The next seven generations: at the heart of care alongside Mi’kmaw women

Abstract

The strawberry is connected to heart teachings for many Indigenous people. The strawberry plant produces beautiful things. However, when exploring the topic of Indigenous women and heart health, the focus of the conversation is most often around deficits. Indigenous women have diseases related to the heart at a higher proportion than both non-Indigenous women and Indigenous men. There is a lack of understanding specific nations’ relationships to heart, and there is little to no research available specific to Mi’kmaw (adjective for a Mi’kmaq (First Nations people, Atlantic provinces, Canada, who call themselves L’nu) person) women and heart health. The focus of this Mi’kmaq research, which aligned with community-based participatory research, was to explore and gain a better understanding of what heart means to Mi’kmaw women on the west coast of Newfoundland, Canada. Four Mi’kmaw women joined the research and shared their experiences to co-create knowledge about heart health. This knowledge in turn shaped my understanding of nursing practice.

I had a dream last night and I was on the ferry. I bumped into someone in a nursing uniform, and we got chatting and she was like “oh yeah Erica is on board with one of her friends, she is downstairs covering some nursing duties.” I went downstairs and your friend (she was very dark) was in the bed hooked up to all kinds of machines. Knitters were sitting in the room and the room was quiet, I went in and said, “My god you are always nursing no matter where you go (you were in full scrubs, doing reports and monitoring the patient) [emphasis added].” You said, “shhhh we don’t want to disturb her.” I said “oops” and then the patient sits right up and says, “got any water I’m so thirsty? [emphasis added].” (Arlene, female)

As I reflect on the research that unfolded alongside four Mi’kmaw (adjective for a Mi’kmaq (First Nations people, Atlantic provinces, Canada, who call themselves L’nu) person) women, who call Mi’kma’ki, which consists of Gaspé Peninsula, Quebec, and the Atlantic provinces, Canada, and northeastern Maine, USA, but more specifically the west coast of Newfoundland, Canada, home, I cannot help but continue to inquire into who I was and am becoming, as a person and as a nurse. I am a Mi’kmaq woman, who grew up in a family with deep cultural connections. These cultural connections fostered my strong and lifelong community connections. My family are tied to lands of Mi’kmai’ki within the Bay St. George area, with distinct and strong ties to Flat Bay, Newfoundland, Canada. Through my mother’s mother, we have connection to community and to lands in western Newfoundland toward the great northern peninsula. It is through my knowledge and connections with community that this research emerged. Mi’kmaq community members told me that the topic of heart is important to them. The importance of heart health is amplified by the knowledge that Indigenous women are experiencing health issues at a greater rate than non-Indigenous peoples (McBride et al., 2021) and that Indigenous women experience cardiovascular issues at a rate of 76% higher than non-Indigenous women in Canada (Conklin et al., 2019).

This research is grounded in a Mi’kmaq worldview from the Mi’kmaq communities located within the west coast of Newfoundland. Some tenants identified specifically to the communities include reverence, interconnectedness, oral values, and ecological relations. In addition, it was recognized that the tenants from the communities align with community-based participatory research (Jackson & Masching, 2016). Four Mi’kmaw women were invited into the research, all of whom had lived experience as L’nu, were from the west coast of Newfoundland, and identified as women. The focus of the inquiry was to explore experiences and the methods were determined by the participants and me in collaborative ways, these included for example: talking circles, conversations, storyboards, and images. Over time, the women and I negotiated other ways of engaging that reflected their insights. The formal work took place over approximately a 9-month period and began by asking each of the women What does the word heart mean to you? Interestingly, three of the four women wanted to meet outdoors to engage in conversations about the initial question posed. The fourth was unable to meet in person, but the connection to the outdoors was evident in our online conversations. Given my close link to the community, I knew each one of the women before the research. This created a basis of trust and allowed for an ease of conversation. This trust was equally important for me as I began to share with the women how my own understandings of heart changed throughout our journey together.

As I think about who I am in this research, I am reminded of the dream Arlene shared with me. I can see in her dream that I am storied as someone who has a deep calling to be a healer. In conversations with my supervisor, she pointed out:

This work is life work. . . . you see a healer’s role as not simply keeping one alive but helping give others life. And I think it’s really important in the way that you also bring those relationships with you, who you are as a nurse is a response to these relationships and to the call to breathe life into what you do [emphasis added]. I can see that Arlene recognizes that the Elders are close to you, like the knitters in her dream, they are present. (Vera Caine, female)

I am thinking about how the relationships I hold were brought into the research. Over time, I learned that it is critical to have relationships that extend beyond the doing of research to engaging with Indigenous peoples in ways that are meaningful and that do not set out a predetermined pathway. During the research, I recognized that I could not other myself or place preconceived labels on any aspects of our work. This allowed the women who participated in this research and me to express what heart means to Mi’kmaw women and to care for each other well beyond the confines of the research. The relationships we hold are not easily defined, they have an openness and ease that helps all of us connect. As I learned to trust these connections to guide the research, I also wondered if this was an approach that could guide nursing practice in new ways.

