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Indigenous communities continue to face disproportionate barriers to health

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Dr. Ojistoh Horn, from the nearby Mohawk Kahnawake Nation, spoke at the Women’s Health Conference hosted by McGill’s Comparative Healthcare Systems on March 11. The conference aimed to spark conversations on the structural and social determinants of health within Canada.

After attending medical school at the University of British Columbia, Dr. Horn returned east to complete a fellowship in maternal and child health in McGill’s Family Medicine residency program.

Dr. Horn explained that over 500 years ago, there was an Iroquois community in Hochelaga, the land where McGill currently stands. It is a very important place for her personally and culturally.

“I have an unbroken female lineage, an unbroken tie to this area, this place,” Dr. Horn explained.

At her workshop titled, “A Day in the Life of My Clinic,” Dr. Horn said a few words of the Ohenthen Kariwatekwen to share a piece of culture with the workshop participants.

“[The Ohenthen Kariwatekwen is] an acknowledgement of where we are in nature and that we are not above nature, we are part of her and we were put here to take care of her,” Dr. Horn said. “What’s happening to our Earth is a reflection of what’s happening to us.”

Due to this belief, Dr. Horn has explained the importance of taking care of one’s health in a culturally relevant way.

“I talk to my patients about taking care of themselves and I do it in a way that is culturally relevant,” Dr. Horn said. ”If I tell them to go running, they are not going to understand that, but if I tell them to go outside and hear the tones of the birds […] and look up at the sky, they go, ‘Yeah, I should do that.’”

Dr. Horn works in Akwesasne, a Mohawk community on the U.S.-Canada border. Half of the community is in New York and the other half is situated between Quebec and Ontario, which creates major problems in terms of travel between the different parts of Akwesasne and health care jurisdiction.

Crossing the border to get different health care or coverage is a huge challenge for Dr. Horn’s patients, many of whom are at a high health risk. She encounters a myriad of difficult cases in her practice, including problems of opioid addicts, fertility problems, obesity, smoking, kidney disease, and sleep apnea. However, she must resort to tackling these problems using outdated medical tools due to the limited health care coverage for indigenous communities in both countries. She also has patients who are healthy yet considered high-risk due to their heritage. Dr. Horn overcomes these barriers by building strong relationships with her female patients.

“I have created a relationship with her where she has trust and that is the crux of the situation on the reserves,” Dr. Horn said.

To be an effective doctor, Dr. Horn emphasized the formation of trusting relationships with her patients. But it is still difficult to come back to the community due to lateral violence—referring to the displaced violence against one’s peers—from the patients towards the doctors. Dr. Horn acknowledges the difficulties of going back to one’s indigenous community after becoming a doctor, but she stresses that  it has been a rewarding journey. She is inspired by the increasing interest she sees in young girls for becoming midwives.

“We have a lot of girls in our community who are really inspired by the idea of becoming a midwife,” Dr. Horn said. “It is so culturally important, so historically important, and it is going to bring our women back to the same level that we lost.”

Dr. Horn hopes to bring births back to the communities and help revive cultural heritage, bringing back a sense of community and empowering the next generation of indigenous women.

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