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March 31, 2022

PaRx People: A Conversation with Dr. Nicole Redvers

Dr. Nicole Redvers, ND, MPH, was the first licensed practising naturopathic doctor in North America who is Dene (a member of the Deninu K'ue First Nation Band). She has traveled the globe, studying traditional medicine systems in various countries and working with Indigenous patients, helping to bridge the gap between traditional and modern medical systems.

Dr. Redvers previously developed Northern Canada's only integrative medicine clinic from the ground up. She also co-founded and chairs a non-profit group, the Arctic Indigenous Wellness Foundation (AIWF), whose purpose is to revitalize traditional wellness services in the Canadian north and to focus on the preservation of Traditional Medicines. Her foundation was awarded one million dollars as a Laureate of the 2017 Arctic Inspiration Prize to work with the unhoused and those most vulnerable in the northern part of Canada.

Dr. Redvers published the trade paperback, The Science of the Sacred: Bridging Global Indigenous Medicine Systems and Modern Scientific Principles in 2019, and is currently an assistant professor in the Department of Indigenous Health and the Department of Family & Community Medicine at the University of North Dakota School of Medicine & Health Sciences.

We sat down with Dr. Redvers to learn more about her unique career path, how naturopathic medicine and Indigenous knowledges can complement Western medicine, what nature prescribing can mean in an Indigenous context, and meaningful ways health professionals can reduce barriers for Indigenous patients to connect to the land.

Trace a path for me from childhood and your early learning experiences, and how they led to your career choices and work today.

I was born and raised in Treaty 8 Territory in the Northwest Territories. The first part of my life was in Fort Resolution, and then I spent most of the rest in Hay River and Fort Smith in the South Slave Region of the NWT.

We spent much of our time out on the land, especially when we lived within Fort Res. Even when we lived in Hay River we went back almost every weekend when younger. My parents had cabins, we had a lot of little spots where we would go fishing, and my family were avid hunters and fishers. We had very much a seasonal kind of eating during duck season and moose hunting season, and lots of time in the boats on the river. Both of those communities are on Great Slave Lake, so we never actually went out on the Big Lake very often. It was mostly around the edges and waterways of Slave Lake and the Hay River predominantly, but also into little bays of Great Slave Lake as well.

I have lots of positive memories picking berries with my grandmother. In Fort Res there was a beautiful area, just probably a couple kilometers from the community, that had every berry you could imagine. Saskatoon berries and strawberries, and cranberries and high bush cranberries—and you just have to know the seasons, of course. So each season we’d go out. I remember my dad always commenting on Grandma, because she'd have her head down in the bushes with her backside up for hours and hours and hours, like, “Maybe you should check up for bears once in a while,” but she could care less. She was just so happy to have her head in the berry bushes, and would come out with these massive buckets that we would make various things with. Those were always fond memories.

Northern berries and nature in Chief Drygeese Territory, NWT. Photo credit Melissa Lem.

My job as a kid was being the duck plucker. You have to get used to lice very quickly when you're in my family (laughs)—tons of lice, usually on ducks. So lots of plucking and flicking off lice that are on your arms once in a while. But it was always a good ending, because Grandma always made the best duck and barley soup afterwards, or, ended up in the smoke house singeing the feathers.

Most of our early life revolved around food harvesting that was based on the land—plants and berries and medicines. There was never really a time where we just went out to, you know, sit on a beach chair and look out at the lake. There was always something that we were doing, either fishing or gathering. There was always a purpose and a meaning for being out there on the land, which continues today as well.

I remember, especially as a kid, not feeling any stress when out on the land. And most often, especially if there were other kids around, while the adults were doing things we'd be tromping around the bush and random places, and bicycling around the community and running off into the woods, and I don't ever remember any of the adults or us ever being concerned about wild animals. It was very much just natural. I don't think we spent any time inside as kids. I mean, it was always out and about doing things.

