Over the summer of 2018, Hotıì ts’eeda summer students went into the field to hear from youth in the Tłı̨chǫ region about their thoughts on the NWT health system, health research and how to best engage youth in the NWT. They conducted two focus groups, several informal interviews and independent research over the summer. Below is a summary of their findings on the research question: what do Tłı̨chǫ youth want to see in the NWT health and research systems?
Health practitioners and researchers working in the NWT can benefit from a deeper understanding of the beliefs, feelings and concerns of NWT youth. During focus groups, interviews and research with young people in the Tłı̨chǫ region, we learned that youth have powerful and meaningful suggestions and ideas for how to make their communities healthier. We identified several key concerns youth have about the NWT health system and health-related research:
Building trust between communities and the health system
Youth feel that they are not taken seriously or treated compassionately by health care providers, both as youth and as Indigenous patients. They feel that as a result, they do not get referred to specialists. They argued for a more thorough intake by practitioners, cultural competency training and more attention to confidentiality would build trust between communities and the health system..
Health practitioners and researchers need to develop their cultural competency. Training and education are crucial for outsiders working in communities. In additional cultural immersion and developing meaningful relationships with community members will make health care and research experiences more positive, more effective and much more respectful for Indigenous communities. Youth felt that Indigenous people are often treated as second class citizens in the health system, and there was a sense that health care workers and researchers come in and out of the community having gotten what they wanted and do not feel a sense of responsibility to the community.
Youth also discussed the need for professional development especially for confidentiality among local health care workers. They called for stricter policies and enforcement on confidentiality, as youth explained that gossiping in the community health center creates a barrier for youth to receive medical attention. Young adults do not want to seek medical attention regarding health issues because they are fearful and embarrassed about local staff and community members gossiping about their medical history. Several examples of personal experiences where confidentiality was broken were raised. They also suggest that there needs to be an anonymous drop box/telephone number/office to make complaints regarding unprofessional health care provider behaviour.
Youth see an opportunity in communities for training to be given to get local people involved in the health sector. They called for opportunities, internships and training to be given through Aurora College and include people without formal postsecondary backgrounds. They argued that the current people working in the health and education systems are often not Tłı̨chǫ, and that having local people in these roles would help the system work for them.
Supporting Culture, Tradition, and Language
For Tłı̨chǫ youth, health is deeply linked to a healthy culture and language. Many youth participants expressed the importance of revitalization through language immersion programs in schools (featuring an emphasis on spoken Tłı̨chǫ, rather than written) and having hands-on traditional activities—for example, a bannock cooking class conducted for Tłı̨chǫ language learners incorporating storytelling. These programs should be both through the formal school system and open to those who are not involved in school. More involvement of and access to Elders in the community, with an emphasis on learning traditions and identity, would contribute to community health. Programs that support activities such as trapping, hunting and other on-the-land activities would build skills, mental health and support healthier lifestyles for youth. Youth expressed a community need for mental health programs and support, especially based in on-the-land and cultural activities. They believe that treatment would be most effective when it takes place on the land immersed in Tłı̨chǫ culture and traditional activities.
Decolonizing health care and research
Youth felt Indigenous people need to be more involved in health decision-making processes, sharing their own stories and having their opinions and health concerns become priorities for program development. Cultural competency training for health care practitioners and researchers was seen as a first step towards a decolonized health system. Integration of Indigenous knowledge into health services and research was seen as crucial both for research findings to be accurate and for health services to serve the needs of the people. For example, traditional foods for Elders and others in hospital or clinic was seen as something that would both increase health and resiliency to illness, and build trust in the NWT health system. Integration of Indigenous knowledge about traditional healing and medicines into Western research knowledge was seen as the ultimate goal of a decolonized health system.
Engaging youth voices
A youth health council/advisory board was one idea that was raised to ensure Tłı̨chǫ youth have their voices heard with regards to health care decisions, policy and research. They also expressed having youth-inclusive summits and conferences for health, and speaking to youth on their own terms (e.g. through social media) were ways to engage youth. They expressed that when health research is being done in their communities, they are often not given an understanding of the purpose of the research, and thus can feel over-studied and under-involved. They also suggested a strengths-based approach and giving space to community stories and experiences were most effective in engaging youth.