Canadian Medical Association

Indigenous Peoples in Canada continue to experience health disparities due to the legacy of colonization and ongoing racism. We must do better, which involves Indigenous Peoples leading the way forward. 

The Canadian Medical Association (CMA) is announcing a new, long-term goal to advance more equitable health care in allyship with First Nations, Inuit and Métis Peoples. It will serve as the North Star for our work over the next two decades.  

Learn more about our focus on Indigenous health

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 our work on tangible and meaningful changes within health care. 

The Indigenous philosophy of a circle stresses equality and the sharing of power — an inclusive approach to ensure every person’s voice is heard. 

“This goal is a bridge between where we are and where we want to be in the future. Indigenous Peoples — patients, their families and their communities — have had their voices devalued and dismissed in regard to our own health care. The Guiding Circle is part of changing that.” — CMA President Dr. Alika Lafontaine, Guiding Circle member   

Values embedded in the Indigenous health goal include:  

  • Recognizing that self-determination and connection to the land are central to the health and well-being of Indigenous Peoples 
  • Aspiring to eradicate racism and discrimination in the health system, including its treatment of Indigenous health care learners and professionals 
  • Being centered in allyship 
  • Valuing a strength-based approach, honoring the agency and knowledge of Indigenous Peoples 
  • Promoting cultural safety to dismantle the effects of white privilege and addressing racial power imbalances 
  • A shared vision that is long-term and high-level to be broad, but not limiting  
  • An inclusive and flexible approach so that all Indigenous Peoples can see themselves included with its scope 
  • Valuing “two-eyed seeing,” acknowledging Indigenous worldviews and medicine as equally important dimensions of health and health care 
  • Promoting accountability to track the goal over time  

Learn more about the process of how the Indigenous health goal was created

The Guiding Circle’s important work represents a milestone in CMA’s journey of truth and reconciliation. This spring, CMA President Dr. Alika Lafontaine is leading a series of intimate discussions with Indigenous patients, providers and leaders on how we can move forward, together. 

Video Transcript

TANYA TALAGA: Boozhoo! Aaniin.


Hi, everyone.


Welcome. Welcome to our second CMA fireside chat. My name is Tanya Talaga. I am an author. I am a journalist. My mom is from Fort William First Nation and my father was Polish Canadian. And I live in Tkaronto. And normally, I would style this evening by giving a land acknowledgment of where I am sitting and where I am standing, but I am actually overseas at the moment so a land acknowledgment will not be working.


But I do want to start this evening by thinking of-- I want everyone to think of where they are in relation to our discussion tonight. And since we are taking place in a virtual meeting that goes from coast to coast to coast, I would like to acknowledge that we are all on many different treaty lands and many unceded territories. We live and work here together and we have to find a way to figure out how to forge a path forward together. Hence, part of the reason why we are having these fireside chats.


And so without further ado, I would like to tell you that the CMA is hosting this series of discussions to hear from Indigenous patients, healthcare providers, and leaders on how we can figure out to move forward together as part of the CMA's commitment to tangible action on reconciliation in healthcare.


In our first session, we discussed the importance of cultural safety and healthcare for both patients and for providers. And if you couldn't attend, a recording is available and a link will be put up in the chat. It was an important conversation. And I would encourage you all to watch.


Today, the focus of our conversation is how we can improve the health of Indigenous peoples, how we can improve the health of First Nation Metis and Inuit. Our people continue to experience unacceptable healthcare disparities due to the legacy of colonization and ongoing systemic racism. Everyone on this call is familiar with the issues that we face. We must do better. This involves Indigenous people leading the way.


For the next hour, we're going to hear from three speakers with insights into this topic and we're going to reflect on the work of the CMA. But before we begin, I've got a few housekeeping items for you. We're going to start with a 30-minute moderated Q&A with our speakers. And following that, there will be a 20-minute Q&A from the audience. Questions will be text-based and can be upvoted. 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.


So I'm going to introduce you tonight to our panel of speakers. They are all members of the CMA's Guiding Circle, which I know we're going to hear a lot more about as part of this discussion, but it's a group that was convened by the CMA to advance equitable healthcare and allyship with First Nations Inuit and Metis people.


Now the first person I'm going to be introducing you to is no stranger to all of you. Dr. Alika Lafontaine is the president of the CMA and a healthcare leader for more than 20 years. He is a past president of the Indigenous Physicians Association of Canada, a board member with HealthCareCAN. 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 in Ontario.


