Canadian Medical Association

Trust comes before reconciliation.

This was the overwhelming message of the Canadian Medical Association’s (CMA) Fireside Chat series, which brought together Indigenous patients, providers and leaders to talk about how we can move forward, together, on reconciliation.

The history of health care in Canada includes the devastating impacts of Indian hospitals, forced medical experimentation on Indigenous Peoples, disparate infrastructure investment, as well as systemic racism, neglect and abuse.

“It’s a ‘past’ that remains present in the day-to-day experiences of Indigenous Peoples across our shared lands,” said CMA President Dr. Alika Lafontaine.

At the third and final Fireside Chat session, Dr. Lafontaine announced the CMA’s commitment to an apology, as the national voice of physicians, for the harms caused to Indigenous Peoples in health care.

“The CMA recognizes that a vital untaken step on the road to reconciliation remains a formal apology to Indigenous Peoples — rooted in an accurate, shared history and what matters most to Indigenous Peoples,” he said.

The path to an apology will be informed by an honest examination of the CMA’s 150-year history, and will require many uncomfortable and painful conversations, said Dr. Lafontaine.

Video Transcript

TANYA TALAGA: Boozhoo! Aaniin. 

Hi, everyone. My name is Tanya Talaga. I am a First Nations person. I am a member of Fort William First Nation. And I am delighted to be here with you today. I'm going to start this evening with a land acknowledgment. I'm here, in my home of Tkaronto. This is home to the Mississaugas of the Credit, traditional territory of the Huron-Wendat and the Haudenosaunee people. 

I would also like everyone to take a moment and pause and think of the lands in which they are sitting on-- you are sitting on right now. I want you to do a virtual land affirmation, if you will. Miigwech, and thank you for joining us. 

This is our very third and final "Fireside Chat on Indigenous Health." The CMA is hosting this series of discussions to hear from Indigenous patients, providers, health care leaders on how to move forward together as part of a commitment to tangible action on reconciliation in health care. In our first session, we discussed the importance of cultural safety in health care settings, for both patients and providers. 

Our second session focused on the work the CMA is doing to improve the health of Indigenous peoples, recognizing that First Nation Inuit and Métis continue to experience unacceptable health disparities due to the legacy of colonization and ongoing systemic racism. If you couldn't attend those first two sessions, recordings are available. A link will be in the chat. 

Today is the final conversation in this series, and the focus is the meaning and the importance of an apology to Indigenous peoples. To kick things off, though, I do want to go over a few housekeeping items. We ask everyone to support a respectful, professional, and collaborative discussion. Questions that are discriminatory, defamatory, abusive, or offensive or that violate privacy or confidentiality will not be addressed. And we will start with a moderated Q&A with our speakers, followed by audience Q&A. Questions will be text-based and can be upvoted, so please do that. And I will see them, and I promise to be fair and to notice all of the upvoted questions. 

And now let me introduce our speakers for tonight's session. First off, I am going to start with Dr. Alika Lafontaine. Dr. Lafontaine has been a health care leader for more than two decades and is a past president of the Indigenous Physicians Association of Canada, a board member with Health Care Can. And from 2013 to 2017, he co-led the Indigenous Health Alliance, which advocated for $68 million in federal funding on behalf of more than 150 First Nations in Saskatchewan, Manitoba, and Ontario. 

In, 2020 Dr. Lafontaine launched Safe Space Networks, a platform for patients and providers to report racism in the health care system and contribute to change. McLean's named him the country's top health innovator in their 2023 Power List, and he was the very first Indigenous physician listed in The Medical Post's 15 most powerful doctors. Dr. Lafontaine is Métis, Oji-Cree, and Pacific Islander ancestry. He continues to practice anesthesiology in Grand Prairie, Alberta. 

And now I'm going to introduce you to President Natan Obed. Natan is the president of Inuit Tapiriit Kanatami, serving as a national spokesperson, representing Canada's more than 70,000 Inuit. He was first elected in 2015 and was acclaimed to his third consecutive term in 2021. 

As president, he implements the direction set out by Inuit leadership from the four regions of Inuit Nunangat, the Inuvialuit settlement region of the Northwest Territories, Nunavut, Nunavik, and Nunatsiavut. He also serves as vice president of Inuit Circumpolar Council of Canada. President Obed grew up in Nain, the northernmost community in Labrador's Nunavut region. He is a graduate of Tufts University. Welcome, Natan. 

NATAN OBED: Nakurmiik. Thank you, Tanya. 

TANYA TALAGA: And we have President Cassidy Caron as well. She's the very first woman elected as a president of the Métis National Council, with roots in the historic Métis communities of Batoche and Saint Louis, Saskatchewan. She grew up closely connected to her tradition, heritage, and culture. From 2016 to 2020, she was elected to the Métis Nation, British Columbia, serving as the organization's youth chair and minister responsible for youth. 

Ms. Caron has also consulted on both provincially and nationally administered programs supporting Indigenous peoples. Her work incorporates innovative approaches to community development and nation building, which promote effective collaboration and deeper understanding between Indigenous peoples and for all Canadians. Welcome, Cassidy. 

