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insured patients in the United States. Plast Reconstr Surg Glob Open 2018;6(04):e1738 8 Indigenous people and Two-Spirit considerations As a provincial program, Trans Care BC operates on the traditional and ancestral land of many Indigenous peoples, and we provide services to First Nations, Métis, and Inuit people who live in diverse settings and communities across BC. Trans Care BC’s main office is located on the traditional and ancestral territories of the Musqueam, Squamish and Tsleil-Waututh Nations. With the use of this guide, it is important to note that historical and ongoing colonialism and racism can affect and interrupt Indigenous people’s identities, and their ability to access care. Impact of colonization In BC, land was taken from Indigenous peoples and many were then forced onto reserves and into residential schools. This colonization harmed Indigenous peoples and their communities in many ways, including causing infectious disease epidemics, repression and criminalization of traditional healing practices, segregation through Indian hospitals and in some cases denial of health services. The impacts of these harms have been shared and experienced from generation to generation. Because of this, the current health care system may be experienced as inaccessible and possibly harmful to Indigenous people, preventing them from receiving safe and respectful care. The spiritual and cultural beliefs of Indigenous people were also impacted by colonial religious belief systems that condemned sexual and gender diversity. Some of the lasting impacts of colonialism have been an increase in homophobia and transphobia in Indigenous communities, often forcing lesbian, gay, bisexual, trans, queer (LGBTQ) and Two-Spirit people to leave their home communities. Two-Spirit The term “Two-Spirit” was created by a group of LGBTQ Indigenous community members in 1990 at the third annual Inter-tribal Native American, First Nations, Gay and Lesbian American Conference held in Winnipeg, Manitoba. It is a term currently used within some Indigenous communities to encompass sexual, gender, cultural and spiritual identity. Two-Spirit reflects complex Indigenous views of gender roles and the long history of sexual and gender diversity in many Indigenous communities. Individual terms and roles for TwoSpirit people are specific to each community. The term Two-Spirit is only to be used for Indigenous people, due to the cultural and spiritual context, however, not all Indigenous people who hold diverse sexual and gender identities consider themselves to be Two-Spirit. iv Acknowledgment & Disclaimer Trans Care BC Primary Care Toolkit Providing care It is the role of all health care providers to ensure that the care they deliver is responsive to the needs of their patients. For Indigenous patients, this includes being considerate of the ways that colonization and racism have shaped their relationship with the health care system. It’s important to take time to understand and reflect on the ways we may need to evolve and adapt our own practice in order to create a welcoming, inclusive and affirming care experience for Indigenous patients and their families. Learn more about Indigenous peoples and tools that you can use for effective communication and relationship building through the San’yas Core Indigenous Cultural Safety Health Training - www.sanyas.ca/training/british-columbia/core-ics-health. The San’yas training was designed for health professionals working in the Provincial Health Services Authority (PHSA), regional health authorities, Ministry of Health and partner agencies in BC. Trans Care BC staff are committed to meaningful, respectful and accountable collaboration with Indigenous communities, and trans and Two-Spirit peoples. We acknowledge gender diversity and Two-Spirit people in Indigenous communities prior to colonization and we are working to understand the perspectives and needs of trans and Two-Spirit Indigenous peoples. Trans Care BC is building relationships with Indigenous communities in BC through community engagement sessions in all five regional health authorities. For these engagement sessions, Trans Care BC has partnered with Two-Spirit content experts and community organizers, as well as the First Nations Health Authority, BC Association of Friendship Centres, and VCH Aboriginal Health and Prevention teams. Acknowledgment of the primary care working group Trans Care BC would like to acknowledge the invaluable contributions of the Primary Care Working Group (PCWG) to the development of this toolkit. The PCWG brought together clinicians with extensive collective experience providing care to trans, Two-Spirit and gender diverse patients. Members came from diverse practice settings, rural and urban communities, and were cis and trans identified people. We thank them for sharing their knowledge and time and for their ongoing dedication to improving access to respectful and dignified health care for trans, Two-Spirit and gender diverse people. Disclaimer The PCWG was comprised of family physicians, nurse practitioners and nurses who have expertise in trans care by virtue of the volumes of patients they have seen and the care they have managed. This Primary Care toolkit has been developed not as a standard of care but rather as a general
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