A call for blended supports in Remote Aboriginal Communities

Recently there was an article in the Winnipeg Free Press about Joe McLeod, who is a 70 year old man who suffers from Alzheimer’s.    Joe, who is originally from Pine Creek First Nation had to leave his home community because there weren’t enough community supports in the community to deal with the level of care that was required for Joe. http://www.winnipegfreepress.com/breakingnews/Chiefs-calling-for-better-elder-care-after-seniors-death-119070794.html   Joe and his wife were more or less forced to move to Winnipeg because of the lack of services available in Pine Creek First Nation.  Over the years Joe had started to become increasingly aggressive and had even attacked his own wife a few years ago.  In Winnipeg Joe was living at a downtown personal care home when an incident occurred in which Joe pushed another elderly man, who hit his head and eventually died.  From the perspective of the Southern Chiefs organization this tragic incident is an opportunity to evaluate the current supports that are available to elderly Aboriginal people in remote geographical locations.  They believe that the ideal situation would still be for elderly Aboriginals to stay in their home communities where community members and family are willing and often desire to look after their aging family members, but are ill equipped and not trained to deal with diseases such as advanced Alzheimer’s and dementia.  In a study conducted by Crosato (2007) it was shown that many remote Aboriginal communities engage in what is referred to as the “Family Circle of Care” this means that many people in the family included cousins, children, aunts and extended family often contribute to the care giving duties of caring for an aged family members.   The entire family was also shown to contribute to the care of an elderly family member in various ways including providing meals, transportation, financial aid, social support and continuous care. (Crosata, 2007, p.6)  This sort of collaboration would be important to help reduce the impact of caregiver burden that could potentially affect the primary caregiver of an older Aboriginal family member.  These kinds of family supports have been shown to be an important component of life in many Aboriginal communities, with many Aboriginal community members identifying caring for family members as being a very important value that has been retained from the past. (Crosata, 2007 p.7)

One of the issues that were brought up by the incident involving Joe McLeod is the belief that many personal care homes and other health facilities don’t provide appropriate care to Aboriginal seniors with a variety of different specific health concerns, including Alzheimer’s.  According to the study conducted by Crosata (2007) many Aboriginal women surveyed found that many healthcare services provided by formal health care were not always seen as being appropriate by the Aboriginal community.  This belief was echoed by the Southern Chiefs organization who has stated that they are trying to work with the government to “move forward on new models of care, where cultural and community supports could be blended with medical care.”  (Winnipeg Free Press, April 2011)

Many of the entries in this blog have touched on the lack of services available to Aboriginal seniors living in remote geographical communities.  It has been shown that many members of many Aboriginal communities are willing and desire to provide care for older members of their community, but unfortunately do not have the resources to do so.  Blending community supports with formal health care services should be a top priority of the government, not only would this help to take some of the burden off of an overloaded provincial health care system, but it would also help to ensure that culturally competent services are provided at a community level.  With a federal election coming up there has been a lot of talk in regards to the lack of services in remote Northern communities, at this point I believe we need more than just talk, we need a government that is willing to act and make real changes for Aboriginal seniors living in remote Northern communities.

Thanks for reading.

Kendall

“Chiefs Calling for Better Elder Care after senior’s death.” Winnipeg Free Press April 1, 2011 retrieved from http://www.winnipegfreepress.com/breakingnews/Chiefs-calling-for-better-elder-care-after-seniors-death-119070794.html

Crosato, K.E., Ward-Griffin C, Leipert B. (2007) Aboriginal women caregivers of the elderly in geographically isolated communities. The international Electronic Journal of Rural and Remote Health Research, Education, Practice and Policy 7(796)

Truth and Reconciliation

On June 11, 2008 Prime Minister Stephen Harper apologized on behalf of all Canadians for the Indian Residential Schools system. He is quoted as saying, "The government recognizes that the absence of an apology has been an impediment to healing and reconciliation. Therefore on behalf of the Government of Canada, and  all Canadians, I stand before you, in this Chamber so central to our life as a country, to apologize to Aboriginal peoples for Canada’s role in the Indian Residential Schools system" (CBC News, 2008, p.2). 

It was  determined that the government of Canada , the Roman Catholic, Anglican and United Church had  all been responsible for  causing harm to Indigenous people their families and communities between  1860 and the final closing of the last federally run school in 1996. As a result all three churches apologized for the effects of the Residential schools. The Anglican Church apologized in 1993, the United church in 1986, and the Presbyterian Church in 1994, all far earlier than did the Canadian Government.  In the year 2001 as a result of the rulings of the courts, these churches paid reparations that were to be given to Indigenous survivors who proved that they had attended a residential school. This money was given as reparation in order to help with treatment to improve their lives (Aboriginal Running, 2010).

 

Many of the survivors of Canada’s residential schools are elderly. In an article from CBC News, it indicates that “the average age of a residential school survivor is 57 years old. It is estimated that every day 5 survivors die”.  These individuals entered into the school system at a young age and have felt the effects of the schools for all of their lives. The impact that the damage of physical, sexual, and emotional abuse has had on Residential school survivors has resulted in many lawsuits against the Canadian government  as was pointed out by Chrisjohn, Wasacase, Nussey, Smith, Legault, Loiselle & Bourgeois (2002), “ The occurrence of sexual, physical and emotional abuse that occurred in residential schools that aroused the public interest,  stimulated governmental action and formed the basis for more than 8,000 civil charges against churches and the government”(p2). As a result of the law suits and allegations, in 2005 the Canadian Government issued an announcement that there would be a two billion dollar compensation package set out for survivors of residential schools. Part of the details of the agreement included an initial payout for each person who attended a residential school of $10,000, plus 3,000 per year, over 80,000 individuals are eligible. (CBC News, 2008)

                        

In 2008 another landmark event occurred, Prime Minister Steven Harper’s apology. This apology by the Nation’s leader marks the first formal apology for Residential Schools by the Canadian Government. The public’s reaction to this statement was mixed, some thought that the apology was well done, others felt that there was too much information left out, while some individuals simply thought this apology was not it was not enough (CBC News, 2008).

 

The Canadian government formed the Truth and Reconciliation Commission as part of the court approved Residential School Settlement Agreement. It was negotiated between legal counsel for former students, legal counsel for churches, the Government of Canada, the Assembly of First Nations and other Aboriginal organizations (CBC News, 2008).  