CASSIDY CARON: Taanishi, everyone. Thank you. 

TANYA TALAGA: And finally, I would like to introduce Marion Crowe. Marion is the CEO of the First Nations Health Managers Association and a proud Cree woman from the Piapot First Nation in Treaty 4 Territory, Saskatchewan. In 2010, Marion launched FNHMA, a national family dedicated to honoring, maintaining, and upholding inherent ways of knowing, while balancing, managing priorities to bring excellence to First Nations communities and to health programs. 

She was appointed CEO of the organization in 2018 in recognition of her exceptional leadership and dedication to serving nations and communities to support quality and equitable health services across Turtle Island. Marion is a true trailblazer and renowned for her vision, commitment, and passion to uplift, educate, and lay a path for future generations. Marion, thank you for joining us. 

Now that we have that all out of the way-- and I apologize if I mispronounced anything-- totally my fault, and I know-- I know I didn't attend, and you can yell at me about that later on. But I wanted to-- I want to thank everyone for joining us tonight. Tonight really is a special evening for all of us. It is an evening of firsts, and I hope a continued conversation with Indigenous peoples all across this country. 

Alika, as the CMA's first Indigenous president, I really want to start by asking you to describe how the CMA has embarked on their journey thus far-- a journey of reconciliation under your leadership and those of your colleagues. 

ALIKA LAFONTAINE: Thanks so much, Tanya. I just want to take a moment just to appreciate the weight of this moment. The CMA has never had Indigenous political leadership that represent Indigenous peoples as part of our webinars before, and just acknowledge President Obed, President Cassidy, and a national advocacy organization that also does training for our health directors across First Nations here in Canada. It's a moment that I'm really proud of, and I'm proud of the CMA for helping to create this space. But even more importantly, I'm proud of our own Indigenous people for filling that space and really looking forward to the conversation that we're going to have. 

For those of you who've been a part of the CMA for the past three years, you may remember 2015 when Ted Quewezance was a past chief, a Keeseekoose First Nation-- came and spoke on the floor of our annual general meeting. And up until that point, there had never actually been a residential school survivor who acknowledged and addressed the gathering of physicians at the CMA in its 150-plus year history. 

And I remember sitting beside Ted as he gave his speech, and there wasn't a dry eye in the room, including me, as he stated, we're here as First Nations as Indigenous people, with our hands outstretched, hoping that you'll reach back. And since that time, at the CMA, there's been a lot of work to build on the path to reconciliation. And it's obviously hundreds and hundreds of steps. It requires space to be created. 

And I think today we're taking an important step that acknowledges that trust and relationships are at the core of reconciliation. That is why truth leads to reconciliation. And with that in mind, I will acknowledge, tonight, that the CMA is going to take a vital step in our reconciliation journey towards a formal apology to Indigenous people, rooted in an accurate shared history about what happened and what matters most to Indigenous people. 

The path to an apology will be informed by an honest examination of our 150-plus year history here at the CMA, and I expect it's going to take us to many uncomfortable and painful conversations. But the hope is that, through this process, the CMA can be a part of reconciling and transforming the relationship that the medical profession has with Indigenous peoples and actually bring us closer to true reconciliation. 

The profession's history is Canada's history. It includes the devastating impacts of Indian hospitals, forced medical experimentation on Indigenous people, disparate investment in infrastructure and health access, as well as systemic racism, neglect, and abuse. It's a past that remains present in the day-to-day experiences of Indigenous people across our shared lands. 

To be meaningful, this apology has to happen over time, building on aggregated moments that we gather together, with an end goal of rediscovering each other and our history and rebuilding trust between providers and Indigenous patients, families, and communities. As the first president of Indigenous ancestry to lead the CMA, I will tell you that I will stand resolute with this organization to take these steps in a good way. 

We are committed to an apology as a meaningful step towards reconciliation, and walking with Indigenous peoples towards our Indigenous health goal, which is transformed health systems that are free of racism and discrimination, that uphold Indigenous Peoples' right to self-determination, that values, respects, and holds safe space for Indigenous worldviews, medicine, and healing practices, and provides equitable access to culturally safe, trauma-informed care for all First Nations Inuit and Métis. Thanks for the opportunity to share those words, Tanya, and I'll turn it back to you, 

TANYA TALAGA: Miigwech. I know that those are incredibly heartfelt words coming from you-- the CMA's very first Indigenous president, and those are heavy words. They're heavy words for all of us to hear, and I'm very grateful that you have-- that you've made them because, as we know, we have been, for the large part, as Indigenous people, shut out of the health care system. And it was not designed for us. 

The universal health care system that everyone speaks of so glowingly, all over the world, sadly was not designed for Indigenous people whatsoever. We have seen that time and time again. And it is very important-- I know I can say this, as a First Nations person, to hear an apology from yourself. And I know it does not come easy and that this is just a first step as well. It is a first step because there's a lot to discuss and a lot to fix. And for that, I'm going to ask all of our panelists-- I will go to each of you, to reflect on what an apology means. And I'm going to start with the very first person I see, and that is Natan. 