In 2020, Dr. Lafontaine launched Safespace Networks, a platform for patients and providers to report racism in the health system and to contribute to change. Maclean's Magazine named him the country's top health innovator in their 2023 power list. And he was the first Indigenous physician listed in the medical Post's 50 Most Powerful Doctors. Dr. Lafontaine has Metis, Oji-Cree, and Pacific Islander ancestry. He continues to practice anesthesiology in Grand Prairie, Alberta.


Next up joining us is Dr. Paula Cashin. She is Canada's first Indigenous radiologist and nuclear medicine physician. She's a member of the CMA's board of directors. A Mi'kmaw physician based in rural Newfoundland, she advocates for equity, diversity, and inclusion in medicine, drawing attention to systemic barriers through work and organizations like Equity in Medicine.


She also openly discusses her own experiences with systemic discrimination and harassment, which prevented her from working as a physician for three years. Dr. Cashin recently completed a master of laws at Osgoode Hall Law school. She is now focused on the creation of a national physician dispute resolution process to address the potential career loss and patient safety issues that arise from unresolved workplace conflict and harassment.


And we also have Dr. Sarah Williams. She is the CMA's strategic advisor for Indigenous Health. She is Michi-Saagiig, Anishnaabe, Mississauga, Ojibwa from Curve Lake First nation in Southern Ontario. And she now lives in the Coast Salish territory of the Lekwungen people in BC. After training as a family doctor, Dr. Williams served the First Nations Health Authority in BC as a senior advisor for health services.


Over the last decade, her career has focused on bringing an Indigenous perspective to medicine and healthcare and for advocating for Indigenous Peoples' right to access services that are culturally safe, trauma-informed, and free from racism. Dr. Williams began her career endeavors as a young actor on Spirit Bay, a family show that aired on CBC Television and TV Ontario in the 1980s.


Well, welcome, and thank you for joining us on this really important conversation. Tonight, I'd like to start our talk on speaking about the journey that the CMA is on in order to take tangible action on reconciliation. Alika, I'd like to start with you to help us understand the path that the CMA is on. Maybe you could fill us in.


ALIKA LAFONTAINE: Yeah. Thanks, Tanya, for that opening. I think like any organization that's been around as long as the CMA-- and keep in mind, the CMA has been around for 155 years. There's a history that we're steeped in that includes colonialism, elements of racism, the good and bad of what makes this country Canada. And like any other organization, the CMA has been on a journey to find itself in this era of reconciliation.


Now I see this journey from a different vantage point. As you know, the two other panel members, Paula and Sarah. As president, I have the opportunity to spend a year preparing for this role and then spending a year being out there as the spokesperson for the organization and then a year as past president. And I can see that I've seen in the year that I've been spokesperson a lot of changes.


We've had our first Indigenous board member. That was Paula. First Indigenous board member of the CMA. I was the first Indigenous president. Sarah was a part of a-- a new part of the CMA that was focused on Indigenous health as well as reconciliation.


And so it's on a journey to find its place in reconciliation. But I can say as someone who has been a part of this organization leading it since last August, it's taking the right steps in the right direction. And this is just another step on the way to really achieving what I think Indigenous people across the country and I think Canadians are hoping for, which is to reconcile our past and build a new future for Canada together.


TANYA TALAGA: That's really well said. And it's a great thing to hear that the CMA is going forward with these changes. And really, I have to say kind of moving quickly, considering for a long time we didn't see a lot of Indigenous faces at the helm of the CMA or on the board or even with the circle that you have put together. It's quite refreshing to see that. Paula, I'd like to ask you, what makes the approach the CMA took and continues to take unique and important?


PAULA CASHIN: So I'll just start by acknowledging that the CMA's approach is the reason why the Guiding Circle has been so successful and it's the reason why circle members were fully engaged and committed to the work. And as you said, Tanya, these are very unique and important ways and ways that the approach of CMA has been different from a lot of other healthcare organizations. So first, and I think very importantly, the CMA board and executive really ceded power to allow the work to happen.


The only expectation of the CMA was that the work had to fit within Impact 2040 strategy. Their willingness to share the power, I think, speaks very strong to leadership from the board, and in particular our board chair Dr. Strasberg, our vice chair Dr. Nohr, and also senior leadership team. It was very clear I think from day one that the Guiding Circle was a priority for our CEO Tim Smith and for Joseph Mayer as the VP overseeing this work. So essentially, power was shared and the importance of the project was communicated from the most senior levels of the organization.


