An inquiry into Cultural Competency. Learning from the Indigenous Wellness Program, spending a week in an Indigenous Diabetes Intake

By: Jack Tang

*** This blog is written from my perspective, with the knowledge that I have gained from the Indigenous Wellness Program, from speaking with elders, and from literature that involves Indigenous health. This blog is not intended to speak on behalf of Indigenous peoples, nor do I mean to say that all Indigenous communities will follow the same practices or beliefs. I do, however hope you consider this as a starting point to learning more about the many Indigenous cultures in North America. The information presented in this blog come mainly from Cree traditional teachings. ***

How do we know whether we are helping people to the best of our ability, in the way that they most want to be helped?

For the past few months, I have been I hoped to find the answer at the Indigenous Wellness Program located near the Royal Alexandra Hospital in Edmonton. This clinic is an Indigenous-focused health center that uses a multidisciplinary and multicultural approach to delivering health-care for a wide array of Indigenous peoples.

The Indigenous Wellness Program’s (IWP) clinic will offer the same primary care health services as any other clinic: check-ups/follow-ups, prescriptions, examinations, etc. But the IWP also works in Women’s Support, Chronic Disease Management, educational programs for at-risk youth, palliative care in the inner city, a Diabetes Intake program, physical therapy, nutritional consultation, establishing temporary health centers in rural communities, and trips to help pick traditional medicines. The clinic is not a true traditional Indigenous medical center because it does not employ traditional healers (medicine men and medicine women). In their stead, a group of cultural advisors provide culturally-sensitive support and knowledge to the clinic. In this way, cultural leaders and the health-care staff have worked together to develop a clinic that follows the guiding principles of traditional medicine.

To understand these guiding principles, we must first think about the Western medicine we are so used to seeing. In Western medicine, the focus for medical professionals is mainly on treating physical problems. Doctors mainly prescribe physical treatments such as pharmaceutical drugs, surgery, or lifestyle changes like exercise and diet. And while mental health is increasingly recognized as a major contributor to patient health, the emphasis for doctors is still on the problems that we can physically see and feel.

In principle, traditional Indigenous medicine values physical wellbeing just as much as Western medicine. But the difference here is that traditional medicine moves beyond a single label of “mental health” for the illnesses we can’t see. Unlike Western medicine, Indigenous medicine divides non-physical health into three distinct categories: Emotional health, Mental health, and Spiritual health. Even more, the emotional, mental, and spiritual wellbeing of a person are valued equally to physical wellbeing – to be whole and healthy, a person needs to be in balance with all four. This philosophy is commonly represented within a Medicine Wheel (Figure 1).


Figure 1. The Medicine Wheel, as taught in an IWP diabetes information booklet. Note: The staff informed me that the medicine wheel within this diabetes booklet was visually incorrect, and has since been corrected: The Northern section of the wheel is White, representing the Spiritual. The Eastern section is Yellow and represents the Mental. The Southern section should be Red to represent the Physical. Lastly, the West would be Blue and represent Emotional health.

There are many Indigenous groups in Canada, and so there are many different interpretations of the Medicine Wheel. Even within one Indigenous group the Medicine Wheel may have multiple meanings depending on what it is being used for: the four directions, the four fundamental elements, traditional medicines, the seasons, the life cycle, and the balance of health within an individual.

But from my understanding, the IWP uses the Medicine Wheel to portray an individual’s health. The Physical portion represents our hands, legs, eyes, heart, kidneys, lungs and everything else that we can physically feel. The Emotional portion represents our emotions, moods, and the relationships we form with others. The Mental portion represents our intelligence: our knowledge, judgement, and critical thinking. The Spiritual Body is the strength of our connection to the Creator, our self-esteem, our motivation, and ultimately our self-identity.

The IWP offers a program called the “Diabetes Intake” which calls upon these four aspects of health. I was fortunate enough to have been given the opportunity to observe this program and learn how this healing process worked.


 “Aboriginal people represent 4.3% of the Canadian population. First Nations people, who make up over 60% of Aboriginal people in Canada, have prevalence rates 3-5 times that of non-First Nations populations. The diabetes prevalence in the Métis population was 7.3% compared to 5% in the non-Aboriginal population in 2008/09.”

