Relaciones entre el sistema de control de gestión

Throughout the inception of my Dad’s admission to the hospital to the current situation of navigating the bureaucratic process of paper work to apply for financial and social

Dementia and substance abuse for First Nations peoples is educating health care practitioners about the impact of colonialism. With doctors and nurses just focusing on the illness and the medical requirements of maintaining sobriety to avoid the risk of further damage to his body, they are not aware of the impact of Aboriginal social

determinants of health within my Dad’s life. When explaining his diagnosis and his long- term health expectations, there is judgment attached to the doctor-patient interaction. When accompanying my Dad to an appointment with a neurological specialist, the doctor’s body language consisted of no eye contact, not explaining his procedures and test requirements in laymen’s terms, repeatedly using risk words and reiterated several times that this is what happens when you drink your entire life. Negative treatment on behalf of doctors because of their moralistic belief that my Dad’s Alcohol Dementia and Alcohol Neuropathy stem from choices he made to be an alcoholic once again works from a neo-liberal governmentality framework based on ‘rationale choice’. But the concept of choice “…suggests full knowledge of options and unlimited alternatives and denies the constraints posed by time, unequal access to resources and differences in individual’s backgrounds, propensities and abilities” (Petersen and Wilkinson, 2008:9). Not having choice has been a part of my Grandma’s life and my Dad’s life, which has affected his overall health and well-being. Choice is an option for those who do not face systemic racism because of their Indigeneity. Using addictions is a way to deal with the stark lack of options faced by colonized peoples.

My recommendation to combat the lack of understanding of health care practitioners providing services to individuals and family members faced with a diagnosis of Alcohol Dementia is to provide education about Aboriginal social determinants of health and the colonial history of the Nation they are serving. The doctors we dealt with did not have any empathy for our family, which occurs because, “physicians enter cross-cultural situations with little or no preparation and bringing their own values which often differ from the values prevalent in the communities they serve” (Kelly and Brown, 2005:1646). Within my experience with doctors, they do not understand that my Dad’s addiction is connected to a historical legacy of suffering, loss and the intentional erasure of identity and memories. If Aboriginal social determinants of health are a part of the curriculum for physicians, illnesses and diseases experienced by First Nations peoples in Canada

including Alcohol Dementia can, “…move away from genetic or biomedical inquiries and instead examine why some people and communities are more prone to health deficits, or suffer more severely from their outcomes, as a function of their social contexts” (de Leeuw et al., 2009:285). My Dad’s Alcohol Dementia needs to be contextualized to understand his addiction and his current health state. The Western epistemology of examining health only in biological terms does not grasp the wholism of the lives of First Nations patients. If doctors were educated about the massive discrepancies of health for First Nations communities compared to their Canadian counterparts, they would have an understanding that illness is connected to macro social structures that shape everyday experiences.

It may seem insurmountable to combat the health disparities for First Nations peoples in Canada, but educating health care practitioners can be a start. Providing cultural training and historical education as a part of the medical school curriculum can allow health care practitioners to have better communication and bed side manner when offering medical services to First Nations peoples, especially for those experiencing health effects

connected to addictions. The effects of colonialism within my Dad’s life could be better understood if they were willing to discuss the “multigenerational trauma experienced by a client’s family and nation. The assessment should explore the meaning of boarding schools, massacres, loss of land, and similar phenomena in relation to contemporary social and health problems” (Weaver and Brave Heart, 1999:29). An important critique emerging from within my interactions with doctors as the daughter and caregiver is about their body language. Many doctors had unwelcoming body language and did not make eye contact. They also did not take the time to listen to my Dad’s understanding of his condition or to explain the medical terms in a way that was easy for my Dad to process. If doctors are going to be providing services in a community that has an Aboriginal

population, they should be introduced to their practice with an education about the people that they will be offering services to. I know educating doctors is a short-term solution because of larger flaws within the health care system for providing services for First Nations individuals and communities.