But I don't ever remember feeling like, oh, this is a pain, I have to pluck all these ducks. It was always just what you did—there wasn't even that concept in your mind. You just contributed to the collective purpose of whatever we were doing that day, and I don't remember feeling stressed or exhausted or tired when doing land activities.

I think those were probably the happiest times, with families, and where people were the most positive, comparatively to being inside, where sometimes all the rest of the problems come through our communities due to the historical traumas that occurred. So I think that the land always brought out the best in people.

Nicole’s mother in her smokehouse in Fort Resolution, NWT. Photo credit Nicole Redvers.

One of the biggest things that was apparent to me growing up—my mother was a residential school survivor, and as well as my grandmother and many of my other family members—was the challenging circumstances within our communities, particularly the small rural and remote communities, not only with educational opportunities but also with social stability and access to relevant supports that met the needs of community members.

I always remember a particular story when I was sitting at a dinner table, and a friend of a relative was sitting with a crooked finger on the table, kind of haphazardly wrapped with a cloth. I can't remember who it was that asked the woman, “Go to the nursing station! What’s wrong with your finger?” And her response was, “I'm not going to the nursing station! You know the nurses . . .”

It was sort of an eye-opening moment for me to realize that somebody was willing to suffer at home instead of actually going to access services. We're supposed to be supportive and helpful, but that aura of the health location not being safe or a positive thing was, I think, emblazoned on my mind from early on, with a lot of the lack of trustworthiness that existed within those environments that I grew up in, and was very much apparent with some of the conversation that would happen around dinner tables and various social circumstances.

How medical care and health care were often seen as an absolute last resort—once things got bad enough to be able to warrant a visit—was something that really made me think and consider the career path of health. How we need more options and opportunities for our community members to receive care that matches not only their needs, but also their culture, their background, and their connection to land and land spaces.

Nicole picking Saskatoon berries outside Fort Smith, NWT. Photo supplied.

What led you to pursue a Naturopathic Doctor degree, and then move into health research?

I started off in exercise science, actually. There's not much else to do up north when you're kids, so I ended up getting into sports quite competitively for a number of years. Originally I had thought of going into sports medicine, and about halfway through my program at the University of Lethbridge I went to one of those lunch-and-learn talks. And I ended up going to the wrong one by accident, and I was too embarrassed to leave.

So I just sat down, and it was a talk on naturopathic medicine. And I was kind of wide-eyed by the end, realizing that I could actually do a program where I could still do some of the western-based sciences, but at the same time learn about different ways of looking at health and healing from the eyes and lenses of different cultural communities around the world.

It was a moment of recognition, thinking back to those memories about nursing stations, and the perception of how medical systems are, and strategically placing myself a little bit further from that viewpoint by having a title that inherently brought in more of the conception of the natural world, and land-base. So I switched my major and ended up going into naturopathic medicine, and ran a practice for about 10 years in the Canadian North, serving northern communities.

But the frustrating part for me was around the five or six year mark, where I became very much more aware that so many of the structural issues that were preventing our people from being well were not being addressed in the clinical room. And it was too difficult to address them one-on-one because they were structural factors. That’s why I ended up doing a Master of Public Health degree at Dartmouth College in the US. It was a big departure from what I was used to, because it's an Ivy League school, and life is different comparatively to the North (laughs). I was joking with my colleagues down here that I probably came off the plane smelling like dry meat, and going into all these fancy—it's this weird place, with everybody in these little sweaters and so forth there.

Nicole moderating a talk with Elders at Stanford University, California. Photo credit Melissa Lem.

But I enjoyed it because it was one of the few schools where they were willing to ask disruptive research questions. I didn't want to be in a place where you weren't able to foster questions that would push on the status quo, and that was one of the few places within public health, but also within medicine, that was willing to do that. And that's when I decided to get into more research and scholarly work, realizing there were some things I could do to improve narratives, help to bring narratives to some of the issues that I had seen within clinical practice for so many years in the North.