The Truth and Reconciliation Commission (TRC) of Canada was modeled after the truth and reconciliation hearings of post-apartheid South Africa. Its purpose is to help repair some of the emotional and psychological damages caused by government mandated schools and to help build new relationships between Canada's Indigenous People and everyone else (Whyte, 2009).  It is an official independent body that will provide former students and anyone else who has been affected by the residential schools to have opportunity to tell their stories (CBC News, 2008).

 

On July 1 2009, Justice Murray Sinclair the new chair of the commission of Manitoba, and commissioners Chief Wilton Little Child of Alberta and Marie Wilson a broadcaster from the Northwest territories formally began their five year mandate to travel around Canada in order to create a record of what had happened in Canada's Indian Residential schools between the years 1886- and 1996 (Whyte, 2009). Together these three members of the TRC will record the testimonies of our Indigenous people about their experiences in the Residential  School system that had been organized by the government and the Anglican, United, Presbyterian, and Roman Catholic Church. TRC member Marie Wilson stated that "We did not get to choose our history. We cannot change the pain which Residential schools has caused, we can take a stand to support  the Aboriginal people in Canada they are important" (Aboriginal Running, 2010).

In reading research and by listening to a former residential school survivor the TRC experience has not been pleasant.  A former residential school survivor is quoted as saying “For a lot of people, when they tell your story, it’s the first time they’ve told anyone. It takes courage to tell someone else what happened to them and it is traumatic but with each telling it gets easier" (Whyte, 2009).

I had the opportunity to speak with an elderly residential school survivor who explained of the difficulties of telling her story. In fact she has decided not to tell her story because the pain is to unbearable to speak about.  The TRC may be looked at as a step for Indigenous people to heal from their experiences but it can’t erase what has happened. The residential school survivor experience for our Indigenous people can never be forgotten.

Arlene

Art Therapy with Indigenous Seniors

One of the things that I have noticed in my field placement is the role that art has to play in the recovery process for mental illness.  At my field placement a couple times a week we conduct a craft group which gives patients the opportunity to express themselves in an artistic way.  Participation in the craft group is optional, but I have noticed that many people attend this group and seem to get a lot out of their participation in the group.  Watching this group has led to me think about what the potential role of art therapy in helping Aboriginal seniors express themselves and work through trauma.  According to Recollet (2009) Arts based methods have been shown to be useful in helping trauma survivors to develop self-esteem, socialize with others and to improve psychosocial functioning.  Not only have art based therapy practices been shown to be helpful to trauma survivors, but I believe that art-based therapies would be easily adaptable to many Indigenous communities because of the importance that is placed on art and different creative forms of expression.  I recently came across a quote which I found to be quite relevant to this topic.  Apparently Louis Riel is quoted as saying “my people will sleep for over one hundred years, and when they awaken it will be the artists who lead them.”  (Gattermann, 1999)  I believe that this quote speaks volumes to the importance that art has played in the lives of many aboriginal and Métis people for many years.  There is a lot of written literature that discusses the importance of art, symbols and different rituals to Aboriginal people.  According to Dufrene (2005) Aboriginal people generally regard art as an element of life which is interconnected to all forms of art including, dance, and song.  In addition an Aboriginal perspective sees art and spirituality as being one in the same. 

As I researched this topic I came across a number of different Aboriginal healing centres that have incorporated the use of art therapy into their programs.  According to a study conducted by the Aboriginal Healing Foundation only 10 out of 104 healing programs didn’t include an arts based program from the period of 2007 to 2009.  One of the healing programs that I came across which offered one such program was the Waseskun Healing Centre located in Quebec. http://www.waseskun.net/eng/Waseskun%20Booklet%20-%20ENG.pdf   According to the Waseskun Healing Centre Aboriginal people have the opportunity to explore their creative side using a variety of different mediums including paper, canvas, sculpture, and wood.  The idea behind the art therapy program according to the Waseskun Healing Centre the goal of the program is “to reflect on the thoughts and feelings that arise during the art-making process.”  Additionally the painting or sculpture becomes a tool for exploring thoughts and feelings with the therapist, either in a group setting or on an individual basis.  The goal of the art therapy in this case is to improve self-awareness and improve communication.

When using Art therapy to work with Aboriginal seniors one of the recommendations that is proposed by Gattermann (1999) is to begin the art therapy session by asking the individual to think of a story from their past.  I believe that this approach to working with Aboriginal seniors could be very beneficial because as we know many Aboriginal seniors have very rich, but often traumatic histories.  By using a storytelling approach to begin the art therapy session I believe that this allows for the opportunity for Aboriginal seniors to either begin to work through a traumatic history through Art or to build on the positive experiences in their life and possibly strengthen their cultural ties through the use of Art.  In addition Gattermann (1999) recommends that in order to strengthen the therapeutic alliance during art therapy that facilitator needs to make sure that they are using culturally sensitive materials which are familiar to the client.  Many of the materials recommended include leather strips or cords, beads, soapstone, fur strips, and natural materials such as wood, bark or rock.

Although art therapy may not be the most mainstream approach to working with people who have a trauma history  it has in fact proven to be one of the most effective approaches.   Because many Aboriginal communities identify so strongly with art and creativity the use of Art therapy with Aboriginal people is considered to be a good fit.  This extends into working with Aboriginal seniors who may not only identify with the creative process of art therapy but may also benefit from the therapeutic aspects of art therapy. 

Kendall

References

Archibald, L. (2010) Creative Arts, Culture and Healing: Building an Evidence Base. Pimitawisisn Journal of Aboriginal and Indigenous Community Health 8(3)

Dufrene, P.  (1991) Utilizing the Arts for Healing through a Native American Perspective: Implications for Creative Arts Therapies. Canadian Journal of Native Studies

Gattermann (1999) Using Art Therapy with Aboriginal Offenders.  Concordia University Thesis retrieved from http://spectrum.library.concordia.ca/927/

Substance Abuse and Indigenous Peoples

Indigenous elders around Canada, the United States and Australia, have had a history of negative experiences such as colonization, oppression and assimilation. Many were removed from their families or communities, forced into residential schools where they were stripped of their language and culture. The treatment of these groups of individuals has created severely damaging effects both on the micro and macro levels. Castellan (2008) as cited in Kirmayer, Whitley and Fauras (1996) stated that "Aboriginal peoples in Canada have faced distinctive forms of adversity. They have been marked by colonization, cultural oppression and expropriation of land and resources”. (14)

Unfortunately many of the elders that have been touched by those tragedies have not been able to cope with the pain they have suffered in their pasts. In order to hide the pain and torment that they are feeling, many have turned to various types of addictive substance.  The inability to cope with the suffering that occurred in the residential schools has lead to various forms of abuse being insidious in Aboriginal communities today. Not only has this trauma had an impact on the survivors, it has had a sustained impact on their families as well. (Indian Residential Schools, 1994)

In additional to the negative psychological effects that have been experienced by all persons involved, there have been impacts to survivor overall health, leading to higher rates of substance use disorders than seen in the general population. (Kirmayer et al., 1996) The use of drugs and alcohol has been found to be common and dangerous problem among the Indigenous people of Canada, and one that warrants a high level of concern. (Aboriginal Health, 1996)

It is however difficult to calculate the percentage of elderly from the Indigenous population, who are substance abusers in Canada as there is a lack of  available statistics regarding the percentage who are substance abusers. Reading (1999) mentioned there is a need to conduct more detailed longitudinal surveys on the health and social services needs on First Nations and Inuit elders, as there are no questions regarding alcohol consumption, drug use and abuse currently in those surveys.  