I believe this approach goes beyond what is often referred to as relational practice in nursing, an approach that misses critical elements of a Mi’kmaq worldview. Through the connections the women and I have, I experienced the spiritual comfort and connection which is grounded in our understandings of what it means to be L’nu; msit no’kmaq (all my relations). It also called fourth intergenerational relationships I hold, relationships with my grandmother and mother, as well as my daughter. Early on in my work, in which I journeyed with Jackson (Hurley & Jackson, 2020), we wrote that the research

requires careful attention to the historical, social, political and relational aspects of the researcher’s life, as this speaks to the Indigenous knowledge they hold. Weaving Indigenous ways of knowing into all aspects of the research not only places value on Indigenous knowledge, but also significantly changes the contributions research can make to the knowledge development within Indigenous communities [emphasis added]. (p. 45)

Moving slowly away from the ideas of weaving, it became important to center Mi’kmaw ways as the foundation of the work. Elder Murdena Marshall said that knowledge is spirit and a gift from our ancestors (Atlantic Policy Congress of First Nations Chiefs Secretariat, 2012). The women in this research shared that heart is connected to spirit and that heart holds knowledge.

Mi’kmaw women open their hearts

I came to this work as a nurse who was trained in a western approach to care and health and for many years, I have felt an uneasiness in relation to care. As I listened to Nicole, another woman who journeyed along with me in the research, I realized that it was important to carefully examine my understanding of heart:

Heart is not just an organ. Its family, community, friendships, relationships, connection to the world, connections to the environment, me taking time for myself, my own discovery of who I am, it’s who I am developing and growing into being. It isn’t static. It is always changing and evolving [emphasis added]. (Nicole, female)

Nicole recognizes that for her heart to be healthy she needs to be entuned to the connections she holds and to the ways in which these help her to recognize who she is and is becoming. She also shared how we each carry things that deeply affect how we preserve our heart and thus our connecting with individuals. Some of these connections might not be safe to hold:

So, you put yourself away. You tuck it away. . . . You ask, am I going to be okay with you (that person). Am I going to be safe with you? (Nicole, female)

Nicole calls us to see that to maintain a healthy heart requires close attention to who someone is; it is personal, and it is always changing.

I am brought back to a day at the sawmill where I was with my dad when I was young. We were often at the sawmill while dad worked, but this time my uncle was also there. I remember watching how my dad was moving pieces of wood using a pulp hook, while my uncle was using his hands. On the drive out of the woods I remember sitting in our single cab truck as we bounced up and down over the ruts and holes of the road and asking my dad why he used a pulp hook and uncle only used his hands. He said, “there is more than one way to skin a cat.” I remember finding that gross and weird saying, “ewwwww you’ve skinned a cat?” He laughed out loud and said, “only the wild ones.” Then he proceeded to say, “I don’t always use a pulp hook.” Thinking back to this now I realize that his response, which seemed simple at the time, entailed certain lessons. Dad was sharing that laughter is medicine, that the outdoors is a playground with medicines, and that being around others and in relation brings teachings. In that moment I also learned that people have reasons for their choices and that these choices can change.

I am called back to think about the dream Arlene shared with me which I communicated at the beginning of this writing. I am brought to the fact that in the dream “the patient sits right up and says, ‘got any water I’m so thirsty?’” (Arlene, female). Interestingly, when I had asked Arlene “What does the word heart mean to you?” Arlene shared her complex understanding of that word:

First and foremost, it’s a part of the body. It keeps you alive, but then heart also means water. You need water to keep the heart pumping . . . . also need water to survive . . . . women protect the water, you know to sustain mother earth [emphasis added].

This link to water is significant in both the dream and also in Arlene’s response to my question. While acknowledging and understanding how water is essential to the physical body and thus the heart, she extends her knowledge about heart to include her cultural understanding. She connects the heart to women’s role as water protectors. Arlene makes visible that Mi’kmaw women have the role of water protectors, but more significantly they are seen as being stewards or kin to the lands. She states that our heart is tied to all aspects of the planet. If there are negative impacts to the plants and lands and our kin, Mi’kmaw women are negatively impacted. It takes me to reconsidering the depth of responsibilities this calls forth and also the implications that this would have for nursing. I wonder: If nurses are removed from the lands, and from relationships that exist between L’nu and both living and non-living things, how can they understand the inherent responsibilities that Mi’kmaw women carry in their heart. How can they understand the stress or trauma, but also the love that is connected to the land and planet.

