Reference no: EM133982578

Question

First Nations Perspective on Wellness

This case focuses on a low-income, non-English speaking Indigenous Anishinaabe people. We will examine one of Canada's First Nations patient and his family who speak the Ojibwe language.

As you read through this story, pay special attention to issues around medical decision-making such as social determinants of health, trauma informed practice, and the contrast of indigenous health practices to traditional western medicine.

Background

Mr. Thomas S., is a 78-year-old widow who lives on the Sheguiandah First Nation Reserve among the tribe of the Anishinaabe people. He worked as a custodian for 20yrs and retired when he was 65yrs old. He is widowed and has 3 children. Thomas lives with his younger son, daughter-in law and their 2 small children: 3yr old Kenny and 18month old James plus two cats. Thomas and his family share a small home with poor ventilation and the roof often leaks during the winter months. Presently no one in the family is working and they rely on government financial assistance and his pension. He often helps entertain the children and helps with household chores. His 2 other children, grandchildren, and great grandchildren all live in his community. They speak only Ojibwe at home and all struggle with the English language.

He has a history of diabetes, COPD, and hearing loss. He considers himself to be healthy, describing his breathing condition as 'not that bad, and his diabetes as 'manageable'. He becomes short of breath doing daily activities which take him longer now. He still smokes occasionally and understands he should quit but feels he is 'too old to try'.

Thomas had 3 toes from his left foot amputated 5 weeks ago, secondary to a wound that didn't heal due to diabetes. Wound care is provided in an outpatient clinic on the reserve. He understands the severity of his situation and is concerned that the wound is not healing as expected. He states "I don't want to have my leg amputated just below the knee". Thomas does his own dressing changes and explains to the nurse that he does not want to bother his family and states 'I can take care of myself'. The wound care nurse assessed Thomas, noting that he was not wearing his hearing aids, and suspected he could not hear the wound care instructions.

Thomas seeks care from the Medicine Person and plans to participate in smudging ceremonies. The Medicine Person recommends Thomas drink herbal teas made of willow bark, black tea leaves, licorice root and choke cherry to help with his wound. As well, he advises Thomas to chew yarrow leaves to improve his breathing.

The following are Jimmy's prescribed medications form the health clinic physician:

· Salbutamol 90mcg 1-2 puffs q4h prn SOB/wheezing,

· Captopril 20 mg once daily,

· Omeprazole 40 mg once daily,

· Metformin 500 mg one tablet daily

What therapeutic communication strategy would you use to communicate these risks to Thomas and his family?