The second, and I think most important reason for the success, is that the project was truly Indigenous-led. And that was only possible because the CMA showed true allyship when it handed over the leadership of this project to Indigenous Peoples. So for example on the day the Guiding Circle was announced, the CMA acknowledged that better health outcomes for Indigenous Peoples had to start with Indigenous voices. And they meant it. And the organization has certainly walked the talk.


Along those same lines, the CMA had Indigenous positions from within the organization lead the work. So the panel members you see here today. I think that's an important first step for the CMA's actions plan towards reconciliation. So having Indigenous folks in the organization helps guide the work but also having Indigenous voices at the decision-making tables is really ultimately what we need for true allyship and reconciliation.


And while we're talking about the Indigenous folks leading the project, non-Indigenous CMA staff members and board members were invited into the process to share in ceremony. So for example, a few non-Indigenous CMA staff members were present for the circles observers. They joined us in ceremonial meals. In our last board meeting, when the goal was presented, we had the board directors and senior executive team join us in ceremony. And I really think it's through that participation in ceremony and hearing our stories that the non-Indigenous members of the organization can truly understand why this work is so important.


And one final point, I think, is that the work being done on the Indigenous Health goal at the CMA isn't compartmentalized into a report that's just going to sit on a bookshelf and just to be taken out when we discuss Indigenous health initiatives. I think the work of the Guiding Circle has really permeated the whole organization. It's helped the organization look at all aspects of itself and work-- and all of its work really through an Indigenous lens.


So as an example, at our last board meeting, we had updates on Impact 24 strategic initiatives. And every initiative and every presentation to the board took into consideration the Indigenous perspective on the work that was being done. And I just think it's so incredible to see that happening.


TANYA TALAGA: I agree. And I wanted to ask us, Sarah, can you tell me about when your roles in reconciliation with the CMA and what tangible action the CMA is taking from your perspective?


SARAH WILLIAMS: Yeah. Thanks, Tanya. I think part of my journey and the CMA's journey together started when I was hired in December of 2021. And what really struck me was the fact that the CMA understood it wasn't an expert in this field. And I think that that's very significant, given the authority and expertise that actually exists within the CMA. So right off the bat, I felt that they were coming to the table being humble and asking for guidance, which I think a lot of organizations need to do in their reconciliation journey.


Because there isn't a lot of Indigenous staff at the CMA, we used Indigenous consultants to help us. And again, it was recognized that we needed the Indigenous voice to be involved in this work. So with our partners Envision, they have really helped the CMA see the importance that just the Indigenous involvement, Indigenous leadership, Indigenous guidance, and I think Paula said it as well, the Indigenous decision-making that's required along this journey, they have put in the right supports to really enable this work that needs to happen.


TANYA TALAGA: Exactly. And Alika, I wanted to ask you the same question that I just asked Sarah. What makes the approach the CMA took and continues to take unique and important?


ALIKA LAFONTAINE: I think when you go down the path of reconciliation-- I've been through it with several different organizations, some doing it better than others. And unless you're a little scared, I think as an organization, you really aren't in the right place. And if there's not a certain level of tension, I think that you're not really getting down to the real core issues of what you have to work through.


And this is a big part why it's so important for work within organizations that are truly committed to reconciliation to include Indigenous folks who are actually part of the community. I can tell you that, just like Paula was alluding to, that the success of the Guiding Circle was almost wholly through lateralized trust that came from folks like Sarah.


I know in the Guiding Circle I heard things that I heard in other places. With the Indigenous Health Alliance when we were working with it, I had vice chiefs come up to me and ask, why are we at this meeting with HealthCareCAN? Why are we engaging with the Royal College of Physicians and Surgeons? People don't often see the value of engaging with organizations because they've been trying so hard to change things and make them better in their own communities and they've been let down in the past.


And so having a person like Sarah or people like Paula sit down with folks and take the trust that they've developed and push it towards the organization and have the organization actually deliver on that trust, I think is something that's really powerful. And I think the reconciliation sometimes is sold as a straight line. All you have to do is this and then you reconcile. When in reality, it's a very zigzag, twisted set of steps you have to make.


