Opening the Circle: Ontario Edition
Alice Eriks-Brophy, a former elementary school teacher who spent 8 years in classrooms on Aboriginal reserves in Quebec and Ontario, is helping children with communication disabilities in the Sioux Lookout Region of Northern Ontario.
Together with community personnel, researchers and Telehealth providers, Eriks-Brophy is improving access to health services in the region’s Aboriginal communities, which report a high incidence of speech and language disorders.
“In the North, we’ve tended to take our medical model and transpose it without taking into account how First Nations people perceive it,” said Eriks-Brophy, an Associate Professor in the Department of Speech-Language Pathology.
“There are also a lot of fly-in-fly-out services to do things like screening. We make the communities aware of a problem, but there’s no follow up and that leaves them to question how this helps them. The services are perceived as disjointed and not focused on the community’s concerns.”
On the other hand, she notes, some Aboriginal cultures are reluctant to identify someone as having a disability.
The answer to overcoming these barriers is twofold, she believes. First, all medical educators should look for ways to expose students to other cultures, including those of the First Nations, and not just on a superficial level.
“It’s not enough to be culturally aware,” she said. “Practitioners must understand the context of how people are living — their history, the colonial experiences, the impact of residential schools and living on reservations — all the political and social justice issues.”
Secondly, it’s essential to have the support of people in the communities who are trusted, reputable, and understand issues such as confidentiality. Eriks-Brophy believes technology can play an important role in providing service to remote communities, if it’s supported by community contacts and uses suitable testing procedures.
For example, in a study designed to identify children with speech, language or hearing disabilities, she worked through school principals and teachers, and found no reluctance to identify children with difficulties, who then were tested using the Telehealth network.
“We achieved some very good results,” she said. “It’s a wonderful technology and offers a big advantage, but you still need to have an understanding of the community and the people.”
She also believes more work needs to be done to develop culturally appropriate testing strategies and approaches. Most standardized tests have been developed for North American or European clients, and do not take into account different cultural backgrounds.
“The way that we assess people’s communication skills is very open to bias, because it’s based on our own perceptions about how people interact,” she said.
“We make assumptions about how it should be. We need to consider cultural background, and make the tests culturally appropriate. This would be true whether you were in Ontario’s North or working overseas.”