Hermaline Bear is a navigator, and that’s exactly what she does – she charts courses through the healthcare system for First Nations and Métis patients and families.
Hermaline is one of two health navigators who work in the First Nations and Métis Health Service (FNMHS) in Saskatoon Health Region.
The role of a navigator is to connect First Nations and Métis patients and families to the services they need, whether offered by the Region or by the community. It might be translating for those who speak primarily an Indigenous language, arranging transportation from Saskatoon to a patient’s home community, or arranging for a smudging ceremony, while they’re in the hospital.
“It’s a holistic approach,” says Val McLeod of FNMHS. “We make sure the mental, physical and cultural needs of patients and families are taken care of, and that includes things like translating for those whose first language is Cree, Dene or Saulteaux.”
McLeod was one of the Region’s first health navigators, and helped establish their roles and responsibilities. She knows this role is one that’s absolutely necessary within Saskatchewan’s healthcare system.
“From chart audits, we know that there was an increased length of stay for First Nations and Métis patients,” she explains. “Often times, delays were due to problems finding transportation back home or ensuring that supplies, pharmaceuticals and medical equipment needed by the patient were available in their home community.”
There is also a significant language barrier for many of those who speak primarily First Nations languages at home and needed to receive care in Saskatoon. Cree and Dene are commonly spoken in Saskatchewan, especially in the North – many Cree children don’t speak English until they are four or five, McLeod explains.
“It’s hard enough for those who speak English as a first language to understand some of the shorthand and medical terms spoken by staff at our hospitals,” says McLeod. “It’s even more difficult when those terms are given in a language that’s not your mother tongue. Before we provided interpretation services, finding someone who could speak Cree, Dene or Saulteaux in a Saskatoon hospital was nearly impossible.”
It’s a huge comfort for those who speak Indigenous languages to be able to speak their mother tongue in hospital, with their care providers, even if it’s through an interpreter. It’s an aspect of cultural safety that the navigators are happy to provide.
First Nations and Métis patients can also feel isolated in hospital. Often they are alone, far from home and their personal connections. They don’t know what resources are available to them.
“Navigators connect them with their community,” says McLeod. “And if needed, we can help make arrangements for their family to come and visit them, so they don’t feel so alone, and can have some support in making healthcare decisions. If their family can’t come, the navigators can help fill that void. Also, the navigators can often get more necessary medical information out of First Nations and Métis patients, and therefore, connect them to more resources that they need, simply by making our clients feel more comfortable with them.”
Help from the two health navigators is in demand in Saskatoon. In 2016, they helped over 3,000 patients at Saskatoon City Hospital, St. Paul’s Hospital and Royal University Hospital.
The program first launched in 2013, and at that time, the FNMHS team did a tour of the north of Saskatchewan – to places like La Ronge, Hatchett Lake, Stony Rapids, Il-A-La-Crosse and Prince Albert – to let the people in these communities know about the services available, if and when they needed to come to Saskatoon.
“Saskatoon Health Region, especially Royal University Hospital, serves about 40 per cent of the North,” McLeod says. “So a lot of people coming to that hospital hear about us.”
Since the launch of FNMHS, news of the service has travelled quickly by word of mouth. But the navigators feel that many people still don’t know about them and how they can help. However, healthcare providers in Saskatoon’s three hospitals are not among the uninformed; they call on navigators consistently – between five and eight times a week for interpretation services alone.
As a fluent Cree-speaker, navigator Hermaline Bear helps with interpretation for patients at St. Paul’s Hospital and Royal University Hospital as part of her responsibilities.
“The people who come in from the North, for some it’s their first time in the city. It’s a culture shock for them, especially for the elderly,” Hermaline says. “They are so grateful to hear someone speak their own language.”
But, she adds, interpreting from Cree to English and back again is just a part of what she does. “It’s not just interpretation, it’s communication that we help with,” she says. “Sometimes, even when we’re speaking the same language, things get lost in translation.”
Bear believes that any issues First Nations and Métis people experience within in the healthcare system are due to a lack of communication and understanding.
“I help with both healthcare team and patients,” Hermaline explains. “I get the healthcare team to hear the patient’s side, and I explain the healthcare team to the patient. When everyone understands each other, potential issues are averted.”
For example, during one patient discharge from hospital that she attended, the patient and family were all nodding as the doctor gave his instructions for after-hospital care.
“When the doctor finished speaking, I stepped in and asked if they understood what he was saying, and what the patient needed,” Bear says. “And they admitted they didn’t. So the doctor explained it in a different way, and everyone ended up on the same page. I got a thank you from the doctor after that – he had no idea that what he was saying wasn’t being understood.”
The most important part of a navigator’s job is that initial visit, Hermaline says. “Once a patient knows there’s someone in the hospital that can help them, they are grateful they have an aboriginal person that can speak with,” she says.
Hermaline uses humour a lot in her work – something that comes through in her smiling eyes and warm smile. “I love talking to people. I want to let Indigenous people know that what the doctors and nurses are trying to do is for their health. And I want to help the staff understand where First Nations and Métis people are coming from.”
Bear grew up in Sandy Bay, but has lived her adult life in Saskatoon. She knows her community well, which is one of the reasons she feels she’s good at her job – she’s familiar with the resources that are out there for people.
“We have the community supports here in Saskatoon, and knowing who and what those supports are is so helpful. We get asked all the time where we find resources for people – rides home, car seats, whatever is asked of us. It’s nice to know your community and what’s out there and how you can help people.”
A navigator’s day can take them to some unexpected places. Hermaline, as an interpreter, once sat in on a brain surgery with a patient who spoke Cree as a first language.
During the surgery, the neurosurgeon needed the patient to speak, to ensure everything was going well. Hermaline was there to hold up a picture and ask the patient “Do you recognize this?” in Cree, and then in English.
“The doctor wanted to make sure the patient understood in both Cree and English,” she says.
Though she never expected to find herself in a situation like that, Bear got through it. “I’m scared of blood, but it was not hard at all,” she says. “I focused on the patient’s face.”
When they’re not helping patients, the navigators are helping staff, educating them on First Nations and Métis culture to increase their cultural competency and awareness – something that was an area of concern before FNMHS was established. It’s another way to help First Nations and Métis patients, families and healthcare providers understand one another.
The navigators are having a positive impact on the healthcare services First Nations and Métis people are receiving.
“Chart audits since we began our work show that when a navigator is in place, First Nations and Métis patients are treated better due to increased understanding, and the navigators’ presence ensures not only cultural safety but also appropriate care. For the patient, this is huge,” McLeod says.
It’s not just her clients who appreciate what she does, Hermaline says. Doctors, nurses – all members of the healthcare team have told her they appreciate what navigators do, and their quick response when they’re called.
“We’re here to help,” Hermaline says.
Hermaline’s advice for improving care for First Nations and Métis people across the system is to have more visual aids and reading materials available to patients and families.
“Indigenous people are visual – if your patient is not understanding something you’re saying, grab some material with visuals, pictures – especially when there’s a language barrier, as some English words don’t translate,” she says. “Once I had a doctor draw something out, and that worked great. Visual aids help Indigenous people know what you’re looking for, and what you’re doing.”
The entire FNMHS team wants to help create change within the system to ensure that all patients, regardless of ethnicity, are receiving equitable care.
“We feel we can do that by focusing on First Nations and Métis people,” says McLeod. “They are the first people of this land, and there are teachings from the Indigenous world that we can learn from, including their holistic approach to treating not only someone’s physical health but their cultural, mental and emotional well-being as well.”