How author Jesse Thistle is helping doctors in Canada fight Indigenous homelessness

Doctors can play a role in ending homelessness in Indigenous communities simply by treating patients with hospitality and respect, says Métis-Cree professor and author Jesse Thistle.

Thistle, who has experienced homelessness himself, is part of a team drafting an Indigenous approach to caring for homeless patients for the Canadian Medical Association. 

"I believe that by reintroducing Indigenous knowledges and ways of knowing, that we can change some of the broken systems and help repair the relationships that have produced Indigenous homelessness on the ground," Thistle, who teaches Métis Studies at York University in Toronto, told As It Happens host Carol Off. 

"Because right now we have our very hierarchical system that privileges Western knowledge over Indigenous knowledge — and the end result is this homelessness."

What is Indigenous homelessness?

Thistle is developing the guidelines alongside Dr. Janet Smylie, a Métis family physician in Toronto, with guidance from Maria Campbell, a Métis elder, author, and Indigenous community research methodologist.

They are part of a wider CMA effort to provide doctors with best practices on how to treat homeless patients by connecting them with the people and systems that can provide housing, income support, mental health treatment and harm reduction programs.

Thistle says the CMA is developing a separate set of guidelines for Indigenous patients because their experience is unique. 

"The drivers that put people into homelessness for Indigenous people are different than the general population. There's dispossession of land. There is loss of culture, destruction of domiciles [and] homes because of under-funding," Thistle said.

"All the way through, if you look at the way that Indigenous people end up houseless, they have all these disconnections from relationships over time through colonial interruption." 

In Canada, Indigenous people are eight times more likely to be homeless than non-Indigenous people, and they make up between 10 and 80 per cent of the total homeless population in large urban centres, the CMA says. 

It's something Thistle knows all to well. He wrote about his own history of homelessness in his memoir From the Ashes, which is on the shortlist for this year's Canada Reads, CBC's annual battle-of-the-books competition. 

• How Jesse Thistle went from being homeless to a bestselling author 

As he was interviewing other Indigenous people who had experienced homelessness, he realized there were themes that connected them all together.

Namely, everyone he talked to had been stripped of their culture somehow, through residential schools, the Sixties Scoop, or separation from their parents by child services. 

"They describe their homelessness really starting when they were taken from their family unit. The end result from the trauma from that, you know, was houselessness later in adult years," Thistle said. 

"I'd never heard that before, and I got to thinking about my own life, because me and my brothers were let go and raised elsewhere without our culture. And I'm like, those people are actually right. And why isn't that articulated in the homelessness literature?"

4 Indigenous protocols 

The guidelines take a Métis-Cree approach to medicine, and centre around four main protocols for care providers:

• Situating one's self
• Visiting (keeoukaywin)
• Hospitality
• Treating patients as you would treat your own relatives

"These four protocols really come from Indigenous protocols of treaty-making and how we're supposed to interact with one another on a basic, daily level," Thistle said.

For a doctor, situating one's self could mean learning about the colonial history of where they are practicing, and introducing themselves to Indigenous patients as guests working on Indigenous territory.

Visiting means taking the time to sit down and get to know a patient. That could be as simple as asking, "What can I do for you?" and providing basic comforts like a cup of tea, something to eat, or access to a shower. 

"It's a very structured type of interaction that goes back through pre-colonial times that Indigenous people have engaged in," Thistle said. "They sit down, they give each other time, they listen, they talk to each other with an open heart."

Hospitality can be as simple as having a welcoming space for Indigenous patients, with Indigenous staff and culturally appropriate art on the walls.

"That goes all the way back through Haudenosaunee law ... where we're actually supposed to treat each other with respect and provide for one another in each encounter that we have," Thistle said.

This goes way back through Indigenous worldviews, and we're trying to bring that way of thinking into the medical establishment.- Jesse Thistle, author and professor 

And finally, there's the idea of treating everyone and everything as if it were your blood relative. 

"That's to treat each other with respect within the web of what's called wahkotowin, or helping each other in a good way ... where everything is interrelated to one another," Thistle said.

"This goes way back through Indigenous worldviews, and we're trying to bring that way of thinking into the medical establishment."

Thistle says some of these concepts may seem simple, or even obvious, at a glance. 

"It might seem very basic, but it doesn't yet exist — and we were wondering why doesn't it?" he said.

"Because the very foundations of Canada, the treaty-making between the Crown and First Nations, had this ethos embedded within it. And, like, really it's the foundation of Canada is thinking like this." 

A preview of the guidelines was published in the Canadian Medical Association Journal on Monday, along with an accompanying commentary by Thistle and Dr. Smylie. The full project will available over the summer.  

Written by Sheena Goodyear. Interview with Jesse Thistle produced by Chloe Shantz-Hilkes.