Decolonization the what, why and how: A treaties on Indigenous nursing knowledge

First, I acknowledge all of the Indigenous Peoples known as the original descendants, traditional right holders, and custodians, as well as their historical relations, to the lands upon which we live and benefit, still to this day. Specifically, I want to offer my respect and honor our kihtêhayak—the Old Ones, Knowledge Holders, Elders, and the children of the past, the present, and the future, for they hold the memories and the traditions and the hopes of all Indigenous Peoples across Turtle Island. I pay special tribute to my own ancestral beginnings, the traditional unceded and occupied territories of Beaver Lake Cree Nation and my grandmother, Marianne Bearskin, and her children, my mother Elma Bourque Bearskin who gave me life and shaped how I live in the world today, and in the everydayness of my nursing work, and my children who have helped me to journey through a life of caring, healing, and love. My family comes from the lands known as amiskosâkahikan nêhiyaw peyakôskân, ostêsimâwoyasiwêwin nikotwâsik Beaver Lake Cree Nation, Treaty 6 Where the original signatories to the Medicine Chest Clause scripted their rights, titles, and privileges into the agreements with the British Crown in 1876. This health clause is one of the first health policies in Canada to influence the ethnogenesis of the Canadian Healthcare System as a Treaty Right to Healthcare (Craft & Lebihan, 2021). Finally, I provide a special tribute to the traditional and unceded and occupied traditional territories of Tk'emlups, to Secwepemc where I have lived and worked for the past 5 years. In 2020, it was through an invitation to the International Caring Conference at the University of Victoria where I first met Peggy Chinn, a tireless, passionate advocate of neutralizing power and privilege in nursing, and founder of the Overdue Reckoning of Nursing collaborative. It was during this first encounter that I was enticed to join her and other nurses who were finally openly addressing racism and normalizing this conversation by naming the tension and consequences. It is this group of leaders that I want to thank for inviting me to join this panel on Decolonization: The What? How? Why? Intentionally, the purpose of this paper is to address questions surrounding decolonizing nursing, and this has led me to think more deeply about the impact of colonization on myself, my family, my community, and my nation, especially when I believe that nursing service aims to alleviate suffering, but I observe the truth that colonial acts of healthcare continue to contribute to the syndemic suffering of Indigenous Peoples in Canada (Stephans, 2020). These philosophical nursing discussions provoke me to draw on my own experience as a Cree/Métis woman, mother, auntie, and nurse, leaving me to question my role, purpose, and responsibility to interrupt racism while being a good human being. I pull from my own Cree/Métis ontological and epistemological points of reference, where knowledge is deeply connected to the experiences of colonization of the land, and the ensuing and related historical trauma intertwined with questions of identity, displacement, equity, power, privilege, and decolonization. These themes are articulated from my own wretched yet colorful experience, woven together and presented as my own bundle of knowledge. I had the privilege and honor to introduce ‘What is decolonization?’, to talk about truth and reconciliation, and to ask what you can do and what we can do together. Looking back, I see where we started historically, I see that our nursing education did not inform us of the nursing history in this country, and I see where we are now. So, what is colonization? In a basic sense, it's a process that can be described as establishing foreign control over targeted territories of people for the purposes of extraction and cultivation of resources, often through establishing colonies the foreigners themselves settling on the stolen lands (Battiste, 2013). Colonization is referred to as a large-scale movement that takes place under the false pretense of protectionism under colonial structures referred to as colonialism (Alfred, 2009). Colonization is directly related to growing inequities of Indigenous health and early death of Indigenous Peoples, such as the case of Joyce https://www.cbc.ca/news/canada/montreal/joyce-echaquan-systemic-racism-quebec-government-1.6196038 and Brian https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832555/ and Keegan https://www.fnha.ca/about/news-and-events/news/remembering-keegan to name just a few of the recent and most publicly-profiled cases in Canada. Further to this, Dr. Rupa Marya delivered a presentation at the Bioengineer Conference that highlights the impact of colonization in biological terms, and the influences of systems domination from a socioecological view. She concludes that the end result is trauma on the body, ultimately causing