Although there are many different substances that are abused by Aboriginals, alcohol abuse is the most common. Statistics and research indicate the high percentage of alcohol amongst Aboriginal communities, "Alcohol use is of great concern to people in First Nations and Inuit communities. Surveys show that  around 75% of all residents feel alcohol use is a problem in their community, 33% indicate that it’s a problem in their own family or household, and  25% say that they have a personal problem with alcohol " (Khan, 2008)

The excessive use of alcohol use by seniors can endanger their lives and physical health. “Drinking at an older age can have additional negative effects: exacerbate some medical conditions, reduce the ability to function, increase the risk of falling, negatively interact with medication” (Buddy T, 2009) The consumption of alcohol can cause a variety of adverse physical effects to numerous systems such as: the heart (high blood pressure), liver (cirrhosis), digestive system (malnutrition and vitamin deficiency), neurological (problems with speech, actions, and thinking) and finally bones (fractures and breaks). (George, n.d)  

Substance abuse has affected our Indigenous population mentally, emotionally physically and spiritually. There is a need for all levels of government, health care professionals and communities to recognize and provide health and financial needs. Nickens (1990) states that “In order to change the health status of minority populations, health professionals must take into account the values, attitudes, culture and life circumstances of the individual. If we are to achieve salutary changes in the health status of minority populations , health professionals and designers of health programs must cope with the extraordinary diversity of the Indigenous  populations” (p.3)

In order to prevent solvent abuse and provide treatment for substance abusers, Indigenous people need to be educated about the effects of substance abuse. There is a lack of treatment centres on reserves and even within urban areas. The government needs to support the building of more drug treatment centres and traditional healing and counselling services need to be established in order  to start the process of healing our Indigenous people.  

Arlene

The Under Representation of Older Aboriginal Adults’ Experiences in the Upcoming Elections

When I first started this blogging assignment I was shocked at how little information was out there on the different issues that Aboriginal older adults encounter as they age. The more I have researched this topic the more aware I have become of the severe under representation of Aboriginal persons in Canadian institutions. Within health care there is a serious problem of cultural competency among health care professionals; various competency testing methods do not take into account these peoples’ lived experiences. Home care and the palliative care program are under developed in the North and cannot meet the needs of the people. Food availability is scarce in the North and in down town city locations preventing older adults to have the opportunity to have nutritious food at a reasonable cost. The people who work in Canadian Universities do not represent the population of Canadians, and unfortunately, the only Aboriginal professors I have ever encountered in the past 5 years have been in the Faculty of Social Work or in the Native Studies department. In our Canadian government, which is supposed to mirror the make-up of society, Aboriginal people and their perspectives are not reflected in the structure of our democratic government. We make laws, pass policies, and structure society without the input from a large majority of Aboriginal peoples, but we expect them to abide by it even when it is not compatible with their belief systems or life experiences.

I was reading an article written by Hunter (2003) in which she outlined the lack of Aboriginal participation at the voting polls. She raises some very interesting points that highlight the need for more inclusion of Aboriginal issues in the current government agenda, by failing to take Aboriginal issues into account during the campaigns potential Aboriginal voters are deterred from voting as they do not feel represented by any of the candidates. Hunter notes that:

The federal government, focused on fiscal restraint and reforming the administrative processes of Indian Act communities,²³ has not given priority to addressing Aboriginal electoral participation in federal political institutions. Because Aboriginal people do not generally have the concentrated populations necessary to collectively affect voting outcomes, there is no direct incentive to place Aboriginal issues on the political agenda (Retrieved from elections.ca, on April 15, 2011).

My personal experience of working in a personal care home has taught me that during election time the candidates come to the care home. Why is that? Because in Canada the largest group of voters are ages 65 plus.  In Canadian society senior citizens are the largest group, proportionately, who vote. What about Aboriginal seniors? There are many barriers in place that often prevent Aboriginal seniors from coming out to the polls. Hunter (2003) outlines four main historical barriers that are still entrenched in the historical memory of Aboriginal people: 1) this historical use of voting as a means to assimilate Aboriginal people who chose to exercise their right to vote; 2) the neglect on the part of the Canadian electoral system to take into consideration the Aboriginal community’s concerns; 3) the lack of Aboriginal representation in the political party system; 4) the inconsideration on the part of the federal electoral administration to meet the needs of Aboriginal voters and abide by employment equity standards. These four barriers are etched into the collective memory of Aboriginal people and continue to contribute to the high voter apathy among this group of Canadians.

I do not want this blog to focus only on the negative, because I do believe things are changing. I believe that Aboriginal people’s voices are beginning to be heard. I believe that the older generation’s experiences are being taken into account. We are only just beginning the Truth and Reconciliation Commission in which the heart breaking stories of past generations are being shared for all to hear. I wanted to find a positive example of Aboriginal representation in the current government. I looked no further than Winnipeg South’s Conservative MP Rod Bruinooge. Rod Bruinooge was born in Thomson Manitboa to a Dutch father and Aboriginal mother (Retrieved from www.voterod.com, April 15, 2011). He has a Métis background and has been very active in Aboriginal initiatives in Winnipeg for the past decade. From 2003 – 2005 he worked as the Director for the Winnipeg Aboriginal Film Festival. In 2006 he was appointed as the Parliamentary Secretary to the Minister of Indian Affairs and Northern Development and Federal Interlocutor for Métis and Non-Status Indians. Rod Bruinooge strives to incorporate his Aboriginal ancestry into his current way of life and political career.

