Aboriginal children express their pain through story and art
Research finds history, culture inhibit expressions of physical or emotional pain
Research in the Maritimes has revealed it's more difficult for Indigenous children to say when they're hurt or feeling pain than non-Aboriginal kids.
That can mean that not only do they suffer unnecessarily, they may not get the medical attention they need because they don't tell anybody something's wrong.
The Aboriginal Children's Hurt and Healing Initiative was born out of an observation by doctors at the IWK Health Centre about eight years ago, when Dr. Margot Latimer, now the ACHH Initiative's principal researcher, was working with the complex pain team at the children's hospital.
It was noticed that of 800 referrals to the hospital over 13 years, only two were for Indigenous children.
'Muted' in pain
"We started to ask the question 'Why aren't we seeing these kids?'" she said.
Latimer says researchers started looking in Eskasoni First Nation, the largest Aboriginal community in the Atlantic region. The health director there was also interested in the question, because medical practitioners saw that children and youth were suffering from various conditions.
Expanding into three other Mi'kmaq communities throughout the Maritimes, the research team held conversation sessions with clinicians, teachers, parents, children and young people and elders.
She heard "overwhelmingly" that children and youth are "stoic."
"They're muted, or quiet in their response to pain," said Latimer.
'It's better to be quiet'
But she says that 'muted' attitude is in contradiction with the way medical professionals are taught to gauge the pain of a patient, for example, through facial expression, the ability to say where pain is being felt, or how bad it is on a 0 to 10 scale.
"If you're not used to talking about your pain or if, within your culture, it's better to be quiet or stoic, or endure your pain, then you're less likely to convey that to your health professional," Latimer said.
Latimer says researchers heard "many, many stories" about how it's better to be brave, to endure pain.
She says that attitude is partly based on the recent history of relations between Indigenous and non-Aboriginal cultures.
Last shred of dignity
"There is a history with Aboriginal people, a very traumatic and appalling history here in Canada of our residential school experiences," Latimer explained, "where Aboriginal children were traumatized and abused in every possible way.
"Our team believes, and we heard from members that, as a result of those atrocities, it was sort of a learned behaviour, to hold in your pain and not show people your pain because it was sort of their last shred of dignity."
Latimer says, culturally too, in many Indigenous communities, bravery and personal control are desirable qualities.
"Also, there's a belief that pain has meaning, a purpose. There's cultural traditions such as sweat lodge, you know; you're taking away somebody else's pain to endure your own pain."
Art as a way in
John R. Sylliboy, ACHH's community research project co-ordinator, says the concept of 'two-eyed seeing' was used to develop a way to recognize when Indigenous children are in pain and to help them recognize it in themselves.
Two-eyed seeing is a way to describe how modern Indigenous people blend ancient Aboriginal and contemporary western understanding in their world view.
"Traditional knowledge, for example, tells us how pain is treated and how we manage pain," he explained. "We also want to know what are the ways our children do cope with and manifest pain?
"How do they discuss it? How do they not discuss it, and in this research, our elders, teachers, clinicians, parents and the children themselves have said how to diagnose, how to recognize it, how to read it."
Sylliboy says the celebrated Mi'kmaq artist Alan Sylliboy was enlisted to help children and young people learn to express themselves, first through narrative, then through art.
"Forty children in all shared their art pieces, and the Art Gallery of Nova Scotia helped us with the logistics and planning and the curating of these arts pieces — very professional," John R. Sylliboy said.
"They treat this art work as a spiritual-nature art."
He said the "visuals are very potent and they didn't only show physical pain; it also showed emotional pain.
"The communication that comes from the children's art expression is showing the research world and also the health world that we need to look beyond the physical."
The children's art will be displayed at hospitals around the province. This week, it's being shown at the Cape Breton Regional Hospital in Sydney.
With files from Information Morning Cape Breton