginal-specific participatory models of health care in
which Aboriginal people are able to tailor their health care experience to include those
systems that most empower them to improve their health, enhance their sense of
belonging, and perpetuate lasting wellness. The sharing of knowledge and culture
through cross training, integrating health care centers, and opening lines of
communication between Aboriginal people, traditional healers, and naturopathic
doctors would aid in the successful delivery of health care to Aboriginal people.
Naturopathic medicine offers a unique way to communication between Western
medicine and traditional Aboriginal medicine. The practice of naturopathic medicine
supports a holistic approach of health that is more closely aligned with the Aboriginal
view of health. In partnership with Aboriginal people, Elders, and Western health care
practitioners’, naturopathic medicine could support a holistic and comprehensive
approach to health within the Aboriginal Community.
The implementation of a pilot project whereby naturopathic doctors partnered with
Traditional healers and conventional medical practitioners in the delivery of individual
and community based holistic care would provide a mechanism to test for both
feasibility and effectiveness. Such a pilot project, taking place at no more than a few
locations desired by the communities themselves would be small in scope to begin
with but would provide preliminary data on the effectiveness and impact of this kind of
integration.
- 39 -

Appendix A: Qualitative Research Study: Semi-structured
Interview Questions
ND Interns/ Supervisors
1. What it is like to work at the AHT?
2. Can you tell me about the population that you treat at the AHT?
3. What are the main concerns of your patients at the AHT?
(Probe: sociocultural issues, health concerns)
4. How are you able to address those concerns?
5. What are some challenges that you face?
6. What resources are available to you and your patients at AHT?
7. What would an ideal situation be for you at AHT, in terms of resources etc?
(Phrased in context of previous answer)
8. Can you describe your treatment goals for your patient population at AHT?
9. What is your relationship to other health care providers and staff at the AHT?
(Probe: communication between providers, integration of care)
10. What strategies have been most effective for you when working with patients?
11. When communicating with other members of AHT?
12. What has been ineffective for you when working with patients?
13. When communicating with other members of AHT?
14. How can you compare your experiences working at the AHT to other health
clinics?
Patients
1. Can you tell me about your experience at the AHT? (Probe: What do you like
about AHT? What do you think can be improved at AHT?)
2. Why did you start coming to AHT?
3. How is your relationship with your health care providers at the AHT?
4. How is your relationship with your ND?
5. What do you like about seeing your ND?
6. What would you like to improve (with your ND)?
7. How has seeing an ND influenced you?
8. What things has your ND been able help you with? (Probe: How? In what way?)
9. What has your ND not been able to help you with? (Probe: What are the
challenges that you still face)
10. Ideally, what you would you like from your ND services?
11. How does your health now compare to before you were seeing an ND?
12. How do you feel about your ability to access health services? Naturopathic
services?
- 40 -

Appendix B: Qualitative Research Study: Coding themes es
Culturally
sensitive
Good fit with
values
Needs
History
ND and
Aboriginal Health
Process
Circle of care
Training
Communication
Clinic and ND
Resources
Rotations
Access
Continuity of Care
Give and take
Understand
community
Trust
Philosophy
Other Settings
AHT
- 41 -

Coding Descriptions
Patients
• Access – re: access to health care, access to timely
services
• Needs – re: health needs, physical, spiritual and emotional
needs
• History – oppression and culture related to care
• Communication – manipulation with other providers,
decision-making push/pulls
Interns
• Experience – related to the cultural differences, the health
needs of the population
• Training needs – certain conditions, mental/emotional
• Process – procedures of the clinic, computers, waiting for
supervisor
• Personal development – how they learn, what they get out
of the experience
AHT clinic
• Limitations – privacy issues, set up of Anish, timing of
appointments, acceptance by others at AHT, air quality
• Circle of care – communication with others in health care,
access to consultations
• Resources – supplements, books, computers, space
Communities • Naturopathic philosophy – in line with aboriginal
communities, need to facilitate trust and work together
Health care system
• Trust required
• Give and take between ND and community
• Integrating into community
• Open minded approach
- 42 -

Appendix C: Qualitative Research Study: Participant
Characteristics
Participant Experience Additional notes
Supervisor 1 6 months at AHT
Supervisor 2 6 months at AHT
Supervisor 3 3 years at AHT
Intern 1 4 months at AHT Native background
Intern 2 2 months at AHT 2-4 patients per wk
Intern 3 2 months at AHT 2-4 patients per wk
Intern 4 2 months at AHT 2-4 patients per wk
Intern 5 2 months at AHT 2-4 patients per wk
Intern 6 2 months at AHT 2-4 patients per wk
Intern 7 2 months at AHT 2-4 patients per wk
Patient 1 Seeing ND for 3
months
Other services at AHT for 1 year
Patient 2 Seeing ND for 9 years Coming to AHT for 9 years with other
services
Patient 3 Seeing ND for 2 years Other services at AHT for 2 years
Patient 4 Seeing ND for 3 years Other services at AHT for 4 years
Patient 5 Seeing ND for 4 years Other services at AHT for 4+ years
Patient 6 Seeing ND for 10
years
Other services at AHT for 10 years
Patient 7 Seeing ND for 4
months
Other services at AHT for 6 years
- 43 -

