Island Health cultural safety department say they faced backlash

Several current and former staff at Island Health are raising concerns after what they say has been a dismantling of the Indigenous Health department’s cultural safety facilitation team.

The staff allege that during the province’s 2020 investigation into Indigenous-specific racism in the health care system detrimental changes were made to their team. This included the firing of long-time cultural safety facilitator and then-Acting South Island Manager of Indigenous Health, Yvette Ringham-Cowan.

“The backlash was real and the person that was fired in that whole organization was me, an Indigenous woman,” says Ringham-Cowan, who is of mixed Kwakwaka’wakw and English ancestry.

“I really strongly believe the reason why I was dismissed is because of the backlash, because of the fear that was underneath this.”

Ringham-Cowan says she was dismissed without cause on Sept. 25, 2020 after working for Island Health for nearly seven years.

“To frame it kind of from a systems perspective, it’s the firing of an Indigenous manager who was the de facto lead of cultural safety,” says one cultural safety facilitator. “She was let go, and then everything kind of unraveled from there.”

All of the cultural safety facilitators who spoke with IndigiNews have requested anonymity for fear of employment repercussions.

Currently there does not appear to be anyone actively working on the cultural safety facilitation team.

As of Feb. 10, 2021, the three cultural safety facilitators listed on Island Health’s website all have the words “on leave” beside their name in capital letters.

Two other facilitators have since quit and another was moved to a different department the same day that Ringham-Cowan was dismissed, according to IndigiNews’ sources.

“It’s so unsafe at Island Health that the cultural safety team had to leave,” says one facilitator.

“I’ve been really shocked to see that it’s gone from a dynamic and successful cultural safety program to nothing left.”

IndigiNews asked Island Health about the current state of the cultural safety facilitation team and Ringham-Cowan’s firing. In an email, they say, “We cannot comment on personnel matters, due to privacy legislation.”

Island Health is the largest employer on Vancouver Island “with over 24,500 employees, 1,900 physician partners and 3,000 volunteers,” according to their website.

Their Indigenous Health department’s cultural safety facilitation team was focused on working to combat anti-Indigenous racism on multiple levels within the organization, explain the facilitators. They say their mandate was to provide cultural safety training with a focus on working with leadership, coaching, reviewing policy and documents, supporting front-line health care staff, and developing strategies to combat anti-Indigenous racism.

Leaving ‘to be safe’

On June 19, 2020, Mary Ellen Turpel-Lafond was appointed by Health Minister Adrian Dix to lead the investigation into Indigenous-specific racism in B.C.’s health care system. This came following allegations that a “game” was being played in hospital emergency rooms where staff would guess the blood alcohol levels of Indigenous patients — at least one hospital on Vancouver Island faced these allegations.

The investigation also looked at the broader context of Indigenous-specific systemic racism in the health care system.

Team members believe that leadership at Island Health felt pressure during the province’s investigation, and their team was unfairly targeted.

“[Leadership] was feeling quite worried and anxious and stressed about the investigation and sort of the spotlight it was putting on Island Health,” one facilitator tells IndigiNews.

“Part of that protection was to find scapegoats, or you know, what was being found problematic about the system and … not to take accountability for what was going on.

“The reason why I stepped away from the role is because I could no longer do my work in integrity.”

“We were hit with a firehose of requests every day to the point that we couldn’t support everything,” another facilitator says. “Six people for 30,000 people — it’s just crazy.”

“For this to be happening anytime is just unacceptable, but for this to be happening during an inquiry into Indigenous-specific racism and to have the only people who are working to address it feeling they need to exit the system to be safe… is just horrible, it defies reason,” says another facilitator.

IndigiNews requested interviews with Island Health’s CEO, Kathy MacNeil, and Island Health’s Vice-President of Indigenous Health & Diversity, Equity and Inclusion, Dawn Thomas, Aa ap waa iik — neither were available. IndigiNews then followed up with specific questions about the allegations being brought forward from the cultural safety facilitation team. In response, we received a general emailed statement from Thomas.

“We know that this transformative change has been difficult for some and we acknowledge there will be different opinions of our path forward,” the email states.

“While we respect everyone’s right to have an opinion, local communities know what is best for them and our attention is focused on developing partnerships that ensure our programs are inclusive of the voices and direction of these communities.”

Bringing concerns forward

One facilitator who worked throughout the investigation says she is “committed to building awareness and trying to navigate and find leverage points inside the system.”

“This is a lifelong journey… to be able to shift the system so that [Indigenous] people actually have enhanced care and services.”

She says after Ringham-Cowan was fired and the other staff member was moved off of their team, the changes continued.

“All of a sudden, it just came out of nowhere that Yvette was let go. And then all of these other changes started to happen,” she says. “It was like this domino effect.”

Facilitators described significant changes, such as a new equity, diversity and inclusion department (EDI) which was combined with Indigenous Health.