And sometimes you step forward a couple of steps and then move back forward, but people need to have that space to develop the trust that things are actually going to change. And I can say with the CMA, we've had all those different elements. I think we've landed somewhere really powerful, but there's a long way to go still. And I think the Canadian Medical Association recognizes that.


TANYA TALAGA: Thank you for that-- thank you for the answer. And actually I'm going to circle back now and go to Paula because I kind of skipped over you and asking you the very first question. And so I want to give you the opportunity to answer. I apologize. That was my fault. But you answered it, but I'm just going to take you back there again, Paula, and ask you about tangible action on reconciliation from your end in particular and the work you're doing. So yeah, I didn't ask you about that so I'm going to ask you now. You're on mute there.


PAULA CASHIN: Yeah. So for me, I guess I can say that reconciliation starts with accepting the truth about the past, about ongoing harms. I know of an organization that's serious about reconciliation based on whether I feel like I can present my authentic self, whether I feel like I truly belong. And I think belonging is really a step beyond equity, diversity, and inclusion that we often talk about because it involves having more than just having diversity at the table and diverse voices and diverse faces.


It means that your whole self is really welcomed and accepted and included and valued by others. It means you have equal opportunities to the non-Indigenous people in the organization. And I really felt that acceptance at the CMA. I know I do a lot of work in EDI and I'm often on committees within organizations. And I feel safe within the committee with other Indigenous or Black or racialized physicians, but you never really feel accepted by the organization. And this work has been very different.


The CMA has really put the Indigenous health goal on the front. And as I said earlier, it's come from the top-down. So it's been identified as a very important issue for the board, from the board chair, from the executive. So I think that's the difference that we're seeing here, is that it's truly identified as something that's very important.


TANYA TALAGA: Belonging is something that we all struggle with and find incredibly important as Indigenous people. And I can only imagine that when you're working in a medical setting that it's even more so, especially with the history of medicine and healthcare in this country concerning our people.


I have one question left and then we're going to shift the questions from the audience. We're going to start asking if anyone out there has something that they would like to contribute. But before I do that, I would like to ask, what is next? Where do we go next on this journey? And to start off, I'm going to ask you, Sarah.


SARAH WILLIAMS: This is a great question because I think we all have a similar vision but different reasons. I know for me what's next is the fact that with the work that we did with the Indigenous Guiding Circle, it proved itself to be so informative and meaningful on both sides of the partnership that the CMA has and is investing in doing this process again and recognizing that this is really the good way to do work with Indigenous people.


I think it's important that we maintain the relationships that have been developed with the first Indigenous Guiding Circle. So when we actually are doing more work with this new Guiding Circle, we're hoping to have some members from the original group on that just for continuity and the memory that's involved.


Yeah. I really see the Guiding Circle, the new Guiding Circle, which I'm calling it because it's not the first Guiding Circle. I'm really seeing that being the next big part of this journey. And again, ceding over the power to give Indigenous People the place to make the decisions that will best influence healthcare and make a difference for us.


TANYA TALAGA: Thank you very much for that answer. And before I ask Alika the next question, which was the same question as I asked Sarah, I would like to remind everyone that if you do have a question for the panel, please submit it using the Q&A button. And you can also upvote questions. And so those are the ones that I see and they all get pushed to the top. So if everyone agrees that they'd like to see those ones answered, please upvote. Alika, what is next? Where do we go from here?


ALIKA LAFONTAINE: Yeah, I think what's next is the actual hard work. We brought the organization with the organization to a place where it's ready to take that first step into the unknown. I think leading into what comes next as we move into the next fireside chat and we continue to expand on, not just what cultural safety is, but where the CMA is at and where it goes next with that next chat, I think the CMA is going to step into the unknown.


What reconciliation has meant for a lot of organizations across the country is adopting a set of recommendations. We'll do 1 through 10 and then reconciliation will be fulfilled. There'll be a bright, new future for Indigenous Peoples. When in reality, I think what reconciliation ends up being is creating space, like Paula was saying, around the table. The actions that I've seen with Sarah and having people feel comfortable and safe around those tables. Having your full self accepted and then framing that into what the organization can actually do.


I think that is a key part that Paula mentioned that I'll just underline again. There's a specific value-add that the CMA can provide that is unique among medical organizations and unique among organizations across Canada. And I think true reconciliation isn't a broad brush where you say, we'll fix everything for you, but instead you say, we will fix the things that we're empowered. We will claim our power. We will use that power to help you claim your power.


