The course, titled Indigenous People, Health and Research: Doing Research in a Good Way, is offered in relationship with Dr. Wanda Phillips-Beck, who was named Manitoba’s first Indigenous Research Chair in Nursing in 2020. It will integrate Indigenous ceremony, land-based learning opportunities, talking circles and knowledge from Indigenous Knowledge Keepers and scholars.

Wanda Phillips-Beck

“We are excited to see this course emerge, which is a step towards creating a culturally safe workforce and a culturally responsive health research community, both of which are key goals of my chair award,” Phillips-Beck said.

An adjunct professor with the College of Nursing, Phillips-Beck is an Anishinaabekwe from the Hollow Water territory on the eastern shore of Lake Winnipeg. She has been a practicing registered nurse for over three decades and all her work has been with Indigenous people.

“We want to provide an environment of learning, scholarship and opportunities to do research and learn about Indigenous people and culture. This course opens spaces to understand there are different perspectives and worldviews that come into play when you are conducting research,” Phillips-Beck said.

Amanda Fowler-Woods, a PhD candidate in the department of community health sciences at the Max Rady College of Medicine, said the course will take a “deeper dive” into Indigenous methodology for health research, something she noticed was missing in her course work.

Amanda Fowler-Woods

“With the approval of my advisors, I started to put together a reading course that would help me do that deep work, looking at scholars who use Indigenous methodologies and learning what that really means for me,” she said.

Fowler-Woods is excited to be sharing her reading course experiences and learnings with other graduate students at the University of Manitoba.

“Relationship with other people is the foundation of Indigenous methodologies,” she said. “We are also extending that relationship out to the community by involving Elders and Knowledge Keepers and incorporating their expertise into the course.”

An Anishinaabe woman born and raised in Thunder Bay, Ont., Fowler-Woods has been a research associate at  Ongomiizwin – Indigenous Institute of Health and Healing for the last decade. Much of her work is centred on achieving health equity for Indigenous people in Canada.

Dr. Annette Schultz

Nursing professor Dr. Annette Schultz is co-leading the course with Phillips-Beck and Fowler-Woods. She said the course is open to any Indigenous or non-Indigenous graduate student interested in health research.

“Both the relational process with course development and delivery along with Indigenous authored course materials, are evidence of the College of Nursing’s actions towards meeting its strategic priorities concerning Indigenous people and decolonization,” Schultz said.

“We respond to over 2,000 requests for information and services a year, which, I think, shows we are a go-to place for research in Manitoba,” says Susan McClement [MN/93, PhD/01] associate dean, research at the College of Nursing.

The centre currently supports 28 researchers in the college, including a Tier 1 Canada Research Chair, providing funding, consultation and other resources.

“Right now we have three researchers with prestigious chair positions and have had 14 chairs awarded to eight different individuals since 2000,” McClement says.

Since 2014 alone, MCNHR researchers have received 131 grants and career awards totaling more than $9.9 million in research funding.

The MCNHR was founded in 1985 as the Manitoba Nursing Research Institute by the late Dr. Helen Glass [Cert.Nurs.(T&S)/58] when she was director of what was then called the School of Nursing.

“We owe gratitude to Dr. Glass for her vision in understanding the need for infrastructure to support nursing research and scholarship,” McClement says.

As part of her associate dean portfolio, McClement assumed the role of director of the MCNHR in 2018, following the lead of seven previous leaders, starting with Dr. Lesley Degner [BN/69], now a distinguished professor emerita.

Senior research manager Diane Cepanec [BA/94, MA/99] has worked with most of those leaders since she started with the centre 20 years ago. “Each of them helped shape what the MCNHR is today and has been an amazing leader and mentor,” says Cepanec.

Hired as a research coordinator in 2000, Cepanec has seen the centre‘s growth first-hand. “We went from offering a single grant valued at $2,000 in 1998 to awarding a total of 12 grants worth more than $60,000 in 2019,” she says.

Dr. Annette Schultz, associate professor, has been a researcher with the College of Nursing for 15 years, with a focus on health services, policy and Indigenous health. She says receiving support from MCNHR staff like Cepanec allows her to keep her focus on writing, crafting ideas and building relationships.

“All my budgets have been done in collaboration with Diane. She is so seasoned at putting these things together,” Schultz says. “As I tell more junior staff, she has read almost every grant that has gone through the college. She sees what gets funded and want doesn’t. To me that’s invaluable.”