“That was just so deflating because EDI work does not address racism and we’re already an under-resourced program,” the facilitator says.

“It was like a wound that was just getting deeper and deeper and deeper.”

With mounting concerns, the facilitators say they requested a meeting with Island Health’s CEO Kathy MacNeil.

“It was to address what we saw as violence and harm happening to one of our colleagues that we held up,” a facilitator says. “It really rocked our entire team, to a point where we were all so emotionally impacted by it and couldn’t make sense of it.”

The staff who spoke to IndigiNews say that MacNeil then invited the then-executive lead of Indigenous health, Dawn Thomas to attend the meeting as well.

The facilitators describe the meeting as tense. “There were a lot of tears, a lot of frustration and anger,” one facilitator says.

Facilitators reference cultural teachings when thinking about the work they were doing before these changes.

“We work with humility, and we work collaboratively, and not one of us owns any of this, and not one of us is over and above the other. We work together,” one facilitator says.

“It’s just become this whole other way of working, that’s being micromanaged, decisions are coming top down, it’s not transparent anymore.”

Island Health did not respond to the specific concerns brought forward, however, in an email, Thomas writes: “In joining Island Health, the first mandate of my role was to begin conversations with the Indigenous communities within our region to listen and learn from their experiences.”

Thomas explains that their commitment was to learn from these conversations to guide their work to combat Indigenous-specific racism moving forward, adding that, “Island Health’s CEO has made it clear that the responsibility to support the cultural safety and humility journeys of staff and physician partners rests with all leaders in the organization.”

The team says, beyond bringing their concerns to MacNeil and Thomas, they filed a “duty to report” with the Ministry of Health. A report was also filed with Safe Reporting, a tool for whistleblowers, according to several sources.

Members of the team say they have been told that an external body will be hired to conduct an “environmental scan,” to review not just their team, but the entire Indigenous Health & Diversity, Equity and Inclusion department.

‘This is the system’s responsibility’

On Nov. 30, 2020 the report In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care was released. Indigenous cultural safety training was a focus of the report.

When referring specifically to cultural safety training programs, one of the conclusions of the report was that “current education and training programs are inadequate to address Indigenous-specific racism in health care.”

It found that training was operating in “independent pockets,” there wasn’t long-term evaluation, access was an issue, and “the current level of training falls far short of meeting the need and creating systemic change within the health care system.” The report found that mandatory training is needed across professional programs.

“When I think about this racism investigation that happened, I really feel like Indigenous programs around the province were faced with a significant backlash as a result,” says one facilitator.

“We were not presented in a very positive light… the more that racism was being reported, the more we were under microscopic eyes.

“Our program faced backlash and that we weren’t doing enough, yet this wasn’t our responsibility. This is the system’s responsibility, yet we’re the ones being presented in a negative light.”

Ringham-Cowan and her colleagues, who say they have spent years asking for more resources to make changes to the system to improve outcomes for Indigenous Peoples, feel that their work wasn’t understood.

“To be told you’re not doing it in the right way without any context is so disrespectful. It was stunning,” one facilitator says.

“I think that what’s really challenging about all of this [is] I don’t know that a lot of people really understand the depth of the work that we do,” says another facilitator. “And that we do this because we want to see a difference.”

The facilitators say they were not spoken to during the investigation and were surprised by some of the findings of the final report.

“How have these Indigenous programs working so hard been characterized in these ways?” asks a facilitator.

The report focused mostly on the San’yas Indigenous Cultural Safety training, offered through the Provincial Health Services Authority’s Indigenous Health program, which is independent of Island Health’s program.

“It was up to the health authorities to build on that program, to build in sort of experiential kind of exercises that could help people deepen our understanding of the knowledge base that San’yas was set out to, to accomplish,” says one facilitator.

In an interview with IndigiNews, Turpel-Lafond says that the investigation was a comprehensive review of the healthcare system and the investigative team assessed the Vancouver Island Health Authority, not the performance of specific teams.

“The idea that they were targeted in any way is erroneous,” Turpel-Lafond says. “This looks at cultural safety training and the need to improve it, because there’s rampant racism that needs to be addressed.”

“We do not review specific performance of teams in an employment context. At the same time, all the information, the Vancouver Island Health Authority cultural safety work, was evaluated as a part of the review,” Turpel-Lafond says.

There was not sufficient work at the point of care, she says, no “clinical work to address cultural humility, anti-racism and safety,” and the review concluded that the “current programs and approaches were largely ineffective.”

“They may have had some valuable training material they developed, but they were not running a point-of-care program,” she says.

“[The report] doesn’t talk about under-resourcing or all the incredible work that was going on. It seems like it is blaming Indigenous programs, and does not get at structural problems,” another facilitator says. “It’s quite laterally violent.”

Some of the reports’ findings also reflect what the cultural safety facilitation team says they have requested for years, such as the need for evaluation, community engagement, and additional resources.

