There's no question that the health
issues facing Canada's First Nations people are serious
and urgent: higher infant mortality and injury rates;
lower life expectancies; safety concerns in water and
food supplies; high HIV and hepatitis C infection rates
...
The atmosphere around the Health
Canada/Assembly of First Nations Task Group, however,
is understated, calm even. A press release, a sensible-sounding
timetable to set targets (see "Native
leaders, Ottawa ink health deal" ). There's not
even been any overt condemnation of the Harper government's
quashing of the Kelowna Accord — which included
some generous provisions for aboriginal health programs
— agreed by the Liberals in 2005. In NRM's
cover interview, Assembly of First Nations National
Chief Phil Fontaine is pragmatic, noting that positive
change for aboriginal people will be won through negotiation
and that requires good lines of communication with all
levels of government.
At the primary care level, the
lines of communication aren't always as static free
as we'd like. A few years ago, a study by Dr Len Kelly
published in Canadian Family Physician looked
at communication issues between aboriginal patients
and non-aboriginal doctors. He found that most doctors
took a long time to adjust to patient consultations
marked by restraint, long silences and an absence of
urgency. Silence and a lack of eye contact were sometimes
mistaken for rudeness or a lack of cooperation. Misunderstanding
and failing to adapt to a different style of communication
could lead to errors in diagnosis and less adequate
treatment. Successful doctors in native communities
learned how to speak less and listen more, give their
patients space and time and build trust slowly and gradually
through participation in the community.
Accustomed as we are to the histrionics
and hyperbole that generally accompany healthcare debates,
it will be interesting to see whether our federal bureaucrats
and health care administrators can learn how to speak
less and listen more. If so, it may be a style worth
appropriating. — Susan Usher, health policy
editor
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