And I think it's going to be tough. And just like Sarah was saying, we all have different perspectives on how to move forward. But just like our creation stories teach us, it's because we're all positioned differently. The places in the world that we're at, the places we are in this organization give us the opportunity to do something really meaningful. And so yeah, what comes next is going to be the follow-through, and that's always the hardest part, but I think we're ready. We're in a good place.


TANYA TALAGA: Thank you for that. And I'm looking forward to our next fireside chat so you can tell us more. Paula, what is next? What does the future hold?


PAULA CASHIN: So I'm really hopeful that the work the CMA is doing here in the example of Indigenous Health is something that's going to carry over into other organizations. So organizations are going to feel inspired to do this work and to do it in a way that's culturally safe, the same way that the CMA has done. So I'm really hoping it's used as an example.


From, I guess, the CMA organizational perspective, one of our circle members described the Indigenous Health goal's the North Star for reconciliation and the path that the CMA needs to travel. I think that's a beautiful way to say it. And I think it's probably the best way to think about this journey. And the CMA recognizes, as Alika said, that this is a very long journey. We're only just beginning that work. And the organization has made a very firm commitment to walk in path-- walk the path in allyship with Indigenous people and to allow Indigenous people to lead. So I think that will continue.


In terms of the overall journey, the end of the path isn't reached really until every component of the Indigenous Health goal is a reality, especially healthcare that is culturally safe and without racism and a healthcare system that respects Indigenous worldviews, Indigenous practices, and self-determination. So I think if I had to summarize the journey, I would just say at the present time in our current healthcare system, Indigenous patients and providers are really-- they're really focused on just surviving. Ultimately, I see this journey ending with Indigenous people accessing healthcare that they can trust in a system that sees them thrive.


TANYA TALAGA: Thank you very much for that. And so true, isn't it, to-- we're just trying to survive and we're trying to find adequate health care within the system. And that's hard. It's not easy. But initiatives like this and what the CMA is doing hopefully is going to create a more comfortable and balanced path for all of our peoples.


So we have the first question from the audience because we are going to switch now to listening to our audience and asking the questions that they want to hear. And the first question that I'm going to ask, and I'm going to start with Sarah to see if this could be all right for you, the first question is, what are your recommendations for how healthcare organizations can create environments that are safe and supportive for Indigenous health leaders?


SARAH WILLIAMS: Yeah. I think that that question is complex in the sense that Indigenous health leaders exist on many different levels within the health system. There's Indigenous health leaders within their communities, within regional governments and with provincial and federal governments.


So really when I'm thinking of this question, I think we have to recognize the fact that we each start from our own place. I think Alika alluded to this earlier. And that healthcare organization has to set up a way to engage Indigenous people and really ask them, how do we create environments that are safe and supportive? And a part of that process is building the relationships that are needed I think to build trust between the Indigenous people and non-Indigenous people and to build trust that the health system cares about us and has our best interest at heart.


TANYA TALAGA: Well, we'll answer it. We'll answer it. And actually, Alika, I'd like to ask you the same questions. What are your recommendations for how healthcare organizations can create environments that are safe and supportive for Indigenous health leaders?


ALIKA LAFONTAINE: No, I'm going to take some liberty with Sarah and Paula and just say that they share my opinion on this, but we've all been a part of system change for a long time. I imagine you've felt this in the same way, Tanya, in different areas. But it's sometimes lonely being the only Indigenous person and it's exhausting having to re-explain over and over again things that folks around the table should understand, if not in an Indigenous context, just in a human context.


You shouldn't have to justify the need to fix problems that affect a broad amount of people. You should not have to argue that resources have to be allocated towards persons who experience things in a much more acute way. They have worse health outcomes. They have a harder time with trusting healthcare providers. And it's often tough to have people shift from a culture of blame, which, to be fair, we promote in medicine. We blame our patients. We blame our colleagues when things don't work. We blame systems we're not happy about how things are working. To get to a place where we fully embrace the humanity of each other.


And I think that at its core, organizations where leaders thrive, especially Indigenous leaders, are organizations that really embrace that humanity in each other. And to be able to do that in a way that that's real is you have to have more than just one Indigenous person in your organization. You have to create opportunities for them to lean and feel the support of each other. And you need a tone set by senior leadership, not just your board, but also your senior executive leaders, that this is something that we're going to lean into and do a better job of.


