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Joe Gallagher is of Tla'amin (Sliammon) Nation ancestry and serves as the chief executive officer of the First Nations Health Authority

The loss of a child is a devastating trauma and extremely difficult to articulate in mere words. Four years ago, my little two-month-old niece, Makara, passed away suddenly without warning. This tragedy was only the beginning of a traumatic series of events within a system that is intended to provide care.

As Tla'amin people, our traditional laws direct us to carry out our death protocols within a week's time, with our loved ones' bodies intact so they can carry out their role in the spirit world. We also appoint an advocate to speak for the family in their time of grief. For Makara, an autopsy was ordered by the coroner, as with any infant death, and the report came back clear of any criminal wrongdoing. We were then informed that, without our consent, her body was being returned to us but her brain stem was to be retained for several weeks for medical investigation despite no further legal concerns. We were told that, regardless of the will of the family or the additional trauma and grief this would cause, this was standard practice and was for the greater good of society.

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This conflict between cultural ways of living and systemic policies is a tragic example of culturally unsafe services that can do more harm than good. As a result of the BC First Nations Health Partnership with federal and provincial governments, work is under way to begin to address these challenges. In July, 2015, CEOs of each B.C. Health Authority, the First Nations Health Authority and the Ministry of Health signed a Declaration of Commitment to advance cultural humility and safety within their health service organizations.

Cultural humility is a process of self-reflection to understand personal and systemic biases and develop relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another's experience.

Cultural safety is an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the health-care system. It results in an environment free of racism and discrimination, where people feel safe when receiving and making decisions about their health care.

This commitment, made in 2015, gives a mandate to health professionals to pay attention to and advance cultural humility in their practices with First Nations and aboriginal peoples. The progress we make in this area will not only benefit First Nations peoples, but also lead to more culturally safe services for all British Columbians.

The work with the BC Coroners Service was difficult at first, but we have built relationships that have lasted to this day. We taught them about the importance of our cultural practices to our peoples and they have shared their processes that support fact-finding for public safety. Through challenging but respectful dialogue, we encouraged the BC Coroners Service to understand our interests and to review the evidence on the value of brain-stem retention.

After this request, they reported back that in 138 infant death autopsies, neuropathological examinations added no value to the investigations nor illuminated findings that hadn't already been identified. The Coroners Service acknowledged these practices caused harm to families and were unnecessary.

Their new practice provides all B.C. families with the choice to determine how their children's remains will be treated once legal requirements are satisfied. Since October, 2014, B.C. families have chosen to avoid brain-stem retention 52 out of 54 times where possible.

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Makara's legacy is a Coroners Service that acts with cultural humility. Their willingness to consider the voices of the people they serve and review their practices has helped them establish culturally safe practices for all British Columbians.

Tomorrow, on National Aboriginal Day, we will be launching the Declaration of Commitment for cultural safety and humility in B.C. health services with a suite of educational materials and an opportunity for health service providers to pledge their commitment with the hashtag #itstartswithme.

Find out more about the movement for cultural humility and cultural safety in our health system and read the declaration of commitment at fnha.ca/culturalhumility.

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