“We had been asking for a number of years… to have some sort of an evaluation done on our program. And it just never materialized,” says Ringham-Cowan.

Another facilitator says that they requested an evaluation program, that would include “researchers and some evaluative tools, alongside of all of this work that we’re doing with San’yas and inside of the system, to evaluate how effective all of this work has been.”

Turpel-Lafond confirmed that her team did hear about the need for an evaluative framework. “Their concerns were heard very loudly and included in this review,” she says.

But it’s “a system-wide issue, the system has to produce it,” she adds. “It’s going to have to happen for the Ministry of Health more broadly.

“Cultural safety education involves anti-racism skills, as well as understanding, appreciating and having real partnerships with local First Nations, consistent with, for instance, the direction of the province for implementing the [United Nations Declaration on the Rights of Indigenous Peoples].”

“The health authorities need to focus their specific training on the local context,” Turpel-Lafond says. “First Nations on Vancouver Island were very critical of the fact that they did not feel they received that direct relationship and First Nations Health Authority was very concerned about that.”

Thomas echoes this in her emailed statement, which focuses on the importance of engaging with local First Nations moving forward.

“This partnership approach with local Nations was validated by the recommendations from the In Plain Sight report,” Thomas says via email.

“What we heard clearly and loudly was that the work occurring at that time was disconnected from these communities and was not done in partnership with local Nations. It became clear that transformative change was necessary and the changes we have underway are driven by Indigenous leadership and communities.”

Working with communities is another element that the cultural safety facilitators say they had been asking to prioritize, but were not given the resources to do.

“Since I started this program, I’ve been asking… that we bring community and, that we train community alongside of employees, because to me, it seemed like it was this…colonial approach repeating itself again, where we trained the non-Indigenous people in the organization on Indigenous cultural safety, but we don’t train Indigenous people,” says one facilitator.

“And, we were always told that that wasn’t part of the role,” the facilitator says. “It was FNHA’s role to… work with community. And it was our role to work with employees inside of the organization.”

Although there were challenges, they say they were making progress.

“That team had so much recognition for the work that was happening. And I would say more so at the systemic level, because we’re actually starting to hear and see changes starting to happen,” says one facilitator.

Turpel-Lafond says she recognizes that the teams that have been working on cultural safety training have done important work, but that the work “has not been effective at addressing racism, yet.”

“Maybe it’s developmental. Maybe it’s because they’ve developed pieces, but the idea that they have the answer that has simply not been applied is simply not there from my assessments,” she says.

If someone had been wronged and mistreated, she says, they “should go through a normal employment process like everyone else. This is why I want whistleblower legislation applied, so that if there’s something there, it gets looked at properly.”

Moving forward

In a Feb. 3 internal communications email shared with IndigiNews, Thomas addressed the changes on the team.

“In the past few months, our Cultural Safety Facilitation team has turned over almost entirely. This is hard on many levels, including being without this important resource during a vital time,” the email says.

“But it’s also a chance to rebuild cultural safety and humility at Island Health in a meaningful and lasting way that centres respect, collaboration, and a shared commitment to justice.”

Several team members expressed shock and frustration with this email, and concern for how their team is being portrayed.

“We would all still be there had they tried to work with us and not let go of Yvette,” one of the team members says, pointing to respect and collaboration as a core value of what they have been doing in their work.

“We wouldn’t be able to have these difficult conversations with our colleagues if we didn’t have a relationship with them.”

In an email to IndigiNews, Thomas says that Island Health is “now in the process of collaborating with local Indigenous communities to build a cultural safety framework and team which is reflective of the learnings shared with us.”

According to Thomas, they have or are in the process of recruiting new team members, from a manager of Indigenous engagement and partnership, to new Aboriginal liaison nurses, to a cultural safety manager, as well as a regional director of Indigenous Health and Indigenous patient navigators.

But each of the team members who spoke with IndigiNews is uncertain about their future. They tell IndigiNews that they are “heartbroken” that the team is no longer in place — especially at this moment where anti-Indigenous racism has been highlighted and more people are coming forward. They say they want to speak out because of what is at stake.

“It’s a matter of life and death,” says Ringham-Cowan.

“People have a right to access health care. Indigenous people have a right to access health care — the way other people experience it, in a safe and welcoming way. It’s about saving lives. It’s about treating people with dignity and respect.”

Another cultural safety facilitator says, “I do this work because I want [this] to change, and it is my job to challenge decisions and the systemic oppression that continues to happen. And if I don’t put my voice out there, then I’m not doing my job.

“As you try to push to, to create change and build awareness, you’re going to continually butt up against systems and people… that are in these positions and are going to be very resistant and protective. That doesn’t mean give up, but just know that it’s a long, hard battle. And it’s not going to be easy.”

Odette Auger is the Indigenous Health reporter for IndigiNews. To contact her, email [email protected]