Etupatumumk (Two-Eyed Seeing) and Ethical Space: Ways to Disrupt Health Researchers' Colonial Attraction to a Singular Biomedical Worldview.

[music] Anin, Tanzee, hello in Bojo to all our listeners and welcome to With This Podcast. I am your host and co-discussed along with Annette Schultz. Every episode of this podcast is published in relationship with the authors, witness the Canadian Journal of Critical Nursing discourse. Our goal is to move close to the author's ideas and analysis and call to change. Each author or author's team has a desire to affect positive change and in sharing our dialogue focused on key points we hope to engage you in these ideas too. Similar to the goals of witness with the podcast we aim to grow and foster critical nursing discourse across Canada and beyond. We hope you enjoy your time with us today. While we gather to listen and tune into this podcast, we acknowledge all the Indigenous peoples across the lands we are on today and acknowledge the importance of the land which we each call home. We wish to reconfirm our commitment and responsibility to improving the relationship with Indigenous peoples. And to improving our own understanding of local Indigenous peoples and their cultures from coast to coast. We acknowledge the ancestral and unseated territories of all the Inuit, Métis and First Nations people on their lives and their health. Please take a moment to reflect and acknowledge the harms and mistakes of the past and to consider how we can be in our own way and move forward in the spirit of reconciliation. We will be having a discussion around the published article, "A Wapata Mam" to hide seeing and ethical space ways to disrupt health researchers' colonial attraction to a singular biomedical worldview. The authors over the last three decades have individually worked in diverse capacities within health care systems as researchers. The lead author, myself, Monica Sinclair, I am Cree Nehanen and I worked in health care for over four decades. And the other author is Janice Linton, who is an Indigenous health liaison librarian at the University of Manitoba and is a descendant of the Scottish and English ancestry. And we have Elizabeth McGiven, who is a white settler of working-class Irish heritage and a professor of the Rankine School of Nursing at St. Francis Xavier. These two authors were unable to be here, but we do have Dr. Netcholts who will introduce herself. Hi, everybody. And thank you, Monica, for that opening. And so, as Monica said, I am a professor in the College of Nursing at the University of Manitoba. And I'm going to, and I'm going to invite a guest here on the lands of Canada or Turtle Island and I live in Treaty One territory, and my background is French and German ancestry. And I look forward to our discussion today. Monica and I were here to not so much talk about all of the paper, but talk about King Concepts and some of, you know, why we said about to write this paper, which is really about health research and reconciliation. And part of what I think we thought a lot about in the research we did together over a number of years, which also included Elizabeth and Janice, who unfortunately are not here with us today. So, with that, I think are we ready to start the discussion? Yes, thank you, Annette. So, one of the things that I was interested in knowing was, like, let's just, let's talk about what, in particular, is world view and research from an indigenous perspective. How would you define world views? Yeah, and those are two, when we thought about doing this and putting this together, they're sort of the two key concepts that I think drove the importance of this. You know, what are we doing when we do research? And why is the world view or how a person understands the world important to research? And then, in particular, when it comes to health research as we were stepping into doing research that was focused on indigenous populations, to really ask these questions of, you know, if we come purely from a biomedical or a Western perspective, what's the impact that that has upon the people that the research is being done? Because those world views are oftentimes quite different, even just a most simplest thing as biomedical or most Western perspectives. Don't come from a relational epistemological position, where it's like everything you do is in relationship to other. That's not what would be driving the questions, where from what I've learned from the people that I've worked alongside of, and walked alongside of, including, you know, Dr. Sinclair, Monica, is everything that is being done is done in consideration. Of those relationships. And that's both in that, then, is I take action, how are those ripple effects? But more importantly, I think sometimes, what's the information that I'm getting from the things around me? And this could be land, this could be, you know, starting research in a good way of talking with elders, and not coming with a definitive idea already defined, but to start in good relationships and to listen to what is sort of coming up from there and finding a way that you get to work across both places. And for me, that is a really key aspect. That, and I also found over the time with research that, and it's something we do talk about in this paper, that oftentimes, with health research, we compare indigenous people to non-indigenous people, and I remember it was Monica who said at one time, when I was talking about analysis, and she said to me, wow, a difference would be, how about if we just look indigenous people for themselves? And how about if we understand what we're seeing from how they are located in the world and how they see the world instead of what? Some other external authority is perceiving that's going on. So those, you know, that's a key part, is that relational component, and that really drives that notion of world view. And one of the things I know we talk about in the paper with world view, is it drives the types of questions you're going to ask? What is going to be seen as valid evidence? How you're going to understand that evidence, like, so how you're going to interpret it, and then of course from that, the types of recommendations and how that would inform things like policy or programs. And again, if all of that is devoid of an indigenous perspective, then really to me, that's, you know, where in the title we have the language of the colonial traction to a