​While providing care in the First Nations communities around Lillooet, BC, Dr. Humber learned that her patients would be better served if she implemented a different approach to health care in these underserved communities. She began by listening and cultivating relationships with community members.

When Dr. Nancy Humber first came to the community of Lillooet in 1997, her practice was focused on maternity, surgery and providing other care in hospital. Trained in family medicine and specializing in surgery, Dr. Humber was the only doctor at the time performing surgeries at the Lillooet District Hospital and as well, much of her work was dedicated to deliveries. 

Building Community Relationships

Throughout the years, Dr. Humber built relationships with First Nations patients and noted that many communities were lacking primary care. When the surgery program was paused at the hospital, it presented an opportunity for her to work in community. Over the past five years, she has worked in the n. St'át'imc Communities of Xaxli'p, Xwisten, Ts'kw'aylaxw, and T'it'q'et. During that time, Dr. Humber asked questions of her patients, to get a better understanding of what First Nations communities need.

“It always struck me as unusual to not have care in community. Because primary care has become a high priority of Interior Health, it would be helpful to ask communities as opposed to assuming. It was a learning opportunity to ask the questions and also be guided into what the community needs are."

 “The path forward is guided by relationships. There needs to be trust in these relationships. The path forward starts one community and one relationship at a time."

As these relationships were cultivated, it became apparent that these communities faced unique challenges that were not being addressed by the current health care approach. This included considering the challenges that many community members face trying to access care.

“Lillooet is a different environment. It's a historically low resourced region and transportation is becoming even more stressful."

“There is a geographic and also a cultural difference. Travelling is not just about the distance. There is a comfort about meeting people in their own community and own home. There is a comfort and trust. It enables me as a provider to provide better care. Environment and culture matters."

For Dr. Humber, being a physician working in community means reducing the barriers to accessing care in order to improve health outcomes.

“In community, I am able to provide easier access to care that's quality care. Lowering the barriers to access care helps communities more. If they want to embed their care into a journey of health and wellness, they can do that. Access is the key to that. Having reliable access is important. Having trust in your healthcare provider is important." 

Cultivating relationships with community members and Elders in particular has helped Dr. Humber shift her perspective and better understand the impacts of colonization and how community members experience that through health care.

Elder Barb Marchand remarked, “When there is relationship building, there will be more trust. Being able to ask more questions and being able to talk over ideas on what a person needs to do to get or stay better will bring a lot of benefit to the community. This establishes trust to start and allows us to be more relaxed entering a health care environment."

“Even from the first time we met, Dr. Humber talked about things that mattered to her heart—and I think that all changes start in the heart," said Xaxli'p Elder Barb Marchand.

Balancing Two World Views in Health Care

“There is such an amazing amount of leadership and knowledge in communities. As a physician, I work with communities only if they are willing to work with me, and that means acknowledging that they are working with this colonial health care system. It's very important not to just assume communities are willing to work with you."

Dr. Humber participated in a number of sharing circles upon invitation of the St'át'imc Nation and communities. Talking to community Elders about the health care system was key to help Dr. Humber understand how equity in care and cultural safety in care needs to have a local context.

This includes recognizing the importance of traditional wellness practices in addition to conventional medicine.

“In Ts'kw'aylaxw for example, there was a traditional healer and I was able to meet with them and learn more about what they do in community. They were able to share some of their medicine with me so I can understand what the people and community experience and what that is like."

Spending time in community and cultivating meaningful conversations and dialogue with the Elders has informed Dr. Humber to take a “two-eyed seeing" approach.

A "two-eyed seeing" approach means shifting from viewing things only from the one eye of Western medicine, to one that uses the other eye to see traditional perspectives as well. Because traditional healing and wellness approaches have been largely excluded from dominant Western approaches, particular attention must be given to ensuring that these ways are fully integrated into service models.

Frances Alec added, “There needs to be a shift in the education of the health care system. We are part of this and the impacts that have happened to our people over the past few centuries. We are still attached to our history and way of life. The health care system needs to be more culturally appropriate and considerate to our ways. And to what happened to us."

“Great people like Dr. Humber are trying to break down barriers to address these issues and provide a type of care that most of us First Nations are not experiencing. We are not receiving the type of health care that other citizens have the pleasure of receiving due to our situation and colonization in institutions. The institutions are still going about their way without listening. It is still unbalanced," said Frances Alec.

“What Nancy has done, relationship building, has built trust within the people. Many people feel that their health has gotten and stayed better. Doctor Humber takes the time to explain what you need to do to stay healthy, unlike other doctors where you are in and out. I really see the change with [her] approach."

Considerations for Physicians

For Dr. Humber, the conversations, dialogue, and sharing circles are not one time events, but rather ongoing. And through these conversations, it became clear that what is called for is change on a systemic level. “The solutions needed to come from the entire group. The Elders were clear about what the solutions could be—locally validated and locally based solutions to care. It needs to be a system change. It can't be just one or two people, but change that is embedded in the system."

“We need to have more relationship-based care. The demands on physicians are so high, and the acuity is so high—trying to balance that has been so difficult. The difference with relationship-based care is it doesn't have acuity of demands, but it builds and grows over time. The challenge is that in care typically, we only place value in things we can track. You can't define relationships in care, but they are essential," said Dr. Humber.  

Dr. Humber's work has focused on how to create strong attachment between physicians and community so that care is less episodic and becomes focused instead on prevention.

In terms of moving forward, Dr. Humber offered this insight: “With new physicians, we don't give them a toolkit.  One of the things we could do is build a roadmap that is guided by communities."

In addition to the addressing systemic and institutional barriers, Dr. Humber reflected on how individual physicians can change their approach to care. “There are a lot of people who never see a primary care provider. It's because there are these barriers. And it is our job to figure out what they are and break them down. It's not someone else's role. It's a different way of thinking."