‘It’s looking at the entire person, not just what’s physically troubling them’

TORONTO–When she was growing up in M’Chigeeng First Nation on Manitoulin Island, Ashley Migwans’ grandfather offered ever-present guidance. The Second World War Veteran seemed to always be telling a story, taking the family to a powwow or illustrating the importance of fighting for Indigenous rights.

Today, nearly a quarter-century after Ernest (Ernie) Louis Debassige passed away while Ashley was still in elementary school, he continues to be a source of great pride and influence for her.

“He stressed the need for education so Indigenous people could be in roles to help Indigenous people,” Ashley says of her grandfather. “The reason I wanted to be in healthcare was because he said there wasn’t enough of our people in the field, and that’s still true all these years later.”

Ashley has spent a decade in healthcare – five years as a physiotherapy assistant and manager of a physiotherapy clinic back home, and since 2015, at UHN. For the past 18 months, as Regional Indigenous Cancer Program Coordinator with the Indigenous Cancer Program (Toronto Regional Cancer Program), she has travelled between hospitals across the city to provide Indigenous cancer supports, education, resources and advocacy.

At the start of November, Ashley became the first Coordinator in Indigenous Health & Social Medicine at UHN, a role that will see her advance cultural safety and health equity in the organization and beyond.

“We’re really hoping to make UHN a culturally-safe institution for Indigenous peoples,” Ashley says. “That means a place where our community can receive quality care or come to work without discrimination or racism or stereotypes in a way that respects who we are as Indigenous peoples.”

Education and awareness are keys; that includes learning opportunities for members of TeamUHN to better understand the history and ongoing experiences of Indigenous people in Canada, particularly with regard to healthcare. And, it’s also about building strong community partnerships with Indigenous organizations and people across Toronto to ensure UHN understands their needs and is accountable.

‘No one person, or one group, can do this alone’

It must be a collective effort, Ashley says. It’s not just about Indigenous peoples highlighting issues and raising awareness about the importance of spiritual values and beliefs, but also having non-Indigenous people take ownership of the need for institutional change for reconciliation and for equality, she says.

“It’s a responsibility that falls to each of us,” she says. “No one person, or one group, can do this alone.”

Dr. Lisa Richardson, co-chair of the Indigenous Advisory Group at UHN and Strategic Lead in Indigenous Health in the Temerty Faculty of Medicine at the University of Toronto, says one of Ashley’s strengths that will see her thrive in the new role is her ability to build bridges between institutions and her culture.

“She represents the future and illustrates why Indigenous people will thrive because she inhabits both worlds and brings them together,” Dr. Richardson says. “She’s able to enhance UHN because of her connection to culture and Indigenous ways, and that is such a great gift she’s bringing to all of us.”

Ashley says one key component of Indigenous health is viewing health as a wellness model rather than an illness model – emotional, spiritual, mental and physical well-being versus treating someone’s physical ailment alone.

It’s in that broader view of healthcare where there is a clear connection to social medicine.

“It’s getting people to understand that when we come into healthcare it’s looking at the entire person, not just what’s physically troubling them,” Ashley says. “Clinical care doesn’t often put as much of a priority on those social determinants of health and that needs to change because they are key components of what’s bringing that patient to the hospital to receive care.”

‘We’re not here to pass judgement’

Dr. Andrew Boozary, Executive Director of Social Medicine and Population Health at UHN, says barely a month into her new role, Ashley is having a positive influence on the team’s work.

“Ashley has already made such an impact in shaping the way we think about the social determinants of health in care delivery, but also shifting views from ‘vulnerability’ to the strengths and wisdom in the communities we serve and continue to learn from,” Dr. Boozary says.

Ashley is excited by the challenges of her new role. She plans to take them on the way she always has, by focusing on relationships and working with – and learning from – organizations and communities which are already delivering safe care to Indigenous peoples “so we can help build each other up.”

And, she’s brimming with optimism. In her previous position with the Toronto Regional Cancer Program and the early days of this role, Ashley has seen people of all cultures emboldened by the safety of a sharing circle or the comfort of a post-meeting one-on-one chat to seek out more information.

“We’re not here to pass judgement,” Ashley says. “Chances are, if you are wondering about something and have a question, someone else also has the same questions, so don’t be afraid to ask.”

“We all have our own stories,” she says. “It’s those stories, those lived experiences, that have brought us to where we are today.”

“This applies to patients as well. We need to thoroughly and thoughtfully listen to their stories in order to provide the highest quality of care.”

“It’s time that we start sharing our experiences and earnestly listen to one another in order to create a safe environment and to grow as individuals, as professionals, and as an organization.”