NATAN OBED: Well, thanks for that. And Alika, Dr. Lafontaine, I've appreciated being able to speak candidly with you in your role now, but also conversations we've had over time. Immediately, I think about the scenarios that lead us to an apology, and the government policies, systemic racism, the lack of humanity, perhaps, that has been attributed to Inuit by the medical profession over the past 175 years in this country, that lead us to this point in time. 

I also think about the way in which apologies can be meaningful and contrast them with the way in which apologies sometimes can seem insincere or miss the target, because it's never too late to apologize in any scenario where you have done wrong to another group. And when there are human rights abuses by particular institutions or governments, I think there is always space for those apologies to happen and a new path to be charted. 

In these times, there are always going to be dissenters, people who don't think this is the right thing to do, either from a risk perspective or from a historic perspective I think it's human nature to never feel like you have done wrong, individually, or you have perpetuated racism or you have participated in an institution that has been racist or has undermined human rights of a particular group of people, especially when the medical profession and the oaths that are taken to pursue this particular line of work are so in contrary to those breaches in conduct. 

But it's uncomfortable sometimes to hear what has happened. And across Inuit Nunagat, that our entire lives are still transformed, to this day, by the inequities within the health system and the foundations of the health system across our homeland. In the 1950s, the tuberculosis epidemic was approached not from providing care within our homelands, but we were taken from our homelands and put in sanatoriums, sometimes for years at a time. Sometimes our patients died. Patients were separated between mothers and fathers and children. And if anyone died within those scenarios, most likely, the next of kin was not notified. We were still trying to find out where some of these people are buried. 

That is just one example of how medical care to Inuit has been a traumatic experience for Inuit, and one that is completely outside of the norms for the way in which human beings care for one another. I do hope that we can have some of these conversations without pointing the fingers at anyone here at the helm today, but I think this is so important. 

When we understand what is happening today and we understand the inequities that are still happening today the idea that, say, in the jurisdiction like Nunavut, which is a territory with 85% Inuit population, there is no obligation for health services to be delivered to patients in Inuktitut, especially if they are done in a Federal way-- and that is within a jurisdiction that has a majority population of a language that is neither English or French. 

And yes, you can hide behind government policy and federal government policy. But when it comes to the expectation of care, the understanding of a patient on what care is happening to them, and the relationship between a doctor and a patient, it is quite obvious that the use of the mother tongue or the use of-- sometimes the only language that person knows is the only way to respectful care. 

Once we know these things, what are we going to do? And what are we all going to do together to close these gaps, not only in the way care is provided but also the gaps in outcomes for socioeconomic status between Inuit, in this case, and the rest of Canada? So there's lots of work to do. But I really appreciate the openness of the CMA to hold a forum like this and also to have the intention to apologize on such a devastating chapter of Canada's history and the role that the medical profession has played within it. 

TANYA TALAGA: Hm, miigwech, Natan. I'm going to turn to Marion Crowe now. Your turn, Marion. 

MARION CROWE: Thank you so much. And it was just an honor listening to you speak, and Alika. I'm emotional in hearing that apology and the path to reconcili-action and the journey that the CMA is on. 

I have to say this-- it's never too late for an apology, and this gives me hope. Hope, meaning, purpose, and belonging are the anchors of how we move forward. This gives me hope that hospitals all across Turtle Island will hear this and ask Indigenous patients to stand with them in creating a zero tolerance-- zero tolerance for any kind of abuse, mistreatment, or racism that a patient experiences. 

When we look at this from a quality perspective and from a patient experience perspective, I think about a racist institute, as the former speaker said-- when we participate in those actions, I, myself, am the very first Indigenous person on the Ottawa Hospital Board of Governors. I can tell you, by being in these spaces, in these places, people are hearing us. They're listening to us. 

And don't be a token on these types of boards. You can inform the system and help it be a better experience for the next seven generations that come behind us. And I'm going to send it back to you, Tanya, because I know you have a great deal of information to get through to our audience tonight. 

TANYA TALAGA: Hm, thank you very much. Miigwech, Marion, for your heartfelt words as well. Cassidy, I'm going to turn it over to you now. Your thoughts on the apology? 

CASSIDY CARON: Sure. Thank you, and thank you, Alika, for having us and for the incredible amount of work that you've done in the few months that you've held this position. I think there's been a lot of conversation in this last year-- this last year and a half-- about reconciliation and apologies and what that actually means. 

And one of the things that you said was it requires listening, and it's clear that you and others at the CMA have listened and now want to move forward on this path in a really good way. And I think having these conversations with Indigenous people is absolutely one of the first places to begin. Of course, Métis, Inuit, and First Nations people have had to work extremely hard, over decades, to reverse the harm that has been caused by colonialism, by denialism, and by systemic attacks on our people within Western and dominating systems, which includes the health care system. 