generalized inflammation. We know and can see the trauma intensifying daily in the increasing numbers of chronic diseases, such as cancer and diabetes, and Marya identifies the ‘error of inflammation and the impact of social stressors’ in her book Inflamed Deep Medicine and the Anatomy of Social Injustice: https://blogs.bmj.com/medical-humanities/2021/09/28/inflamed-deep-medicine-and-the-anatomy-of-injustice-2/. Along with my understanding and interpretations of DiAngelo (2011), I think colonialism is really about white systems built on white supremacy expressed in many ways and outcomes, but it is white fragility that I am forced to contend with on a daily basis when discussing Indigenous health rights in nursing. As Tuhiwai Smith (2006) explained, ‘western knowledge and science are ‘beneficiaries’ of the colonization of Indigenous Peoples’ (p. 92). Colonizing knowledges has led to increased feelings of isolation, voicelessness and disconnection from identity, land, culture and economic poverties. Consequently, when we think or talk about colonization, we have to also think and talk about what decolonization means. Decolonization refers to that process of deconstructing those colonial ideologies of ownership, superiority, white privilege and western thought (McFarlane & Schabus, 2017). On the one hand, decolonization involves a dismantling of structures that perpetuate the status quo, and on the other hand, it involves the acknowledgment, valuing, and revitalizing of Indigenous knowledge (Battiste, 2013). From Secwepemculecw (the land of Secwepemc), Arthur Manuel, https://www.theglobeandmail.com/news/british-columbia/bc-aboriginal-leader-arthur-manuel-fought-tirelessly-for-rights/article33679268/ a United Nations leader, is well-known, for his advocacy on Indigenous rights within the context of colonization and discusses how decolonization can support the repatriation and rematriation of Indigenous knowledges. It is really about the return of the land (Manuel, 2018) and ‘Affirming further that all doctrines, policies, and practices base on or advocating superiority of peoples or individuals on the basis of national origin or racial, religious, ethnic or cultural difference are racist, scientifically false, legally invalid, morally condemnable and socially unjust’ (United Nations, 2008; p. 3). When we think about that, what does that mean? For many people, returning the land is a difficult concept to understand let alone admitting that the foundation of the Canadian state is built on principles of genocide. For purposes of clarity, a rethinking of possible questions might help us to understand the meaning carried within the United Nations Declarations on the Rights of Indigenous Peoples. The questions that I think about are: What factors contribute to and sustain oppression? What is your truth about colonization? About decolonization? How does it align with my truth? What will you do to reconcile towards a collective truth? How do we achieve epistemic justice to reduce epistemic exploitation and avoid epistemic appropriation and epistemicide. These are some of the key questions that require deep analyses conducted within processes of critical deconstruction and decolonization of meaning and lived experiences. To understand how systemic racism works to sustain the oppression of colonization; we have to go back to the founding principles and beliefs of this country we call Canada. I am unsure if there remain any reasonable arguments against the claim that these foundations are deeply rooted in attitudes of white supremacy. We can still see those attitudes in present-day governmental and institutional relationships with Indigenous Peoples, where legislative forms and agreements continue to govern and dictate Indigenous Peoples' lives and well-being. A good example, the Indian Act continues to represent the most difficult legislation to recognize or counter, particularly because it is perpetuated by institutions and lower levels of governments that do not understand that this policy, as the oldest, sexist, and most racist regulations existing in Canada today, was used to ‘kill the Indian in the Child’ (Milloy, 1999). https://www.thecanadianencyclopedia.ca/en/article/indian-act#:%7E:text=The%20Indian%20Act%20is%20the,obligations%20to%20First%20Nations%20peoples Still, many nursing students, including my own children, are left questioning their own understanding and wondering, in anguish, about how they were to reconcile ‘taking the ‘Indian’ out of the Nurse’ (Kennedy et al., 2021; p 2). Nurses are very familiar with the health inequities in Indigenous populations and call for a new frontier, an avant-garde of nursing practice (Drummond, 2004) to bring back actions needed to address this health burden labeled as the legacy of Canada's colonization. Advancing Indigenous health knowledge and wellness practices offers a timely and irreplaceable opportunity for the resurgence of local traditional knowledges to help nurses move beyond the