Dr. Donna Martin [BN/91, MN/97], associate dean of graduate programs, also praised the centre’s staff, including James Plohman [B.Sc.(Hons.)/97, M.Sc./00], a research coordinator who has been with the centre for 12 years.

“I remember early on submitting an application to the research ethics board and getting this long response with 24 items I’d need to address before it could be approved. I was beside myself,” Martin says. “I went to the centre and James’ positivity dissipated all of that angst in me.”

In 2015, Martin, who led the MCNHR in 2017-2018, conducted a study in partnership with Little Saskatchewan First Nation, documenting the impact that a flood in 2011 had on the community after half its residents were displaced from their homes. The study received $717,855 from the Canadian Institutes of Health Research.

“The centre really helped with the grant application and providing feedback from earlier drafts, as well as with the dissemination of findings,” she says. “It was an honour to receive that funding, which affirmed that the community’s experience was worthwhile studying and supporting.”

In 2008, the research unit’s name was updated to MCNHR to reflect a growing interest in multidisciplinary health research. Maureen Heaman [BN/78, MN/87, PhD/01], director of the centre from 2006 to 2008, says the name change and refocusing of the centre were the result of a three-year process after a UM senate committee review in 2005.

“We revised the mission, vision and goals and decided to broaden our appeal to researchers and health professionals from disciplines outside of nursing,” she says.

With the updated focus, the centre began offering memberships for those outside the college to access grants and consultative services. Today there are 276 members from across the Rady Faculty colleges, Red River College and Brandon University, as well as professionals from Shared Health, the Winnipeg Regional Health Authority and beyond.

“Our members come from across the province, North America, and even as far away as Chile,” says Cepanec.

The MCNHR’s core team also doubled from three to six people, and five part-time student research assistant staff have since been added.

The centre has also grown in terms of the programs it offers students. It currently offers support to graduate students through research grants, an annual poster competition as part the Helen Glass Research Symposium, and travel awards to enable students to share their research with larger audiences.

For undergraduates, the MCNHR has a Summer Research Internship Program, founded in 2010, which teams each student with a research mentor on a project that aligns with their interests.

Fourth-year nursing student Sandra Aboh.

In 2020, the program allowed first-time intern Sandra Aboh, a fourth-year bachelor of nursing student originally from Nigeria, a chance to work alongside Roberta Woodgate [BN/89, MN/93, PhD/01], Canada Research Chair in child and family engagement in health research and healthcare, on a project focused on culturally sensitive services for youth.

“Even though we couldn’t work face-to-face because of COVID, I felt very supported by Dr. Woodgate, who was accessible through videoconferencing apps, email and phone,” Aboh says.

In total, 16 student interns worked with 14 mentors in the program this year.

McClement notes that the MCNHR continues to evolve in its support of researchers.

“The future and ongoing development of the centre is really important, and I think there’s some real untapped potential for nursing to enhance industry partnerships and collaborations,” she says.

She points to a project by associate professor Michelle Lobchuk [BN/92, MN/95, PhD/01] to develop a smartphone app that focuses on empathic communication and self-care management as a recent example of this kind of partnership.

“There are lots of ways nursing researchers can engage with people in different sectors,” McClement says.

She also wants to create a climate that will see greater synergy between researchers and other faculty members. “Instructors have a role to play in identifying issues in classroom and clinical teaching that can provide the basis of researchable problems,” she says. “I think we have lots we can learn from each other.”

Both researchers are located in Max Rady College of Medicine departments and are advised by Dr. Annette Schultz of the College of Nursing.

Dr. Anna Chudyk, a postdoctoral fellow in the department of family medicine, and Amanda Fowler-Woods, a PhD candidate in community health sciences, are both first-time recipients of the SPOR national training fellowship.

Both said they are honoured to have their work recognized by CIHR and receive their fellowships, which were created to support development of leaders in the field of patient-oriented research.

Dr. Anna Chudyk

Chudyk was awarded $70,000 per year plus a research stipend for three years for her work on the theory and application of patient-oriented research, which she is leading in collaboration with patients, the departments of family medicine and surgery, College of Nursing, Faculty of Kinesiology and Recreation Management and St. Boniface Hospital Research Centre researchers.

“My current projects are focused on developing a deep theoretical understanding of patient-oriented research and applying this knowledge to enhance capacity for patient-oriented research, both within St. Boniface Hospital Research Centre and the broader Canadian patient-oriented research community,” she said.

Chudyk began her research career by obtaining a master’s degree in epidemiology and biostatistics from the University of Western Ontario. While at the University of British Columbia, she found an interest in applying her research skills to helping people in the community through participatory research, which brought her to UM last year.

