平特五不中

Thus says our God:
Stand at the crossroads and look;
as for the ancient paths, where the
good way lies and walk in it, and find
rest for your souls.
-Jeremiah 6:16

RITES OF PASSAGE IN THE LIFE OF CREE OF QUEBEC

Like families and communities everywhere in Quebec, the Cree families in northern Quebec never miss happy celebrations of birthdays, graduations, weddings and anniversaries. However, unlike many others, the extended Cree families also celebrate the more memorable ceremonies, or rites of passage, which mark those important milestones in each person鈥檚 life: the baby is born and named; the toddler first 鈥渨alks out鈥� onto the earth outside the dwelling; the child first walks on snowshoes; the adolescent celebrates his or her first hunt or her first moon; the adult experiences visioning ceremonies; and, later, the person鈥檚 dying is marked by the rite of passage of letting go at the end of life later followed by the memorial give-away.

Ceremonies like the walking out and the first snowshoe walk were infrequent for several decades until their revival in the mid-1970s. Although residential schooling seriously disrupted the first hunt and the first moon ceremonies associated with puberty, they have been and are being reclaimed. And modern medical services have intruded into the social patterns which formerly celebrated each person at the beginning and the ending of their life鈥檚 journey.

In the last few years, the Cree Board of Health and Social Services of James Bay, or the Region 18 of Quebec鈥檚 health and social services, has introduced, or rather re-introduced, midwifery services and bringing back Cree rites of passage around birth. These services have begun in Chisasibi, the largest community and are systematically being extended to the eight other Cree communities. Before this, all pregnant women from each of the nine communities had to travel, usually to Val d鈥橭r or Chibougamau, to deliver. Today this is changing and soon midwifery services will be one ordinary aspect of maternal health care in the region.

This leaves one significant rite of passage which has not yet been incorporated into health services: that of marking the person鈥檚 experience of life at the crossroads of its ending 鈥� the Cree version of a palliative approach to care of the dying.

WORKING TO SUPPORT THIS CREE PALLIATIVE APPROACH IN SERVICES

• Through better coordination

The Qu茅bec policy on palliative care stated the main issue with palliative care services is lack of coordination and this characterises the situation at the Cree Board of Health. However, it has a project funded by the Health Care Policy Contribution Program of Health Canada to explore how to adapt services for the Cree by focusing on four activities. With the project as a catalyst, the organisation is now actively planning how to structure and coordinate palliative care within its services.

Palliative care for Cree not only involves the Cree Board of Health but also the three other regions where Cree patients with long-term serious illness are sent out to receive specialized care, including palliative. In the five years ending in 2019-20, an annual average of about 28 Cree were being diagnosed as palliative and dying in hospitals outside of the region. This was around 40% of annual deaths and is a minimum number. Other people died following long-term serious illnesses but were not necessarily documented as palliative either inside or outside of the region.

During the lockdown, creating linkages in the context of the continuum of care with Abitibi, Nord-du-Quebec and Montreal regions was impossible. However, recently, the 平特五不中 Continuing Professional Education Day on Palliative Care has resulted in linking Palliative Care 平特五不中 directly into the Cree Board of Health鈥檚 planning in this area.

• Through documenting what is happening

With a need to understand what has been happening within services before suggesting improvements, the project is listening to the experiences of health care workers and those running community services along with their hopes for improvements; it is documenting current resources; and exploring training needs and how training might be best accessed for professionals, para-professionals and community helpers.

• Through self-assessing local clinical services

A second stage in documenting the state of situation is to detail the adequacy and appropriateness of services that the local clinics have recently offered to patients at the end stage of serious illnesses along with their families. A self-assessment tool is being explored for use by clinics who wish to examine past practices in the context of their available resources.

• Through promoting language and cultural approaches

With the highest retention of its Indigenous language of any region in Canada, almost all Cree speak Cree as their first language, at home and with friends. In the Cree Board of Health, the majority of managers are Cree, all para-professionals are Cree, almost a tenth of the nursing workforce are Cree and now two doctors are as well. At this time the Cree Board of Health has neither a language policy nor plan, and no interpreters formally hired in services, although many are hired in other job titles to also interpret. The project has developed Cree terminology and concepts common to discussions of a palliative approach and is working to make all existing medical glossaries accessible on the organization鈥檚 website. At the same time, the project is interviewing elders and others to understand how to adapt services to an approach which will be familiar and safe.

THE NEED FOR A PALLIATIVE APPROACH

Similar to birthing, the process of dying in Eeyou Istchee has become medicalized and often far removed from the comforting, familiar and familial patterns only found within the family, community and language. Cree rites of passage during the process of dying were founded on common understandings and known practices to witness together that person鈥檚 final transition onto their new journey. Today, people in the communities and those working within health services are ready to support initiatives to adapt services to find a better approach to ease the way of those who are dying and those they are leaving behind.