The Diabetes Intake program was developed by the IWP to address the high number of Indigenous peoples afflicted with diabetes in Canada. Every month, a group of participants spend 4 full days in the clinic together to learn about how the disease works, as well as diabetes management topics such as nutrition, medication, and life-style changes. The program also includes topics in mental health from a traditional perspective – guided by a cultural helper who specializes in addictions and mental health. But the most eye-opening part of this program for me was the use of a daily sharing circle where participants could speak on their experiences, their fears, and their goals with diabetes.

Each morning, a cultural helper would open up the sharing circle by smudging (Figure 2).


Figure 2. A smudge is a traditional ceremony that involves the burning of traditional medicines such as sage, sweetgrass, cedar, or fungus gathered from the earth. In the center of the pan is a ball of sage and a braid of sweet grass. The smoke from the burning medicines are used to cleanse the spirit.

The cultural helper who performs the smudge explained to me the purpose of this traditional ritual (this is as close as I can get to his direct statement):

When we wake up in the morning, we shower because we want to cleanse our physical bodies to prepare for the day ahead. So you can think of a smudge as similar to showering, because a smudge is our way of cleansing our spirits. We wash ourselves with the smoke:

We smudge our eyes so that we can see the goodness in others.

We smudge our ears so that we can hear more clearly what others are saying to us.

We smudge our mouths so that we speak no evil. The mouth is powerful. It is said that a lifelong friendship can be ended by the speaking of only a few words.

We smudge our minds to open our minds, and to wash away our negative thoughts.

We smudge our hearts so that we can open up and feel what others are going through. It is said that the longest distance a person travels in life is the journey from their mind to their heart, and from their heart to their mind. A person can live with a closed mind and an open heart, and this makes you irrational because you are not able to think clearly about the things you feel. A person can also live with an open mind but a closed heart, which prevents you from feeling the feelings in world around you. We smudge both our heart and mind so that they can both be open.

We smudge our feet so that we walk the right path, and that we are not weighted down by negativity.

Note: This teaching has been borrowed, with permission from the cultural helper after giving protocol (an offering of tobacco). The cultural helper emphasized that in Cree tradition, teachings are passed down through experiential learning and that people grow to understand every part of a ceremony. When we try to write these teachings down, we only show a small part of the whole picture. For example there are important protocols that must be followed to turn sweet grass into medicine, which is not described in my explanation of the smudge.

After the smudging and prayer (which are completely voluntary for each individual), participants have a space to share any thoughts they have relating to diabetes. From their discussions, I saw that a lot of healing occurred when people listened to others and saw the same fears and challenges within other participants with diabetes. In both Aboriginal and non-Aboriginal communities, having diabetes can carry a lot of stigma. Some people may jump to the conclusion that it’s a person’s own fault for their diabetes, while others may try to avoid the conversation because they do not understand the disease. In either case, patients can become isolated from the outside world and lose the will-power to fight the condition. Especially in diabetes, which requires multiple lifestyle changes and constant monitoring, a loss  of community support can be devastating to their self-management and self-treatment. Many members within this sharing circle expressed similar views on diabetes, such as a fear of over-medication, a desire to have their medication adjusted, wanting to control the disease so they have more time with their families, and feeling relieved that others know how they feel. One participant in particular said “I thought I was by myself with this disease. But there are so many of you have the same questions that I want to ask. I will keep listening to your experiences, because the things that work for you might also work for me.”

The traditions I have written about are just the beginning of traditional medicine. With the written word, there are many parts of a traditional teaching that are not acknowedged. As a cultural helper put it:

“When we do our teachings in the traditional way, speaking our language, working together in person, it’s like going through every letter of the alphabet from A to Z. We see the whole process and not just part of it. When we try to write the teachings out, we do not get A to Z. We only see a small part of it. But writing it out can be helpful to give people an idea of what we do – and if people are interested in learning more, they can seek to learn these things in person, in the traditional way.”

In many ways the ideas within traditional medicine, such as the high value placed on non-physical health, treating people holistically, and establishing a strong support structure from the very beginning of treatment, are concepts that mainstream society could stand to learn from. And as we move into discussions of decolonization in the Canadian society, it is not enough to remove the oppressive structures that hold people back. For Indigenous and Non-Indigenous communities to truly become partners, we should also acknowledge and critically think about the ideas within Indigenous traditions that can add to our health-care system.



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