First and foremost, I want to acknowledge that I am privileged to live and work in unceded territory of the Syilx, Okanagan people. The People of the Okanagan Nation have lived, traded and gathered on these territories since the first people set foot on these lands and have always cared for all living things within their territory. Their traditional ways include using only what you need and leaving the rest for others, for the future. What an amazing principle we should all live by.
By Steven Hopp
Owner, Rutland Medical Pharmacy | Director, BCPhA board
I also want to acknowledge that I am the grandchild of uninvited white settlers to this land. I do not claim to know everything on these topics, or be perfect in my practice, but I have benefited in recent years from extensive learning opportunities during my time on the board of the College of Pharmacists of BC, especially during my time as Chair, when I was so fortunate to work with and learn from wise and knowledgeable Indigenous elders and leaders including Joe Gallagher, Elaine Alec, Len Pierre, and the late Sulksun – Shane Pointe.
When it comes to providing culturally safe care, there may be a misconception that this means treating every client the same way. While well-intentioned, this approach suggests that culture and belief do not directly influence individual choices and needs. Just as it ignores the fact that First Nations clients are not a singular entity. There are hundreds of First Nations communities in Canada, each of which have a distinctive identity and culture, developed over thousands of years before the arrival of settlers.
As pharmacists, we have a responsibility to provide patient-centred care. This means recognizing that every client is not the same. When an Indigenous community member visits your pharmacy, you should recognize there may be a perceived imbalance in this client’s interaction with your team. To them, you may represent the institution, the descendant of the oppressive systems that have for years committed real and significant harms to Indigenous Peoples that continue to be felt today. You may be perceived as part of a system that tells instead of listens.
There are people that may suggest that these harms are a thing well in the past, but this is not the case at all. The final residential school closure was only 30 years ago in 1996. It was one of 139 schools where Indigenous children were sent after being forcefully removed from their families with the purpose of fracturing and eliminating Indigenous identity.
Pharmacists come from the school of evidence-based care. We are medication experts, trained and equipped to advise our patients what the safest pathway is to meet positive health outcomes. In the eyes of an Indigenous community member, sticking to a strictly rigid approach of Western medicine, may be interpreted as yet another directive from an oppressive system. If we do not check ourselves and accept that it is OK for someone to be using traditional medicines as part of their therapy, we reject client autonomy. We miss a very important principle that pharmacists are taught, patient specific care. We should be collaborating with our clients to ensure that the care they receive includes what they need and wish. Cultural knowledge of traditional medicines passed down through generations is a form of evidence. Indigenous community members and people of all cultures have a right to autonomy, a right to their own care. It is our duty to facilitate what they wish, not to direct something that may not match their idea of healthcare. There is nothing wrong with suggesting Western medicine, but it is essential to do it without making someone feel their traditional medicine is inferior or wrong. We should be helping clients to combine both safely.
Shifting our attitudes to becoming pharmacists who provide culturally safe care is not just good practice, it’s a new standard.
In 2022, the College of Pharmacists of British Columbia, along with the Colleges regulating nurses and physicians, adopted an Indigenous Cultural Safety, Humility and Anti-Racism Practice Standard. As of April 2025, all pharmacy professionals in B.C. must complete a minimum of three hours of learning per year related to Indigenous cultural safety, cultural humility, and anti-racism.
The BC Pharmacy Association's 2026–2028 Strategic Plan identifies cultivating trusted, collaborative relationships with First Nations partners as one of its four core areas of strategic focus.
Here are a few suggestions you should consider to help make pharmacy care more welcoming, safe and inclusive for our Indigenous community members.
Steven Hopp (right) is a Director of the Board at the BC Pharmacy Association and owner of Rutland Medical Pharmacy in Kelowna.
Proactively identify whether your patient is an Indigenous community member
Many patients will self-identify as Indigenous individuals but not all. As a pharmacist, a practical way to start this conversation can be to ask whether the patient is aware of any coverage that would pay for their medications, such as insurance from work or from the government. You may even directly mention that individuals who are Indigenous have coverage through the Plan W program as an example.
Also consider that when filling a prescription, Pharmacare will identify Plan W as the payor when you are filling a prescription. When I see this, I will proactively inform the patient that many over-the-counter medications may be covered for them as well.
Inquire about traditional medicines
If an individual has identified as Indigenous, do not be afraid to ask if they use any traditional forms of medicine, and to make that individual comfortable if they do. You would ideally want to know if any of your clients are taking vitamins, herbal or natural health products to ensure safety of overall therapy. The same applies for traditional medicine. While I am not an expert in traditional medicines, what I can do as a pharmacist is to ensure that if the patient is also taking Western medicines, that they are aware of any potential interactions or effects that the Western medicine may have with their traditional forms of medicine.
A useful reference to assist with this is NatMed Pro, an evidence-based natural medicines database for health care professionals.
Train your staff on providing culturally safe care
Train your staff. Encourage them to take courses in cultural safety and humility. There are excellent anti-Indigenous-specific racism training courses available such as, San'yas, a nationally recognized training program created by the Provincial Health Services Authority and Indigenous educators. It is available at sanyas.ca. Also encourage your staff to learn about the First Nations that are local to your region.
Take opportunities to speak with staff members about Indigenous community members, the challenges they may have experienced with the health care system, why that has resulted in a loss of trust, and what they can do to help provide a culturally safe experience for patients. We must avoid the trap of having pharmacy staff take the training once, check off the box, and forget about it. You want to keep going, and normalize the idea of cultural safety in your workplace.
Take a stance against racism
Occasionally in the pharmacy, you might witness a racist encounter. It might be an uncomfortable situation, but it is important for you to become an accomplice for anti-Indigenous racism, to stand up for Indigenous people and block or impede those who may say racist things. Often, racism can come from someone who is naïve, who doesn’t understand that what they are doing or saying is not appropriate. Their ignorance does not make it excusable.
Upon seeing the Expectations of Care Poster from the College on our pharmacy wall, and reading the part about providing culturally safe and inclusive care, and asking me what it meant, one of my clients made negative and disparaging comments about Indigenous people. I could have chosen to take the easy way out and ignore these comments, to not say anything, but if I did, I would be an accomplice to racism, instead of an accomplice to anti-racism. Instead, I had a conversation with this person, challenged him and explained to him why he was wrong. While he did not change his opinion, I believe I have a duty to have these difficult conversations when they come up. When your staff see you set an example, they are more likely to stand up as well. Taking a stand against racism is always the right thing to do.
Cultural safety is not a one-time training module or a requirement to be met. It is something we need to demonstrate through our actions. The trust many Indigenous community members have in the health-care system has been damaged through real experiences and real harms, and rebuilding that trust will take time.
As pharmacists, there are practical steps we can take now to make a difference. By recognizing the unique experiences of Indigenous community members, supporting their autonomy in care, and creating a pharmacy environment that is welcoming and free from racism, we can help build the trust that is essential to better health outcomes