Arlene continues to express how the westernized medical system ignores women’s responsibilities; responsibilities that are not only tied to the land, but that are also directly tied to the relationships one holds:

We are forced into a system where we are just numbers not people who have changing needs. I have recently been in a situation with a family member where health care providers do not include the people closest to the person in all aspects of care, not understanding the responsibility we all hold in our relationships. It does not matter that they are considered “capable” of understanding, it does not mean they are in a place where they can process fully the language being used nor necessarily want to without their support people. They don’t see in their 5-minute visit the times that our family member tries to exercise herself. That’s because they think communicating between each other and not with us is okay when it is not. This lack of communication, consultation and real understanding hurts not only my family members heart but all of ours. No one sees the family stress, worry, anxiety and increased distrust towards everyone within the system. We know what we need but no one is listening [emphasis added].

As the research unfolded, the women requested that we all meet together. While I contemplated the request, I came to understand that it was important—thinking about what heart means was and is a much more collective undertaking. What happened when we all came together was beautiful. During our time, we came together as women who bonded and found strength in each other. During this event, Sabrina pointed out,

That by spending time with like minded kin who gather together, for various reasons as crafting, talking circle, teachings, or so on, in a respectful way that the once empty cup is filled back up.

Sabrina shares that by surrounding herself with things that she loves, things that ground her and supports L’nu connections she is able to fight off the heart sickness. She talks in terms of fighting heart sickness long before one is sick. By utilizing one’s gifts such as crafting or singing, women are engaging in healing and protecting their heart. I too can see this in the stories of the other women—a strong understanding that connecting to one’s spirit and grounding within cultural ways of life our heart is cared for and in some ways protected. As we came together, I am reminded of the laughter my dad shared with me often—for him laughter too was medicine, it came from deep within. For others it is the sound of the drum that acts like medicine and that allows for a deeper connection with the land. I wonder why we continue to pay so little attention to healing practices that sustain our heart health from a young age—practices that recognize the connections to the land, to relations, and to our teachings. Instead, we as L’nu women are continued to be asked to conform to westernized expectations.

Nursing with two ears

No one is listening. Symenuk et al. (2020) state that while nursing may say that it has undertaken a lot of work looking at its role in harm toward Indigenous peoples, it fails to do so with a true examination of its current role within a colonial health system. The authors state that the system has and continues to perpetuate harm. I recognize that these harms are multiple. For Symenuk et al. (2020), nursing has not yet committed to reconciliation and as a profession is complacent with the harms that are caused. As I contemplate the heaviness associated with this notion of complacency, I stop and think back to the strength the women displayed when telling their stories, particularly I am drawn to the story Nicole shared earlier. She continued within that conversation by sharing the following:

Am I going to be safe with you. And after a while if you are, you start to let a little more down. Is it trauma that is passed down to us that we feel we need to be so guarded or is it called preservation. (Nicole, female)

For Nicole being guarded is a survival skill. The women’s stories allow me to think about how each Mi’kmaw woman entering the health care system does so in different ways. I am mindful that the idea of creating a relationship within a system that harmed and continues to do harm and relationships with persons within a profession that continues to do harm is difficult. Working within institutional settings, I can see that nurses are often inattentive to actual and perceived power imbalances, that they do not inquire into intergenerational coping mechanisms related to historical traumas, and that they rarely ask about connections to the land or place. Hearts cannot be fixed without attending to the deeper connections to peoples and places over time.

Charlene shared how an interaction within the health care system affected her health for years and continues to do so:

A long time ago I was struggling with a rash on my leg which had lasted for years. Someone said to me maybe it’s dirty blood? I’m like dirty blood? Yes, because you are native, but your blood has mixed so you probably have dirty blood. For years I actually believed this was possible until I found a healthcare professional, I was actually comfortable with, someone I felt I could actually talk to, and they said that wasn’t true. However, to this day I don’t like going to the hospital to get blood work. I am thankful for a few kind people in healthcare who have recently made me feel safe and comfortable to ask questions because there are a lot of them that I would never talk to about things like that. Maid, I got good blood now [laughter]. (Charlene, female)

Ending the painful story with laughter was Charlene’s way of healing from the impact of the experience. Similar to Charlene, the trauma and pain Arlene, Nicole, and Sabrina associated with their hearts was countered by laughter and love. Laughter and love are very important piece of heart health for Mi’kmaw women.