limits of Western healthcare systems. If Indigenous nurses were provided options to consider, and actively and safely explore the significance of Indigenous knowledge, their deeper understanding would be generated through first-hand experiences, languages, processes, and relationships that would support the reawakening of their own embodied knowledge, along with Indigenous memories required to contextualize ancient and effective medical knowledge. Embodied knowledge is reflected in and embedded in our narratives; such narratives are carried through blood memory across generations, made strong through geographical connections, and activated by Indigenous Peoples' expressed relationships (Weber-Pillwax (2021). The common understanding of traditional medicine is much deeper and more complex than basic knowledge of herbs and plants. Traditional medicine encompasses a wide range of other knowledge, addressing and including forms of wellness practice accumulated over thousands of years, and deriving from a groundedness of sacred relationship with the land. The current and common, but limited, understanding of traditional medicine persists despite decolonization efforts because nursing systems still function on the principle of extraction and exclusion of local Indigenous knowledge from their colonial sites of healthcare. In fact, Western healthcare centres are the bastions that uphold the structures of invisibility and silence surrounding traditional Indigenous medicine and wellness knowledge. Nonetheless, through my own Cree/Métis ancestry and lived experience, I learned that these ancient forms of health knowledge and wisdom helped our peoples to survival the heinous acts of genocide. It will be this same wisdom that will prevent the erasure of Indigenous wellness knowledge systems today. I believe Indigenous Peoples' knowledge systems need to be protected from our western biomedical interventions and further, that we as health professionals need to support and afford Indigenous Peoples their full intellectual property rights in the context of healthcare and wellness knowledge and practice. When we discuss Indigenous Rights and traditional knowledge systems within current health and social contexts without the authentic and/or authoritative voice of Indigenous Peoples to address that same context in full, this is a salient form of racism that reinforces the exclusion and epistemic violence being practiced against Indigenous Peoples globally (Brockie et al., 2021). Here within British Columbia, an independent review examining the impact of Indigenous-specific racism in the delivery of healthcare services highlights the continued impact of colonization that results in prejudice and bias-informed care that perpetuates poorer health outcomes for Indigenous Peoples (Turpel-Lafound, 2020). The report identifies the need for research related to Indigenous-specific racism in education and courageous conversations on the values of structures, policies, and programs that continue to guide and function within false notions of reconciliation, decolonization, and Indigenization. The truth telling in a reconciliation process is intended to achieving an overall holistic and comprehensive response to the numerous government policies of assimilation, including the Indian Residential School legacy https://www.rcaanc-cirnac.gc.ca/eng/1450124405592/1529106060525, the Sixties Scoop https://www.thecanadianencyclopedia.ca/en/article/sixties-scoop, Indigenous women's forced sterilization https://ijrcenter.org/forced-sterilization-of-indigenous-women-in-canada/, Indian Hospital https://www.thecanadianencyclopedia.ca/en/article/indian-hospitals-in-canada and the current Child Welfare system https://cwrp.ca/ to identify just a few. To move beyond these current practices, the government that legislated and installed these actions along with its own institutions of implementation, has been called upon to render unto Indigenous Peoples sincere acknowledgement of its actions and acceptance of its responsibility and accountability for the injustices perpetrated against Indigenous Peoples for multiple generations. The need for appropriate healing continues to be evident and unfulfilled, as the negative health and social data indicates unquestionably. This profound commitment to action can only be found in a renewed relationship imbedded in mutual authentic partnerships. These partnerships have to be strong enough to stand strong in the face of heart-wrenching truths, such as those associated with Tk'emlups to Secwepemc and its recovery of the 215 mass unmarked graves. https://storymaps.arcgis.com/stories/cfe29bee35c54a70b9621349f19a3db2 I do this work to honour those children, and my own lived experience as a survivor of the child removal era. I work to support the families, communities, nations, fellow colleagues and allies in this arduous task of revealing and understanding societal complicity with white privilege and how the purposeful blindness of white performative