And for years, this work has been on our shoulders alone. It has taken a significant amount of advocacy, patience, and dedication of leaders who have come long before me. But it shouldn't have to just rest on our shoulders as Indigenous peoples. There's a role for everybody to be playing within reconciliation, within all of these systems, within all of these sectors, big or small. The role that you can play is significant. 

An apology-- it really acknowledges-- it acknowledges that a harm has been done, and that requires being truthful about the past. And it requires thinking about the future where Métis and other Indigenous peoples are respected as the peoples of these lands, as the unique peoples with recognized rights under Canada's Constitution. And it truly is-- an apology is a first step. It's opening a door to rebuilding trust if it is done in a good way because trust is just not simply handed out with a few words. It's really earned through a process of relationship building and rebuilding. And I think that the process that the CMA is looking to roll out is one that is really honorable, and I do look forward to seeing how this goes. So thank you so much. 

TANYA TALAGA: Miigwech, Cassidy, for those wise words, as always. And I want to make a special mention, at the moment, for the role that Alika is playing here. I think that we should all take a moment to recognize the strength and the importance of what Alika is doing, especially since he is an Indigenous person. Alika is Oji-Cree, and he is Métis. And he is also a doctor and head of the CMA. 

By virtue of his blood, of who he is, he is connected to this land. So I want everyone on the CMA to think about that for a moment. Reconciliation is something that Canadians must do with us. The onus is not on ourselves to be the ones reconciling. Yet here is Alika, doing something that is really quite incredible and bringing the institution forward I just-- I think it's important that we acknowledge that fact here today. Alika, do you have any thoughts on that at all? 

ALIKA LAFONTAINE: Yeah, I just want to say, first off, I think the burden on my shoulders is a lot lighter than the burden on Natan's, Cassidy's, Marion's and every other Indigenous leader out there. Tanya and I were having a conversation about dual identity not too long back. And I I'm often asked in interviews-- when was the first time that you witnessed racism in the health care system? And I remember every moment of that clear as day. I had experienced racism myself, prior, as a patient, but it was the first time that I was on the other side of the curtain. 

I was a medical student, and I watched two men come in in a short period of time of each other. And one of them was clearly Indigenous, could have been Métis. He could have been First Nation, and had similar presenting symptoms-- slurred speech, unsteady gait. They were having trouble standing up, and a change in their level of consciousness. 

And one of the men was moved over to a bed and had a full workup that I was a part of. We tested for a variety of different things that it could have been. It included things like alcoholism, but it was also-- we checked for stroke and heart attack and all these other things. And the other man was taken over to a room. The light was dimmed. He was given a sandwich and a blanket. And everyone said, we'll just let him sleep it off. 

And in that moment, I think there was something that turned in me where I realized that I had signed on to be part of a system that often creates a lot of harm for my family and the family and friends that I've grown to love across this land. And I think, for Indigenous physicians, Indigenous teachers, Indigenous social workers-- anyone who are in these systems where this-- this an unreasonable treatment happens to Inuit and First Nation people. 

We struggle because we're both part of the system that creates this harm, but we're also part of the people who experience that harm. And I think that puts, sometimes, an unfair burden on a lot of us. But until we reach the point of reconciliation, it's a necessary burden. 

I remember, shortly after being inaugurated as president last summer, my mom gave me a hug, and she said, if it wasn't you, it would have been someone else, to be the first Indigenous president, but treat this year like it should have been you. And I've tried to move forward, with every step, over this past year, with the idea that I could make a difference, not because I'm unique or special but because I'm here. 

And I think, when I listen to Natan and Cassidy and Marion talk, I think to myself, thank goodness they're there, standing where they are and lifting where they are. And I just see all of my Indigenous colleagues who work in the medical profession-- physicians, nurses, pharmacists, other colleagues. We have a real opportunity, today and then moving forward, to really make a difference for our people, for ourselves, and to really use that dual identity to push things forward. And we have to carry that burden because if not, who's going to? 

TANYA TALAGA: Mm, so well said. We've heard-- this was in the last year-- this has been-- there's been a lot of apologies. I'm thinking of the Pope's apology last summer and the importance of apologies. So how do you begin to build trust? An apology has happened. How does trust happen for Indigenous people once they've heard this word or the words, I'm sorry? Natan? 

NATAN OBED: In many ways. I just think of my friends and family, myself , and what that means. Do you ever go to an Inuit community? A lot of people are going to welcome you. People are going to ask you where you're from. They're going to ask you if you're rich. They're going to ask if you're married, if you have kids. This is just like the 8 to 12-year-old on the street. 

Other people will offer you a meal, will make sure that you have whatever you need during your time. If it's in the winter, perhaps people will be saying you need-- you need better minutes. We're, to a fault, very welcoming. And I think when we go into medical care facilities and we have interactions with doctors, there's another history that's side by side with our openness and willingness to bring people in and welcome people into our communities, versus the way that we've been treated over the past 70 or so years, especially within health care delivery. And that is that we are subhuman, that we really don't matter, and that we are, in many cases, administrative footballs. 