“I truly believe that those affected by a problem should be actively involved in the generation of solutions to it, and that individuals’ reflections on their first-hand experiences are essential to effecting individual and social change,” she said.

While this is her first SPOR fellowship, her master’s and PhD studies were also supported by national CIHR scholarships through the Frederick Banting and Charles Best Canada Graduate Scholarship and Vanier Canada Graduate scholarship programs.

Amanda Fowler-Woods

Fowler-Woods received $50,000 per year for two years for her Indigenous health research. A two-time UM alumna who works regularly with Ongomiizwin – Indigenous Institute of Health and Healing, she said this is the first time she’s received CIHR funding for work that she leads, although she has worked on several other CIHR-funded projects.

“This fellowship will allow me two years to finish my dissertation research project, which is part of a larger project initiated through Shared Health which involves the development of a system for the collection of racial and ethnic identifier data within the Manitoba health-care system.  This is something we don’t do consistently in Canada, but is being done in other countries, like the U.S., New Zealand, Australia and the U.K.,” she said.

She said the award will also help with her work at UM’s George & Fay Yee Centre for Healthcare Innovation, where she is working to incorporate Indigenous health perspectives throughout its various platforms.

“As an Indigenous researcher, it has always been important to me that my work is focused on the health of Indigenous peoples,” said Fowler-Woods, who grew up in Thunder Bay, Ont. “I have a very strong connection to my Ojibwe culture and I feel very fortunate that this fellowship will allow me to continue my work in this area.”  

PhD candidate Tara Horrill and Dr. Annette Schultz, professor in the College of Nursing, recently published a study in BMC Cancer, an international peer-reviewed journal, comparing cancer incidence, stage of diagnosis and outcomes between First Nations and all other Manitobans. The study was funded by the U of M’s University Indigenous Research Program (UIRP) grant and had input from several university academics, decision-makers and Indigenous community partners.

From her doctoral research, Horrill also published a systematic review of access to oncology care for Indigenous people across Canada in Social Science & Medicine, another international journal, in October.

She said First Nations cancer patients also have poorer survival rates than other Manitobans, another disparity which may result from obstacles they face at various levels of diagnosis, treatment and care.

Horrill describes Canada’s health-care system as fragmented and complicated for status First Nations people living on reserves, where health-care access is funded and sometimes delivered by the federal government. Oncology care, however, is specifically funded and delivered at the provincial level. She noted this jurisdictional gap sometimes leads to governments disputing funds while patients are waiting for care.

“At the individual level, a First Nations patient may not have good access to primary care within their community. They may also have limited financial resources, so they may not be able to afford transportation to a different health-care centre. Add in barriers at the systems and structural level, and accessing care can be very difficult,” she said.

While these compounding barriers explain the later-stage diagnoses, the fact that First Nations cancer patients had higher death rates and shorter survival times is harder to explain, Horrill said.

“We factored the stage at diagnosis into our statistical models, so what we found wasn’t related to that. We don’t know from these results specifically why the outcomes are worse, but we can guess,” she said, noting the impact of social inequities linked to historical and ongoing government policies, resulting in differences in income, education, housing and clean drinking water.

Horrill hopes that by clearly identifying the gaps in care, decision-makers will have the evidence required to address these barriers and provide Indigenous patients with cancer the same level of care as everyone else.  

“From reviewing other research looking at access to cancer care, one of the things we saw was that most, if not all Indigenous patients experience some level of discrimination or racism when trying to access services, which impacts access to care and health outcomes,” she said.

Horrill, who was born and raised in Morden, Man., does not come from an Indigenous background, but was drawn to her research after working as an oncology nurse at CancerCare Manitoba for almost 10 years.

“When you look someone in the eye and they tell you their story of going to their health-care provider over and over and not getting the services they need, I feel a certain sense of obligation to use the knowledge and training I have to make a difference,” she said.

Horrill received her bachelor’s degree in nursing from the U of M in 2005. In 2014, she returned to the university to pursue a master’s degree, and then fast-tracked into the College of Nursing’s PhD program. She is currently wrapping up a portion of her doctoral research that looks at health-care provider perspectives on access to oncology care for Indigenous populations.

While she misses the clinical work, Horrill noted conducting research allows her to think creatively and have an impact in a different way.

“When you’re working with patients directly, you can see the impact that you’re making,” she said. “You don’t necessarily see that with research, but research can impact policy and practice on a much bigger level, and indirectly make patient experiences better.”