benevolence in the helping professions cripples all of us (Gebhard et al., 2022). Creating space for me and others like me to claim my own history, my own health and my own desire to uphold the sovereignty of Indigenous knowledge systems, intellectual thoughts lands and bodies is imperative. I think it is important to remember that, as of May, 2022, the number of graves located with confirmed names of children has reached 4130. That number represents only of that have been The I am from this is that we go back and ask the how did we and are we not and this as a It the of Canada in of the for the trauma from the Residential that the of Canada to and the and The report in to action to address the trauma by Residential School this only to action have been 2022). What does that us about Canada's in the name of to reconciliation with Indigenous Peoples who the injustices and violence of the Residential School is there such an in from Canada and there a there need to be a we ask about the for Canada's exclusion of Indigenous people as the of Canada is of the legacy of cultural in Canada the Residential and the to action and are of the social and attitudes with which Indigenous people are in Canada. In the context of nursing, I thought deeply about those original Indigenous nursing and about the that I was about the first in Canada and a of the or the first in British Columbia, was I about one of our most leaders in who in was the first Indigenous to hold a of to the of and It the that I started about these in nursing or about the Canadian Indigenous Nursing These were all who to be within the same respect and honour as As Indigenous and for all we need to acknowledge and through of our own Indigenous nursing history and these who are important in our and practices of decolonization as We need to to white in nursing 2021). In the of the we as healthcare let me of our recent history as nurses and Indigenous nursing I how many will remember the of Joyce as these were globally on social we can think about Brian who in with a number of on healthcare to in the was to to a 2017). remember Keegan who was to the because the of healthcare led to believe be 2022). These are not in the of Indigenous Peoples at health these are cases that The how such from healthcare can the healthcare in populations and can bring about and contribute to the early of Indigenous Peoples. The of and cultural is needed to bring important of colonization and power that with Indigenous social of such would understanding of these experiences of Indigenous nurses across the et al., 2021). A history of colonization is in the of nurses who of For example, et that the influence of a has and their own Indigenous knowledge. The the of health are and related to colonization, and of and all of which are by the of Indigenous people from the land, disconnection from their identity, and the of over the years. Dr. that in decolonization in healthcare and on the Western cultural of history, practices, and that have all our and (p. 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As we need to to with how Nations, and of social suffering, health and violence with and social We can believe that of one is the of but we can also see that, in the does not hold when we see the data to health and children in care and and most in very few the that the experiences of past, have to be to and to the from health and to health and If we are to move within the of our as Nations, and we can be that Indigenous nurses who are and about the lived history, cultural beliefs and of their own Indigenous communities, as well as those of other will be the that they to be as Indigenous they were Indigenous Finally, I am who that education is the us into this and it can us It is important to from this history of Indigenous Peoples across the because we can this has not been the that comprehensive are needed at we to practices without first cultural it's like on a on in & p. 3). In my case as a Cree/Métis nurse, this practice of and to the salient and forms of Indigenous-specific racism and epistemic I my own and into my understanding of the of colonization, some of which might bring that I still about these as expressed in the my process for meaning of through colonization. We continue to the colonization to the land and our to our and The are and the is is us its and I a I see a and the It is to our original To life back into our human and the and the talk that others As human from with We are all with to the past and questions of the of our the impact of us in the As Nurses do we really respect the and the is it more that we know how to in the As we see it is the Indigenous Peoples who are their So, the truth of the question at the of it Nursing in of ways of and will colonial acts of continue to be the I am for the provided by the Canadian Indigenous of of Indigenous Peoples and and with Nations the Canadian Nurses and the University of The of

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