A Discussion Paper on Indigenous Custom Adoption Part 2: Honouring Our Caretaking Traditions

This paper forms Part 2 of a two-part discussion paper. Part 1 outlined a short history of adoption in Canada, examined the impact of forced, closed, and external adoptions on Indigenous adoptees and families, and traced the move toward more open statutory adoptions and greater cultural continuity in adoptions. Having zeroed in on the entangled histories of adoption and colonization in Part 1, here we explore traditional and contemporary practices of Indigenous custom adoption and caretaking. We first recount Western understandings and impositions, then feature Indigenous perspectives that centre spiritual and ceremonial protocols, values regarding child well-being and community connectedness, and the importance of kinship and customary forms of caretaking. We consider both the promises and complexities involved in designing and implementing custom adoptions, and the urgent need for adequate, equitable funding and supports to ensure their feasibility and sustainability. Finally, we highlight the resurgence of Indigenous authority over child welfare within a context of Indigenous self-determination and self-governance

Creating Places of Belonging: Expanding Notions of Permanency with Indigenous Youth in Care

This paper calls for creative pathways of engagement that delineate places of belonging for and with Indigenous youth in care. It draws on two community-based research studies conducted in British Columbia, with urban and off-reserve Indigenous youth to contextualize and extend understanding of permanency for Indigenous youth in care. Our discussion explores permanency in relation to both Western understandings of government care, guardianship, and adoptions, and Indigenous customary caregiving and cultural planning for cultural permanency, such as naming and coming home ceremonies, custom adoptions, and kinship care

A Discussion Paper on Indigenous Custom Adoption Part 1: Severed Connections - Historical Overview of Indigenous Adoption in Canada

This paper forms Part 1 of a two-part discussion paper on Indigenous custom adoption. Zeroing in on the entangled histories of adoption and colonization, it outlines a short history of adoption in Canada, examines the impact of forced, closed, and external adoptions on Indigenous adoptees, and traces the move toward more open statutory adoptions and greater cultural connection and continuity in adoptions. This historical review sets the stage for Part 2 of our discussion paper, “Honouring Our Caretaking Traditions,” where we highlight the connections between customary laws regarding caregiving and the resurgence of Indigenous authority over child welfare within a context of Indigenous self-determination and self-governance.

A Discussion Paper on Indigenous Custom Adoption Part 2: Honouring Our Caretaking Traditions

This paper forms Part 2 of a two-part discussion paper. Part 1 outlined a short history of adoption in Canada, examined the impact of forced, closed, and external adoptions on Indigenous adoptees and families, and traced the move toward more open statutory adoptions and greater cultural continuity in adoptions. Having zeroed in on the entangled histories of adoption and colonization in Part 1, here we explore traditional and contemporary practices of Indigenous custom adoption and caretaking. We first recount Western understandings and impositions, then feature Indigenous perspectives that centre spiritual and ceremonial protocols, values regarding child well-being and community connectedness, and the importance of kinship and customary forms of caretaking. We consider both the promises and complexities involved in designing and implementing custom adoptions, and the urgent need for adequate, equitable funding and supports to ensure their feasibility and sustainability. Finally, we highlight the resurgence of Indigenous authority over child welfare within a context of Indigenous self-determination and self-governance

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care