I would strongly recommend watching this video of Judge Murray Sinclair. As I watched this video I became aware of the inherent differences between Aboriginal approaches to justice/government/systems and the dominant Euro Canadian approach. I feel that the views expressed in this video depict the tension Aboriginal people experience as they attempt to bridge the gap between their culture and Canadian culture. http://www.youtube.com/watch?v=1LoXRW8_R9o

Thanks for reading,

Michelle Kehler

References

Bruinooge, R. (2011). Retrieved from: www.voterod.com, April 15, 2011

Hunter, A. (2003). Aboriginal participation in elections: Exploring the issues of Aboriginal representation in federal elections. Electoral Insight, Retrieved from: elections.ca, on April 15, 2011

Indigenous views on Dementia and Memory Loss in Older Age

            Dementia, everyday in my placement I see the effects of this “disease” “stage of life” “natural part of life” on families and individuals. Dementia has many different forms but manifests in some common ways. No matter what sort of dementia a person many experience it marks a drastic life change for both individuals and their families. I would like to share with you the findings of a study done in BC about Elders’ views on Memory loss.

Traditionally dementia was seen as a “natural part of the life cycle” however colonization has influenced the degree to which Indigenous people continue to ascribe to these beliefs (Hulko et al, 2010). It is important to recognize that there is much diversity with in the term “Indigenous”. There are many different nations who all have unique understandings and practices. Additionally some Indigenous people do not ascribe to traditional belief and practices and may even belong to other religious organizations. Therefore it is important to remember that although there is a “traditional Indigenous view” of dementia, this view may not be assumed by the particular client or family you may work with.

In the past dementia has been seen as “not a concern” for Indigenous people because of its rarity with in the population (Hulko et al,  2010).  However this is no longer the case, Indigenous people are living longer and coupled with multiple risk factors for dementia (diabetes, obesity, poverty etc.) are actually at a greater risk (Hulko et al, 2010). Research by Hulko et al (2010) has begun to address the topic of Indigenous people and dementia. They state that services especially in the North are not adequate or appropriate for the population’s needs and are not congruent with Traditional Indigenous practices.

The study by Hulko et al, (2010) outlines a number of different view about dementia and memory loss as explained by Indigenous Elders from BC:

-Memory loss was seen as a natural part of life by the broader community but was not necessarily welcomed by the Elders who were experiencing it for themselves. (p. 327)

-Many believed that changes from eating natural foods to store bought foods has made memory loss more common. (p. 327).

-Others stated that “accidents, age, alcohol and drugs, loss of oral care, medication, pollution and trauma (including residential schools)” were all cause for greater occurrences of memory loss. (p.327).

-Prevention strategies put forth by Elders were “talking, eating healthy, getting sleep, being chemical-free, avoid gambling and exercising the mind, body and spirit”. (p 327). These prevention methods were commonly called “mind always going”. (p.327).

-Interestingly the Elders in this study viewed memory loss as environmentally caused contrary to a westernized view that labels it as “brain disease” (Hulko et al, 2010, p.238).

Traditionally dementia was seen as a natural process or part of the family circle (Hulko et al, 2010, p.329).  They explained that as we age we become more independent and then we begin to return back to a child like state. This child like state is considered “closest to the creator” and is highly valued (This is very different from a westernized view of “child-like” which in reference to an Older Adult would be considered infantilizing of them) (Hulko et al, 2010, p.330). At times this closeness to the creator can also be considered an ability to communicate with the spiritual realm (Hulko et al, 2010).

            One part of this study that particularly struck me was that the researchers found that although they spoke with Indigenous Elders in sharing circles that they found that many of them expressed views that were more often congruent with a “shémá way” or  “white way” emphasizing "your dementia" rather than the traditional views discussed above (Hulko et al, 2010, p.330). This served as a reminder of the strong effects that residential schools had on the survivors (Hulko et al, 2010).

So what can we learn from this information? I believe that as social workers we have a duty to become culturally competent and to become aware of our own positions and viewpoint and how they may differ from those we are working with. Too much hurt has been inflicted on Indigenous peoples because we have not taken the time to listen and to understand their needs. Self reflection and a listening ear I believe can go far in trying to be culturally competent. Remembering that simply because someone is a member of one group does not necessarily mean that they will ascribe to all the particular values and practices. Dementia in particular is a difficult part of life for anyone to experience. There are many losses involved and changes in roles and responsibilities within families and communities. As social workers I think that it is important that we recognize this struggle but also be open to seeing the beauty in the life cycle.

I recently worked with a family who was in the process of placing their parent in a personal care home. This family had attempted everything they could think of to care for this family member at home but it had become too dangerous for her to live in her community as the dementia progressed. I saw the love that this family had for this patient and that they did not want to place her in a PCH.  There were over 10 people in the room, more than I had seen before in similar meetings with other families.    Some had travelled for hours to be at this half-hour meeting. This woman was truly loved and respected. I was touched by the care and concern the family paid to this woman and her best interests.

            I always find that my own views are challenged when I learn different perspectives on life. This is one of them. As I prepare to graduate I look forward to learning more as I work with others and hear their stories. I look forward to learning more from people themselves rather than from a textbook or journal articles. I hope that the knowledge I have gained as a student will help me as I take the next steps as a social worker.

Hulko W., Camille, E., Antifeau, E., Arnouse, M., Bachynski, N., & Taylor, D. (2010). View of first nation elders on memory loss and memory care in later life.  J Cross Cult Gerontol. 25(4). 317-342. doi: 10.1007/s10823-010-9123-9. http://www.ncbi.nlm.nih.gov/pubmed/20593232

Resilience of Residential School Survivors

It is with hesitance that I begin to write this blog. This comes because of the gravity of the subject. I find that in Social Work we often speak of the “effects of residential schools on Aboriginal people” but I feel as if many of us do not understand what it really is we are speaking of. I come to this discussion and I admit that I know very little of what it means to be a survivor or a family member of a survivor of the residential school system in Canada. As well the knowledge I have on this subject is based mostly on academic research and instruction.

Kendall has already written a great post on this topic however I wanted to address it again in a slightly different light.  We had a guest speaker join our class a few weeks ago. She was studying the effects of earlier experiences of trauma that resurface in later life. She explained that people who experience trauma often suppress their emotions and do not speak about it. Although this ability to suppress is a survival mechanism that can help individuals survive their experience of trauma it can continue throughout their lives and some may never seek help to address or discuss their experience. She explained that this has particular impact on older adults and especially those who have dementia. As older adults’ mental abilities begin to weaken individuals may not be able to suppress their emotions and memories as they are used to. Additionally as long-term memories stay intact the longest experiences of younger life may be at the forefront.

