FormalPara Key Points

  • Métis-specific concepts provide a foundation for demonstrating the resilience and healing powers of Métis science and knowledge.

  • A broader recognition of the essentials of culturally relevant cancer care provision must include an understanding of the omnipresent interconnections and interactions between Métis patients and families.

  • Métis conceptualizations of wahkohtowin (natural kinship laws) and keeoukaywin (visiting as a means of constructing Métis knowledge) promise to generate new knowledge grounded in our worldviews and ways of knowing and being that is useful to our people, communities, and nation.

  • Research grounded in Métis science and knowledge is required to support increased uptake of human papillomavirus (HPV) vaccines across Métis communities.

This chapter introduces new understandings of the ways Métis people traverse health systems to seek out the support required to meet their health- and cancer-care needs. Findings from HPV/HPV vaccine research among Métis people in Alberta, Canada, are discussed with the intention to give voice to Métis, including Métis Elder, perspectives. We describe important concepts for health as a foundation for demonstrating the resilience and healing powers of Métis-specific knowledge and science. Addressing challenges in cancer and cancer prevention among Métis people, the chapter refers to political, social, and cultural inequities that impact the health and wellbeing of Métis people.

Métis People in Canada

Within Canada, there are three distinct groups of Indigenous people—First Nations, Inuit, and Métis [1]. Métis peoples originated with European settlers entering Canada and adopting First Nations’ customs, including conjugal arrangements with women [2]. In this way, settlers learned the skills to survive in the Canadian wilderness and to pursue economic wealth and power in Canada’s far north.

More than 127,000 Métis reside in Alberta, the only province to have land-based agreements with Métis settlements. There are eight such settlements, home to approximately 5600 people, who are provided health coverage by the province [3]. Métis people across Canada do not have the same treaty rights as First Nations peoples, contributing to limited programming dollars, insufficient health infrastructure, a lack of care providers and health programs, and barriers to care.

Health and Wellness in Métis Contexts

Canada’s political landscape and its relationship with Métis people are complex and often serve to undermine their overall health and wellbeing. Unique to Alberta, Métis settlement communities have land-based agreements with the province and view themselves as independent self-governing entities. However, until recently, most communities have not received funding to develop Métis-specific health programs or services. Forced to rely on project funding, this lack of equity contributes to and perpetuates poor health despite needs and challenges similar to First Nations and Inuit populations.

In the past, dialogue with Métis Elders [4] has identified the many losses that impact Métis health: the loss of identity, traditional teachings, access to land, hunting, fishing, and trapping. Also, experiences of relocation, residential schooling, and influences from colonization and religion were noted. A recent gathering with First Nations and Métis Elders confirms that these factors persist with additional factors, including homelessness, human trafficking, substance abuse, and premature deaths from poison, including drug overdoses, affecting Métis youth [5].

Métis Identity and Language

Métis identity, as referred to by Bartlett, is grounded in the historical, cultural, and political experiences of Métis people [6]. These experiences or influences on the daily lives of Métis people are determinants of Métis health, which Cooper et al. describe as “structured around eight key wellness areas—nature, identity, development, relationships, supports, networks, environment, and governance” [7, p. 212]. Similarly, the values depicted below in the work of Métis artist and author Leah Dorion, based on extensive engagement with Métis Elders, are shown to mirror or be in parallel with what constitutes wellness in the context of Métis people (Fig. 32.1) [8].

Fig. 32.1
A poster titled Metis Values Give Us Roots illustrates the twelve values, with each Metis community or family having their own version. These values include honesty, respect, love, sharing, caring, courage, balance, mother earth, patience, strength, kindness, and tolerance.

Identified in both English and Michif, the 12 cultural values represent important ways of being and knowing and are intended to inform expectations for daily living from within Métis contexts. [8, p. 32]

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Language and language loss affect Métis health in distinct ways. Michif, a language spoken only by Métis, is a mix of Nehiyawewin (Cree), Annishinabewewin (Annishinabek), and French and is inherent to Métis in northern parts of Canada’s prairie provinces of Manitoba, Saskatchewan, and Alberta. Michif is significant to health and wellbeing as many of the cultural concepts that envelop and describe Métis health are best understood in that language. Métis Elder Tom McCallum says that Michif:

… shows love, compassion, caring and dedication…. [Language is] one of your greatest identities, because the Creator gives you a language when he put you on this earth. He gives you language to describe who you are and what you are about. Your connection to the whole universe comes through that language. It is much more than the spoken word; it’s not only the spoken word. It is a whole state of being and a way of viewing things [4, p. 88].