Appendix D: Telephone Survey: List of Aboriginal Health
Access Centres
Reference
Number
Aboriginal Health Access Centre
1 Kanonkwa/tesheio:io Social
Akwesasne [homepage on the Internet]. Cornwall, ON.
Mohawk Council of Akwesasne; c2008 [cited 2008 Mar.17].
Available from: http://www.akwesasne.ca/health.html
2 N’Mninowyaa: Community Health Access
Mamaweswen, The North Shore Tribal Council.Cutler, ON.
Mamaweswen, The North Shore Tribal Council; c2007 [cited 2008 Mar.17].
Available from: http://mamaweswen.ca/health/
3 Gizhewaadiziwin Access Centre
Stanley, Cheri. From Health Records Department. Gizhewaadiziwin Health
Access Centre- communities serviced, services offered, mission statement.
E-mail Johanne McCarthy (mccarthyjohanne@hotmail.com) 2008 Mar.18 [cited
2008 Mar.18].
4
De dwa da dehs nye>s Aboriginal Health Access Centre
De dwa da dehs nye>s Aboriginal Health Access Centre. Hamilton, ON.
De dwa da dehs nye>s; [cited 2008 Mar.18].
Available from: http://aboriginalhealthcentre.com/Home.page
5
Wassay-Gezhig Na-Hahn-Dah-We-Igamig
Wassay-Gezhig Na-Hahn-Dah-We-Igamig: Kenora Area Health Access Centre.
Kenora, ON.
overdrive-Nadya Kwandibens; [cited 2008 Mar.18].
Available from: http://www.kahac.org/about.php
6 Noojmowin Teg Health Access Centre
Noojmowin Teg Health Access Centre . Little Current,ON.
Noojmowin teg Health Centre; c2006 [cited 2008 Mar.18].
Available from: http://noojmowin-teg.ca/index.aspx
7 Ganaan De We O Dis^Yethi Yenahwahse- SOAHAC
- 44 -

Southwest Ontario Aboriginal Health Access Centre. London, ON.
Southwest Ontario Aboriginal Health Access Centre; c2004 [cited 2008
Mar.18]. Available from: http://soahac.on.ca/
8
Wabano Centre for Aboriginal Health
Wabano Centre for Aboriginal Health. Ottawa,ON.
Wabano Centre for Aboriginal Health; c2003 [cited 2008 Mar.18].
Available from: http://www.wabano.com/main.html
9 Shkagamik-Kwe Health Centre
Shkagamik-Kwe Health Centre [homepage from the Internet]. Sudbury,ON;
Shkagamik-Kwe Health Centre; c2005 [cited 2008 Mar.18].
Available from: http://www.shkagamik-kwe.org/
10 Anishnawbe-Mushkiki
Anishnawbe-Mushkiki: Thunder Bay Aboriginal Community Health Centre.
Thunder Bay, ON;
Thunder Bay Aboriginal Community Health Centre; [cited 2008 Mar.18].
Available from: http://www.anishnawbe-mushkiki.org/
11 Misiway Eniniwuk Health Centre
Misiway Milopemahtesewin Community Health Centre. Timmins, ON.
Misiway Milopemahtesewin Community Health Centre; [cited 2008 Mar.18].
Available from: http://www.misiway.ca/home.html
12 Anishnawbe Health Toronto
Anishnawbe Health Toronto [homepage on the Internet]. Toronto, ON:
Anishnawbe Health Toronto; c2005 [cited 2008 Mar.18].
Available from:http://www.aht.ca/about-aht/
- 45 -

References
1. Health Council of Canada. The Health Status of Canada's First Nation, Metis
and Inuit People 2005.
2. Government of Canada. Report of the Royal Commission on Aboriginal
Peoples, 1996.
3. Treasury Board of Canada. Canada's Performance Report 2005. Available at:
http://www.tbs-sct.gc.ca/report/govrev/05/ann304_e.asp. Accessed March
19 2008, 2008.
4. Tackling health inequalities. Department of Health, United Kingdom. Available
at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_083471
5. Health Canada. Health Sectorial Session Background Paper 2004.
6. Lemchuk-Favel L JR. Aboriginal Health Systems in Canada: Nine Case Studies.
Journal of Aboriginal Health 2004(January):28-50. .
7. National Aboriginal health Organization (NAHO). An Overview of Traditional
Knowledge and Medicine and Public Health in Canada. 2008.
8. Chambers E. Applied Ethnography. In: Denzin N, Lincoln Y, eds. Handbook of
Qualitative Research. 2nd ed. Thousand Oaks: Sage; 2000:851-869.
9. Creswell J. Qualitative Inquiry and Research Design: Chosing Among Five
Traditions. London: Sage; 1998.
10. Denzin N, Lincoln Y, eds. Handbook of qualitative research. Thousand Oaks:
Sage; 1994.
11. Berg BL. Qualitative research methods for the social sciences. Second ed.
Needham Heights: Allyn and Bacon; 1995.
12. Richards L, Richards T. NVivo 2.0 [Software for Qualitative Research].
Melbourne: QSR Solutions; 2002.
13. Hertz R. Reflexivity and voice. Thousand Oaks, CA: Sage; 1997.
14. Cutcliffe JR. Reconsidering reflexivity: introducing the case for intellectual
entrepreneurship. Qualitative Health Research. 2003;13(1):136-148.
15. Aboriginal Health and Wellness Strategy. Overview [Online]. July 16 2007.
Available at: www.ahwsontario.ca/about/overview.html. Accessed March 15,
2008.
16. Aboriginal Health and Wellness Strategy. Consultation Process [web page].
July 16 2007. Available at:
www.ahwsontario.ca/about/consultationprocess.html. Accessed March 15,
2008.
17. Canadian Task Force on the Periodic Health Examination. The Canadian Guide
to Clinical Preventative Health Care. Ottawa: Health Canada; 1994 1994.
- 46 -