Although there is little literature on Early-Life trauma in older age I think we can draw connections between the information above and the aging survivors of residential schools. Although I would hope that all of us Social workers would know what the Residential Schools were I also know that many other do not. If you are wanting to learn more please visit the website www.wherearethechildren.ca (WATC) . This is a fantastic interactive website that is designed to educate anyone about residential schools.

In brief the Government of Canada along with both Catholic and Protestant churches designed residential schools essentially to “kill the Indian in the Child”(WATC). These schools came in different forms but all inflicted much trauma upon the children who attended (Stout and Kipling, 2003). Although some children had good experiences the majority experience severe physical and sexual abuse, separation from families, extreme work conditions, diseases, loss and devaluation of culture and language, fear, loneliness and death of fellow classmates (WATC).  During their time in school, survivors learned to cope in different ways such as challenging authority or repressing their emotions (Stout and Kipling, 2003). For some however once they left the residential school system their coping methods remained and created difficulties in adult life (Stout and Kipling, 2003).

I think it is reasonable to assume that some aging Residential School survivors may experience resurfacing of their earlier-life trauma in later life. As social workers we may be the ones who are working with these individuals and their families. Understanding the impacts of residential schools on individuals, families and communities of people throughout generations is essential to anti-colonial and decolonizing social work. Part of the interest and value of working with Older Adults is the wealth of experiences and knowledge that they have acquired over their lifetime. However at times their experiences are not pleasant or happy. We as listeners have the benefit of recognizing the strength and resilience of these individuals who have overcome immense adversity.

Resilience is such an important part to remember when working with these individuals (Stout and Kipling, 2003). We call them “survivors” for a reason. The adversity that survivors of residential schools experienced is unfathomable and yet they are not defeated. Stout and Kipling (2003) use the term “risk pile-up” which describes the multiple levels of risk experienced by Aboriginal people throughout their lifetime. As social workers we are unique in our strength-based approach. Although we cannot ignore the realities of pain and suffering too often experienced by our clients we also have the privilege of seeing the resilience and strength of our clients. This is a very powerful tool we have to work with and empower our clients.

I experienced this when I worked with an Indigenous woman who had experienced much loss in her life and recently in very compounded ways. She would often cry and state that she didn’t understand why she was so sad. She expressed feeling embarrassed that she would cry so much. One day I was visiting with her when she began to recount all of the losses that she had endured in her personal life.  She then apologized for her tears. I told her that it was ok for her to cry if she needed to. I told her that she had been through so much and I understood why she would be sad. Then I shared with her the strengths I had seen in her. She demonstrated strength to carry on despite many difficult life experiences and she had a very bright smile. I could see that this made an impact on her and we had a few more very nice talks before I finished my placement. I think about this woman at times and remember the stories she told me. When I told her about the strengths I saw in her I really meant it. I truly did see those things in her and I am thankful that she shared her story with me.

-Meagan

Stout, M.D. & Kipling, G. (2003). Aboriginal people, resilience and the residential school legacy. The  Aboriginal Healing Foundation Research Series. Retrieved from http://www.ahf.ca/publications/research-series

Aboriginal Healing Foundation & Legacy of Hope Foundation (2009). Where are the children: healing the legacy of residential schools. Retrieved from: http://www.wherearethechildren.ca/ 

The Crucial Role of Older Aboriginal People in the Suicide Epidemic

In order to fully appreciate this blog  please watch these two you tube clips in the respective order that they are displayed: 1) http://www.youtube.com/watch?v=Eynv-E35mHM and 2) http://www.youtube.com/watch?v=i2AHcitZ4x4&feature=related

The two videos powerfully demonstrate the effects that Aboriginal youth suicide has on an entire community. Issues are discussed such as: spirituality, historical trauma, intergenerational pain, identity loss among youth, coping through addictions, and the urgent need for Aboriginal youth to reconnect with their culture through dialoguing with elders and grandparents.

The issue of Aboriginal youth suicide is not something to be taken lightly. According to Kirmayer, Brass, Holton, Paul, Simpson & Tait (2007) rates of Aboriginal youth suicide are currently higher than that of the general population. The overall suicide rates among non-Aboriginal people in Canada has declined, however in some Aboriginal communities they have significantly risen in the last two decades. It is also noted that Inuit rates of suicide are 6 to 11 times higher than the national average suicide rate. Why is suicide so prevalent among one particular group of Canadians? What are the factors that have brought these communities to such dire circumstances? And what is the role of the older Aboriginal generation in all of this?

Kelly (2007) identified three specific cultural effects that Aboriginal reserves have experienced over the past century: first, there has been an overall breakdown of cultural values and belief systems through the interruption of the normal family life cycle by the Indian Residential Schools and the Child Welfare “Sixties Scoop”; second, there has been a loss of control over both land and living conditions among Aboriginal peoples living on reserves; and third, prejudice, racism, and discrimination have contributed to the development of negative attitudes within non-Aboriginal persons towards Aboriginal persons. Kelly posits that these three factors have set the stage for the marked increase in Aboriginal youth suicide on reserves. The Advisory Group on Suicide Prevention (2003) has noted that Aboriginal suicide rates are two to three times higher than non-Aboriginal suicide rates. Aboriginal youth’s suicide rates ages 15-24 are five to six times higher than those of non-Aboriginal youth.

Masecar (2007) has examined the effects that Aboriginal youth suicide has on the community as a whole. One youth suicide has a ripple effect within the whole and further deteriorates reserve communities. It is a vicious cycle, because research has shown that a break down in reserve communities only further increases suicide risk for the community as a whole. To restore healing and harmony within the reserve community one must first examine the source of the intergenerational pain. The community needs to address the historical and cultural trauma it has endured for the past 200 years.

Masecar (2007) defines cultural and historical trauma as a cluster of events that disrupts the social and cultural patterns of a community. The disrupted patterns are transformed into maladaptive patterns of behaviour which are then manifested as negative symptoms such as substance abuse, addictions, and self-destructive behaviours. The break down in community social functioning can last for years, or in this case, centuries. Disruptive events that have led to the breakdown in normal Aboriginal family processes, and the passing down of culture from one generation to the next are:  the Indian Act, the residential schools, the sixties scoop, and the systemic racism built into Canadian institutions. The high rates of Aboriginal suicide only further traumatize and imbed pain within the community. The effects of historical and cultural trauma within the community is then perpetuated and re-embedded with each loss endured.

What is the role of Aboriginal older adults one may ask? After the previous discussion focused on the disruption of normative family life cycles, and the interruption of the transmission of Aboriginal culture from one generation to the next; the future of Aboriginal culture lies in the hands of grandmothers, grandfathers, and Elders who have the culture and the ways of their people within themselves. The older generation is a fading source of Aboriginal culture. There we find the language, wisdom, and teachings of centuries past. It is through this older generation that the transmission of culture will be passed down to the younger generation.

