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Creating Welcoming Environments through Indigenous Representation in Healthcare Design

Access to healthcare is a right for all Canadians, yet Indigenous peoples continue to encounter racism, discrimination, and anti-Indigenous attitudes within the system. The In Plain Sight report from BC highlights these persistent issues, revealing deep-rooted mistrust that dates back to the traumatic experiences of Indian Hospitals and Residential Schools. For many Indigenous individuals, particularly elders, this intergenerational trauma results in hesitance to seek care.

Canada’s built environment has historically reflected colonial architecture, often disregarding the Indigenous cultures native to the land. Such architectural language can inadvertently perpetuate trauma. As Canada progresses towards truth and reconciliation, it’s crucial for architects to reconsider how we design spaces, especially those intended for healing and community care.

At the heart of this transformation is engagement. Collaboration with Indigenous communities is essential – listening before designing. Architects cannot claim expertise in inclusive or representational design without first building relationships and learning from those they aim to serve. In healthcare, this requires integrating user input from the start to ensure spaces reflect the values and needs of their occupants.

The Cowichan District Hospital Replacement Project in North Cowichan, BC, is a groundbreaking example of this approach. As part of an alliance with Island Health, EllisDon, BCIB, and Infrastructure BC, and Parkin Architects, the Project has prioritized meaningful Indigenous participation throughout project phases, including design. Over the years, regular meetings with local Indigenous communities through Chief & Council meetings, Elders’ consultations, and community journey mapping have taken place, alongside shared meals to learn about their specific needs.

This partnership has yielded invaluable lessons. Indigenous representation in healthcare design that goes beyond just providing access to services; it’s about creating inclusive, welcoming environments that respect cultural practices. For instance, the Emergency Department (ED) triage desk was redesigned to reflect these values. By reorienting the security room to be less prominent, patients entering the ED wouldn’t feel surveilled. The space was renamed Ts’uwtun, meaning “greeter” in the Hul’q’umi’num language, embracing a more welcoming approach.

Cultural storytelling is another powerful tool for fostering connection. The hospital will showcase art from Indigenous artists within its service area, selected through a non-colonial procurement process. Each piece will be accompanied by descriptions in English and the artists’ languages, fostering connection and understanding.

Indigenous healing customs, such as burning ceremonies, are also integrated into the design. Initially, only one designated space for burning practices was planned. However, in pursuit of greater cultural inclusivity, the design was revised to include provisions for burning in 185 patient and staff rooms, enabling these practices to take place with respect and dignity.

Natural materials, like mass timber, are used throughout public spaces, aligning with Indigenous preferences and evidence-based biophilic design principles. The community hall, inspired by Coast Salish Big Houses, features exposed wood and offers a two-story structure to connect staff and patients to nature. By collaborating with infection prevention specialists, we found ways to safely expose the wood structure while providing large operable windows for fresh air and access to outdoor spaces.

The project demonstrates how a sense of belonging can be fostered through intentional design and genuine engagement. However, the traditional competitive procurement models often limit these opportunities. The Alliance model used in the Cowichan District Hospital Replacement Project illustrates how early-stage collaboration with Indigenous communities can meaningfully advance representation. Moving forward, it is hoped that more projects will adopt this model, ensuring Indigenous voices are heard and honored.

Renderings by: Cicada Design Inc. and 95degree Inc.

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