A BC First Nations Case Study Reflection Underscores Impact of Systemic Racism, Endorses the Transformative Changes that Cultural Safety and Humility Can Make in the BC Health Care System
Fraser Salish Region – The First Nations Health Authority (FNHA) today announced the public release of its report titled Remembering Keegan – a BC First Nations Case Study Reflection. Keegan Combes was a 29-year old First Nations man who died in hospital in 2015 following delayed diagnosis and clinical management of a treatable accidental poisoning.
Remembering Keegan is part of ongoing anti-Indigenous racism actions in BC's health care system that includes a number of other reports, reviews, recommendations and the formation of a provincial task team. It is also a tool meant to inform and guide the pursuit of definitive change and to support the establishment of a cultural safety standard within the health care system.
First Nations have a deeply rooted culture and tradition of storytelling as one of the ways of passing on knowledge. Storytelling is a traditional method used to teach about cultural beliefs, values, customs, rituals, history, practices, relationships, and ways of life. First Nations storytelling is a foundation for wholistic learning, relationship building and experiential learning. This Case Study Reflection is a narrative tool for health professionals to learn from and to reflect on the personal and systemic biases that shape their practice, and to encourage conversations leading to safer health care environments and experiences for First Nations and Indigenous people, so that what happened to Keegan never happens to others.
A first of its kind report produced by the FNHA's Office of the Chief Medical Officer (OCMO), Remembering Keegan provides an in-depth look at the different paths that could have led to culturally safe care, offers clear examples of what Cultural Safety and Humility should look like, and how it could have contributed to a different outcome. The report also explores intersectionality, the interconnected nature of social categorizations such as race, class, abilities and gender, encountered by BC's frontline healthcare workers in the care of their patients.
Loved and remembered by many, Keegan Combes was a local chess champion, grade ten piano player, and high-school graduate living with developmental disabilities.
In the aftermath of the incidents leading to his death, Keegan's family, the BC Coroners Service, Fraser Health, and the FNHA committed to working together on building a better health care system to deliver culturally safe and equitable services to all Indigenous people in the Fraser Salish region. A plaque and artwork in Keegan's honour were unveiled at the hospital during a ceremony on the fourth anniversary of his passing. You will find the Healing Hands of Friendship Commemorative plaque outside of the Chilliwack General Hospital affirming this first step of commitment.
Keegan brought together Stó:lō and Coast Salish leaders to transform the health system from a sickness model to a wellness model of care. He is a transformer stone for the region. Telling Keegan's story is important as a way to bear witness, document culturally unsafe encounters within the health care system, and contribute to changing the system to prevent similar deaths or harm in the future. Keegan's legacy has been to help shape the Cultural Safety and Humility transformation that is currently underway in BC's health system.
Rhianna Millman, Keegan's Family Advocate and Caregiver
“It is imperative for the entire healthcare ecosystem to hear Keegan's story, to read the case study reflection and embrace the teachings within the document; as they are vital to providing culturally safe care. It will be their call to action to actively commit themselves and their respective institutions to dismantling and eradicating systemic racism, with a lens of intersectionality so that systems of oppressions that continue to be embedded into the beliefs, behaviours and practices within our healthcare system are not an obstacle to anyone receiving care. Keegan's identity and life experiences made him who he was, and should have never prevented him from getting timely care. The onus is on the health system to grow and transform, to make sure what happened to Keegan, never happens to anyone else."
Dr. Nel Wieman, Deputy Chief Medical Officer FNHA
“Remembering Keegan" is a call to action for greater change, working toward eliminating anti-Indigenous racism in the health system. Keegan's legacy is to be a Transformer Stone for the Fraser-Salish region and this case study reflection is intended to be a learning tool for health providers to advance culturally safe care. We know there are other cases like Keegan's around the province and the OCMO is interested in partnering with the other regions to create case study reflections. This helps to elevate anti-Indigenous racism as a priority to be urgently addressed."
Richard Jock, CEO FNHA
“This report is a BC First Nations story gifted by Keegan and his family which is an important tool for understanding anti-Indigenous racism in the work we are doing. It supports ongoing dialogue and collaborative partnerships with Fraser Health and other organizations, where solutions are sought together."
Colleen Erickson, Board Chair FNHA
“The Case Study Reflection informs the work of the FNHA, First Nations Health Council (FNHC), and First Nations Health Directors Association (FNHDA), with our health partners. I salute the courage of Keegan's family in this tragic story."
Willie Charlie, Chief Derek Epp, Chief Andrew Victor, Fraser Salish representatives, FNHC
"The FNHC acknowledges the advocacy of Rhianna Millman and Keegan's family for bringing awareness to this case and working for justice. Participation from First Nation leaders including Chief Combs of Skwah and partners at Fraser Health Authority and the Chief Coroner on this case study is a step in building a culturally safe health care system in BC. The FNHC works with its partners at the FNHA and FNHDA to eliminate systemic biases and create a racism-free health care experience for First Nations people."
Dr. Victoria Lee, President and CEO, Fraser Health
"Fraser Health is firmly committed to working with our local, regional and provincial partners to improve Indigenous health outcomes. Culturally safe and equitable health services will not only reduce existing gaps but also improve the health system for all. By listening and learning from our partners and from storytelling such as this case study, we strive to better understand the Indigenous worldviews and work together to eliminate systemic racism."
Jim Sinclair, Board Chair, Fraser Health
“Providing culturally-safe health care to Indigenous people in a way that honours and respects wellness traditions is something we all stand by. Strengthening governance, promoting better communication and transparency and providing staff with Indigenous Cultural Safety will help build a better health system for all. In partnership with the Fraser-Salish regional caucus, we pledge Yeqwethet – to heal and make things right."
Kevin Boothroyd, Director Media Relations
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