A calling to help Indigenous patients
Dr. Esther Tailfeathers knew from an early age that medicine was her calling. “As a teenager, I worked as a candy striper in the Cardston Hospital,” recalls the family physician. “One day a friend of mine came in ready to have her baby and there was no one else there to support her. I asked the doctor if I could go in with her. She was 14 and I was 16. He let me gown-up and I was with her as her baby was born,” explains Dr. Tailfeathers. “Right then, I knew what I wanted to do.”
Today, she spends most days working four blocks from where she was born and raised, serving the people of the Blood Tribe in Southern Alberta. It was a long and winding journey home for the family physician (known by her patients as “Dr. T., Dr. Esther or Esther”), who is also the medical lead for the Population, Public and Indigenous Health Strategic Clinical Network at Alberta Health Services and an impassioned advocate for improving Indigenous health care.
Good advice
Despite her early interest in medicine, Dr. Tailfeathers found the journey to family physician anything but easy. “I had a high school guidance counsellor tell me it was impossible, and that I should look at teaching or nursing – something that was more realistic.”
Instead, she completed a degree in Native Studies, married and moved to Norway, where she lived amongst the Sami people. Dr. Tailfeathers was living there when her younger brother, Darcy, in his third year of medical school at the University of Alberta, died in a car accident.
“I had spoken to him the week before he died,” says Dr. Tailfeathers. “And he told me I should go into medicine. He said the profession needed more people from our community and that it was very rewarding.” When she returned home to Alberta for his funeral, Dr. Tailfeathers decided to follow his advice.
After receiving her medical degree from the University of North Dakota, Dr. Tailfeathers returned to Canada, and as part of her family medicine residency at the University of Alberta, worked at the Royal Alexandra, Grey Nuns and University hospitals. “It was eye opening,” she recalls. “There were very few Indigenous physicians at that time and many Indigenous patients needed that connection.”
Dr. Esther Tailfeathers: "The Impact Colonization has on Indigenous Health." from REDx Talks on Vimeo.
Back home, to challenges in access and quality
When given the opportunity to return to her family and the Blood Tribe in 2000, Dr. Tailfeathers did not hesitate. Since then, she has devoted herself to delivering the kind of health care that is so desperately needed in Indigenous communities across Canada. In addition to working as a family physician at clinics in Stand Off and Cardston, Dr. Tailfeathers provides on-call and emergency services at the Cardston Hospital.
“There are a lot of health issues facing our community, especially chronic diseases like diabetes, that are linked to inter-generational, learned behavior,” says Dr. Tailfeathers, adding that many of those behaviors are protective; a legacy of the trauma people endured at residential schools and through systemic poverty.
Dr. Tailfeathers adds, “Trauma and poverty contribute directly to Indigenous health, creating complex challenges” which are compounded by the lack of available or appropriate primary health care in many Indigenous communities.
“Many Indigenous patients have no access to a family physician in their own community and have to drive several hours just for primary health care. Still others seek help and are lectured by health care providers who don’t understand what they are struggling with, and blame the patient for the disease,” she explains.
Those negative experiences sometimes result in patients refusing to see doctors again. “It’s another reason why we need more Indigenous physicians, who understand the history of trauma and won’t pre-judge people who are most in need of help,” says Dr. Tailfeathers.
“We still need more Indigenous health professionals …”
Throughout her career, Dr. Tailfeathers has advocated consistently and steadfastly for better Indigenous representation in the health care profession. In recent years she has been heartened to see a new generation of Indigenous health professionals join her in advocating for change.
“There are two young physicians from my community working with me in the Stand Off clinic – Dr. Eagle Bear and Dr. Fox. And there are others coming along in other communities too. We still need more Indigenous physicians, but we’re getting there.”
Dr. Tailfeathers has received many awards recognizing her work, including the 2019 Dr. Thomas Dignan Indigenous Health Award from the Royal College of Physicians and Surgeons of Canada. She remains grateful for her brother’s advice to pursue a career in medicine. “To have this education and this experience, and to be able to use it to help my community is a privilege. I’m doing the work I was meant to do.”
Meet Dr. Esther Tailfeathers
Blood Tribe detox centre offers hope in midst of opioid crisis
“We see a lot of injury in our people at a young age,” Dr. Tailfeathers observes, noting the strong link between trauma, mental health issues and resulting risky behavior and addictions, particularly in young people.
The Blood Tribe community has been battling the opioid crisis for several years, but the damage was devastating in 2018. An onslaught of carfentil (mixed with other drugs) – an opioid 100 times more potent than fentanyl – caused 34 overdoses and three deaths in October and November. Paramedics and other health care providers were stretched to the limit, recalls Dr. Tailfeathers. People were losing their friends, neighbors and loved ones to addiction, and children were losing parents.
Dr. Tailfeathers and Blood Tribe leaders developed their own harm reduction strategy based on creating a detox facility to support their community’s unique needs. “We knew that abstinence-based detox doesn’t work, because many of our people died trying it that way,” explains Dr. Tailfeathers, medical director of the clinic.
Bringing the Spirit Home Detox Centre
“Our first step was to save lives,” explains Dr. Tailfeathers. “So, we brought in naloxone kits, taught people how to use them and made them available to anyone who wanted them. We know it worked, because for three months after that training, we had no deaths.” Next steps involved introducing opioid replacement therapy and, in January 2019, opening a dedicated detox centre in the community.
The Bringing the Spirit Home Detox Centre is a safe withdrawal site, staffed 24/7, providing patients with seven to 21 days of detox. The centre’s 20-24 patients are treated with medically managed opiate replacement therapy.
“It’s been incredibly successful,” says Dr. Tailfeathers, adding the centre’s 100-person waiting list includes patients from northern Alberta and Montana. “We’ve built a pretty strong reputation in a short amount of time, but our biggest success is what we’ve been able to do for our patients and their families.”
Beyond detox: Strengthening families
As part of addiction recovery, the community helps connect patients to the resources and supports they need to stay clean. “We help addicts access education, employment and housing services, and improve their parenting skills so that they can strengthen their families,” says Dr. Tailfeathers. “Those social determinants of health are essential to their recovery.”
Although the opioid epidemic is far from over, the Blood Tribe community is fighting it together.
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About Community Connections
The AMA knows that many Alberta physicians are involved in helping to build healthier, stronger communities in Canada and throughout the world. These physicians are going ‘above and beyond’ to make a difference as they advocate on behalf of their patients and their communities, with an unwavering commitment to improving peoples' lives, whether individuals, community groups or entire populations. With AMA’s Community Connections, we want to celebrate and share the inspiring stories of these dedicated physicians.
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If you have a colleague whose work extends far beyond the doors and walls of their practice, and you’d like to nominate them for recognition by AMA’s Community Connections, please submit a nomination form.
Banner image credit: REDx TALKS