Métis Traditional Knowledge and Science

Indigenous Elders are the keepers and transmitters of traditional knowledge (TK) and science, including community histories, societal norms, beliefs and philosophies, traditional teachings, and healing methods. Such knowledge is maintained and transmitted through ceremonies and medicines. Moreover, Elders translate TK through oral means, rooted in ancestral stories and histories perceived to be relevant to the maintenance of Métis culture and critical to the health and wellbeing of Métis people. Likewise, Métis Elders are “rights-holders” and scientists of Métis TK, with information originating from a specific community or region often transmitted in Michif. It is important to note that Elders speak about TK as “not something of the past, but something that should be considered in a contemporary context” [4, p. 83]. For instance, although knowledge of land, climate, and water is traditional knowledge, it is by no means knowledge of the past [2].

Collective Ties to Land, Language, and Culture

The impacts of colonialism, including the loss of land, language, and culture, are generally understood to impact the health and wellbeing of Indigenous peoples globally [5]. Métis people in Canada are no exception, and until recently, they were often unseen or they represented a forgotten people, with the broader Canadian population offering limited or no acknowledgment of their place in the country’s historical, economic, and sociopolitical landscape. This is evidenced by the lack of health research articulating or even recognizing the existence of Métis cultures, knowledge, and science to any degree of depth [7].

The following sections present two examples of Métis-led research that has taken place within Alberta Métis communities. These reflect the significance of grounding research with Métis people, in Métis science and concepts of health and wellness, and in connecting these concepts to provide culturally appropriate cancer prevention and care.

Metis People and HPV

Human papillomavirus (HPV) is a sexually transmitted infection that most sexually active people will contract at least once in their lifetime. Most infections resolve on their own, but those that do not can lead to cancers in the mouth, throat, anus, or genital areas of both men and women. HPV infection causes nearly all cases of cervical cancer [8]. Disproportionately impacted by HPV, Indigenous women in Canada experience higher rates of HPV infection [9], higher incidence of cervical cancer [10], and more cervical-cancer-related deaths [11] than the general population. Research recognizes that these differences may be a result of historical trauma from residential schooling and the Sixties Scoop (in which Indigenous children were adopted by non-Indigenous families, became Crown wards, or were placed in permanent care) experiences, the imposition of government policies, and marginalization due to poverty and racism [12,13,14]. Such very recent historical circumstances contribute to mistrust by Canada’s Indigenous people of the healthcare system and care providers [15, 16].

HPV and Métis Nation of Alberta Project

A population-based descriptive epidemiological study has identified cervical, anal, and head and neck cancer incidence among the Métis. Due to comparatively small case numbers in comparison to the general population, the research has been unable to draw statistical comparisons [17]. Additional research is underway in collaboration with the Métis Nation Alberta to explore Métis vaccine coverage, attitudes and beliefs about HPV vaccines, and experiences regarding cancer screening and HPV vaccines.

Early vaccine coverage findings for a cohort of Métis children aged 17 in 2019 reveal that vaccination coverage among Métis children assigned female at birth had higher rates of complete vaccination for HPV at age 17 (82.6%) than the general Alberta population (81.0%). However, the same cohort of Métis children aged 17 in 2019 assigned male at birth had lower coverage (66.2%) than their general population counterparts (70.7%) in the same birth cohort. For children aged 13 in this cohort, Métis children’s coverage in those assigned male (73%) and female (71.4%) at birth was higher than their counterparts in the general population (m = 69.6%, f = 69.1%). Additional phases of this research will include survey data on Métis parents’ attitudes and beliefs about HPV-related cancer prevention and qualitative visits exploring their experiences.

This research is grounded in Michif traditional ways of gathering, expanding, and sharing knowledge among Métis people and scholars. The methodology used is referred to as keeoukaywin (the visiting way). Keeoukaywin is a decolonizing process that involves hospitality and teaching with the reciprocal exchange of knowledge and ideas, in connection with land and kin. Grounded firmly in the Michif kinship law system of wahkohtowin, it engages the shared responsibility to kinship relations, both human and nonhuman [18]. Métis Elder Maria Campbell speaks to the reciprocal relationship and responsibility embedded in life teachings:

At one time, from our place it [wahkohtowin] meant the whole of creation. And our teachings taught us that all of creation is related and inter-connected to all things within it. Wahkotowin meant honoring and respecting those relationships. [It was] our stories, songs, ceremonies, and dances that taught us from birth to death our responsibilities and reciprocal obligations to each other. Human to human, human to plants, human to animals, to the water and especially to the earth. And in turn all of creation had responsibilities and reciprocal obligations to us [19].