Around 2016 or so is when I started to do mostly participatory supportive work with the Institute for Circumpolar Health Research up North. We don't have a university up North—we have non-profit research centers. So I started participating on some local projects through the Arctic Indigenous Wellness Foundation, and kind of getting my paws into a little bit more work before making the official decision to switch to academia in 2019, as an assistant professor at the University of North Dakota’s School of Medicine and Health Sciences.

How do you think NDs and other healthcare practitioners can complement each other, in practice?

From what I've seen up North, in an environment where fifty per cent of the population identifies as Indigenous, it's very difficult to make the assumption and publicly assert that only Western ways of knowing and applying medicine are going to be tolerable within a community.

It created an opportunity to open those dialogues, and work wonderfully and consistently for ten years with a group of family physicians, and some specialists. And I think the biggest things that I noticed, at least with some of those partnerships, were with patients where all means have been exhausted within Western systems. Patients that come in with chronic fatigue, or irritable bowel syndrome—things that are not as easily addressed. And we would have such great success with them. It's a small enough community that if you've seen a patient who’s been unwell for six years, and then they see somebody for two months and all of a sudden they're back to normal, then the eyebrows go, what the heck are you doing?

What usually facilitated the conversation was when they were clearly able to see that their patients that had been not successful in attaining their goals were all of a sudden getting better. So then the referrals would start, you know, back and forth.

Those were always my favourite patients, because they're a challenge, but at the same time I have a whole toolbox of things from thousands of years of history that I can bring upon, in a way they haven't experienced before but also at the same time demonstrates impact very clearly and quickly to other providers.

Nicole on an oceanside hike in Tunisia. Photo supplied.

Number one, naturopathic medicine is always based on a systems approach as opposed to isolated pieces. A diagnosis is helpful from a medical standpoint, but if there are no physiological abnormalities that are able to determine why somebody's critically fatigued, then we go back to the ways that traditional medicine providers have assessed patients for thousands of years, which is based on signs and symptoms of the body. I go into many of those in my book, The Science of the Sacred, on the types of assessments that were done historically for those patients.

Within our Indigenous traditional medicine, everything and anything is always brought back to some sort of balance, usually within the spirit, mental, emotional components.

I think the clearest example is in autoimmune patients, where most often they'll either flare under high stress, or a huge stress was a precipitator to their illness. A lot of people don't focus on that. But when patients are able to make those connections and see those patterns themselves, then they're able to take steps better to address them. Traditional providers do that very well, where they're not telling somebody, this is what is wrong with you. Patients have to find that out themselves through the exploration process. We're guiding them even though we might know what the problem is.

And then the second piece that I see used very successfully, with patients, is the use of stories and metaphors. I don't know how many times I get patients coming in saying that they just don't understand what's going on, or what the tests mean. Many providers just don't have time to address those issues. So if I can sit down with for somebody for an hour, and just explain it to them in a way that's understandable, even that alone causes a decrease of anxiety—recognizing that things are not actually as bad as they thought. So the doctor as teacher, docere, is another fundamental piece that is underutilized in our system because we don't have the resources or time to do that. It's not the fault of physicians, it's just the structure of the system.

The approach is very much focused on what we would call root causes. And “root causes” is so misunderstood, because the root cause could be you're eating crap so you're getting overweight, or diabetes. Or a root cause can be you're eating like crap because you’re depressed because your husband left you. How far do you go back in that root really determines how far you can go with the healing process. The further you go back, the more you can go forward. The less you go back, the less you go forward.

Aurora borealis in Chief Drygeese Territory, NWT. Photo credit Melissa Lem.

The concept of “prescriptions” dates back to the beginning of history; as long as there were medications and writing systems to capture directions for preparation and usage, there were prescriptions. Could you elaborate on northern Indigenous ideas of what it means to be “prescribed” something?

The caveat with anything that I say or contribute is that it’s my own experience of the teachings that I've received, but may not necessarily be representative of the entire northern landscape given the diversity of communities that currently live within that area.