In our communities, there are health centers with nurses. Largely, our systems are to refer people into major Canadian centers. Governments have service agreements with provinces and territories, and so most of the care happens with people who know nothing about the lived reality or even the geographic place on a map where this person is coming from. And often, it is thousands of kilometers away for this person sitting in one of the most difficult times in their life, being serviced by somebody who is not part of their community, and can't speak their language, and has vastly different cultural norms about communication. 

So what I hope for the system is for-- that those types of things to be recognized and incorporated into care and for people to be humans first and to care for fellow humans, rather than, in many cases, where either it is a frustration with the burden to care at all for these patients, because they're not part of the system, the local system, or then the considerations, in many cases, for payment, which often are negotiated between the federal government and interjurisdictional issues. 

And it is, going back to Jordan's Principle-- it is, provide the care that a person needs, and figure everything else out somewhere else. And think of them as your neighbors and people that you have to have empathy for. I think it's a huge challenge for the medical establishment to do that. I think, as Alika mentioned, there is systemic racism and cultural prejudice. And there's also this understanding-- sometimes this baked-in belief that somehow Inuit cannot understand what is being told in these encounters. 

But ultimately, we're not stupid. We just are coming from a very different place and speak a very different language. And if medical doctors had to come into our communities and speak our language to deliver care, it certainly would be a very different reality. And I think there would be a greater appreciation for what we go through when we go to places like Ottawa and Winnipeg and Edmonton. 

TANYA TALAGA: Extremely well said, Natan, as always. Marion, as well. Now that you've heard an apology, an apology is on the offering, how do you build trust? 

MARION CROWE: Well, I think trust is 1,000 cups of tea. It's getting to know the patient population in which you're serving. And I think right away about not just an apology but the hope of reconcili-action. As somebody who gets to lead an amazing organization of health directors in my role at the hospital, I start going into operations mode, and what does that mean? How do we become allies in getting rid of racism? How do we acknowledge the territories that we are on? 

And I don't mean performatively, like a check mark. I'm talking about, how do we put into the system spaces that reflect us, that create space for us to practice ceremony? Some day, I picture a hospital that has signed on to rise above racism, like the CMA. I'm putting a plug in there for folks who are looking for a roadmap. 

If you go to the website, you'll find an amazing campaign on eliminating racism in the health care system. You'll be able to see the reconcili-action journey that the CMA is on, that the Ottawa Hospital is on, and many other pan-Canadian health organizations. I hope that one day I can walk into a hospital and I am prioritized in emergency, just like I was during COVID. I know I'm dreaming, but I think we're getting closer to seeing us prescribe traditional medicines in the hospital from an Indigenous physician. Those are my dreams. And it's possible. We see this happening in Toronto, by the amazing work of Dr. Lisa Richardson. So again, I know that this is such a heavy and traumatizing conversation, but let's talk about the steps in how we eliminate racism in health care. Thank you for the question, Tanya. 

TANYA TALAGA: Miigwech, Marion, and I applaud the work you're doing. Rise Above Racism-- please google search it. Check it out on Marion's website. And I know that every little bit helps, so I urge you to check out Rise Above Racism. Now, Cassidy, you've heard the apology, the beginnings of an apology. How do you build trust? 

CASSIDY CARON: I think what we've learned and what we've heard over and over again in these last number of years when talking about apologies is that, of course, it has to be followed with action, and action that is actually creating real systemic change. I have an elder who has told me time and time again that we have a closet full of, sorries, but not enough action to follow those stories, and that we don't have a word in our language for reconciliation. 

But the word that closely translates to reconciliation actually means, setting things right, and that's what's needed right now. We need to set things right because, for Métis communities, similar to Inuit and First Nations, we've long faced significant barriers in accessing this quality health care that is free of discrimination. And it's resulted in severe health disparities for our people. So moving forward, there has to be a significant amount of action to change that system. That takes a lot of work. It's ingrained in a system. 

So the health care system has to commit to providing and actually doing it-- providing culturally safe and accessible care to our people. As Natan was saying, it requires recognizing and respecting our unique worldviews, our traditions, our healing practices, and ensuring that health care services are also geographically and financially accessible, recognizing the social determinants of health for our people, or, in our case, we've done a lot of work to understand what the Métis-- the determinants of health for meaty communities are, and really applying that and taking those into consideration so that we can make sure that health care actually addresses the unique needs of our people. 

And so a lot of this is going to require cultural competency training for health care professionals. It's going to require the recruitment and retention of Métis health care workers-- speaking Métis-specific here, the integration, like I say, of traditional Métis healing practices into these mainstream systems, and finding a way to actually make it work and not just-- putting an infinity sign on it doesn't make it culturally relevant. 

It also means including Métis voices and perspectives in decision-making processes that shape the health care policies and practices, just like what Alika is doing right now-- holding these leadership positions, not just on the ground positions but the ones that are making decisions. There's so much that can be done. There's so much work that our institutions have done to understand what the unique needs of our people are-- the Métis National Council, ITK, AFN. All of those institutions-- we know what our people need. We've done the research. And now it's looking for equal partners to actually roll this work out and create the systems change that's needed to take care of our people the way that they deserve. 