singular world view, it becomes a colonial force in our world. And that's the very thing that with this paper, we were, that's our call to changes to break that. And to find a way that we're working across, it's not about getting rid of biomedicine, but it is about finding a way to have respect for more than one way of looking at things. Do you have something to add Monica? As I'm sitting here listening to you talk, I'm thinking about, like, for me as an indigenous woman, I see world view as if we take a box, and we have two people sitting on the left of the box and the right of the box. The people on the right can only see certain points on that box, and the people on the left can only see certain points on that box. And so their world becomes the left side of the world or the right side of the world, and that's all they can see. But if we shift that box so that people can start to see the other person's world, and then we get to understand that people do come from a perspective, because I know as an indigenous woman, when I went through school, even from the very beginning of school, I never felt like I belonged. I never felt like I lived in that world, and because I was raised to be helpful and be kind and be generous. But when I entered into the school system, we had competition, and people were friendly to you, and you were outed for certain things, and it's the same story that I experienced right from elementary to my graduate programs. And so for me, it wasn't until I did my PhD that I started to really understand, like, I definitely come from a specific worldview, and that worldview is something that really drives me to want to see change, and to be able to take another person's hand and say, This is the world view I come from. and how I believe and see the world is important. And so that's been my journey is to, is to be able to help people see that I come from a worldview. And because I think lots of people in the healthcare system don't recognize that they come from a worldview. They don't recognize that. Maybe I'm asking the question in a way that doesn't make sense for someone. And where is this evidence coming from? I know when I was doing my graduate studies, I used to ask a question like, why are you asking that question? Why are we, where does this idea come from and whose gold standard is this? And I got into a lot of trouble. But those are things that I think about when I think about worldview that it's not just thinking about the world that I come from, but it's the world I live in and the world that I have to sort of bridge two worlds. And that, to me, is what worldview is. And so I was also interested in how you understand research from an indigenous perspective. - That's a big question, Monica. And I think before I jump right into that, with some of what you were just speaking of, I noticed, 'cause I have my notes in front of me, that it was the gifts that we received from Senator Sinclair when he did the Truth and Reconciliation and did all those talks and then produced that report in the calls. Because what came from that, all that got revealed through that, always existed, that knowledge existed. Although some of it was surprising to me as I began to hear it, there were a number of people around me, in particular people who obviously were indigenous who none of that was news. And that's a really good way of sort of describing this notion of the view you have of the world, right? For indigenous people, a lot of what came through in that report are things they knew is how they saw the world, they had evidence of that, it informed who they are, how they went about making decisions where for non-Indigenous people, unless you had created those relationships or had somehow been shown, his reports blew people's eyes wide open. And so then their worldview, their understanding about having with the IRS system was forever changed. And we've seen a number of changes in our world since that report and that is part of, to me, what really began to call research to task, that we no longer can do research as purely comforting from a Western perspective, focused on exploring anything to do with health with indigenous people that we needed to figure out a way to do better. And so when it comes to indigenous research and yes with you Monica, but also with Dr. Wanda Phillips back and now Dr. Amanda Fowler Woods, who with those two first nation scholars I should correct myself, we created a course that was about indigenous people health research and doing research in a good way. And when I think of Western and what I would have been taught when I was going through my graduate years, you turn to the literature or you turn to stories that may have been amongst people as the beginning of the idea. And you craft what that idea is about, which then begins to drive the types of questions you're gonna ask. 'Cause as researchers and this is something I often tell grad students, you need to be responsible to the literature. You can't just be, this isn't just for you. There's this larger community, right? And that certainly a lot of how I think health research is done. But when I now put the additional lens, so again if we move out of just a Western perspective than today, the relationships are different. The relationships need to be with indigenous communities. There needs to be indigenous ways of knowing, starting with elders and having elders being a part of it all along the way. Especially if you're, you know, if you're like me who is not an indigenous person, I have no business doing interpretation. Because the interpretation can only then come from a Western perspective and is that really why we're doing the research. I can be a part of it, but it could never be driven by me. And so those are some of the challenges, I think for non-indigenous people in doing this work. It's not that I don't think we can do no work, but we need to really be checking ourselves. So, you know, knowledge is also seen differently as, you know, teachings and learnings that I've heard over the time. I'll flip that into maybe the notion of story, which is a lot of times how things are shared. It's not about coming to definitive answer. It's about coming to a place of understanding in this moment and knowing that that may change. And that's very different than a lot of Western perspectives that are looking for some definitive answer to be able to fix something, I guess, I don't