Incorporating the Medicine Wheel in the Treatment of Aboriginal Communities

Check out this article I wrote while I was a resident in my Masters degree and completing an internship at the Rehabilitation Centre. 
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According to the 2011 National Household Survey, Aboriginal people comprised of 4.3% of the Canadian population. Furthermore, Canada’s Aboriginal population is the fastest growing in our country, increasing by 20.1% from 2006 to 2011. That is nearly four times the growth rate of non-Aboriginal populations during the same period of time, which was 5.2%. However, for such a large and rapidly expanding community, very few strides are being made in our healthcare system to accommodate the distinct needs of these communities.
 
The Urban Aboriginal Peoples Study (UAPS) found that 43% of aboriginal individuals they surveyed reported poor treatment as a result of racism and discrimination, and 18% reported negative experiences of discrimination or racism causing shame, lower self-esteem/self-confidence, or the masking of their aboriginal identity. A similar study by AANDC reported that 42% of aboriginal individuals surveyed experienced racism in the past two years, 74% of which was enacted by non-Aboriginal people. A separate survey by OHC First Nations Hamilton found that 1 in 5 participants believed that racism affected their health and wellbeing. Understanding the impact of historic trauma in the lives of aboriginal people is necessary in order to improve health care access as well as service delivery and quality.

Alarmed by these worrisome statistics, a group of us began discussing the potential benefit of incorporating the concept of the medicine wheel in the treatment of aboriginal people. Using our knowledge of various facets of health as well as our unique experiences and teachings as indigenous people, we began expanding on this model as a possible educational tool for healthcare providers in our country. The medicine wheel, a tool used to conserve and transmit teachings, is a symbol deeply rooted in many aboriginal cultures. Each quarter of the 4-point wheel represents a unique colour, cardinal direction, and component of health and wellness (the order and pairing of these may vary depending on individual teachings). I believe that addressing these 4 components of health in a culturally appropriate manner can help improve the experiences of aboriginal peoples in our healthcare system.

Starting in the east, the first of the four cardinal directions, we find the component of spiritual health. A history of settler-indigenous relations as well as a variety of indigenous belief systems has made it so that the concept of spiritual health varies drastically among individuals. Though it is important to address this aspect of the medicine wheel, it is all the more important to recognizing that appropriately caring for this can mean an assortment of things ranging from smudging, sweat lodges or consulting elders or senators to communions and consulting priests/churches.

Emotional health, found in the southern quarter of the medicine wheel, embodies aspects of health such as stress management, sustaining wholesome relationships, and having a positive outlook on life, health, and when applicable, prognosis. Another component of emotional health is avoiding the use of detrimental vices. A recent research by Currie et al. examined the relationship between PTSD, racial discrimination, and problem gambling among Aboriginal people in Edmonton, AB. The findings suggest that gambling may be a response that some Aboriginal adults use to escape the negative effects of racial discrimination. Emotional factors can have a strong influence on an individual’s perception of pain. As such, it is important to address this component of the medicine wheel.

Turning to the west we find the physical component of health. A study by Veenstra sought to assess the link between race and health focusing on high blood pressure, diabetes, and self-rated health among nine minority groups.  In this study, Aboriginal respondents reported some of the highest risks for diabetes as well as fair/poor self-rated health. This component of the medicine wheel focuses on achieving a healthy, active lifestyle. One suggestion is to incorporate culturally relevant activities such as hunting, Pow Wow dancing, or jigging when encouraging activities.

Lastly, facing to the north, we find mental health. Many aboriginal communities face a history of systemic racism and segregation such as residential schools as well as other various forms of oppression, many of which continue to affect aboriginal communities today. These have led to suicide rates ranging from 6 to 11 times the Canadian average (depending on community) and depression rates at twice the national average. It is unmistakable that mental health is an imperative factor to address when caring for aboriginal communities in order to promote a healthy and sustainable lifestyle. The extreme burden of PTSD, suicide, and other mental health conditions are increasingly being documented across aboriginal communities in Canada. These can be viewed as an effect of systemic racism against Aboriginal people through both past and present policies and their application.

Seeing as how pain is experienced by 1 in 5 Canadian adults and accounts for up to 78% of visits to the emergency department, I strongly believe that the implementation of these concepts in pain management as well as preventative care in Aboriginal communities can drastically improve the experiences of indigenous peoples within our healthcare system and possibly improve global health among communities that have been historically disadvantaged.