At the same time, the idea of a prescription, speaking again from a traditional medicine standpoint, is kind of lost a little bit in translation. With a prescription the assumption is that somebody like a provider is providing instructions on how a person could do X Y Z to be able to get from A to B.  It's a map, so to speak. Whereas with traditional medicines, it's not necessarily the practitioner that's giving that prescription; it's the land, Creator, ancestors, spirit—there's a whole conglomerative of things that come into them. So the story piece of a provider just giving a prescription that's from themselves—you can't really translate that in any way.

From the traditional way of thinking, it's the land that is giving you a gift, an opportunity to be able to heal. Or the Creator or the ancestors that have come through that ceremony are providing this gift. But it's a stepping stone to the healing process, and not necessarily the prescription in and of itself, as the main mediator.

In guiding people to find their own solutions, to sort out the systems issues around that participant, including the family, the community, the environment, the prescription is just a small little piece of that larger puzzle that can support that person to get a little quicker to where they need to be.

Many Elders I've talked to really like to see, especially in the Western context of health care, the idea more of a prescription being a consultation process between a provider and a patient as an equal participant, not only in the knowledge they have because they're an expert in their own bodies, but also in their environments and in their communities. So that consultative process evens out more to a shared decision-making environment, as opposed to something where a provider is just writing on a piece of paper, this is what you need to do.

So we say prescription in the Western context, of course, but there's an inherent power differential innate within that term that is nuanced for some people, but in other cases furthers the lack of trustworthiness if it's not done in a way that brings in all of those other holistic factors amongst our Indigenous communities.

Something we don't think about very often is how something so basic and innate in the practice of medicine—we just prescribe—is how it can bring in so many power differentials and histories of thousands of years from the traditional medicine side, the hundreds of years of trauma within the Western side, and how that conglomerates in just handing a piece of paper to somebody.

British soldier lichen in the NWT. Photo credit Melissa Lem.

You published a paper last year on the patient-planetary health co-benefits of prescribing, as well as a recent Indigenous consensus perspective on the determinants of planetary health. Could you tell us about the key messages in your articles?

The patient-planetary health co-benefit prescribing piece was based on some scholarly work through Oxford. One of the frustrations I had was with trying to communicate information about prescriptions, regardless of in what form, that have the specific intent to take both the patient and environment into account. And there's ten billion terms out there that are being used in different ways, whether it's nature prescribing, green prescribing, eco-directed sustainable prescribing—tons of them. But they're all kind of saying similar things with no overarching principles, although ultimately with all of them you’re taking both the patient and the environment into account as participants in that process.

So I wanted to come up with a terminology that more easily described the umbrella of all of the various prescribing practices that fall under that realm of co-benefits, and described the rationale and reasons bridging off Indigenous traditional medicine; where patient and planetary were joined even grammatically by that hyphen, but more symbolically, in the way we think about providing care. Because wellness is innate within the environment, there's no separation possible in there.

So I think the key piece that came from that work is that there are a number of different prescribing practices within the clinical environment that have the potential to take into account both the patient’s and the planet's health—those co-benefit actions. And really trying to create a common narrative to root that very key principle was the main thing that came out of that first paper.

The second one with the determinants of planetary health was probably one of my most favourite projects to work on. We just had such an amazing group of Indigenous Peoples representing so many different Nations across the world. And I'm always mind-boggled that you can get communities from very different global regions, different political contexts and different histories—although there is a shared history of colonization and continued impacts—and the narratives that are discussed are so similar in what matters and how to move forward in the world in a good way. It's humbling, but it also gives hope, that somehow all of these Indigenous Peoples fundamentally come to the same place on what we need to make our planet well.

One of the things I like to highlight is that we don't often think of the health of Indigenous Peoples as the solution for the climate crisis, but without Indigenous Peoples you don't have Indigenous traditional knowledge. Without Indigenous Peoples you don't have stewardship of the environment that's protecting 80 per cent of the biodiversity on the planet. Without Indigenous Peoples you don't have the Indigenous languages that categorize the vast taxonomies of information from the biodiversity we have.