TANYA TALAGA: Amazing. Thank you very much for your words, Cassidy, and I encourage everyone to put their questions in the chat. We'd love to listen to what you have to say. And please submit your questions for the speakers to the Q&A button, and you can upvote questions as well. And I have a couple of questions in there. As soon as we put the call out, they came. But Alika, I'm going to switch to questions, but I-- is it possible to quickly answer the question that I posed to everyone else, in, how do you build trust now? 

ALIKA LAFONTAINE: Yeah, I think trust starts with relationships. And I know one of the things that was really important to myself and other folks in the CMA who've been pushing for this work-- the Guiding Circle, Indigenous staff, our senior executive, and our CEO was making sure that we engaged in proper ways. This year, we engaged with the AFN, ITK, and MNC all through proper protocol. Before this conversation, we actually sat down and we talked about what was important. 

And I think that, at the beginning, we actually will lean pretty heavily on Indigenous folks inside the health care system-- advocacy organizations like Marion's and our political organizations, like the organizations that President Caron and President Obed lead-- in helping us to understand how to develop that trust. And I think folks on the ground-- patients, families, and communities, who see the movement of people that they trust-- trusting the CMA is a big part of starting that journey. 

And I think our job at the CMA is not to let them down. Just like Cassidy was saying, we have to make sure that we follow through with these conversations with action, and that we make a difference in the lives of patients. I know, when I was speaking with President Obed and when we were having our first meeting, we talked about how everywhere else in Canada, there's an expectation that you'll be introduced by your name, that there'll be a bit of your conversation at least in the language that you speak fluently, but that's not true for Inuit people. Sometimes providers don't even attempt to pronounce Inuit names. 

And I don't understand how you can train and understand a complex procedure like a Fontan but you can't spend three minutes to try and learn how to properly pronounce someone else's name. And I think that a lot of what we do in medicine-- we get used to doing it that way. I don't think it's necessarily rooted in trying to create harm. But I think we have all these norms where we focus on one area and try our hardest. And then when we try and humanize each other, we fall short. 

And I think this process gives us an opportunity to line those up better. And I think it will not only be better for patients. It'll be better for us as clinicians as well. Wouldn't it be wonderful that, in every encounter that you have with an Indigenous person, you feel the trust, you feel the closeness, and you can move forward in helping them with their path through the health care system so they can return back home? 

TANYA TALAGA: Miigwech. I'm moving on to the Q&A, now, with our participants, and I've got a really good question here from Dr. Emmett Franco Francoeur. The doctor asks, for many physicians across Canada who are choosing to be committed to this kind of reconciliation, the frustration is that we do not come in contact with many or any First Nations people. How do we make a difference? So that's an interesting question, and I am going to turn that over to Marion first. 

MARION CROWE: I knew you were going to pick me. I'm not sure why I knew that. Well, I would definitely say, I'm pretty sure you do come into contact with First Nations, Inuit, or Métis people, and you don't know. So here's one small step, and it's an easy one. Read Indigenous, buy Indigenous, shop Indigenous. But it really is about being an ally and an advocate for-- I hate the word, underserved, and, marginalized, for a whole host of reasons. 

But we need allies in this space. We need you to be informed about our Indigenous ways of knowing, of ceremonies that we might be practicing. We need the compassion of allies like yourself. So I would just encourage you to start opening the books. We have an author who has an amazing book right here I would start with that one. 

TANYA TALAGA: Miigwech, thank you. I appreciate all plugs for my books. Thank you very much. Yep, new one coming out shortly. So I'm going to-- I'm actually going to ask this question, as well, to Cassidy, actually. It's a tough one, but it's interesting, right? It's interesting, too, that physicians think that they're not coming across Indigenous people when, in actual fact, they are. 

CASSIDY CARON: Mm-hmm. Yeah, I was going to say the same thing as Marion. It's very likely that you have come across an Indigenous person in the work that you do. For Métis people specifically, were not phenotypically distinct. We don't all look the same. You can't just look at a person walking in a room and say, oh, that's a Métis person. So unless that person self-identifies, you wouldn't know. 

And a lot of Métis people don't self-identify within the health care system because they know the horror stories of Indigenous people and how they are treated within the health care system. So if somebody is able to walk into a doctor's office and not automatically look like what people think an Indigenous person looks like, they may not choose to self-identify because they think that they will get better health care service, and it's likely that they will. So part of that is, again-- just being aware of that is an extremely important factor. 

Just treating everybody with humanity is the other thing. If somebody feels like they're being treated in a very good way, they're going to open up a little bit more. And if they have a good experience, that goes a long way. So it's just treating everybody with absolute humanity and decency. 

The other thing, I guess, is-- if it is, in fact, that you haven't ever come across an Indigenous person within your practice and you are looking for something to do to contribute to this conversation, read up on the work that we are doing. For us, the Métis National Council, specifically, read up on the research that we're doing that shows data on how many people are not getting the health care services that they need and the work that we're doing to advocate at the federal level, at the provincial level to make sure that that changes so that you can be aware in your own way and be an advocate just from the work that you're doing. So there's a lot that you can do. Just raising your awareness is step one, I think. 

