Trauma Informed Practice -- An indigenous resident's experiences

• Patient is 70-year old indigenous male living in a long-term care facility with lung cancer, stage 4.
• His room is spotless.
• Patient lives frugally and has little disposable income.
• Family caregiver is a younger sister who lives within a few kilometres of patient’s LTC facility. Patient’s children have already died as has his spouse.
• Older indigenous elders are often venerated within their family and community.
• Within Western community health, this respect for elders is often not obviously demonstrated. Those patients who have lived through the residential school system (or their immediate descendants) have often lost their language, their assertiveness to speak up (distrust of authority figures and institutions often leading to late diagnosis and therefore sicker patients in the community), and their overall system of beliefs and behaviours. They do not talk very much, have little eye contact, and may appear in shock by being in the system. They are often isolated from community health or unable to use it to the fullest. Racism also plays a real part in their care, or lack of care.
• They typically also have a high tolerance to pain (so if they say they are in pain, they really are), they won’t question professionals since they worry they will be punished for doing so, and they may appear generally afraid.
• Building relationships with the patient and their family caregivers is the single most important aspect in such a community care situation.
• An elder’s request is very important to them as they are the ones that have kept traditional medicine practice alive in their communities. They have resisted traditional western ways and continued to practice these traditions even when it was forbidden for generations. Those who resisted have a deep historical connection to these medicines.​

Trauma informed practices includes an understanding of each individual patient within the context of what traumas they may have experienced. Trauma informed practice is an interdisciplinary approach that deals with patients and their families who have gone through very difficult traumas. This strengths-based framework is responsive to the impact of trauma, emphasizing physical, psychological, and emotional (and spiritual) safety for both service providers and survivors; and creates opportunities for survivors to rebuild a sense of control and empowerment. The effects of individual traumas can last through three or four generations of a family, but can last centuries when the traumas started long ago and continue to today (the experiences of many indigenous peoples). Various examples include, and can be a combination of some of the following:

• The effects of the residential school system on indigenous peoples and their families;
• The effects of forced relocation of entire indigenous communities from one geographic location to another;
• The effects of forced assimilation policies on indigenous populations, some of which continue to this day;
• war, terrorism, military trauma, political violence (e.g., families who immigrated to Canada since the 17th century after experiencing many of these traumas);
• abuses: emotional/psychological, physical, and sexual;
• long-term and destructive bullying;
• natural or manmade disasters;
• traumatic grief or separation;
• historical trauma including forced displacement, e.g., internment camps in Canada for Japanese, Italian, Ukrainian Canadians);
• illness, serious accident, or torturous medical treatment;
• severe and ongoing neglect;
• system-induced trauma and re-traumatization;
• victim or witness to domestic and/or community violence (including in schools, workplace, social gatherings).