Hallett, Chandler, & Lalonde’s (2007) did an exploratory study on Aboriginal language retention and the buffering effect it had within Aboriginal communities against suicide. It was discovered that between 1987 and 1992 bands in which the majority (over 50%) of population who had working knowledge of conversation level Aboriginal language experienced low to absent youth suicide rates; 13 out of 100, 000 youth. Such rates were below provincial standards of both Aboriginal and Non-Aboriginal suicide rates. In contrast, those communities in which less than half the population  reported conversational knowledge had suicide rates six times greater  than the previous; 96.59 out of 100, 000 youth. It was determined that language retention is an indicator of cultural resilience within Aboriginal communities. The inverse relationship between language retention and suicide rates demonstrate that language, as an indicator of cultural retention, is a strong buffer against suicide in reserve communities.

Who carries the language within them? It is the older generation that holds the key to healing and to the restoration of the traditional way of life. Currently, Aboriginal youth are beginning the process of dialoguing with their grandparents, elders, aunts, uncles and community leaders in an attempt to restore what was once lost. I hope this helps to highlight the extremely important role that older Aboriginal people have in their culture, especially during this limited time that they have to pass what was once thought lost, onto the new generation. Thanks for reading.

Michelle Kehler

References

Advisory Group on Youth Suicide. (2003). Acting on what we know: Preventing youth suicide in First Nations. Ottawa, ONT: Health Canada.

Hallett, D., Chandler, M., & Lalonde, C. (2007). Aboriginal language knowledge and youth suicide. Cognitive Development, 22, 392-399. Retrieved March 28, 2010, from Google Scholar.

Kelly, F. (2007) Traditional and contemporary approaches to youth suicide prevention. Ottawa, ONT:  National Youth Council

Kirmayer, L., Brass, G., Holton, T., Paul, K., Simpson, C., & Tait, C. (2007). Suicide among Aboriginal people in Canada. Retrieved March 28, 2010, from:  http://www.ahf.ca/pages/download/28_13246

Masecar, D. (2007). What is working, what is hopeful. Ottawa, ONT: Health Canada.

Culturally Appropriate Competency Exams

 Imagine being a 76 year old man who is dying of cancer. Your first language is not English, you are in pain, you don’t know who all these people are that are trying to help you, and you are scared. You are informed that you cannot go home because home care services are not able to meet your health needs at this point in your illness. You have been told that you are too healthy for the palliative unit, because all of your presenting symptoms upon admission have been taken care of. Your prognosis is not clear at this point, so you do not fit the criteria of admission into a hospice, but still the doctors insist that the unit is not the best place for you at this point. The only option left is to sign the Application for Long Term Care, and wait to be paneled for a Personal Care Home. When you disagree to dismantle your estate and sign the papers the doctor calls into question your competency.

I find the above scenario frightening. It is frightening because it is a situation that is too common in the hospitals and in-patient facilities. There are a number of factors at work in the situation above. This gentleman is in pain and has reverted back to his native language. He does not necessarily understand all that is happening to him, this is not to say that he does not have the capacity to understand, but that the information is not being presented to him in an understandable fashion. He is not complying with the medical team to sign the papers for long term care, and should he refuse this option than his competency must be called into question and tested. This man was competent, he could make decisions; he was just ill and did not want to accept the options that the medical system was offering. What I saw was a man who refused to comply with what the system felt was best, and as a result of which his competency and capacity to make decisions was called into question. The system was not challenged, but a man’s competency was.  

When the masters student came into our class and gave a talk on her thesis project which was focused on competency exams, the above scenario came to mind. I immediately recognized the need for a team of health care professionals who were removed from the situation, but would be the ones to administer a competency exam. Should the doctor from the scenario above be the one to administer the exam on the gentleman than the results would be biased and the validity of the test would be compromised.  As social workers it is our job to see the whole picture and to challenge the system when it is apparent that an abuse of power and authority are occurring.

I want to expand on this topic one step further. I want to look at the issue of competency testing and our Aboriginal older adults. How do we actually test a person’s competency? How is a simple 15 minute Mini Mental State Exam able to give enough information about an individual to take away their ability to make decisions for themselves? In the above scenario the older gentleman was not born in Canada, and English was not his first language. Even though Indigenous older adults were born in Canada, their culture and life experiences are vastly different than those of a Euro-Canadian older adult.  Indigenous older adults are coming from a collective culture, many of them have grown up on reserve communities, and for some English is not their mother tongue. So how would a 15 minute examination take into account the inherent cultural differences that have shaped this person’s life?

Cattarinich, Gibson, and Cave (2001) examined the cultural barriers present in many of the competency exams administered by health care professionals. The goal of their research was to help health care professionals develop new tools to help in the development and administration of cross cultural competency assessments. What I thought was particularly interesting about this article was that it highlighted the fact that Aboriginal people are over represented in mental health services.  This fact supports the article’s importance for furthering research, as it would be unjust to have a certain population over represented as incompetent, due to a lack of cultural awareness when administering a competency exam. The barriers present when administering competency exams to Aboriginal seniors lies in both the content of the exam questions themselves, and in the process’s through which the exams are administered. Neither the content of the questions nor the interview process take into account the older Aboriginal’s life experiences and cultural lens.

The term Degrees of Acculturation was used by Cattarinich et al (2001) in order to determine the varying levels of diversity present within the older Aboriginal community. Four categories of particular life styles were developed to gain an understanding of how Aboriginal people have responded to colonization, the four categories include: traditional, marginal, bicultural, and assimilated. The group most affected by problematic competency exams are those who adhere to a very traditional life style. One of the suggestions that the authors gave was to develop an understanding of how the older Aboriginal person has lived their life, before their cognitive capacities are examined. In this way the tester can develop cultural competency as it relates to this individual, as there are many contradictions between Euro-Canadian conventional ways of testing and traditional Aboriginal life styles.

Cultural considerations should be taken into account when a competency exam is being administered, as such cultural influences will have an effect on the outcome of the exam (Cattarinich et al., 2001). The study found three key areas of cultural “interference” if you will, or better defined as Aboriginal culture that clashed with conventional testing methods. The first is the Aboriginal ethic of non-competiveness. In competency examinations there is a built in tendency in the very process of administering the exam that expects the person taking the exam to demonstrate their knowledge to the full extent. Whereas in Aboriginal culture traditional elders will often down play their knowledge in an act of humility, so as to acknowledge how small they are in comparison to the Creator.  