TANYA TALAGA: Mm, yes, thank you for that. I want to get to this one, and I'm recognizing that we've got 9 minutes left, but it's a good one. It's loaded, too, here. Is there any examples of physicians being held accountable by their organizations or institutions or regulatory bodies for racism, causing harm? This one doctor said that, my experience is that they are protected on every front as a profession. And recently, the doctor was in a meeting with Indigenous leadership, and the leadership of the hospital said that if-- any physician causing harm through racism will be fired. But this doctor said that they have yet to see a real example, despite many complaints coming through the patient experience or on social media. 

Now, I'm unclear as to whether or not that means this doctor has not seen many examples of racism or how doctors are held accountable. I'm going to turn it to Alika first. And then I'm going to ask Natan of any examples he might have heard of physicians being held accountable. 

ALIKA LAFONTAINE: Yeah, I think this is a really valuable question and one that I really hope that we dig into and unpack over the coming months, as we go through this apology process. The reality is that you don't see what you don't measure. And if you don't see something, you never solve it. And I think that it's very clear that racism has existed across Canada, but we're unsure where it's a big enough problem that we have to do something about it. 

And I think, in medicine, we're very good at reframing situations to mitigate responsibility. When a person has a hostile experience and they choose not to pursue further medical care because they don't trust the folks that are providing that care and that leads to harm, whose fault is that in medicine? 

And I think that aspect of the experience of racism in the health care system can't be underestimated. There are many folks across the country who are Inuit, Métis, and First Nation who delay presentation to care until they have no other choice because they're afraid or because they've had previous bad experiences or they're worried that they will actually have something worse happen to them, as a result of stories that they've heard or stories that they've experienced personally. 

And I don't think that, in general, our way of dealing with patient concerns and complaints has done a great job at addressing racism-- not only Indigenous-specific but also racism felt by many other persons of color across Canada. That means that we have an enormous opportunity to hear these stories and change the way that we look at these experiences. And I think-- the final thing that I'll say is that it's important to recognize that, in many places where people experience these harms, there's not a lot of physicians who go there. 

So just to the previous question, if you don't see a lot of Indigenous people in your practice, go to places where there is Indigenous people. Sign up to do a locum in Nunavut. Sign up to do a locum in the Métis settlements here in northern Alberta, where I live and work. Go to an underserved community. They need your skills so they can have access to these things. 

Don't just read about things. Go and meet the people. That's the most important part of reconciliation, honestly. It's the most wonderful part of reconciliation, is-- we understand and create accuracy in our history, and we create new memories moving forward that are things that we can be proud of and that bring us joy and happiness. 

TANYA TALAGA: Miigwech for that. I'd like for Natan to spend a couple of minutes as well, quickly-- if you can quickly, as well, talk about-- have you seen physicians being held accountable? And should they visit Nunavut? 

NATAN OBED: Well, physicians are a self-regulated profession, unlike many other professions. That doesn't mean they're not above the law and legislation that governs the practice and also criminality within the practice. I'm not aware of any physician that has been held to account for simply being racist. 

And then, immediately, we're still back in the place where I immediately then think of-- for forced sterilization or for misdiagnosis or for the lack of interest in pursuing medical care-- the self-regulatory part of the medical community. And the ability for the accountability from within I hope will be a foundation of this reconciliation movement within the medical community. 

I also hope that there would be more accountability within the system to identify incidences of racism and then to properly address them. I don't think that we're there yet either. And as far as medical professionals coming to Inuit Nunagat, there are very few communities where you can actually practice. But there is a huge need, and they're usually general practitioners. There are a few doctors that are resident doctors that stay, their whole careers, in places like Iqaluit or places like Kuujjuaq. But if a part of your career overlaps with, or if you are at a particular expertise that you can provide service to a particular portion of Inuit Nunagat, please, let's find a way to make that happen. 

TANYA TALAGA: Miigwech, I know that was a difficult curveball of a question there, Natan. But I'm going to make a plea here for access, for the CMA to continue their work in trying to access our underserved communities, as you've heard from all three of our peoples here tonight. I'm going to make a plea, as well, for Northern Ontario, who-- we hardly have any doctors whatsoever. In fact, barely any in a lot of our communities. So there's a lot of work to be done. 

And I want to give everyone a minute to say closing response, and I know that's tough-- it's a minute. But I'm going to start with you, Cassidy, and then I'm going to go around my little circle and end with Alika. 

CASSIDY CARON: Sure. I guess I'll just close just by saying, thank you again, to the CMA and to Alika for hosting this, and to Tanya as well for guiding this conversation. A big part of reconciliation is just ensuring that the conversation continues, that we don't stop talking about the injustices that Indigenous people face in this country and the solutions that we can apply. 

It takes-- again, like I said, it takes dedication. It takes patience. It does take time. It will be frustrating. But I do hold a lot of hope that we can change systems from within to better serve our people within this country. So I'm thankful for the time that we have to discuss this today, and I look forward to continuing to work with you with your last few months, Alika, and then again into the future as well. So thank you so much. 

