Alberta Cancer Foundation

Indigenous Albertans: Building Understanding and Trust

Arrow Big Smoke. Photography by Colin Way.

Arrow Big Smoke, a member of the Piikani Nation, has always been passionate about providing quality health care to Indigenous people. Her role as southern Alberta’s new Indigenous Cancer Patient Navigator (ICPN) allows her to do just that. Created by Alberta Health Services in April 2019, the ICPN role is funded thanks to Alberta Cancer Foundation donors. There are two positions in Alberta — one in the south and one in the north. As the southern Alberta ICPN, Big Smoke’s scope of care includes patients south of Red Deer to the American border and everything in between.

Big Smoke has worked in the health-care field in Alberta for 10 years — she has experience as both a licensed practical nurse and a registered nurse. As an ICPN, she sees patients primarily out of the Holy Cross Centre in Calgary and sometimes provides services at the Tom Baker Cancer Centre. She works specifically with Indigenous patients and their families impacted by cancer. The position includes offering advocacy, support and connecting patients with resources. Often, during appointments, having another Indigenous person in the room can promote awareness and sensitivity.

“In a meeting with a patient and doctor, if I see that the client appears withdrawn or distant, I will ask if they’re okay and check in with them to see if their needs are being met or if they have further questions for the health-care provider,” she says.

Big Smoke draws from her own experience as an Indigenous woman to bridge understanding between an Indigenous client’s visualization of their care and the health-care community.

“I feel completely honoured to be able to work with our people in this way, and I want to take a sense of humility and modesty with me in doing this work,” she says.

Along with locating cancer programming within the city, Big Smoke helps clients find and connect with other services that are already in place in Calgary, such as through the Elbow River Healing Lodge, Aboriginal Friendship Centre and other Indigenous programming. These facilitators often have cultural helpers, as well as Elders who have access to and understand protocols of certain cultural practices, such as smudging, singing, prayer and drumming.

Bridging the client’s own knowledge with that of medical professionals is an important part of Big Smoke’s role. More and more, health-care providers recognize the vital connection between physical and spiritual healing for Indigenous patients. It was once illegal in Canada for Indigenous people to practice their culture, so, in order for health-care providers to promote acceptance, they need to help create a safe space for the use of traditional medicines and cultural practices.

“Throughout my journey, I have worked with and have seen Indigenous clients in emergency and cancer care, and I continually find that there are still gaps in understandings,” she says. “I have personally seen and experienced biases in health care, and that’s part of what fuels my passion to do better.”

Arrow Big Smoke. Photography by Colin Way.

Big Smoke also uses her own experience as an Indigenous woman through her understanding of intergenerational trauma — the idea that trauma is transferred from one generation to the next. For example, she didn’t attend residential school (a network of Canadian government-run schools that separated Indigenous children from their families and culture) herself, but she has family that did. Big Smoke can draw on that shared knowledge to provide quality care for her patients.

“I’m working closely with other providers to contribute to a system change,” she says. “But there’s still a lot of work that needs to be done to acknowledge bias and stereotypes within the health system. It deters people from wanting to come and see us.”

Another barrier to care is that, historically, Indigenous people don’t talk about cancer. This may be related to fear associated with cancer and the thought of burdening their friends and families with the negative stigma that is associated with a cancer diagnoses. This has made it difficult to find and connect with Indigenous cancer survivors. Through her role, Big Smoke has witnessed that Indigenous people can be diagnosed late, which means their prognosis is often not good.

“If no one’s talking about [cancer], then how do they get tested and screened and find out what’s going on in the early stages?” she says.

If there’s one thing Big Smoke would like to advocate for, it’s that people get screened earlier and receive earlier diagnosis. She hopes to help even one person feel safer accessing and navigating the cancer system.

“It’s about coming from a place of recognition, where understanding and trust can be built,” she says.

Getting Wise

Created in 2001, the AHS Wisdom Council provides guidance and recommendations to AHS on the design, delivery and evaluation of innovative and culturally appropriate health programs and services for Indigenous peoples across Alberta. The council includes 19 people who are First Nation, Métis and Inuit Elders, Traditional Knowledge Keepers, and Traditional Healers. Council members draw upon their traditional knowledge and cultural practices to offer recommendations for improving things such as health equity, health service quality, access and delivery. For example, the Wisdom Council has offered insight into how AHS supports and services can evolve to include traditional Indigenous healing practices. It has addressed issues of racism by implementing education and training for culturally safe and patient-centred care approaches, and has created practices to encourage more Indigenous people to work in health care.

Learn more about the Wisdom Council at