There's a lot for the CMA to still do. I think like lots of organizations, having more Indigenous employees at all levels within the organization, continuing to keep Indigenous peoples as a part of the board moving forward. I think it would be a failure if myself, Paula, and Santana who are the members of the board who are Indigenous were the last members of the board who were Indigenous for years to come.


And that takes a lot of work. It takes a lot of ongoing work. And that's why this is such a long and hard process, is because the effort that you have to pour in to really transform something. It's not something that happens all at once. And you reach points where you can really celebrate that things have changed, but then you have to sit down and just get right back to work.


TANYA TALAGA: Well said. Well said. And I think Paula wants to add something here as well. I see that she's had her hand up.


PAULA CASHIN: Yeah, I just want to build on what Alika and Sarah have already said. The key to keeping Indigenous health leaders safe and welcoming their environments is, like Alika said, is having Indigenous health leaders. So not being by yourself, having that community around you and that support.


And particularly when we're bringing in and mentoring younger members, so we have our student member right now is an Indigenous physician, and just having-- she has that support around the table from Alika and from me, and seeing someone like Sarah in an important Indigenous role within the organization. So I just think that really needs to be the focus. If you want safety, you just have to have-- you have to have those leaders in place. And ultimately, that makes the system safe for patients as well because we bring a different perspective, which is probably the most important thing.


TANYA TALAGA: And here's another really insightful question that really says a lot. And this audience question is from Alexandrine. And this question is translated, and it is. I am a medical student and was wondering if you had an approach to suggest when we see, hear racist or misplaced comments. Considering that students are evaluated at all times, this sometimes prevents students from intervening. So what do you do when you hear racist or derogatory or misplaced comments in a medical setting? And I'm going to-- I see Dr. Lafontaine Alika, your hand is up, so you're first.


ALIKA LAFONTAINE: Yeah, I was reading this in the comments. And part of the reason why we created Safespace Networks was to deal with the risk of-- the real risk of retaliation that people have. And I know Paula, like you have your own lived experience Sarah, I can't imagine that you don't have deep knowledge and expertise on this area.


But to the medical student, I just say it's not safe to report. And I think we have to acknowledge that as a starting point regardless of how supportive senior leadership are in health systems, the trickle down impacts of safe spaces have not yet trickled down to your level. When you come out and you talk about things that you've seen or heard or been a part of, a lot of health systems, they're not ready to accept those things.


And so what do we have to do? We have to have folks like myself, folks like Paula and Sarah, create those environments for you because we're relatively more empowered. And so I'd really encourage you that if you do have experiences, if you have someone that you trust that you know will protect you to share that experience with them, it's really important that you don't experience this by yourself, I'd encourage you to reach out to senior leaders.


One of the things that I know the Canadian Medical Association is focused on is how do we enable that? Maybe it won't be housed in the CMA but how can we support other places to kind of bring this and kind of gather these stories? But just as a starting point, don't carry this burden on your own shoulders. I was a medical student 2002 to 2006. I've been in practice for 12 years. I reported a noose hung at my hospital back in 2016 and I was afraid for my job, and I had a national profile. So this is the reality of where you're at. So protect yourself. Share with people that you trust and give us time as leaders to figure this out for you because we are focused on figuring it out.


TANYA TALAGA: Thank you for sharing that. And I can imagine that Paula and Sarah also can share some insight onto Alexandrine's question. Paula, perhaps you could take that on as well.


PAULA CASHIN: Yeah, sure. So I think really what's being asked here and what we have to look at is what power do you have in that situation? So as Alika has already alluded to, as a medical student in that situation, you're probably answering to someone who's going to be, as you said, filling out your evaluation. It becomes very difficult in that moment.


One thing you can do if it's a low stakes sort of situation is just ask someone to repeat themselves. So ask them, what did you just say? Sometimes that causes enough reflection that someone will sit back and say, OK. Well, maybe I shouldn't have said it that way. Or, at least they can understand that it upset someone that was in the room. So that's what you can do in a low stakes. But as far as, like Alika has already said, it's sometimes best to reach out to someone with a bit more power.


One of the things I love about what the CMA is doing in the space is our mentorship program. They fund it through the Indigenous Physician Association of Canada. So the IPAC has set up a mentorship program where you can be matched with a more senior person or a physician. And that person can be a help for you and someone to reach out and just to discuss it with.