TANYA TALAGA: Miigwech. Marion. 

MARION CROWE: If you see something, say something. Remember all of the ads and the airports, all over the place? Please. I know it's a really hard experience to report racism, but please find a patient navigator. Find the Indigenous person in the hospital. And put forward the complaint. I have witnessed where somebody has been fired-- security guards have been fired from a hospital for their actions and their response and racism. And if you're a hospital administrator, deploy safe spaces. Thank you. 

TANYA TALAGA: Miigwech. Natan. 

NATAN OBED: Well, I look forward to the future conversations with the CMA with you, Alika, on making good on this pledge to apologize. Perhaps the one thing that I'd say-- a piece of advice-- is to try your best, all of you who provide care, to work in an anti-racist way. And that means be very careful about how you word questions-- your unconscious bias, some of the things that you might want to say or ask. 

Let the patient lead in those cultural conversations. They expect you to lead in the medical conversation. But don't think, because you read a book or you watched a movie about our communities, that then you can-- then, that you have the license to be able to just cast your judgment or filter and expect the patient to reflect what you think you know. Just simply learn. And it took you seven or eight years to get a medical degree. Just imagine how long it will take for you to truly understand our language and culture. And have that respect for it, and you'll do really well. 

TANYA TALAGA: Mm, Miigwech. Alika. 

ALIKA LAFONTAINE: Yeah, and the only piece that I'll say-- and I'm so grateful for the wisdom that Natan, Cassidy, and Marion, and you, Tanya, have shared tonight. Don't get too focused on tomorrow when we have stuff we can do today. It's true that we need more investment, that government needs to create programs, that we have a system that just is not designed to provide great care to Indigenous people and really supports a lot of the bias and racism that we see. 

But don't forget-- we do workarounds every day as providers in the health care system. We keep things stuck together. And if we turn our attention to doing the same thing for Indigenous people, we can make a difference right now in the care that they receive, while we try and work towards that better tomorrow. 

TANYA TALAGA: Miigwech. I'd like to Thank all of the panelists-- Alika, Natan, Marion, Cassidy. You are all incredibly wonderful. You're all leaders. And the work you do is so important. I urge you to keep going. I know it's hard, but don't stop. These Fireside Chats have helped inform the path forward. And together, the CMA is committed to continuing the reconciliation journey. 

Now, if you would like to participate in any further future conversations, the CMA would like you to attend its upcoming Health Summit in August, both in Ottawa and online. A link for more details will be in this chat. I want to thank everyone for joining us, and I apologize for keeping you three minutes over time. But this is one of those conversations that we could have for an incredibly long period of time. There is much work to be done, but I'm confident that, working together, it is going to happen for the betterment of all of Canada. So with that, I'd like to say, good night, and I was delighted to host you through this webinar. 

This commitment follows the CMA’s announcement of a new, long-term goal to advance more equitable health care in allyship with First Nations, Inuit and Métis Peoples.

The CMA’s Indigenous health goal: 

Indigenous Peoples achieve measurable, on-going improvements in health and wellness, supported by a transformed health system that is free of racism and discrimination; upholds Indigenous Peoples’ right to self-determination; values, respects and holds safe space for Indigenous worldviews, medicine and healing practices; and provides equitable access to culturally safe, trauma-informed care for all First Nations, Inuit and Métis.  

This goal is a balance of the different perspectives, experiences, priorities and stories shared by members of the CMA’s Guiding Circle, a group of 16 Indigenous leaders and knowledge-keepers convened over several months to steer the CMA’s work on tangible and meaningful changes within health care. 

“An apology has to be followed with action that is creating real, systemic change,” said Fireside Chat panelist Cassidy Caron, President of the Métis National Council. “Having these conversations with Indigenous Peoples is absolutely one of the first places to begin.”

“I think about the government policies, systemic racism and lack of humanity that has been attributed to Inuit by the medical profession,” said Natan Obed,

“It’s never too late to apologize in any scenario where you have done wrong to another group. There is always space for a new path to be charted.” said Natan Obed, president of Inuit Tapiriit Kanatami, the national body representing Canada’s more than 70,000 Inuit.

“This gives me hope that hospitals all across Turtle Island will hear this and ask Indigenous patients to stand with them in creating zero tolerance for any kind of abuse, mistreatment or racism that patients experience.” — CEO First Nations Health Managers Association Marion Crowe

Hosted by journalist and author Tanya Talaga, the Fireside Chat series has included panelists Denise McCuaig, executive director of healthcare transformation and capacity building at Healthcare Excellence Canada, Dr. Paula Cashin, Canada’s first Indigenous radiologist and a member of CMA’s board of directors, and Dr. Sarah Williams, CMA’s strategic advisor for Indigenous health.

Discussions focused on cultural safety in care, improving the health of Indigenous Peoples, and the importance and meaning of an apology.

Learn more about the CMA’s focus on Indigenous health.

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