Cowichan Indigenous Connection Team

In the Cowichan Valley, Vancouver Island, over several years, the Cowichan District Hospital Replacement Project (CDHRP) Nuts’a’maat Alliance*, Cowichan Valley Primary Care Network and Island Health Research department have been working with local Indigenous communities to foster trust between leaders and communities while advancing culturally-safe designs, programs and care that feels welcoming, safe, and inclusive to all. The First Nations communities include Ditidaht, Pacheedaht, Ts’uubaa-asatx, Malahat, Stz’uminus, Penelakut, Lyackson, Halalt, Cowichan Tribes, as well as the Métis Nation – and Hiiye’yu Lelum – House of Friendship, which serves the urban Indigenous population.

Two $50,000 grants – awarded to Island Health by the Social Sciences and Humanities Research Council (SSHRC) in 2018 and 2021– created a foundation for this co-design work. The first grant explored respectful protocols and processes for building a hospital and evolving a primary care network in Indigenous territories. The research team and leadership met with the communities to understand cultural protocols and processes and identify their needs. Since then, Island Health leaders and teams—including the community, Primary Care Network, acute care and the Alliance—have engaged with Nation Health Directors and the First Nations Health Authority to continue building relationships, improve processes and programming; and collaborate to enhance quality and care. As a direct result of these engagements:

• An Indigenous Advisory Council has been formed with representation from each of the communities, ensuring ongoing collaboration in the new hospital design and for future health services planning.
• A Cowichan leadership Community of Practice has been launched to foster understanding of systemic anti-Indigenous racism, and leadership is piloting a tool to measure cultural safety.
• Among other changes to improve health quality and cultural safety in advance of the new hospital, resources for Indigenous Liaison roles have increased, and the chapel has been renamed as a Gathering Space.
• Co-design with the communities has informed all aspects of the new hospital design and planning, including:
• Indigenous art and design elements inspired by Coast Salish values;
• Ventilation for cultural burning in patient care rooms;
• Space for an expanded Indigenous Health Program;
• An overnight suite for families in remote Nations; and
• Healing gardens and an Indigenous food kitchen.

Continuing the recommendations from the first grant, the second grant is funding co-development of a video series to define and enhance culturally safe care. Each community has guided production of its own video, leading content around protocols for territory acknowledgement, introductions, and showing respect. In each video, a spokesperson shares a strengths-based story about what is important to them when accessing health care. As the videos are completed, they will be shared with care providers to enhance culturally-safe care and services.

For Patricia Thomas, Laxelewetstnaat, of Xeláltxw (Halalt) First Nation, “Cultural safety is about being heard and understood. For us to be able to work together in a good way, we have to share.” The work of ensuring culturally safe care is ongoing, and much remains to be done. The co-design process has been an important step in that ongoing work; it has fostered lasting relationships and built a culture of leadership and collaboration based on sharing, openness, and listening.

As part of CDHRP, Nuts’a’maat Alliance team members, including all construction workers, have received respectful workforce and cultural safety education to build capacity to address anti-Indigenous specific racism and discrimination in construction and healthcare.

“As health care providers, builders and architects, we share a commitment to working collaboratively with local Indigenous communities, said Emma James, executive director, Island Health. “Together, through meaningful co-design, we are shaping hospital and health services to improve quality and create cultural safety in Cowichan.”

*The Cowichan District Hospital Replacement Project Nuts’a’maat Alliance includes Island Health, EllisDon Corporation, Parkin Architects, BC Infrastructure Benefits, and Infrastructure BC and is planned to be completed in 2027.