11 Dec Healing Begins with Being Heard: A Conversation Exploring the Path to Culturally Safe and Accessible Care for Indigenous Communities
Healing Begins with Being Heard: A Conversation Exploring the Path to Culturally Safe and Accessible Care for Indigenous Communities
In this insightful conversation, Dr. Jessica Carfagnini, ND, shares with the Canadian Association of Naturopathic Doctors (CAND) what inspired her to explore how Indigenous patients experience naturopathic medicine in her paper, “Exploring the Experiences of Indigenous Patients Accessing Naturopathic Medicine in Thunder Bay, Ontario.” Drawing on years of clinical experience and community engagement, Dr. Carfagnini, ND, discusses the barriers Indigenous patients face, the importance of trust and collaboration between naturopathic doctors (NDs) and Traditional Indigenous Healers, and the meaningful steps practitioners can take to move from intention to action in reconciliation and culturally safe care.
Every project begins with a spark – what was yours? What observations or experiences moved you to study how Indigenous patients engage with naturopathic care, and how did that lead to your paper?
“I was a mature student by the time I decided to be an ND. I’d been working at the Sexual Assault Support Centre of Ottawa, it was a feminist collective, offering free services to women who were survivors of abuse.” The seven years spent there shaped her worldview: “I learned a lot about unlearning racism … and I developed an anti-oppression framework for how I wanted to help other humans in this lifetime.”
A turning point came during a hospital visit with a client. “I walked into the hospital and I had this weird flash where I was like, I want to be a doctor … and I thought, that’s strange, because my brother is the doctor, I’m the grassroots feminist counsellor.”
She was also a patient of a naturopathic doctor and loved “acupuncture and plant medicine and her holistic perspective.” Yet she resisted pursuing the profession herself: “I was not interested in becoming a naturopathic doctor because it’s not accessible to everyone.” She applied to two mainstream medical schools before a friend mentioned CCNM’s satellite clinics, where free naturopathic care was offered to underserved communities, including Indigenous patients. “I was like, you know what, I’m going to follow my heart … I love the model of care. I don’t actually want to be a medical doctor. So, I applied, and I got in.”
Even in school, accessibility was top of mind. “I started a club where we talked about, how to make naturopathic medicine more accessible to underserved communities” She arranged placements at both the Anishinaabe Health Toronto and Sherbourne Health Centre satellite clinics – it’s unusual to receive two – and then carried her vision into her career.
After moving to Thunder Bay to open a clinic, Carfagnini found herself in a region where “Thunder Bay’s become almost like a hub for Indigenous health in Northwestern Ontario.” Over the years, she noticed a research gap: the only published work on Indigenous patients’ experiences with naturopathic medicine was early studies from 2008 and 2010 (Walji et al). “The research had just started, we hoped we were going to hear more, and we didn’t. It was just crickets.”
During COVID, she reflected on the many Indigenous patients who told her, naturopathic care “really works for me … it fits with my concepts of health and wellness,” and on the barriers that were preventing others from accessing it.
Dr. Carfagnini, ND, speaks plainly about the realities around Indigenous health, noting that “we have a massive problem … because of colonization, residential schools, intergenerational trauma.” These factors, she emphasizes, are evident in the research and continue to drive poorer health outcomes for Indigenous Peoples. There’s growing awareness that these inequities are not just a result of past colonization but the result of “ongoing colonialism and how that plays out in the structures of the healthcare system.”
What stood out most to you from the patient experiences you captured for your paper?
The study interviewed 12 participants using open-ended, narrative-style questions grounded in Indigenous Storytelling methodologies. Themes emerged naturally – especially colonization. “Even though we didn’t ask specific questions about colonization, it did come up … how colonization impacts their experience of health care.”
The participants also compared the mainstream system to naturopathic care, without being prompted. They expressed a desire for better collaboration between their healthcare providers. Many wanted their medical doctors and NPs to “know more about naturopathic medicine” and work collaboratively. “That’s what our patients want – they want us all to work together.”
“They unanimously agreed that naturopathic medicine is a good fit,” with threads of connection that included land-based healing, natural therapies, and looking at health holistically. “It aligns with Indigenous philosophies of health and wellness.” Dr. Carfagnini, ND, shared the example of the Medicine Wheel: “Even your average ND – who’s never worked with Indigenous communities – can look at it and say, ‘that makes sense’, in terms of how I was trained.”
Participants also spoke about feeling “really listened to,” developing trust, and experiencing a sense of safety over time. “The trustworthiness was really key, and that is part of our model of care.”
What kinds of barriers – financial, geographic, or systemic – most limit access to naturopathic medicine in Indigenous communities? What are your thoughts on the resolution to include naturopathic care under the Non-Insured Health Benefits (NIHB) program?
Funding was identified as the largest barrier. “Our appointments are not funded, and beyond that, the things we prescribe are not funded.” NDs have to rethink treatment plans: “A $60 bottle of fish oil, it’s is not going to work for a lot of people.” She describes how one participant shared, “When my ND was asking me what I eat and drink and what I do in my spare time, she found out that I like to hunt and fish.” Her ND noted that fish are a good source of omega-3 fatty acids, so she had no need to buy the oil. She affirmed the patient’s practices, which were rooted in the patient’s own traditional ways.
