Early morning sunbeams slant through the elder Oak trees, as palliative care doctors, Indigenous advisors, nurses and social workers from as far afield as Belgium, the UK and New Zealand take a "walkshop" across the campus of the University of Victoria (UVic), to the beach at Arbutus Cove.
They have travelled here, from around the globe, to discuss a different journey, the biggest final journey that every human will take from life, into death.
All are participants in the 4th International Research Seminar on Public Health and Palliative Care, co-chaired by Kelli Stajduhar at UVic and Hsien Seow of McMaster University, during June 2025.
Their focus? Equity. Because the death journey does not impact us all equally.
Care and comfort, well-managed medications, access to nature these can ease the physical and emotional pain that many experience while dying.
"Nature teaches us how to grieve," says walkshop leader Sonya Jakubec, a professor of nursing and midwifery at Mount Royal University, as she guides us through the Haro Woods to a large "touchstone" rock. "Animals, plants, rocks, they provide important lessons for us around grief, loss and acceptance."
And yet nature, care, comfort, even medications are impossible to access for many who are unhoused, struggling with poverty or racism, dying with drug toxicity or lacking access to Indigenous cultural practices.
These are the challenges that Stajduhar's program of equity in palliative care at UVic are trying to address through a web of partnerships with organizations such as Victoria Cool Aid Society, Victoria Hospice Society and Island Health, as well as multiple national and international collaborations.
Impact on the streets
"I saw people's diseases going undiagnosed, people not wanting to access the medical system, people having wounds go septic because they didn't want to go to emergency and just so much death," says Char Futcher, of her time as a harm reduction worker in downtown Victoria." That was very disheartening and very mobilizing."
Now Futcher works closely with Stajduhar and her team at UVic to better support those people, as a social worker with Island Health's Palliative Outreach Resource Team (PORT).
PORT is a small, mobile, clinical team in which Futcher works with two doctors, two nurses and a psychosocial consultant, to provide safe palliative care for people who are precariously housed or facing other barriers to care in Victoria, such as poverty and stigma.
As the social worker, Futcher works alongside the clinicians. She also accompanies people to hospital appointments and helps with bucket-list requests, like taking someone out for ice cream.
The care aims to address the wishes and needs of every individual. And it works.
People tell us they never got safe healthcare until meeting either the PORT team or the people we were able to connect them with, at the end of their life."
Char Futcher, PORT social worker
Inner city action
An otter scrambles up a rock on the beach as Ashley Mollison, manager of Stajduhar's transformational research into equity and palliative care, explains how their team generated the evidence needed for PORT to be funded.
And PORT is just one of many local, national and international partnerships that weave through their work, says Mollison, who is also a PhD candidate in UVic's Social Dimensions of Health Program.
An inner-city Community Action Team here in Victoria is another central element.
"Health-care systems have not traditionally seen non-medical workers as part of palliative care," Mollison explains. And yet shelter workers, Indigenous support workers, harm reduction workers, inner-city health workers these are the people who are providing the care for many people.
Through an initial process of participatory action research, Stajduhar's team funded the creation of the community action team to provide a space of support for these workers.
"We are all working in difficult settings and through the action team we've been able to support each other and think of it as a collective care process," says Piotr Burek, a member of the team and a harm reduction worker with Victoria's Substance Drug Checking project at the Canadian Institute for Substance Use Research.
"This impacts how we are able to show up in our own jobs," adds Burek, who is also a masters' student in UVic's Social Determinants of Health Program and a former housing worker.
The day-to-day experiences of the team members also guide the research. These are the people on the ground. "All the work we do is guided by the priorities of the community," says Mollison.
Unlearning colonial logic
"Dying is a journey of becoming an ancestor. It can be beautiful," says Holly Prince, another of Stajduhar's collaborators, and a keynote speaker at the conference.
There is no fear in our traditions around dying and death."
Holly Prince, Anishinaabekwe scholar, Lakehead University
Prince is an Anishinaabekwe and a member of Opwaaganisiniing in Northwestern Ontario. She leads the Indigenous Peoples' Health and Aging Division at Lakehead University's Centre for Education and Research on Aging and Health.
She co-chairs, with Stajduhar, a national Indigenous Guidance Circle that guides their research, along with the work of PORT and that of the community action team in Victoria.
"We must unlearn the colonial logic that disregards Indigenous Peoples' knowledges regarding caregiving, health, dying and death," says Prince. "Models of care must be based on Indigenous Peoples' values and principles and worldviews."
Another of her collaborations with Stajduhar involves coaching 23 teams across Canada to improve equity and access to palliative care for people experiencing structural vulnerability, as part of a four-year pan-Canadian learning collaborative funded by Health Canada and led by Healthcare Excellence Canada and the Canadian Partnership Against Cancer.
"I see impacts among my peers and colleagues in how they approach the work, and the ripple effects they have in community," says Prince.
"They are doing research differently, community development, education, engagement work differently. The impact for the community is substantial."
And yet huge challenges remain, as Prince is quick to point out. "It is challenging to get policymakers on board. Equity means a shift in existing resources.
"How do we get people to understand that dying is a public health concern?"
Research as collective action
It's about creating a collective that cares for each other deeply and focuses on collective action forward."
Kelli Stajduhar, Canada Research Chair in Palliative Approaches to Care in Aging and Community Health
"It is deeply hard and challenging to continually watch people die unjust deaths in inner city contexts. It pains people in our communities every day," says Stajduhar herself, addressing a packed seminar room.
"That's why we have PORT. That's why we have our clinical services and our inner-city action team, undergirded by an Indigenous guidance circle.
"We don't just work in Victoria; we work in Toronto, Edmonton, Thunder Bay, Calgary, other cities
"Our rage propels us, and we also find so much joy in palliative care."
The 4th International research seminar on public health and palliative was organized by the Institute on Aging and Lifelong Health, University of Victoria and the European Association for Palliative Care Reference Group on Public Health & Palliative Care, in partnership with McMaster University.
