Op-ed: Creating welcoming environments through Indigenous representation in healthcare design
Most buildings in Canada have in no way represented the peoples or culture of the traditional territory on which they are built, but have more often resembled the vernacular of traditional colonial nations. We know that some architectural language can trigger memories.
Access to medical services is a fundamental right through Canada’s publicly funded healthcare system. However, Indigenous peoples continue to experience racism, discrimination, and stereotypes within the health system , as identified in the findings of the In Plain Sight Report and locally relayed feedback. There is deep rooted mistrust that stems back to the days of horrific abuse at Indian Hospitals and Residential Schools. Some Indigenous people, including elders, routinely resist seeking health care because of this lived and intergenerational trauma.
Most buildings in Canada have in no way represented the peoples or culture of the traditional territory on which they are built, but have more often resembled the vernacular of traditional colonial nations. We know that some architectural language can trigger memories.
As Canada continues to learn, confront and educate about this truth and history, architects need to change how we design for and provide care for our communities. Early and frequent engagement with Indigenous communities must be at the core of this.
As architects we cannot go into new projects thinking we are the experts in inclusive and representational design the same way we may be experts in typology or building type. In healthcare projects we never start designing without input from the users of the facility to understand who they are and the nature of their strengths, needs and challenges. Effects of colonialism didn’t happen on the terms or timeline of Indigenous peoples. But engagement needs to happen on the terms and timelines of their communities. To create inclusive and representative architecture for Indigenous peoples, we must have a focus on building relationships and trust: learn first and design second.
Canada’s first healthcare Alliance project demonstrates a move in this direction. The Cowichan District Hospital Replacement Project in North Cowichan, BC is setting a new standard for how Indigenous communities are involved in the design of their health facilities.
Parkin Architects (with ZGF Architects), along with Island Health, EllisDon, BCIB and Infrastructure BC are now three years into the project. As alliance partners we have allocated meaningful funding for Indigenous engagement, staff cultural safety education, and significant representation through art, language and culture.
We continue to meet with the local indigenous communities through Chief & Council meetings, Elders consultation, community journey mapping, and sitting down for meals to learn from their experience, needs, and to share in the design process.
And we have learned so much. It’s clear that incorporating Indigenous perspectives into healthcare design is not only about providing more access to services but also about creating environments that are inclusive and welcoming, and reflect and respect their cultural practices.
As the arrival point for many visits to the building, the Emergency Department (ED) triage desk was a main focus for the designers and clinical care providers in alliance collaboration. We oriented the security room in a way that would maintain safe sightlines, yet be ‘tucked away’ enough to not feel prominent so patients would feel more comfortable when entering the ED. The triage security area was renamed Ts’uwtun, meaning ‘greeter’ in the Hul’q’umi’num language.
To create a welcoming place for healing, storytelling will be intrinsic to the look and feel of the facility. The project will offer significant opportunities to Indigenous artists representing the service area of the hospital, both for established and young or emerging artists. Their pieces are being selected in a non-colonial method of procurement and will be accompanied by descriptions in English and the various languages of the artists.
Cultural practices involving burning can play a major role in Indigenous healing customs. Initial project specifications required one room with provisions for burning meaning patients would need to leave the comfort of their rooms for this part of their healing journey. Striving for greater cultural inclusivity, we decided to design provisions into 185 patient and staff rooms instead. Working closely with the mechanical engineers, each room will have its own smoke system which can be individually controlled by staff, allowing for burning practices with ease and dignity, not requiring special accommodations.
Indigenous vernacular design is represented by a natural material and colour palette. It responds to desired aesthetics as identified by the community in engagement sessions as well as follows evidence-based design principles of biophilia. The stunning two-storey community hall features exposed mass timber structure and platforms that echo the vernacular style of Coast Salish Big Houses. There are two mass timber structure buildings that house several departments, including Indigenous Health Services. The design team collaborated with the Infection Prevention and Control specialists to find ways to expose the wood structure in strategic spaces to provide staff and patients a connection with nature. We also included large operable windows for access to fresh air and natural light, along with dedicated outdoor spaces to facilitate access to natural surroundings.
Through these learnings, it is evident that a sense of belonging is vital for visitors and staff. The engagement and input enabled by the Alliance model in the Cowichan hospital project have significantly advanced Indigenous representation in the design. However, it is important to acknowledge that traditional competitive procurement models hinder the project team’s ability to engage sufficiently at the initial stages of design. Reconciliation will remain a secondary concern without fundamental changes to procurement methods that permit this essential involvement before design parameters are set. I am hopeful that emerging Alliance models will offer enhanced opportunities to form genuine partnerships with Indigenous communities and ensure their meaningful representation in design.
About the author:
Shane Czypyha is a Principal Architect AIBC at Parkin Architects. He provides a hands-on, personal approach to his projects. An engaged project manager and project architect, Shane enjoys the tangible experience of taking design concepts at a project’s inception, developing the details through the design phases, and seeing the project come to life in construction. His experience includes projects in healthcare, education, residential and transportation sectors. In his capacity as Project Architect Shane has worked closely with clients, contractors, consultants, First Nations representatives, and design and BIM compliance teams.