Geography also plays a large role, though the remodelling of old systems offers hope. Northern communities are adopting modernized telemedicine kits – “little backpacks … with an iPad and everything you need to take vitals built in”. An on-site nurse assists the on-screen doctor with a physical exam. Carfagnini believes naturopathic doctors “can be plugged into those systems as well.”
A more unexpected barrier was stigma and misunderstanding. Participants said their family members often dismissed naturopathic medicine as “witchcraft” or “kooky”, a sentiment that echoes colonial history, when Indigenous practices were punished and suppressed. “When you look at the history of naturopathic medicine, and how NDs have been de-legitimized, there are connections. That said, there are huge differences as well and as NDs we need to be accountable for the cultural appropriation of Indigenous medicines that our profession has engaged in since it’s inception.”
She remembers the excitement around the NIHB resolution, recalling how she and colleagues “represented the CAND at the Chiefs Assembly of Ontario in 2023.” They spent their time networking, raising awareness, and sharing a video by Dr. Johanne McCarthy, BA, MA, ND, explaining why naturopathic medicine matters in Indigenous primary care. “We managed to talk to the right people to get that shown to the Chiefs in the room,” she says. When the vote finally came, the resolution was supported unanimously.
Still, Dr. Carfagnini, ND, admits to some skepticism: “I’ll be honest, I don’t trust the federal government to actually make it happen … we are small potatoes in the larger political landscape.” Instead, she places her confidence in the people closest to the work – CAND CEO Gemma Beierback and Assembly of First Nations (AFN) Senior Policy Analyst Jenny Gardipy – trusting them to keep up the pressure federally.
Themes of trust and reconnection with natural medicine really stand out in your research. How can NDs build genuine, lasting trust with Indigenous communities, while distinguishing respectful collaboration from appropriation? Is there a greater opportunity for synergy between NDs and Indigenous Healers and leaders?
Carfagnini describes appropriation vs. appreciation as “tricky”, emphasizing cultural humility, “I can’t stress that word enough.” The limits of academic knowledge should be acknowledged, noting that “not every ND knows what these medicines look like in the wild.” That gap, she says, should spark curiosity: “What medicines grow around my clinic or home? How are they harvested traditionally? What do the local Indigenous Peoples call them?” These remedies have been used for thousands of years, in ways we continue to discover.
One of her own goals – and a way for other NDs to connect – is “to meet up with any Elders or Traditional Healers who are willing to share some of that knowledge with me.” She highlights the urgency: “We have Elders who are in their 80s and 90s … if you have the opportunity to sit with them, that’s a gift.” She recalls travelling with Dr. Sarah Connors, ND, to a Traditional Medicines conference led by West Coast Salish Elder Dr. Jeannie Paul, ND, – “the very first First Nations person to become a naturopathic doctor in Canada” – and being invited onto the Land to harvest medicine. She encourages other NDs to seek out such opportunities to get out on the Land and learn from Elders.
Dr. Carfagnini, ND, sees an ND’s training in Traditional Chinese Medicine as an example of the natural synergy between naturopathic medicine and Indigenous healing traditions. “We are well placed as NDs … we have a lot to offer if we’re called upon by Indigenous leaders,” she says, highlighting how both share a respect for land-based knowledge and patient-forward care.
At the same time, she sees the profession’s frustration: “NDs want to work, and Indigenous people want naturopathic medicine … and we’re not funded by OHIP, we’re not funded by NIHB. We have well-educated, compassionate health care providers,” so it feels like an unnecessary gap between a willing community and an existing human health care resource – an alignment with the potential for collaborative, culturally safe care.
There is growing recognition that the “Calls to Action” require more than just words of support. What steps would you suggest NDs take to move beyond intention and begin the work in their own communities?
She promotes self-reflection and education: “It’s important for us, as NDs, to recognize that we all need to do some work to unlearn racism.” This includes taking courses, reading, and participating in local Indigenous events, like powwows or visiting the local Friendship Centre. She recommends looking into existing grassroots efforts, such as advocacy through the CAND’s Two-Eyed Healing Collective, Dr. Laura Batson’s Facebook group discussions around the book 52 Ways to Reconcile by David A. Robertson, and continuing education like Dr. Johanne McCarthy’s BA, MA, ND, “decolonizing health care” series, available from the OAND.
Dr. Carfagnini, ND’s advice: “Engage in cultural humility, engage in critical reflexivity … be open-minded, and be curious.” And for NDs unsure where to start: “Think about the people who could be your patients, but aren’t your patients yet … if this strikes a chord, reach out to me, because … we need to collaborate more, we need to have these discussions, we need to support each other.”
Dr. Jessica Carfagnini, ND, is a passionate naturopathic doctor based in Thunder Bay, Ontario, whose work bridges community health, Indigenous wellness, and holistic care. She earned her Doctor of Naturopathy degree from the Canadian College of Naturopathic Medicine (CCNM), and has since built a career focused on making integrative health more inclusive and culturally responsive. She recently completed a Master’s degree in Health Sciences with a specialization in Indigenous and Northern Health from Lakehead University. Jessica is deeply committed to equity, accessibility, and ongoing advocacy for collaboration between naturopathic and Indigenous healing traditions. Dr. Carfagnini, ND’s recently published paper, “Exploring the Experiences of Indigenous Patients Accessing Naturopathic Medicine in Thunder Bay, Ontario,” offers valuable insights into patient experiences and the potential for system-wide change. You can read her paper here.