Preserving and passing on Indigenous languages is crucially important in maintaining traditional knowledge and cultural heritage. International Mother Language Day, which falls on February 21 each year, was created to help uphold the traditional knowledge, cultures and languages that are so essential to multilingual and multicultural societies.
The theme for this year’s event is the role of mother languages in fostering inclusive societies, improving education and ensuring the preservation of Indigenous cultures – goals that align with many of the principles outlined in the AMA’s Policy Statement on Indigenous Health.
Connection between language, culture and health jurisdictions
From a health care lens, it is important to remember that for those who do speak Indigenous languages, language barriers can make it difficult for them to participate in their own health care decisions or provide informed consent. That’s why interpreter and translation services are so important.
“Even with partial language barriers, interpretation is a critically important part of providing culturally safe care,” explains Dr. Wayne Clark, the Director of the Wâpanachakos Indigenous Health Program for the Faculty of Medicine and Dentistry at the University of Alberta and an assistant professor in the Department of Psychiatry at the University of Alberta. “Language barriers can be a challenge for any ethnicity group, but for Indigenous peoples, identity and culture are so incorporated into language that it is not only fundamental to providing culturally safe care, but for a person who's been marginalized or has experienced systemic issues in our health care system, the interpreter can serve as a cultural broker or navigator.”
In Alberta, health care providers must obtain informed consent from all patients, including Indigenous patients with language barriers, by ensuring they fully understand the proposed treatment. This may require using qualified interpreters or culturally appropriate communication supports. “Indigenous language interpreters align with principles of cultural safety and equity, respecting the patient's autonomy and ensuring they can make well-informed decisions about their care in a manner that honours their linguistic and cultural context,” explains Dr. Clark. Not adequately addressing language barriers could result in ethical and legal violations, compromising patient rights and the quality of care.
Dr. Clark notes that communication challenges can be daunting for both the patient and the provider, something that is exacerbated by Canada’s parallel health systems. “There are two systems in Canada, and when you're on reserve you are a federal responsibility. So, when you are discharged from an AHS hospital to a First Nation community, you're moving from one system to another.” Those transition processes include legacy policies that are different and separate and make the work of an interpreter even more important. “These interpreters are trained not only to do language interpretation but also to understand Indigenous health and how to navigate both systems, which is key to supporting those transitions of care and a discharge to the community.”
The availability of interpreter services also lessens the burden on family members, who are otherwise expected to provide both interpretation and emotional support. “When health care providers have to rely on family members, it can be hard to know if you are meeting the needs of what the patient truly wants,” cautions Dr. Clark. “We have all seen situations where maybe a patient wants to please or protect their family members, or the family member is uncomfortable with relaying sensitive information. In those instances, health care providers have to look for creative ways to communicate.”
Here in Alberta, Alberta Health Services’ Interpretation and Translation Services was created to offer patients and families with language barriers medical interpretation in AHS facilities. The service offers translation services in 23 Indigenous languages for Indigenous patients and families accessing health care in AHS facilities across the province.
“Language translation and interpretation services have been a priority for a long time,” explains Nadine McRee, the Director of the AHS Indigenous Wellness Core. “But there were challenges at the start, particularly with trying to find a way to translate medical terminology into Indigenous words. Often there is not a direct translation of medical words available in Indigenous languages. There was also the challenge relating to the requirement of certification for Indigenous language translators, where again, the traditional ways of certifying our knowledge keepers are practiced and acknowledged differently. Understanding these practices took some additional education in our health care system.”
AHS recently launched the Indigenous Support Line, a toll-free phone service that connects Indigenous callers with Indigenous listeners to help people access culturally appropriate care. Operating in the North, South and Central Zones, the service is available to First Nations, Métis and Inuit peoples and health care providers supporting Indigenous peoples, including youth and Elders, living on or off reserve, in a Settlement or in cities and towns. The Indigenous Support Line was created with the goal of helping Indigenous peoples receive better, faster and more seamless care from AHS while connecting Indigenous patients, families and communities to the supports they need. It can be accessed by calling 1-844-944-4744 or 811 from 10 a.m. to 6 p.m., Monday to Friday.
