White Coats: Terrie Foster on Cultivating Inclusive Donor Community Engagement

January 23, 2025

“White Coats” is an AABB News series that interviews the experts that are transforming the fields of transfusion medicine and biotherapies. Join AABB today to read the rest of this month’s issue.
Terrie Foster (she/they), RN, MScN, is a registered nurse and a longtime Canadian Blood Services employee. They currently work in stakeholder engagement, where their job is to engage with diverse communities to advance the work of Canadian Blood Services. They are also currently serving as co-chair of the AABB DEIA Committee.

Their research interests center around enhancing donor well-being, especially for equity-deserving groups. They have a Master of Science degree in nursing with a focus in leadership in health services delivery.

Who or what influenced your career path in transfusion medicine and biotherapies?

I started working at Canadian Blood Services as a screening nurse in 2006. I was drawn to the altruistic cause of blood and plasma donation and the prospect of a career where you interact with amazing humans trying to do a good thing for other humans. In 2012, 10 blood donors saved my life, and it brought the point home even more for me how amazing donors are and the profound difference they make for patients and their families.

Along the way I have worked in many areas of transfusion medicine, including the donor center, on the medical team investigating transfusion reactions and complex cases, policy change, and, most recently, engaging with diverse groups of people involved with Canadian Blood Services to better understand their perspectives.

I’ve had many great mentors along the way who have taught me so much about the impact we can have on people’s lives with the work we do. Transfusion medicine is a field that is constantly evolving, and we as people can constantly evolve with it. There is never a dull moment, and that’s what makes this work so enjoyable.

How have your research interests in enhancing blood donor well-being shaped your career?

Donors are rockstars, and anyone who wants to donate should feel welcome and safe at the donation center. Some of my contributions that impact donor well-being I am most proud of are the research projects that helped to evolve the donation criteria that impacted gay, bisexual and other men who have sex with men (gbMSM) and some trans people.

I’m also proud of our recent qualitative study to better understand the donation experiences of trans and gender-diverse donors. My thesis also centered around how health care providers can provide culturally safe care for trans and gender-diverse patients. One of the ways we used this research as well as engagement learnings was to plan the staff preparedness training for our sexual behavior-based screening changes. This training also informed the foundation of the AABB individual donor assessment training.

What are the most impactful moments of your work to date?

We’ve made a number of donation criteria changes at Canadian Blood Services that impact equity-deserving groups, and we engage communities most impacted during the process of these changes. Criteria change is important, but what we’ve heard during engagements is that criteria change alone isn’t enough for many to consider donating, especially when trust is low. In May 2024, based on our engagements with 2SLGBTQIA+ communities, Canadian Blood Services issued a historic apology to 2SLGBTQIA+ communities for the long-standing harms that were experienced in relation to the former criteria that impacted gbMSM and some trans donors.

Being a part of this historic moment is something that’s hard to describe in words. The impact that the apology has had on our ability to engage with 2SLGBTQIA+ communities cannot be understated. We were invited for the first time to march in one of the largest Pride parades in Canada and engaged with 2SLGBTQIA+ communities at many Pride festivals this past summer.

The warm reception from 2SLGBTQIA+ communities at these events, including many sharing that they are donors, and they were glad to see the work we were doing to make things better for 2SLGBTQIA+ donors was so affirming.

Although there is more work to do on this journey, the foundation we have set by meaningfully engaging 2SLGBTQIA+ communities, working to understand and address barriers, and issuing the apology has made such an impact.

What do you enjoy most about your career? What energizes you?

The most enjoyable aspects of my career are the ability to make a difference for diverse communities and making sure that people who are so good to donate or engage with Canadian Blood Services feel valued. I get to talk with donors and people interested in donation who are passionate about the work we do and with patients and clinicians who are directly impacted by the work we do. Listening and reflecting on what stakeholders share with us, and incorporating this to the maximum extent possible into the work we do is rewarding and energizing.

What are some challenges impacting your work in community and stakeholder engagement today?

There can be barriers of trust in engaging with blood operators for many reasons such as harm experienced due to historical exclusions from donation and inequities and challenges experienced in the health care system, to name a few. Trust is an essential component of any relationship, and building a foundation of trust is important to really connect with stakeholders and communities.

Building trust takes time, sustained effort and active listening. Often it involves just being present with communities and listening to them. Changes in a highly regulated environment are complex. We can’t always immediately implement recommendations shared with us, but making a genuine effort to listen with the intent of understanding is essential.

It’s always important for those who engage with us to know they are heard. When we make a change that was informed by stakeholder perspectives, underscoring how their perspectives helped shape the change can help to cement trust. Non-extractive engagement takes time, but it is well worth the investment.

Your work focuses on diversity in community engagement and advancing equity and inclusivity for sexual- and gender-diverse donors. What best practices can blood centers implement to develop inclusive, community-centered donor initiatives?

Policies, training and anything else about 2SLGBTQIA+ people should be developed with them. The great thing is that there are 2SLGBTQIA+ people everywhere! A good place to start to engage with 2SLGBTQIA+ communities if you are just starting out is to connect with 2SLGBTQIA+ staff in your organization. Many will want to help to make things better for donors from their communities and will have perspectives to share and will have connections with other 2SLGBTQIA+ individuals and organizations to engage.

Training on cultural safety and cultural competency for 2SLGBTQIA+ communities and sex positivity training (like the free AABB IDA training) are foundational to providing a great donor experience. Visible gestures of inclusion and allyship go a long way to signify safe and welcoming spaces. These can include Pride lanyards, pins with Pride ags or messages of safety and inclusion, asking and using pronouns, putting your pronouns on ID badges and in email signatures.

Other ways to demonstrate inclusion are hiring 2SLGBTQIA+ staff and having visible representation of 2SLGBTQIA+ people in marking materials. These are just a few ways to create safer, more welcoming spaces.

What’s a surprising/fun fact most people don’t know about you?

I once fixed my washing machine by watching a YouTube video and purchasing a $5 part. This gave me the confidence to take on bigger home improvement projects, including renovating my kitchen with the help of YouTube.

What’s your biggest takeaway or lesson learned from 2024?

2024 was a year of some historic and first-ever events for our organization like the apology and marching for the first time ever in a Pride parade. These events really made an impact on communities, and it felt amazing to be a part of them. However, these were the result of many years of engagement. My takeaway is that it’s always worth the time it takes to build relationships and to meaningfully engage.

What activities do you enjoy in your spare time?

I love spending time with and seeing the world through the eyes of my child. I also have a great group of friends whose families have become our family, and I love to spend time with them too. We get together and camp and travel a couple times a year. It’s always rejuvenating to experience doing new things with them.