18. Canadian Medical Association. Bridging the Gap: Promoting Health and Healing
for Aboriginal Peoples in Canada. Ottawa ON: Canadian Medical Association;
1994.
19. Ontario Health Quality Council. Q Monitor: 2007 Report on Ontario’s Health
System: Queen’s Printer for Ontario; 2007.
20. Romanow RJ. Building on Values: The Future of Health Care in Canada – Final
Report. 2002.
21. Galanti G. caring For Patients from Different Cultures. Philadelphia: University
of Pennsylvannia Press; 1991.
22. Waxler-Morrison N. Cross-Cultural Caring: A Handbook for Health Professionals
in Western Canada. Vancouver: University of British Columbia Press; 1990.
23. Aboriginal Health Policy for Ontario; 1999.
24. Assembly of First Nations. Background Paper on First Nations Health 2004.
25. Saskatchewan Institute of Public Policy. Final Report in Aboriginal Health
Blueprint Engagement Process: Saskatchewan Health; 2005.
26. Vaccho. How we see it !! Broader Determinant of Health within an Aboriginal
Context. Available at: www.naho.ca/english/publications / vaccho.pdf.
Accessed: March 15, 2008.
27. Valerie Gideon P. First Nations Health: The Landscape: AFN Health & Social;
May 10, 2005. Available at: www.naho.ca/english/publications.
28. Smylie J. et al. A Guide for Health Professionals Working with Aboriginal
Peoples. Journal SOGC. December 2000 2000;22(12):1056-1061.
29. Dunn AM. Culture competence and the primary care provider. J Pediatr Health
Care. May-Jun 2002;16(3):105-111.
30. Hackett P. From past to present: understanding First Nations health patterns
in a historical context. Can J Public Health. Jan-Feb 2005;96 Suppl 1:S17-21.
31. R. Betancourt MD, M.P.H., Alexander R. Green, M.D., and J. Emilio Carrillo,
M.D., Cultural competence in HealthCare: Emerging Frameworks and Practical
Approaches: The Commonweath Fund; 2002.
32. Culhane-Pera KA, Reif C, Egli E, Baker NJ, Kassekert R. A curriculum for
multicultural education in family medicine. Fam Med. Nov-Dec
1997;29(10):719-723.
33. Wright AL, Naylor A, Wester R, Bauer M, Sutcliffe E. Using cultural knowledge
in health promotion: breastfeeding among the Navajo. Health Educ Behav. Oct
1997;24(5):625-639.
34. Seely D. Naturopathic Medicine Textbook of Complementary and Alternative
Medicine 2nd edition ed: Parthenon Publishing, UK; 2006.
35. Zeff J. The Cornerstones of Naturopathic Medicine. Journal of Naturopathic
Medicine. 1999;8(2):62-65.
- 47 -

- 48 -
36. Martin Hill D. Traditional Medicine in Contemporary Contexts: Protecting and
Respecting Indigenous Knowledge and Medicine. : National Aboriginal health
Organization (NAHO); 2003.
37. Obomsawin R. Traditional Medicine for Canada’s First Peoples. 2007.
38. McCarthy, J. Naturopathic Medicine: A Step towards Culturally Appropriate
Health Care; 2008.
39. Herrick JW, Snow DR. Iroquois medical botany. 1st ed. Syracuse, N.Y.:
Syracuse University Press; 1995.
40. Cajete G. Native science : natural laws of interdependence. 1st ed. Santa Fe,
N.M.: Clear Light Publishers; 2000.
41. Macaulay AC, Paradis G, Potvin L, et al. The Kahnawake Schools Diabetes
Prevention Project: intervention, evaluation, and baseline results of a diabetes
primary prevention program with a native community in Canada. Prev Med.
Nov-Dec 1997;26(6):779-790.
42. Ory MG, Peck BM, Browning C, Forjuoh SN. Lifestyle discussions during
doctor-older patient interactions: the role of time in the medical encounter.
MedGenMed. 2007;9(4):48
43. Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is
there enough time for prevention? Am J Public Health. Apr 2003;93(4):635-
641