But ultimately, at the end of the day, it's what Alika says, it's going to have to be system change. We need a process in the system that makes it safe to report when these things happen. Right now as a medical student you feel like you don't have that power. I can tell you as a staff physician, I don't have that power. So it's not unique to your stage of training. It's a problem in the system. It's a problem that we recognize and hopefully it's a problem that we're going to be able to solve in the near future.


TANYA TALAGA: And Sarah, I'd like to ask you your opinion on this as well. I mean, what-- I'm sure you've probably had comments said to you and it's uncomfortable. And how do you handle it, especially if it's coming from your peers? It's tough. What do you say?


SARAH WILLIAMS: Yeah. I really-- well, I'm learning even in this conversation. I think like what has been shared so far is very meaningful and very powerful and honest in the sense that we have to be honest about these power relationships that exist. We can't actually address something unless we honestly and truthfully look at what is in existence.


I've carried the burden of not seeing anything, not feeling empowered, not even knowing how. It is a skill to be able to call somebody on inappropriate behavior. And as a medical student, you definitely aren't empowered. I think, again, it's a system change that needs to happen. And I think the In Plain Sight report that was produced here in BC about racism in the BC healthcare system, it identified this and it had said the system needs to develop an approach for people to report things on different levels, this being one of them, where a colleague can call out another colleague or report a colleague.


And I think part of this whole journey is then what do we do when that calling out happens? We can't just wipe the slate and say, you're fired. Get out of here. We have to be very intentional in how we approach these situations because it really is an opportunity for learning and it's a larger opportunity about everyone's safety.


TANYA TALAGA: Very well said. It's hard too, isn't it? The next question has as a point. And it's someone who is saying to us, and I know who this person is. It's Marion Crowe. She's saying, thank you very much for your collective work. She's also saying too, it's taxing and emotionally exhausting for Indigenous people to do this work.


And I actually just wanted before we get on to the rest of her question, I wanted to ask all three of you how you handle that. I mean, like that's a tough thing, isn't it? It's like I know it feels like you've got two different jobs too. You have the job that you're doing. You're practicing medicine and then you're also educating. You've got that second other-- it's almost like a burden sometimes. How do you handle that? Alika, I'll start with you.


ALIKA LAFONTAINE: So I just want to acknowledge that for any folks working in this space, I know it's hard and I acknowledge how difficult it is for you. I think for myself-- so in Pacific Islander culture, you're named after your ancestors. And my middle name is [INAUDIBLE]. And that's the name of an ancestor, who without going into too much detail, has a whole lot of bad karma.


And my grandfather, when he was alive, told me at one point of the reasons why we wanted you to be named after him is so you could clean up his bad karma. Do good in the world. That way, you could fix that part of our family tree. And I've thought a lot about that over my lifetime.


And I'll say that in moments where I feel overwhelmed, whether it's because I feel really small sitting around tables that are unwelcoming or I feel overwhelmed because I'm feeling and experiencing so much trauma from other folks or reflecting on my own, I think to myself, if not me, who?


And I think that folks like Paula and folks like Sarah and leaders like Marion and everyone else who is really struggling, I think the reason why we continue on is because we recognize, if not us, who? Tanya, you authored many books that have changed the conversation around very, very important things in Indigenous health and in other areas.


And I think that the question that I think a lot of us ask when we feel like giving up is, if I give up, who's going to actually do this work? And so, yeah, just once again to everyone out there who's struggling, who feels like things are heavy, I'm there with you carrying that load. But yeah, if not us, who and when?


TANYA TALAGA: It's beautiful and it's so true, isn't it? Somebody once described this work to me, it's kind of like playing musical chairs and the lights go on, you're the one sitting in the chair. It's like no one really has to do this but you just find yourself in the position. And so you've got the will of your ancestors behind you and you just have to keep going and keep going forward.


Paula, I wanted to ask you that same question too. How are you handling things as well?


PAULA CASHIN: So for me, as Alika said, it's good to have your colleagues around you to support you. And Alika, in the Guiding Circle, it was this built-in support system so you could reach out to anybody, you could have those conversations. Sarah and Alika, and I would often talk after and just support each other that way.


I also have-- very fortunate to have a family I can lean on. So my husband is a physician so he understands the challenges of the medical system. My sister is a radiologist so she gets it. So I have safe places at home to decompress. And I think we don't acknowledge that enough because it's not just us doing the work, it's our families doing the work. So if I'm having a rough day and have done this work and I'm just done, I have a family that recognizes that and supports me through that. So that's a very good thing to have in a very safe place to be.


