In September 2024, the Canadian Medical Association (CMA) will apologize, on behalf of the association and as the national voice of physicians, for continued harms to First Nations, Inuit and Métis People. As part of the apology process, CMA Past President Dr. Alika Lafontaine moderated a virtual discussion on reconciliation as a community effort with both Indigenous and non-Indigenous physicians.
Here are some highlights:
‘Physicians need to embrace their old role as community leaders’
Dr. Evan Adams, deputy chief medical officer First Nations Health Authority, general practitioner in the Tla’amin First Nation near Powell River, BC, and CMA advisor.
“I’m the son of two residential school survivors. My mother was in a TB hospital for two years from when she was five until she was seven. It’s very hard to think about that and who would do that, who would institutionalize children, who would isolate children, who would experiment on children, who would be callous about Indigenous People? All I can really conclude is that they didn’t see our humanity.
I feel like sometimes as doctors, we forget we serve not just individual patients, but communities. I think physicians need to embrace their old role as community leaders, as examples to their communities of kindness, service and a helping hand, and as thought leaders and people who can show others a better way of being.”
Video transcript
DR. EVAN ADAMS: I'm the son of two residential school survivors. My mother was in a TB hospital for two years from when she was 5 until she was 7, even though she didn't have TB.
Her father did. Her father didn't get to go to the hospital. He died from TB whilst she was in residential school like five years after they took her to put her in the TB hospital.
Part of my work in reconciliation is to reconcile that journey. It's very hard to think about that. And who would do that. Who would institutionalize children? Who would isolate children? Who would experiment on children? Who would be callous about Indigenous people? And really, all I can conclude is that they didn't see us, see our humanity. We were things.
And I feel like I need to appeal to citizens, to the people here, to doctors, but I feel like they know it very well, there's a humanity in there.
So please, let's really try and do our best for our Indigenous people.
And I can't believe that I've spent so much of my career saying Indigenous people deserve our care. Please don't leave them out. Please don't be negligent in looking after them. My hope has always been that medicine and the health system and the doctors would help with improving Indigenous health.
In Canada, we have the worst health of anyone in the country. I trained as a family doctor, and it took me a long time to understand that I had a really good understanding of family and I had to develop my idea of doctor. And I feel like sometimes as doctors, we forget that we serve not just individual patients, but communities. And that we actually have a responsibility to the multicultural success story and the sophistication that is Canada.
I've learned a lot from seeing other countries and how they deal with their Indigenous peoples. There are lessons there, like literal lessons where you have to go and read what's happening in those other countries. So I encourage our physician colleagues to do exactly that.
I would love for us to learn more about anti-Indigenous racism. It's very strange here in my hometown. The English name is Powell River. The pushback against renaming places so they have Indigenous names again is just extraordinary and appalling to me.
When we're speaking to ordinary citizens about reconciliation, they all say very mean spirited things. They won't show up in a good way, saying things like, well, y'all didn't have a writing system.
So your knowledges are inferior. You lost the war, so now we own all the land. We think you're exaggerating about those babies and those residential school. And so we go down rabbit holes where I'm having to educate and beg for confession. Like, could you not be crass about what happened to these children?
And be a person, like a legitimate partner, like in a family where you show up and say, I'm going to do my part and not be a jerk. I think reconciliation is really about something easy to say and hard to do, which is equity of service, equity of outcomes.
And I think physicians need to embrace their old role as community leaders as examples to their communities of kindness and service, and a helping hand. And as thought leaders are people who can show others a better way of being.
And, of course, we need to include our Indigenous physician colleagues in Indigenous competencies, Indigenous knowledge systems, including knowledge keepers and the like. And I think I'm going to stop there.
Watch The Unforgotten, a five-part film exploring the health and wellbeing of Indigenous Peoples
‘You have to do the work’
Dr. Onye Nnorom, Black health faculty lead, department of family and community medicine, University of Toronto
“The example I use is when you’re a medical student you have to do the work; you have to study; you have to do your due diligence.
When you’re going to do an arterial blood gas [test] for the first time, it might not work, but you’re committed to learning because you want to save the patient’s life. And when you do perhaps make a mistake and you poke a few times, that patient does not have to forgive you or say, ‘thank you for your bravery.’ No, they might be very ticked off at you, actually. But you stay committed to that work because you want to be a good doctors. You, with humility, apologize and you learn from your mistakes and try to do better because you know that it’s critically important. You don’t just say, ‘well, I’m just not going to learn arterial blood gas [test], I might make a mistake.’