know. Do you have something you want to add, I bet you do. - Yes, I do want to add something. When I think of a Indigenous research, you're talking about working with elders. To me, what Indigenous research has to be is from the very get-go, our knowledge is and the way we do things and the way we see the world has to be the center point and they have to be equal and in a line with the biomedical worldview or the Western worldview. They have to be honored and respected. Currently, when research has done, researchers come with the idea that they come with an idea already in place in their heads. But with Indigenous people, what we like to do is gather and sit and have tea and talk about what's important for us right now, what needs to be worked out. And how can we fit what we need to happen in our communities where the funding is from. So we try to figure out ways to develop a project around what it is our communities need and it starts from there. And then you work out the details about how that project is going to fit that funding. So often, the research is already developed in the researchers' mind. And there's no, for me, it starts with ceremony. It starts with the offering of tobacco to the elder or to the people working on the research project. It's the gathering of people that's important in the very beginning because you need what we call good minds. We need good minds to come together, to talk, to discuss. And to create research that's going to be a possibility for the community because that's what research is. It's about the gathering when I think of research. It's about researching, re-looking, looking again, seeing where things could fit and where they don't fit. And what's important for us, we don't want to be, for me, I don't want to be an add-on or an afterthought or I don't want to be researched on. I want research to be fore-end with indigenous people. And I welcome people that are allies that can guide me through the process and but not take over the research 'cause so often I've been in research projects where, yeah, my ideas are there, but then it gets used by the greater research and how the indigenity of the researcher gets lost. And so in thinking about research and thinking about the paper, how would you describe the idea of ethical space? - So that's right, there's sort of the two key, I call them philosophies 'cause they're really both something that can become a barometer that can guide your work. It's not about creating a static point. It's about, you know, as you go about, they become a way of sitting back and critically reflecting and asking yourself, how are we able to be doing this? So ethical space, which will your mind really took and had it become something that was well known within health research in Canada, although its roots are really in, I think it was philosophy and ethics and pool was a person, he's a Buddhist. And it's that whole concept of, you know, I and the other person and how do we create that space in between? Because there's always relationality in our world and I think sometimes we, and I'll leave it as a we 'cause I think it is way more of a Western thing that happens that we forget that how we are seeing the world is not how everybody is seeing the world and how do we create space for that other people? and how that can come to play to influence not only the moment but influence ourselves as we proceed and so things like ethical space and when you get that concept in your head and then you're out doing your research to have those moments where you sort of look at it and go okay what's really driving this what's dominating and is this what I want and if it's not then to start to look at ways to create that space for the places that are being silenced to have a lot of boys for that to be able to come in and feed because you know I'm not going to fool myself as somebody who grew up in a white supremacist system and then was educated in you know the academy completely from Western ideology it's not easy like it's way more easy for me to fall back into what I know because I've never had to be challenged this becomes something I make a decision to do so having these kinds of tools are really useful because they can stop me to then take that moment to do that reflection and to figure out a different way to proceed forward and I personally believe the more you can do that then it becomes easier but more importantly I think the research has greater value for a greater portion of the world and I think there's things that we learn just because there's things that are not commonly seen and then we can start to proceed differently hopefully in a more humane way thank you and at and in the paper we had two-eyed seeing how would you describe this two-eyed seeing so with ethical space I talked about you know what pool saw that it's remembering there's an other and how you know what's that space in between how are we doing two-eyed seeing Albert and Medina Marshall from yeah from their McMala from Nova Scotia oh actually I think they're from New Brunswick and they they brought this teaching into some of the education they were doing I think they were teaching science students and what they were wanting to do was find a way to bring Indigenous knowledge into the classroom but doing it in a way that allowed for the Western that people would be expected to be learning there and so that's my understanding of two-eyed seeing is it's about finding good ways to be bringing both eyes to a situation but also to then take those to see what you can learn from both so it's like not one dominating the other so again there's a lot of similarity between the two but there are definitely several differences and two-eyed seeing from that point got taken up by the Canadian Institute of Health Research and sort of got plopped into Health Research across Canada as a way an approach is probably what people would say and again for me yeah it's kind of an approach it's a philosophy it's a way it's a lens you can bring to your work it's not about you know designing this and it's like there this is two-eyed seeing it is something that will be dynamic and you will always have to be pulling yourself back to the point that you were hoping to have where both eyes get to be a part of it do you want to add? Yeah I'm to me two-eyed seeing is one of the philosophies that we could look at there are many different philosophies but because this was the one that