The challenge of diversity in the delivery of women's health care

Over the last 8 years at BC Women's Hospital and Health Centre (now part of the Children's & Women's Health Centre of BC) we have had the opportunity to develop holistic programming in a number of challenging areas to respond to the diversity of the community we serve. We have come to appreciate that when working with groups that have been underserved or marginalized by the health care system, an essential first step is to establish a trusting relationship based on mutual respect. This can take longer to achieve than one might expect. It involves creating an environment in which the community involved feels safe examining its vulnerability with respect to health care issues. Humility on the part of the professionals involved, together with a willingness to learn about different perspectives on health, sickness and wellness are key ingredients. In our experience, it has been very important to include not only physicians and nurses but also professionals in other disciplines. We have been fortunate that our government colleagues have supported a responsive approach that encourages communities to set their own health care agendas. Over time, opportunities have arisen to put cervical cancer on the table for discussion. After nearly 4 years, we have co-sponsored women's health workshops and conferences in various communities, framing the issues from an aboriginal perspective. For many communities, this was the first occasion when priorities in women's health had been examined and discussed. As a result of this partnering, BC Women's has developed training programs to address the specific needs of nurses and community educators from aboriginal communities with respect to women's health issues. Five communities are now providing their own women's wellness services, staffed by aboriginal nurses who received training through our program. Along the way, a number of resources have been developed that look at women's health issues from an aboriginal perspective, and strong partnerships have been developed with other agencies and organizations who are also working to better meet the needs of aboriginal communities. Dr. Ballem is Vice-President of Women's and Family Health, British Columbia's Women's Hospital and Health Centre (Children's & Women's Health Centre of British Columbia), Vancouver, BC.