Cattarinich et al (2001) identify the next area of incompatibility between competency exams and Aboriginal culture as it relates to Aboriginal attitudes towards gratitude. The administrator of the competency exam is told to, as part of the process, encourage and praise the individual taking the test. However, in Aboriginal culture displays of gratitude or approval are not commonly shown. It is believed in Aboriginal culture that the intrinsic satisfaction that comes with performing a task is thanks enough, anything above and beyond that is viewed as superfluous. Therefore when the administrator of the examination is encouraging and praising the person taking the exam, the older Aboriginal person may respond by “underachieving” as a way of trying to ease the discomfort they are feeling.

The last area of conflict I am going to discuss is what Cattarinich et al (2001) identifies as communication style and taboos. The authors view the misunderstandings that health care professionals often have of Aboriginal culture as the direct result of cultural incompetence on the part of the health care system as a whole. They state:

Native American Indians emphasize a non-verbal communication style. Moderation in speech and avoidance of direct eye contact are nonverbal communications of respect by the listener, especially for respected elders or authority figures. Traditional Native American Indian people are not rewarded for asking questions or verbally analyzing situations. Rather, they are expected to learn through patience and observation (p. 1472).

In closing, after my own experiences with the possibilities of deeming a man incompetent due to cultural differences, and after reviewing the previously discussed article, I feel that as social workers it is our responsibility to advocate on behalf of older Aboriginal adults who find themselves in a system that does not understand them. Competency examinations do not take into account fundamental historical differences that these individuals have lived through. The question and response format of a competency exam is not compatible with traditional ways of communication that older Aboriginal adults have been socialized with. It is only through open communication with Aboriginal communities, and families of older Aboriginal patients, that one’s true “competency” can be determined. We cannot summarize an individual’s whole life experience into a 15 minute mini mental state exam. I believe that a person’s competency needs to be tested in an appropriate, respectful, and culturally accommodating way in order to truly understand their perspective.

 -Michelle K.

References

Cattarinich, X., Gibson, N., & Cave, A. (2001). Assessing mental capacity in Canadian Aboriginal seniors.
            Journal of Social Science and Medicine, 53, 1469-1479.

Historic Trauma and the Residential School Experience

Most, if not all of us are familiar with the residential school system and the devastating effects that it had on the Indigenous community. Similar to the impact that the holocaust had on holocaust survivors, the residential school system has had a deep and lasting effect on many Aboriginal people who were pulled out of their home communities and forced to attend these schools.   According to Robertson (2006) the churches that ran the residential schools were attempting to eliminate the influences that Aboriginal communities had on their children by separating them from their families and tightly controlling their communication with them.  In addition children in the residential school system also experienced physical and sexual abuse at a very high rate.  Many residential school survivors have begun to break their silence about the suffering and pain that they have experienced as children.  Many of these survivors spoke of feeling helpless when they witnessed the abuse of other students and their ongoing feelings of abandonment, loneliness and isolation.  (Chansonneuve, 2005)

These traumatic experiences have led to what is often called “historic trauma”  Robertson (2006) defines historic trauma as cumulative psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences.  Not only have many older Aboriginal people experienced the trauma of attending the residential schools first hand, but the theory of historic trauma believes that this trauma has been passed to Aboriginal elders, their children and their grandchildren.  The theory of historic trauma is also often referred to as “soul hurt” or “soul wounding” because it is believed that the memories of the residential school experiences have become imbedded into the shared memories of Aboriginal communities. (Castellano, 2010)  The Aboriginal Healing Foundation has published an extensive study describing the various physical, mental, spiritual and emotional impacts that the residential school experience had on survivors, as well as the numerous impacts that the residential school experience has had on the Aboriginal community.  Some of the detrimental effects of the residential school legacy on communities include the following, high rates of suicide and family violence, addictive and destructive behaviours such as substance abuse, sexual abuse and gambling, feelings of isolation within the community, and a lack of traditional skills and role models. (Channsonneuve, p.46 2005)

Because of the community nature of historic trauma some of the proposed interventions that are encouraged in working with individuals who have experienced residential school trauma include group education focused on the legacy and impact of residential schools, along with facilitating groups that are centred on cultural activities.  It has also been shown that Aboriginal elders who have begun their own personal healing journeys have a lot to contribute to the healing process that is being undertaken by the younger generations of Aboriginal children and grandchildren who have are experiencing historic trauma.  In particular the Aboriginal Healing Foundation (2005) has found that it is incredibly important for the Aboriginal to take control of their own healing and to determine for themselves what they believe to be the most important aspects of their own healing journey.

According to Castellano (2010) there are several stages that victims of historic trauma often go through on the road to healing. These stages should be encouraged by facilitators.

1)      Establishing cultural safety 

In this stage cultural identities which are suppressed are reaffirmed, often with the help of elders who have gone through their own personal healing journeys.

2)      Fostering Relationships

This stage is characterized by sharing stories in talking circles, which is believed to foster relationships among survivors and encourage survivors to remember what they have lost as a result of the residential school experience.  The sharing and healing circles that were lead by Aboriginal elders have been shown to create bonds of trust and mutual care.

3)      The reclamation phase

The reclamation phase is characterized by the individual reclaiming a healthy way of life.  This is obviously easier said than done, and this stage takes a considerable amount of time and support from the individual’s community.

I personally can’t imagine what it would be like to be an older Aboriginal person, reflecting back on their life to see an endless amount of trauma and suffering.  Many older Aboriginal people have taken the courageous first steps to not only embark on their own healing journey, but to act as leaders and mentors to their children and grandchildren who are also suffering from the impact of the residential school experience through historic trauma.  Not only have residential school survivors shown incredible courage and resilience in addressing their own personal struggles, but they taken the very important steps to make sure that future generations begin their own healing journeys.

Because this blog only begins to explore the issues surrounding the residential school experience and the trauma associated with these experiences I suggest that anyone interested in learning more check out the Aboriginal Healing Foundation Website http://www.ahf.ca/publications/research-series There is an extensive collection of publications about the residential school experience.

Thanks for reading!