It’s the same thing with this work. Racism kills patients.”
Video transcript
DR. ONYE NNOROM: The example I use is thinking about when you're a medical student, you're trying to do the arterial blood gas, right?
And so, you have to kind of do the work. You have to study. You have to do your due diligence. You don't just kind of walk around the ward with a needle, ready to inflict that on somebody. You do the work. You read.
You know, in this example, and, say, doing, like, the cultural safety training, different types of learning and understanding, and also understanding indigenous, like, strength, and sovereignty, and solidarity, and art, and, you know, beauty, and resistance, and all of those things. But learning.
And then, with the help of colleagues who are more advanced than you, getting into the action, as you put it. So the reconcili-action. And so, what that means is that you also, in that process, might make mistakes.
And it's that-- you know, you want that fight or flight kind of reaction can happen. And I think, in medicine, the way we get over that-- when you're going to do an arterial blood gas for the first time, it might not work. But you're committed to learning because you want to save a patient's life.
And when you do, perhaps, make a mistake, and you poke a few times, that patient does not have to forgive you, or say thank you for your bravery, or whatever. No. They might be very ticked off at you, actually. But you stay committed to that work because you want to be a good doctor. Because you realize that you want to save people's lives, you, with humility, apologize, and you learn from your mistakes and try to do better. Because you know that it's critically important. You don't just say, well, I'm just not going to learn an arterial blood gas. I might make a mistake. So I think it's the same thing with this work.
Racism kills patients. Right? Through either assumptions made about patients, the violence towards patients, or sometimes it's just the plain neglect and the dehumanization and lack of empathy.
You know, Joyce Echaquan is just the tip of the iceberg of these examples. So you have to understand that you have to do this work, so that you can help your patients.
Commentary: Reflecting on reconciliation as a non-Indigenous physician
‘Change can only happen with difficult conversations’
Dr. Michael Kirlew, family physician for the Weeneebayko Area Health Authority in northern Ontario.
“I think about the insidious effects of colonization — if you don’t get at it, it’s not going to go away. It’s just going to morph into a form that’s more palatable for this generation. I find that sometimes … there are spaces that seem to be more inclusive and want to have these conversations, but they can still be paralyzed by [the question] ‘what do we do?’ We don’t really see a lot of action points. Or sometimes these spaces don’t include the communities which they are trying to serve.
Change can only happen with difficult conversations. Change is never a comfortable process. And I find that sometimes we need to be committed to the discomfort of engaging in a process.”
Video transcript
DR. MICHAEL KIRLEW: SPEAKER: I think about the insidious effects of colonization. And that if colonization is something that if you don't get at it, it's not going to go away. It's just going to morph into a form that's more palatable for this generation.
And I find that sometimes, yes, there might be these spaces that seem to be more inclusive and want to have these conversations, but they still sometimes can be paralyzed by a what do we do.
And you don't really see, as we say a lot of those action points. You know what I mean? Or, sometimes these spaces don't involve, I find, still the communities in which they're trying to serve.
So those community voices are not really at the table. So it's interesting. Sometimes you'll have these conversations, and there'll be no community representation at the table that you're talking about.
So I find that overall, I think that there is--there isn't a general acceptance to have these conversations. I think, though, that there still is resistance, there's no question. There still is that resistance to have these difficult conversations.
Change can only happen with difficult conversations. Change is never a comfortable process. And I find that sometimes we need to be committed to the uncomfort of engaging in a process.
I can say I'm committed to a process. The question is, am I committed to the intrinsic,
I'm not going to feel well in that process. It's going to be uncomfortable. Can I commit to that? It's easy to commit to the tenets of, let's say, fairness. But if it comes to me giving up something I want, to give to somebody else to make it fair, that's really the question that we have to think about.
Engaging in these uncomfortable dialogues, you know what I mean? Really, that's how we get that growth. We need to be able to have these conversations. And at times, because of the insidious effects of colonization, systems and structures are not built to take those conversations and have them germinate into action.
These sessions were part of the CMA’s work preparing to deliver a public apology to Indigenous Peoples. The formal apology will build on the CMA’s work to improve Indigenous health outcomes and advance truth and reconciliation in health care.