Indigenous access to informed consent
“It’s really important to make sure patients in the system understand what is being said so they can be part of making decisions,” says McRee. “Sometimes consent of Indigenous peoples is misunderstood, even if Indigenous peoples don’t fully understand what is being asked our people might not speak up, which can be due to a variety of reasons such as mistrust in the health system, language barriers, racism and discrimination concerns, or even past colonial history or trauma. As a result, providers sometimes interpret no voiced concerns as consent. We’ve come a long way in making sure our Indigenous languages are available for our people in the health care system and have had really good feedback that the Indigenous Support Line is a great way of building trust.”
For McRee, the importance of recognizing and respecting Indigenous languages can’t be overstated. “My Kokum spoke her language when she was a kid, but she was in residential school for 13 years and never taught us. As a kid, I always wanted to learn. It’s a part of your identity I didn’t even realize I was a missing piece of me until I was an adult and thought ‘I would love to learn my language.’ Now, I’m so happy to see that there are so many resources available to revitalize our languages after the calls to action. It really connects you on another level and when you hear prayers in your traditional language, you feel more connected to the spirit and you really, truly feel it. I feel and believe your language helps heal you in another way. I’ve seen that connection and it’s so important in our health care system.”
International Mother Language Day offers an important reminder that we must do whatever we can to retain our linguistic diversity. Statistics Canada reports that currently there are more than 70 distinct Indigenous languages spoken by First Nations, Inuit and Métis people in Canada. Here in Alberta, that same 2021 Statistics Canada survey indicated 18,880 people spoke Cree languages in 2021, down 5.9% from 2016, while 6,440 people spoke Blackfoot – a drop of 12.6% from 2016, most likely due to the aging of mother-tongue speakers.
Language revitalization in care delivery and health management
Fortunately, there are signs that younger generations like McRee are embracing their traditional languages. Statistics Canada reports that in 2021:
- 28,725 First Nations people in the prairie provinces had learned an Indigenous language as a second language, up 7.0% (+1,890 speakers) from 2016
- Almost one-third (30.9%) of First Nations people who could speak an Indigenous language in the prairies learned it as their second language, up from 27.4% in 2016.
The Supporting Indigenous Language Revitalization (SILR) project at the University of Alberta is working to make sure the importance of Indigenous language sovereignty is recognized and celebrated.
“The revitalization of ancestral languages comes in many different forms,” explains Pamela McCoy-Jones, the Executive Director of SILR. “If we bring awareness of Indigenous language and culture into the home, into the school, into your workplace and your environment, those are all steps in the right direction. Sometimes people don't know where to begin, but I think the starting point is the acknowledgement that language is interconnected with everything, including our health care system.”
SIRL hosts a gathering each year that is intended to offer a space for Indigenous language champions, speakers, learners and advocates to come together to connect and collaborate on ways to revitalize Indigenous languages. The next gathering is planned for March 17 and 18, 2025 and registration is now open.
“It’s a great opportunity to come together and talk about how we can bring language and culture into the conversation, and everyone is welcome,” stresses McCoy-Jones. “If Indigenous languages matter to you, this is the place to be.”
Resources
- There is a growing body of literature emerging within Canada and internationally that Indigenous community language revitalization programs confers improved mental health and overall health benefits. Healthcare Excellence Canada's article Indigenous Languages, Health and Wellbeing outlines the 2019 Canadian Indigenous Languages Act and many ways in which preserving, promoting and revitalizing Indigenous languages impacts health and wellness.
- Clinicians know from experience that the words they use and how they use them have an immeasurable impact on assessments, diagnoses and management plans. The BC CDC Language Guide is a helpful clinical tool for adapting common phrases and words in a patient-centred and informed way. In particular, the sections on frameworks, purpose and guiding principles include several Indigenous-specific references.
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