From this perspective, every living thing is a keeper of wahkohtowin and for these reasons, keeoukaywin holds great promise as it aspires to bring all the pieces back together and lead us back to what is right—relational obligation and spiritual responsibility. By visiting with the information, knowledge and stories of our Métis kin, the research promises to generate new knowledge that is grounded in our worldviews, ways of knowing and being, and that is useful to our people, communities and nation.

HPV and Alberta Métis Settlements Project

Research to address the Action Plan for the Elimination of Cervical Cancer in Canada, 2020–2030 [20], included a qualitative study led by Alberta Health Services (AHS) to explore HPV immunization programming in Alberta Métis settlements. Designed to engage key stakeholders, the purposes of the study were to identify barriers and facilitators to HPV vaccine uptake among school-aged youth and to identify the information needs of care providers delivering HPV immunization services.

Utilizing survey outcomes, information from care professionals providing immunization services on settlements informed dialogue with AHS regional program leads and health managers. Community gatherings were held with five of the eight settlements to determine knowledge and awareness of HPV, identify barriers and facilitators to HPV immunization uptake, and learn about community-based solutions for increased uptake of the vaccine. A focus group with AHS health managers concluded the research activities to gain insights into potential improvements in vaccine uptake on settlements.

Community participants overwhelmingly spoke to the need for trust building with communities, including having culturally informed care providers, engaging with family and youth, and knowing the community through increased knowledge of Métis people and cultures. During the focus group, Elder Elmer Ghostkeeper conveyed how critical it is for care providers administering the HPV vaccine to build trust within communities to increase acceptance and uptake: “The community has to accept you. If you don’t get to that first base, you’re not going to develop a relationship, [you] might as well go home” [21, p. 10].

Elders, viewed as primary support in receiving reliable information about health and wellbeing, are trusted community members who are often asked to provide mediation with the healthcare system and care professionals. They do this, variously, through ceremony, knowledge transfer to health systems about the specific cultural needs of their communities, and community-driven solutions grounded from within the knowledge and values of the people. A key outcome from the gatherings emphasized the need for healthcare providers to “know the community.” Elder Julia Auger speaks to the importance of multilevel “knowing” when working with Métis Settlements:

…[it’s] really crucial to look at your community and develop a type of community profile. What does the community look like? How many people are there and what are the characteristics of the population? Once you start to look at your community as a whole, you’re going to be able to create a very culturally appropriate approach—that whole cultural piece has to be strong in terms of how you’re going to develop your strategy [21, p. 11].

The research clearly revealed that many community members lack a good understanding of HPV and the role of the vaccine in preventing its spread and, in the long-term, preventing HPV-related cancers. These outcomes suggest that further research grounded in Métis science and knowledge is required to support increased screening and uptake of HPV vaccines across Métis communities.

Connections Impacting Métis Cancer Experience

Diverse in nature, Métis communities, knowledge, and culture are considered living, dynamic entities. Manifested through connections to land, community, and family, these connections are viewed as sacred and as immeasurable as the connection between the air and the wind or water and the wet.

Connections to the land, as our first teacher, come through harvesting foods and medicines, and we attribute significance to learning from the land that continuously provides us with lessons on how to heal and care for one another. Connection to family is also inextricably linked to Métis wellbeing as commonalities allow people to share health information in familiar settings through familiar language and mannerisms. These oral connections enable collective knowledge to be shared in stories from personal experiences to support Métis wellbeing.

These connections are essential to Métis health. The removal of any one of these is likely to delay healing as the balance between each connection erodes and becomes lost. Removing the connection to community, for instance, reduces the likelihood of sharing medicinal knowledge; removing the Elder removes the ceremony; and removing the land removes the teacher. When any of these elements are missing, essential cancer prevention, healing, and end-of-life care may be interrupted, avoided, or lost.

A broader recognition of what is essential to providing culturally relevant cancer care must include an understanding of these omnipresent interconnections in the interactions with Métis patients and families. These connections must be considered prior to, during, and after care to support healing and achieve optimal wellness. Families spread information through communities. By bringing the information to the family, the connections within and between families and across the community can adequately prepare patients, their families, and the entire community for informed decision-making when presented with new health information.