History. Health. Healing.

The myth of COVID-19 as the great equalizer, shared early on in news articles and through social media feeds, was swiftly debunked as the pandemic evolved and infection rates spiked in communities facing existing systemic racism and disadvantages. As the pandemic amplified health inequities faced by targeted, neglected and marginalized communities, the Centre for Wise Practices in Indigenous Health (CWP-IH) at Women’s College Hospital (WCH) quickly pivoted to build a network of community partnerships supporting the development and implementation of community-led COVID-19 public health responses for urban Indigenous communities.

Rooted in interconnected relationships, CWP-IH focuses on Indigenous perspectives of well-being and healing through community-informed education, research and knowledge translation.

“If we look at Indigenous health outcomes more broadly, we know there are massive disparities that are actually getting bigger rather than getting narrower,” explained Dr. Lisa Richardson, the Strategic Lead in Indigenous Health at WCH. “I find the idea of normativity is helpful in understanding how to make an institution more inclusive. What are the norms in your social, cultural, workplace environments—the implicit standards, the usual or “correct” ways of being, knowing, behaving, doing?”

Tkaronto (Toronto) has the largest urban Indigenous population in Ontario and the need for such transformative work only increased with the onset of COVID-19.

“When COVID-19 emerged, we had to quickly shift and diversify services for the Tkaronto urban Indigenous communities during the pandemic to meet COVID and non-COVID related healthcare needs,” shared Selena Mills, lead of health transformation and strategic communications for CWP-IH. “COVID-19 challenged us to nurture our relationships and develop new ones under the guidance of our Decision-Making Counsel Elders and Knowledge Keepers.”

Partnering with Indigenous Health Organizations such as Anishnawbe Health, NaMeRes, Seventh Generation Midwives, Well Living House, and Waakebiness-Bryce Institute for Indigenous Health, meant reconciling current relationship accords, cultivating trust and sparking new alliances.

“Terms like ‘consultation’ and ‘engagement’ no longer seem relevant to me when working with Indigenous communities. It should be all about meaningful partnerships – every step of the way,” said Dr. Richardson.

An Indigenous Four Directions Well-being Virtual Support Hub and an Anishinaabe and Haudenosaunee Grandmother Wisdom Guide were created in March, sparking the development and implementation of diverse Indigenous community-led COVID-19 public health responses. The CWP-IH team connected with other Indigenous healthcare and community leaders across the Greater Toronto Area as members of the Indigenous Pathways Ad Hoc Group.

In collaboration with these partners, a warm referral network was created to extend wrap-around support services, manage communications and connect referrals between these organizations and the Call-Auntie Hotline run by Seventh Generation Midwives and The Baby Bundle Project. The hotline provides Indigenous community members, organizations and programs with access to information and resources around COVID-19 testing, housing, mental health support, as well as sexual and reproductive health access.

As expanded testing became a priority in order to prevent community spread of COVID-19, the hospital’s Mobile COVID-19 Assessment Team visited Nishnawbe Homes and Na-Me-Res residences. In partnership with Urban Native Ministries, the mobile teams also provided testing for staff and residents at the Sanctuary Day Shelter and Holy Trinity Church outdoor living sites.

“The Centre for Wise Practices worked closely with the clinicians on the ground to ensure that we were providing kind, respectful and culturally safe care,” described Mills. “Following the mobile assessment team’s initial visit, we also worked with the hospital’s Community Support Squad to provide follow-up and ongoing wrap-around support to staff members of these organizations.”

Ongoing support included building capacity within the community by conducting virtual Infection Prevention and Control training for staff at shelters, friendship centres, congregate living centres, encampments, as well as Anishnawbe Health’s Mobile Street Outreach and Testing team, which launched in June. Guided by CWP-IH, WCH’s COVID-19 Assessment Centre also provided Indigenous community members with both testing and a safe place to stay with access to traditional medicines and supports while awaiting results.

Looking ahead, the CWP-IH team aims to continue building upon the trust and community partnerships that have been strengthened over the course of the pandemic, providing ongoing support with risk reduction and space management strategies, mobile testing, staff training and warm referrals for timely access to non-COVID-related health services and virtual care.

“The community partnerships that the CWP-IH forged in the heights of a public health crisis will have a lasting impact on how we can provide care for Indigenous community members,” said Dr. Richardson. “Through the CWP-IH and its partnership network, Women’s College Hospital is working toward a health system that acknowledges and respects Indigenous identity, trauma and resilience while providing meaningful, culturally safe care that is free of racism and discrimination.”