Kendall

References-

Castellano, M. (2010). Healing Residential School Trauma: The Case for Evidence-based Policy and Community-led Programs. Native Social Work Journal 7 11-31

Robertson, L. (2006). The Residential School Experience: Syndrome or Historic Trauma. Pimatisiwin 4(1) 1-28

Chansonneuve, D. (2005). Reclaiming Connections: Understanding Residential School Trauma Among Aboriginal People.  Ottawa: Aboriginal Healing Foundation

Blog 2: To Feast or Famine? That is the Question: Barriers to Food Accessibility

Food availability is a basic human right for all, is it not? How many of us grew up hearing from our parents, “You’re not going to waste all that good food are you? Think of the starving kids in Africa?” But how many of us heard this “Think of the starving people living in Point Douglas?” I would assume that not too many of us heard our parents say that. As Winnipeggers how many of us while growing up realized that hunger is not only an epidemic in Africa, but right here in our own city? Aside from seeing the homeless person on the street, those who go hungry are often not visible. There is no one hour exposé given by a celebrity which uncovers the hunger of older adults living in Winnipeg’s North End. This is not a glamorous subject.

Diet, exercise, income, housing, employment, education, and healthy life style choices are all indicators of whether or not a person is at risk for chronic illness and disease as they age (Gionet, 2006). Knowledge is of key importance in understanding how to build one’s life around healthy choices. According to Mendelson (2004), 46% of people ages 45-64 who identified themselves as Aboriginal had not completed high school. This figure doubles to 80% of self identified Aboriginal adults over the age of 65. For many members of the older population education was often discouraged or unattainable due to lack of resources. Statistics Canada (2009) reports that the level of education seniors have is directly linked to their participation in the labour force. Data collected in 2005 revealed that older adults with a university degree were four more times likely than those with eight years or less of formal schooling, to participate in the labour force.

Education, housing, and employment are intricately linked to one’s ability to engage in healthy aging (Gionet, 2006). Having an educational foundation of at least grade twelve is a necessity in today’s work force. Aboriginal people without this basic educational requirement are in a precarious position, because their income will be significantly lower than the rest of the “educated” population. Gionet (2006) noted that the annual median income of self identified First Nation peoples was $14, 517. This is $11, 000 less than the median income for non-Aboriginal persons. For Aboriginal people living on reserves the median income is even more startling, it sits at $11, 224.

What link is there between education, income, and housing? Gionet (2006) has discovered from the 2006 Canadian Census that Aboriginal people as a whole are five times more likely to live in crowded dwellings than non Aboriginal people, which translates into 15% of Aboriginal people versus 3% of non-Aboriginal people. It was further discovered that 26% of Aboriginal people living on reserve were in crowded dwellings. The quality of housing that Aboriginal people are living in, and aging in, is questionable at best. The study also revealed that 28% of Aboriginal people in the 2006 census were residing in homes in need of major repairs, compared to 7% of the non-Aboriginal population who resided in homes in need of major repairs. On reserves it was reported that 44% of Aboriginal people were found to be living, and aging, in homes that were in need of major repairs.

These frightening statistics leave me with a grim picture in mind of the circumstances that Aboriginal older persons are finding themselves faced with in old age. I began to wonder: what does aging look like for them? Are they part of the baby boom population that is living longer and healthier lives? Or are they succumbing to the health risks posed by inadequate education, income, housing, and employment opportunities?  The picture looks something like this: An older Aboriginal person over the age of 55 living in crowded dwellings, is unemployed and does not yet qualify for old age security, and is likely on social assistance due to a chronic health condition that has affected them at an earlier age than it would have a non-Aboriginal person. This person has a limited income that must cover prescriptions, rent, food, clothing, and transportation.

After reading these articles that outlined the grim circumstances that older Aboriginal people are finding themselves in today I came across a Winnipeg Free Press article that discussed the lack of grocery stores in down town Winnipeg. The article is titled “Hunger Amid the Plenty: The Inner City is a Food Desert—A Nutritional Nightmare”, written by Jenn Skerritt (2009). As I read it I realized that it describes the predicament that many older Aboriginal person’s face as they age in down town Winnipeg. I began to see a connection between the articles I read, and how these statistics translate into real life scenarios.

In Skerritt’s (2009) article she brings to light the progression of events that has led to the depletion of affordable healthy food choices in down town Winnipeg, and its associated ripple effects on the residents in that part of the city. Urban sprawl has contributed greatly to the lack of available and affordable grocery stores that offer healthy food choices at reasonable prices. Many of the big box grocery stores are being built in the suburbs of Winnipeg, leaving what Skerritt calls a “food vacuum” in the centre of the city. The convenience stores, of which are plentiful down town, have a limited produce selection at very high prices. When an older adult is living on a fixed income that stretches just enough to cover living accommodations and prescriptions, than food options are very limited in what can be afforded. A green pepper at a down town convenience store will cost $2.00 but the chips are on sale for 2 for $1.50; what do you think will win out, quantity or quality?

As the statistics demonstrated earlier, the older Aboriginal population is more likely to live in crowded dwellings, in need of major repair. They do not have a high level of education on which to fall back on, and financially they earn considerably less than a non-Aboriginal person. The people who fall within this category do not have the money to spend on the high prices that nutritious food costs in the inner city, and they may not have the resources they need to travel by bus or taxi to the suburbs to obtain the food that they need. The results of such a predicament are evident in the level of Aboriginal people developing Type 2 Diabetes at earlier and earlier ages. Cheap foods are high fat and high sugar, which contributes to heightened risks for developing chronic disease such as diabetes or cardiovascular disease.

As I look at all the different issues touched upon in this blog: housing, employment, chronic illness, education and income, and food availability, I ask the question what does this have to do with Social Work? Everything. There are so many different facets to the problem of malnutrition among older Aboriginal adults. To begin to explore one issue, such as adequate housing, leads into the next issue of poor employment and lack of education. I believe that people generally know what is best for themselves, and that if the opportunity is given they will choose well. How is food selection any different? However, as it appears from the article and research, the people residing in down town Winnipeg are not being given the option to choose what is best for themselves.

Thanks for reading.

-Michelle Kehler

Interesting links that are Aboriginal Initiatives to fight diabetes in their own communities:

 http://www.quesnel-friendship.org/html/diabetes/

www.nada.ca

References:

Gionet, L. (2006). First Nations People: Selected Findings of the 2006 Census. Canadian Social
            Trends Stats Canada-Cataolgue No. 11-008.

Mendelson, M. (2004). Aboriginal people in Canada’s labour market: Work and unemployment
            today and tomorrow. Caledon Institute of Social Policy.

Skerritt, J. (2009, January 11). Hunger amid the plenty: The inner city is a food desert—A
            nutritional nightmare. The Winnipeg Free Press.

Statistics Canada (2009). Retrieved March 26^th from: www.seniorlivingmag.com/articles/a
            portrait-of-seniors-in-canada