So I think that's a natural tie to health systems, and why it's so important for our systems to be open and accepting and inclusionary when it comes to ensuring our Indigenous communities are well in their own way.

Nicole dogsledding in Chief Drygeese Territory, NWT. Photo supplied.

What activities do you like to do outdoors and on the land?

Well, my environment seems to be changing on a regular basis, because I can tell you, the prairies of North Dakota are very different from the Northwest Territories, and Chelsea, Quebec [where Dr. Redvers moved during the pandemic from her academic work in North Dakota] is so hilly that I was joking to my husband that I forgot what it was like to walk up hills. I was huffing and puffing going for walks around here, when I could go for walks for hours in North Dakota without a problem (laughs).

But I love walking. I’m a big fan of just walking in natural spaces, and I try to ensure that I go out every second day into spaces where there's no people, and it's just me regardless of where that is—I seem to be able to find places to live where that's possible. Our family in Yellowknife had a cabin that was located about a 45-minute drive north up on an isolated lake, and that was our favourite place to go to do various land activities. We had our secret cranberry patches and various spots to find the things that we needed, and my kids would snare rabbits and fish, and we would spend a lot of time having fires and storytelling, and all the things that I used to do when I was young.

Up North we have different ceremonies that happen in various Indigenous communities. But one of the things that my Elders have instigated throughout many, many generations is ceremonial fasting. I'm into my sixth year of a seven-year journey; it's seven years you commit to when you spend four days and four nights completely alone in the middle of the wilderness without food and water. That time is very much a space to give a break to Mother Earth from all of the taking that you've done throughout the rest of the year, but also a way to connect and be connected to, not only the land, but also to the entire environment.

So you don't talk to anybody—no social media for four days and four nights. You’re suffering a little bit, because having no food and water is not easy. But the world just slows down during that time, and it's very calm, and there's nothing between you and the environment out there. That quiet is very restorative. You are literally on your own in the middle of nowhere for the purposes of connection, because you're not alone—you're actually more connected than you ever are. When I say alone, it means alone from people, but you’re more connected to everything else.

That keeps me well in balance when I can have the silence and listen to the squirrels, and the birds, and whatever else is going on around.

Where are your favourite spots to spend time outdoors—anywhere in the world?

My favourite place, probably by far just because of my childhood, is on the banks of the Great Slave Lake, regardless of whether it's in Fort Resolution or in Hay River. Those two communities specifically are unique in that when you're sitting on Great Slave Lake it's like you're on an ocean. Comparatively if you're in Yellowknife and you go to the lake, you're kind of in a bay, and there's lots of islands, and you don't have that expanse.

Nicole canoeing on Lake Itasca, Minnesota with her youngest daughter, Mayah, and husband, Vincent. Photo supplied.

I really love that feeling of the expansiveness of the power of the lake. That's one place that I will sit in a chair and be very happy (laughs), doing nothing for a period of time, is on the edges of Great Slave Lake.  Of course we have sunlight most of the night time up there in the summers, so it's just beautiful where you get the sun not quite setting, but just sort of on the horizon, with the pink skies and nothing in your expanse. It’s definitely one of my favourite places to be in fresh air.

In northern Canada, nature seems much closer than in many urban settings in southern Canada. Yet it doesn’t mean that people are necessarily choosing to spend intentional time outside. What barriers do you think people face to spending time outdoors in rural or northern settings?

These days everybody always thinks of the financial piece. People can minimize it when they don’t understand the hardships that happen when you're unhoused or in unstable environments, and the difficulties that occur with even being able to get through the day and provide meals for your kids and your family, let alone taking time to get out in space. Yellowknife is of those locations, or even Hay River, where we don't have dog teams anymore, where you can load up your dogs and not worry about paying gas to get out and attend your cabin. You have to have supplies, and the time, and wherewithal, and all that stuff to pack up. So I think in those bigger urban centers, those definitely end up being barriers. You end up having to go quite far out in Yellowknife to avoid people's properties.