Holding hands forward

While engaged in this work, I was often reminded of my Grammy (Francis) Webb a well-known traditional healer from Codroy Valley and later Flat Bay, Newfoundland, Canada. Nowadays, she would be known as a midwife, as she helped deliver hundreds of babies. The health and healing knowledge that she held was sought after by many people, not just community members, within the western region of Newfoundland. She gained her knowledge from being on the land learning, from being mentored, and through intuition. No one questioned where she obtained her skills, or if her skills were legitimate, instead people believed in her abilities. As I think about Grammy, I am reminded about Arlene’s dream. Through sharing this dream with me, Arlene shows me how our ancestors, identified as the knitters within the dream, who while they are quietly sitting and watching, are also sending us messages in many ways. They are the representation of the knowledge shared for thousands and thousands of years; knowledge that is held by Mi’kmaw. As I think about what this means to nursing, I am being wakeful that Arlene’s dream calls me as a nurse to think about my work in ways that reflects healing, that attends to the heart health of L’nu women through being attentive to their connections with water and land. Perhaps my work as a nurse is to connect L’nu women with those who are identified as healers within our communities.

Arlene has a deep connection to her spirituality and her role as a cultural leader. The knitters in the story are representative of our knowledge keepers who hold experiences, wisdom, and foresight, but wait patiently to provide support when asked. Arlene is a pipe carrier, sweat lodge conductor, jingle dress dancer, and much more within community. It is Arlene who helped the research to unfold as it has. She provided guidance and feedback to me, and placed responsibility in my hands. Arlene helped me understand even more deeply not only the responsibilities I have to uphold but also the strength I carry in all the heavy lifting. The word research is no longer, and perhaps never was, an adequate description of the journey I found myself living alongside other L’nu women. We found ourselves co-creating knowledge through the unfolding of our connections and relations. Arlene showed us a generosity and patience that helped us gain new insights into what heart health means, perhaps more so what it means to live heart health.

Thinking about this work, I came to understand that nurses need to help people live rather than try and keep them alive. One of the first steps in the practice of nursing must be to listen and to engage in experiential learning, to create the possibility to value different ways of knowing. There is a need to connect and to understand cultural values that align with each community. Each person and each relationship is gifted with knowledge; knowledge that helps us to know how to best care for Mi’kmaw women and their heart.

At various times in this work, I too asked myself: What does heart mean to me? The experiences I have had during the times I spend alongside the women resulted in a various array of emotions, thoughts, and clarity. These were called forth by experiences that include close family members journeying into the spirit world, which created an increased self awareness and change in how I engagement in ceremony. It was the relations I held with the women that allowed me to recognize the colonial impacts on my experiences as a person and nurse. I too was reminded of my connections to my mother. As mother and daughter, we are so deeply connected on both an ancestral level and through our hearts that having her in my life through this process was something never wavering. My strength through these experiences and thus this research process was also connected to hers. I watched my mom take care of her father at home during his last days on earth. This care included laughter, comfort, and peace. My mom, like other L’nu women, has been supporting families to connect better with their hearts. L’nu women have been said to be leading the way in communities, and it is time to ensure that they are supported to allow them to have the healthiest hearts. To help them live, not simply stay alive.

As I think with my experiences over the past few months, I am drawn to the word life. A definition found in the Merriam-Webster (n.d.) describes life as “the period from birth to death” (para. 5a) or “the sequence of physical and mental experiences that make up the existence of an individual” (para. 2a). There are over 20 different definitions within the dictionary, which alludes to the complexity of trying to understand this word and its importance. Yet, there are even more associated with this word when Mi’kmaq meanings are acknowledged. In the experiences of the women, I noticed a deep connection between the word life and heart, which has made me realize that nurses would benefit from understanding how L’nu women sustain life. To understand how a person experiences life is to understand how one can and does care for one’s heart. Through the relationships with Mi’kmaw women, I learned how much our heart is integrated and shaped by the multitude of relations, the well-being of the land, and the wisdom of generations before us and those yet to come. As a nurse, even as I take care of the person in front of me and their family, it is important to see the care I provide in relation to the next seven generations and in relation to the land.

I conclude this writing with a poem which I have composed and titled At the Heart of 7 Generations: A Mi’kmaq Nurse’s Perspective.

Registered nurse, practical nurse, nurse’s aide, nurse.

Medicine person, midwife, caregiver, healer.

Titles, jobs, roles, names.

Myself

My soul and who I am is the most important thing I can offer the next generations.

Not a title, not a name.

Offering, not assuming.

Clients, patients, charts, healthcare numbers.

Illnesses, diseases, conditions, sickness.

Labels, categories, branded, classified.

Them. A soul sustained by generations to come.

Their soul and who they are is the most important thing they can offer.

They are not to be labeled, not a number.

Hopeful, not assuming.

Us. Equal. Balanced.

Seven Generations are at the heart of what matters.