Research Profile - Q & A with Dr. Janet Smylie

A Toronto-based researcher and maternity care expert says the Indigenous Knowledge Network addresses the need to make infant and toddler health promotion more relevant to Aboriginal people.

[ Back to main article ]

Even though they live in urban centres with excellent health care facilities, First Nations, Inuit and Métis children don't enjoy the same level of health as other Canadians. Part of the reason is the health information and care they receive sometimes doesn't connect with their culture. Dr. Janet Smylie of St. Michael's Hospital and the University of Toronto heads the CIHR-funded Indigenous Knowledge Network, which is linking Aboriginal front-line health care workers, policy makers, knowledge-keepers and university scholars to combine cultural knowledge with health promotion to improve infant and toddler health. Here she answers questions about the network and what it is accomplishing.

CIHR: First, why is there a need for the Indigenous Knowledge Network?

Janet Smylie: Currently Aboriginal health services and programs and the people who run them and work for them operate with a deficit of good quality information. For example, if you're running an urban midwifery practice here in Toronto there's not good information about the major illnesses that the Aboriginal women suffer from or the rates of infant death – something as basic as that.

CIHR: So, the idea is to develop public health information – especially regarding infant and toddler health – that's more relevant to Aboriginal people?

JS: We have incredible diversity in Canada. Intact cultural and social systems have this common characteristic: important knowledge is shared so that infants grow into healthy, self-confident and productive adults. The challenge is that culture-based skills and knowledge systems of First Nations, Inuit and Métis people were thought of as less important than European systems. So there was a disruption of this kind of cultural transmission. But you just can't impose another system. We're trying to regroup and recover this knowledge and ensure its active transmission and application in young Aboriginal families.

CIHR: How are you recovering that knowledge?

JS: One of the things we're doing is supporting front-line workers to spend one day a week talking to people who are knowledgeable about our culture in the communities – often older people. And they talk to their day-to-day clients and gather everyday wisdom. Because sometimes, as health care providers, we forget that our clients and patients have a lot of knowledge to share.

CIHR: Is that why it's important to have input from elders and traditional resource people such as healers?

JS: Basically we're trying to uncover best practices. If we can find the best practices cross-culturally, people are more likely to follow advice that fits in, that is familiar to them. If the source is an auntie or a community based midwife, that's something people might trust a little more – as opposed to something from a doctor who they just met that day.

CIHR: Does this mean you have to look at integrating both the traditional knowledge with Western best practices?

JS: Yes, integrating it – or just finding the teachable moments. For example, most new parents have always felt a time when they've been stressed out or overwhelmed. I can remember one of the midwives that I worked with sharing a teaching that her grandmother had passed on to her in their Aboriginal language. It translated roughly into 'this too will pass.' It comes from cultural teaching. So passing that on to someone – if you pick the right time to do it – can be quite comforting.

CIHR: The front-line workers, are they all Aboriginal health care workers?

JS: In our network, currently there are 10 communities participating in Saskatchewan and Ontario and I believe all the representatives are Aboriginal, although some of the front-line providers are non-Aboriginal.

CIHR: This is a five-year project and you already have the communities lined up and research agreements in place. Now you're in the knowledge-gathering phase. What does that involve?

JS: Those frontline community workers are interviewing clients who participate in their programs. They are asking them a little bit about where they've been getting their knowledge about parenting and reflecting a little bit on how this project could help their day-to-day clients. And they are gathering oral histories in their communities, identifying people who are knowledgeable about cultural-based parenting and infant-toddler health promotion and practices.

CIHR: How will the oral histories be used?

JS: In the second half of the project we're going to support the front-line workers in developing strategies to use the knowledge. We're looking at information technologies and hoping to get lots of the oral histories digitally archived. We have a filmmaker who is helping us. We're very open in terms of the modalities. It will be the community participants who decide. It may be as simple as having an Elder regularly visit a children's program and just tell stories. Or it could be as sophisticated as building a customized IPod program that has an Elder sharing sound bites on whatever topics the clients might be interested in. You have to go with where the audience is.

CIHR: You are Métis woman and a health care provider. While your main work is research, you're still seeing patients as part of your practice, is that right?

JS: I do have an active research program, but I work as a consultant family doctor with a group called Seventh Generation Midwives in Toronto. This midwifery practice is one of the community partners in the network. I see the challenges that young Aboriginal people still face, even in a centre like Toronto. I'm here at St. Michael's Hospital with some of the best care in the world but two or three blocks away at Anishnawbe Health Toronto, which is one of the first settings in which I did family practice and maternity care, there are people facing incredible challenges.

CIHR: Is there a greater need for this kind of network and what it can do in urban settings, given that urban Aboriginal people are often cut off from the culture of the people, of the reserve, of where they come from?

JS: Over half of Canada's Aboriginal people now live in urban centres. But there is a real gap in urban Aboriginal research. Infant mortality for Aboriginal people is 1.7 to four times higher than for the rest of the Canadians. It doesn't get better in urban areas, so why is that? Obviously, health care services alone won't solve everything. So part of it is also setting up supports in the community so that it strengthens knowledge transmission and abilities to be healthy and well.