was taken up by by the Canadian Health Research this is the one that's what's the word have the most influence on? Yeah has the most influence in health research and I think it's important to note that this isn't the end all be all philosophy when you think about philosophies in the western culture there's the Greek philosophers the Buddhist philosophers and there's many different philosophers and so this is one of the things that happens and I think part of people using this philosophy is it's that whole idea that indigenous people can be compartmentalized and that we can be put in one space but that's untrue because we have different languages we have different cultures and our cultures are very much based on the land so people in BC would have a different philosophy people in Saskatchewan would have a different philosophy because when you think about the land the land is very diverse and it changes so that philosophy needs to change according to the land however this too I'd think I think is a good starting starting point for non-indigenous people to have an understanding that like coming back that they do have a worldview and that's that these two folks we're trying to say is that you have to recognize that you come from a worldview and that you have to do your own work to be able to work with indigenous people if you don't do that work then you'll never understand that you you come from a worldview and in the paper we have a diagram that shows like an indigenous eye and a western eye and how they merge together and unfortunately right now the biomedical worldview dominates indigenous worldview and the hope is that at some point there'll be an equilibrium where we have both indigenous and western eye working together in a synergistic way and I think Stolly but surely we're getting to that point and the space that happens between those two eyes that's the ethical space that Annette was talking about that's the space where we can have respect where we can have people honoring each other's worldview and honoring each other's way of doing research because currently right now as an indigenous person I'm always fighting to get our worldviews into research and having people understand that that we do come from a perspective and that what we understand and know is important because we survived millennia before western cultures came to Canada to North America to Turtle Island and so that tells me that the way we conducted ourselves our values and our beliefs in our culture helped us survive and helped us live and help us thrive and so in the back of my head is like what happened what caused that change what caused that shift and the paper does talk about that shift and change and I think it's a good idea for people to like do their own work and figure that out so my other question was about what are your experiences in working with indigenous people and what are some projects that you've seen that worked well using ethical space and worldviews sure and thank you for that and I will say on the paper we you know we did not intend to be exhausted but we put a few examples in here and one of them one that is that Monica and I both worked on around heart health and you know we we demonstrate in that how some of that shift happened that you know when I was applying for the funding for what became known as the Deweywin project I was not nearly as educated I will say about how to go about doing this research in a good way so you know that project really was my learning ground and unfolded and so in particular the qualitative part you know we thought we would interview patients and that got thrown completely out of the window and we have a really fascinating brief um documentary done with five indigenous medicine people slash elders where you know it's like the process we were talking about we met four times over a year all of those meetings were recorded there was no scripting that went on there it was what bubbled up the focus was always on heart taking care of the heart heart and the system um and and we created pack away Tay and it's a really interesting um it's a very different way of looking at heart and what goes on with the heart within indigenous people and how to take care the other study that isn't mentioned here that I was involved in uh is Medea Chimoan which was working with uh I think there were four or five indigenous women and we co-created digital stories with indigenous women who had heart conditions and the piece so that one I was just there as a guide and along for the ride because that was definitely um you know Larena in particular Roberta were the two people driving a lot of what went on there um and so again it was a really big learning for me and we had two elders that were involved in it but I remember still as a non-indigenous person when I looked at the beginning of the analysis of data that eventually became a paper as somebody who's been in her since I was 19 years old. old. So for a lot of years, when I looked at what the women created, the digital stories were talking about, I remember thinking what most health professionals would be interested to know if they understand is there. They understand about diet, they understand about exercise, they understand the medications, the things they need to do. But if that's all you were looking for, you'd only see about 25% of what these women were talking about and how they understand their heart, what went on with their heart, and what they do to take care of their heart. And that was, again, just a big aha moment for me around what the benefit can be of stepping, of getting out of your own way as a western person. Yeah. Yeah. I wanted to say I was involved in that process also. Part of the process was I was called a story catcher. So what I did was I sat with the person that was being interviewed and we talked about her life. And through that storytelling, which is one of the indigenous method, all of these in research, it emerged like what she felt her heart was about and how important her heart was. And so from that story, we created a smaller paragraph because we did photo voice and then she had pictures. And it was through talking to her that her and I created a relationship. We had a relational accountability towards each other. And she trusted me to write her story the way that I heard her tell it. And because we are in a western world and it was a photo voice that had to be only so many