I think, for some of the very small communities, it's fairly easy to just get out. But some of our social issues, and the legacies of residential schools have impacted our communities so much that in some sense we've lost our connections in that way, or have a difficult time being able to figure out how to navigate those within the other challenges we have within our lives. It’s very complex, those pieces.

But we've seen some great programs coming up now with Youth on the Land programs, and trying to get people out for addictions and substance use support on land bases. One great example is a gentleman that had grown up in a Northern community his whole life as a youngster, and had been on the street for 30 years—a hard alcoholic—and had come to our urban land-based healing camp once in Yellowknife. And basically he told the healing camp coordinator, I can't do anything anymore. I don't know anything about the land, and really dismissing his knowledge and ability within that moment. And then somehow, 50 minutes later, he was chopping wood and making a fire, and the camp coordinator was like, wow, you make a good fire.

And then he kind of just sat up, and was like, that moment of, yeah, I know how to do this.

It was this pride and confidence that came, like, this is innate in me. So I think it's examples like that where people are mentally cut off from their experiences because of the trauma, and sometimes just need those small, safe spaces to literally have that reconnection of, wait a sec, actually I do know, I am connected, and I've just forgotten or blocked it off because it was too painful to reconcile those histories that I've had.

A stop sign in Old Town in Yellowknife, NWT. Photo credit Melissa Lem.

When somebody can engage in a cultural activity, or something that was connected within that outdoor time, I think you'd have an easier time trying to make space for that as opposed to just going to a park. That's not something historically we would have ever done, is just go to a park. It kind of brings in the experiences I mentioned with my childhood. We never went out unless there was a reason to do it. There's this interconnectivity between process and life that happens. But it’s not just to be—it's engaging in a participatory process when you're out there.

How can healthcare professionals help address barriers to people getting outside in the North?

Probably the largest thing when speaking in the context of Indigenous Peoples is not actually anything to do with nature. It's you being more open to different ways of looking at the world, and learning and engaging in shared decision-making as it pertains to cultural practice. As I just noted, it's not about only getting on the land; it's about participating in culture as a part of that. So that reconciliation process and the acknowledgment of other ways of health and healing, of bringing in those cultural features, are first and foremost in the context of anything that engages with land with Indigenous Peoples.

You can't just jump three steps ahead and assume that somebody's going to entertain a prescription for nature without first addressing all of the baggage that comes with it. That's the last step of the ladder.

All of the rest of the stuff, that's where health-care providers have the best opportunity, because it's not only going to affect their engagement and being able to participate in nature spaces, but also all of the other disparities that we have within our communities as well. It comes as a package with Indigenous Peoples—I don't think we can separate that out very easily.

Is there anything else you'd like to share that would be valuable for nature prescribers to know?

The only last thing I’ll point out is a teaching from my Elders, and many Elders, that I've heard of highlighting the fact that we are nature. Because of that it makes it kind of humorous to some Elders being interviewed for land-based programs, because it's like, we go out on the land but we are land, so how can we go on the land when we're land?

Sunlight on a trail near Yellowknife, NWT. Photo credit Melissa Lem.

So the idea of this interconnection, where we are those natural spaces already. Within us we're an ecosystem. And remembering that in the context of Indigenous Peoples is important, because when we heal ourselves, we heal the land; when we heal the land, we heal ourselves. There's no separation in that. That is a key feature that makes a conversation different in an Indigenous context, and something we could learn a lot from. I think if we all changed our brains to think about us being of the land and part of the land we wouldn't do so many awful things to ourselves and the land.

And that's a fundamental distinction from some of the Western ways of going out into nature, instead of being of and with nature. It's already in you, your connection’s there—it's just a matter sometimes of reconnecting those pieces.

Learn more about Dr. Redvers’s research, teaching and other work here.

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