How an Indigenous health centre in Montreal is making care more welcoming
As Shirley Pien-Bérubé walks through the halls of the Indigenous Health Centre of Tio'tia:ke, she pauses to point out all the ways the Montreal-based clinic has grown since it opened in 2023.
"Our services have expanded so much," she said. "We have a diabetic foot-care clinic, we have an optometry clinic, physiotherapy, mental health, clinical psychologist, addictions worker, a spiritual healer."
Just inside the main entrance, a table is set up with sage and sweetgrass. Patients are invited to smudge or make their own medicine bundles. Care here is offered in several Indigenous languages, including Inuktitut and Cree.
Pien-Bérubé works as a health navigator, accompanying patients and advocating for them within the health-care system. She says that's just one of the services offered here.
The clinic aims to close gaps in health outcomes for Indigenous patients, which was one of the 94 calls to action of Canada's Truth and Reconciliation Commission (TRC). Clinic staff also work to overcome deep-rooted mistrust in the health-care system. Data from a recent Statistics Canada survey found about one in five Indigenous people reported experiencing unfair treatment, racism or discrimination from a health-care professional over the previous year.
Pien-Bérubé says patients at her clinic can feel safe and understood.
"They are finally being heard — after how many centuries? We are finally being heard," she said.
WATCH | Inside the Montreal clinic:
10 years after TRC's calls to action
It's been 10 years since the Truth and Reconciliation Commission, which looked to document the impact of residential schools, released its final report. In it, the commissioners pointed to "troubling gaps in health outcomes between Aboriginal and non-Aboriginal Canadians."
Those include disparities in the rates of infant mortality, diabetes and suicide.
Seven of the TRC's 94 calls to action focused on health, including a call to identify and close gaps in health outcomes, funding for existing and new Indigenous healing centres and recognizing the value of Indigenous healing practices.
Fay Virginia Desjarlais, the family violence prevention co-ordinator at the Indigenous Health Centre of Tio'tia:ke, says the clinic is a sign there has been some progress.
"There were gaps in the health system to really understand the needs of the Indigenous people living in Montreal," she said. "People didn't feel safe. A lot of advocates, elders and different organizations came together to say 'We need to do something.' "
Desjarlais says hospitals and other health-care settings can be unwelcoming for many Indigenous people. She has seen patients face discrimination and racism, and has been through it herself with a family doctor.
"I'm diabetic and I was explaining that I'm not feeling well," she said, adding that when she described her symptoms, the doctor replied that when people feel that way, "that's because you're drinking."
She says the doctor then dropped her as a patient because she had missed a single appointment.
"I couldn't believe it," Desjarlais said.
Improving access to health care
According to the website Indigenous Watchdog, which tracks progress on the calls to action, while four of the seven calls related to health are in progress, three have stalled, and none are complete.
The site's publisher, Douglas Sinclair, says the call to identify and close gaps around health outcomes has stalled in part due to a lack of access to government data.
"There's just no political will across the country to sort of co-ordinate activities to identify that information and make it available," Sinclair said.
"You can't develop policy if you're working in a vacuum."
The federal government tracks its response to the recommendations on its website. It includes a health inequalities data tool available for users to visualise and "understand the size of inequities in social determinants of health and health outcomes."
Sinclair says that where there has been progress, it hasn't been enough. He says access to health care remains a major issue for a lot of communities.
Building treatment centres in the North
In Iqaluit, Nunavut, an addictions and trauma treatment centre called Aqqusariaq is currently under construction that will allow people to receive culturally-based treatment in the territory, in Inuktitut, rather than having to travel south.
"Travelling all the way down south to have to take part in treatment and care, you are being removed from your language and culture," said Kylie Aglukark, program director with addictions and trauma at Nunavut Tunngavik Incorporated, a treaty organization that represents Inuit in Nunavut.
"I'm hopeful that once this is up and running that we have an opportunity to build centres in each of Nunavut's regions," she said.
Beyond that, Aglukark wants to build up the Inuit workforce for the centre and other services and to establish more treatment centres in more communities.
"It's very important for Inuit to lead and have that opportunity to provide the services in Inuktitut," she said.
Dr. Terri Aldred, academic lead with the National Collaborating Centre for Indigenous Health, says progress on the calls to action around health has been "moderate."
While she's impressed with new Indigenous health clinics and healing centres like the ones in Montreal and Iqaluit that are "rooted in our ways of knowing and being," Aldred says such projects need to be scaled up to meet the need. She says they also need sustainable, long-term funding.
"Indigenous people that are able to access those services will start to have a different relationship with accessing health care," she said. "And we'll be able to build trust with those providers, and we'll have a positive ripple effect.
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