Interview: Lynette Lucas - Hishukish Tsawalk (Everything is One, Everything is Connected)
A January 22, 2020, research news bulletin from Simon Fraser University (SFU) announced a collaborative project involving SFU’s Faculty of Health Sciences (FHS), the Nuu-Chah-Nulth Tribal Council (NTC) and the First Nations Health Authority (FNHA) aimed at improving Indigenous children’s development and health.
The project, called Hishukish tsawalk (everything is one, everything is connected): Using two-eyed seeing to optimize healthy early life trajectories for Indigenous Peoples, forms part of a global initiative to reduce adult and child onset chronic disease and foster health and wellness. The project is focused on optimizing children’s early environment in order to help “reduce the risks of chronic disease outcomes including mental health, anxiety, depression, substance use and suicide, and cardio-metabolic diseases, such as obesity, type-2 diabetes and heart disease”.
“The project has received one of three Indigenous Healthy Life Trajectory Initiative (I-HeLTI) team grants from the Canadian Institutes of Health Research (CIHR). With more than $1 million in funding over two years, researchers from SFU, UBC and the University of Victoria will collaborate with the FNHA and other partners, including the Indigenous Health Education Access Research Training Centre (I-HEART) and UBC-Providence Health’s Centre for Heart Lung Innovation (HLI).”
We spoke with Lynnette Lucas, NTC Director of Health and a SFU adjunct professor, about the project. Their nursing department has regular interaction with SFU, and having heard of potential upcoming funding for the project, were able to connect with their community from the very start to engage in discussion in anticipation of submitting an application. They are very pleased to have been successful in their application. She notes that the research team from SFU, Jeff Reading, Pablo Nepomnaschy, Charlotte Waddell, and Scott Venners, are vested in approaching from a strong ethic of working with the community to identify how to move forward with research in the community, how to engage, and how to build capacity.
FHNA Chief Medical Officer Dr. Evan Adams, quoted in the SFU research bulletin, comments, “It is very exciting to see indigenous perspectives and approaches placed at the center of health research, the benefits of this will be felt for generations to come.” The SFU bulletin notes, “The project is designed from the bottom up, respecting the nation-based and community-driven principles of the FHNA’s approach to work”. The partners in the project all “agree that Indigenous children’s early environments should include immersion in traditional knowledge, culture and language in community and on the land, and in early childhood education.”
The process of starting the research is just beginning at this point. Phase 1 is the Development grant. The NTC CPNP program is actively involved in the project. NTC’s CPNP program forms part of their Healthy Babies program. Gathering pregnant women together fits in with the traditional model of community providing support for pregnant women and new mothers. Elders and Knowledge Keepers are incorporated into delivery of the programming. They are being engaged in how to fine tune delivery of programming. As part of the research, there is a desire to identify clear outcomes.
The research project offers hope to be able to investigate some traditional models of parenting and support for parents, building an evidence-based service delivery model which can be shared with other communities. The SFU bulletin notes, “The project hopes to find ways of integrating First Nations’ ancient ways of knowing and creating knowledge, with academic health sciences and health services.”
Lynnette notes that services to parents and their children offered by not-for-profit agencies require multiple funding sources, often coming from many small grants and short-term contracts, each with their own accountability requirements. This can create challenges in establishing a sustained delivery model. A large-scale host agency such as NTC is able to maximize tailored programming combining multiple funding sources and to help to provide continuity and a laddered model of integrated support for families, through their nursing, early years outreach, and infant development and supported child development teams. They are also able to offer in-house referral options for issues such as post-partum depression and maternal mental health. The integrated access point allows for a more personalized approach and builds trust and a sense of safety for participants requiring specialized support, along with ease of access to services.
The Canadian Institutes of Health Research (CIHR) outlines that “the concept of I-HeLTI is grounded in the approach to research that takes into consideration the Develop0mental Origins of Health and Disease (DOHaD) by exploring how environmental factors – including Indigenous social determinants of health, i.e. poverty, racism, intergenerational trauma, housing, geography, etc. – interact with an Indigenous child’s genes during conception, fetal life and infancy/early childhood, and the effects that has on health later in life. “
The project is designed to “build infrastructure and capacity along the continuum of care and prevention from pre-conception to pregnancy, infancy and early childhood with a life trajectory perspective”. The SFU bulletin comments, “The research team will build on Nuu-Chah-Nulth’s strengths and promote resilience by using both Indigenous knowledge and Western scientific methods to evaluate existing early child health and parenting programs, and to inform the development and evaluation of new programs. As well, students and community researchers involved in the project will obtain training while participating in public health research and policy development, which creates opportunities for future leadership.”
The issue of food security has already been identified as a priority area for community members, including challenges and additional costs of shopping if you need to access transport with child seats to do a shopping trip, which mean that it may only be possible to shop once a month, along with the high cost of groceries in rural/remote communities.
An added advantage of setting the research in the Nuu-chah-nulth communities, which provides services for 14 communities, including the two served by the CPNP project, is that the findings and outcomes should have immediate relevance for the many rural and remote communities throughout British Columbia.