minutes long. And so we cut back her story. But she was happy with the changes. And I didn't do anything without her consent. Everything had to go by her first and we'd sit and chat and talk. And we talked about this through having tea together and getting to know each other. And I think through that process, that relational accountability that we had together, this beautiful story emerged and how she felt about her heart and what she felt her heart was. And it wasn't how in the western way it's this thing that's separated from you. It's a separate organ that has nothing to do with the rest of you. And her story was so beautiful because she described her heart as something that was given to her so she could take care of other people so she could take care of her grandson. And the heart only beat because she was able to have a relationship with that heart. And I just thought it was so beautiful. And she was very strong in her idea of it. She said I give thanks to my heart for pumping blood to me every day. And she knew what she had to eat and how much exercise she had to do. But for her, it was the relationship that she was having with her heart and how she was able to talk to it and be one with it. That to me was really important. And when I went through that process, it was like, yes, this is what, to me, indigenous research is about. It's about including us and recognizing the way we think about things as important. And when you see yourself in research, like for me, I get happy. And so that's one of the wishes in my academic journey was to be able to see research done from an indigenous perspective. And this research accomplished that. And so the other thing I wanted to finally talk about was what we hope to take away from this process that we've been talking about. Yeah, it's sort of one of the key goals of the podcast. And when I reflected on that, I think I go back to that notion of health research and reconciliation. So, you know, I'll speak to the non-indigenous researchers out there. And if you have interest or you're being called to become involved in, to really take the time to do your work, to be informed, but also to really look at how you're approaching. And what's dominating? What's driving this? And are there other ways you could go about doing it that you're not currently involving in your study? And also, we talked a little bit in the beginning about the notion of worldview. And it's really hard for something to describe that just over a podcast with no visuals. And so I really invite people to really realize the waters you swim in and what's shaping and informing what you see and what kind of questions arise for you. I think as researchers, those are really important questions to always be asking yourself. But I think in particular, if you're doing work that has to do with indigenous people or you're working alongside of indigenous people, I think it's really important if you're somebody who comes from a privileged background as I do to be doing that to do this work in a good way. So that's my hope that comes out of people reading the paper and listening to this podcast. Thank you, Annette. One of the things that I think is important that comes out of this research is how it's important to recognize that indigenous researchers are here to stay and that we're going to raise our voices and that we don't want to be an afterthought. We don't want to be an add-on and that we have to question even as a non-indigenous researcher when we look at research, who is this research for? What is it going to accomplish? Because that's in nursing, they talk about how the patient is important. And so, who is the patient? Who's the important person in that scenario? How do we make sure that their health is looked after regardless of where they come from, who they are? Because they're in the end, we're all human beings and we have to recognize that we come from a bias and we have to recognize that we, like Annette was saying, we have to do our work, you have to do your work, you have to figure out what your biases are and what perspective you're coming from and why are you asking these questions when you wouldn't ask that question of someone else and researchers develop all this research and in the research when you develop it, it also develops policy and programs. And the way those policies and programs work is that it may not fit Indigenous perspectives. For example, Indigenous people when someone gets ill and it's an important person in that community, lots of people come visit. And so, if the policy in the hospital and in the nursing station is only one visitor per person, that's not going to fly with Indigenous people because people and relationships are good medicine. And that's what the heart health study said is that gathering of people is good for the heart and it's good for the spirit. And so for me, that's important and I'm thinking of one of the authors of Elizabeth McGibbon, she said, like, you have to question who is this research for and who is making these standards. And if we don't question that, research is always going to be done the same way. Elizabeth is one of those people I would consider a really good strong ally. And, you know, I give thanks for her coming into my life and reading her work and, you know, and same with Janice Linton. I learned so much from her about how to conduct research in the library because she has a specific way of looking at how do you capture specific words to capture specific articles. Because there are certain words that aren't used in articles, but need to be used. And so these folks, both to me, contribute a great deal to this article because without their voices, this article wouldn't have been as rich as it was. And so I want to give thanks to both of the women that weren't able to be here, but they're here in good spirits and good minds. So we're coming to a close and I want to thank you, the listeners, to listening to myself, Dr. Monica Sinclair and Dr. Nat Schultz. Witness the Canadian Journal of Critical Nursing Discourse is a Canadian nursing journal scholarly and open access nursing journal which invites critical nursing and health, social justice and advocacy. we encourage you to take a look at www.witness.journal.yourq.ca the link is provided below. Our tagline is see it, speak it, write it, change it, and we hope you will join us in our movement of social change, EgoSani. [Music] [BLANK_AUDIO]