I've had amazing colleagues. When I've had the difficulties in my workplace, I had the full support of the medical staff where I worked, which really helps you survive that. And not just my local physicians, but across the country. So when I was going through that difficult time, a physician in Alberta, I think she might be online, Dr. Kim Kelly reached out and gave me that support that I needed at that moment in time. And that can be life-changing.


So I think when we see other people going through this and we see other people struggling or see people doing a lot of this work, just reach out every now and again and just say, how are you doing? How are you handling this work? Because I know a lot of people that do-- like Alika literally speaks on this every single day for the last year.


And I don't know if people that don't do this work realize how difficult that is to be the face of that all the time. So I imagine he has a huge support system at home as well as within the CMA and within his community. So I think that's how you survive it. And step back when you need to, that's the other thing. If you need that break and you're just sort of at the point, if it's a day, if it's a week, it's a month, you just take it and you do the self-care.


TANYA TALAGA: Miigwech. Very true. Very true. Sarah, I have to ask you quickly about how you feel too. How do you practice self-care when it gets a lot because it is a lot.


SARAH WILLIAMS: Yeah, great question. I think I always fall back on the relationships that I have in my life. I find that really like when I feel safe and I feel connected, that's where I get energy from, from being in relationship with people, that being my family, friends, and extended family. And I think it just goes to show that it's together carrying the load, the load is that much lighter. And I have to say having Indigenous board members is very significant. I recognize that this definitely lightens the load on me.


And I also just want to say there is a non-Indigenous side to this. And for those people who are a part of the relationship but non-Indigenous, a part of helping us carry the load is to really listen when we speak and really take value in what we have to say. And when we say this will make a difference, that usually will make a difference. And that way, you can support us in making sure that this work is-- there's continuity to it.


TANYA TALAGA: So well said. Very well said. Paula, you mentioned-- I believe you mentioned Kim Kelly, and Kim Kelly has a question. So I'm going to ask it. And I'm going to put this question to you, Paula, and also to-- well, to all of you. What is the tipping point-- what was the tipping point for the CMA to start prioritizing Indigenous issues? Alika, we'll start with you.


ALIKA LAFONTAINE: Yeah, I think each of us is going to have a different perspective on this. But I could say as a spokesperson, there was a lot of symbolism around having Sarah join the CMA, Paula join the board, me become the first Indigenous president. And sometimes we think that it's those moments that change everything. But in reality, for me where I sit, it's kind of like a layering. And so I think tipping points are sometimes construed as if that didn't happen, things would not have moved forward. When in reality, I think this had been building for a long time.


But what I think the CMA was waiting for was having the people in place to kind of help to shepherd it and kind of accelerate it. And so maybe I'll rephrase Kim's question just a little bit and say, what really accelerated the work? I think what accelerated the work was the bravery of folks like Sarah and Paula like coming out and speaking truth to power. I think things had accelerated the work was having senior leaders in the board sitting back and saying, we believe you.


It was having members of the Guiding Circle tentatively coming out in that first meeting and kind of sharing some things but not quite sure what was going on but trusting Sarah that if they dove into this, something actually would change, and then seeing that things actually changed. It was engaging with a First Nation company to help with the consultation that had to do with engagement with what we're doing. It was a variety of many, many different things. But all those things layered until they eventually created the path for us to walk down now.


And I think keeping up that pressure, keeping up the momentum will depend on the people here continue to push to work forward but also us eventually being replaced by other voices. And I think that's one thing that sometimes we don't do great with reconciliation. We don't do a lot of legacy planning. Eventually, I will move on from the presidency this summer so what happens to the next person that's in place? How do they continue to embrace this movement? And same for the other folks on the panel.


TANYA TALAGA: I have to ask you, Paula, because you reference Kim Kelly. Do you think there was a tipping point for the CMA to prioritize Indigenous issues?


PAULA CASHIN: As Alika said, a lot of this sort of started just before we got to the board. I think that's the reason why we were here and we were recruited to be on the board, is because the CMA was looking at that. I think it's just been a really fortunate occurrence of events where we had a CEO and executive team that prioritized this and we have very strong leadership from the board. So our board chair currently and even coming before Alika when we had leaders like Dr. Gigi Osler and Dr. Ann Collins, they certainly prioritize this.


And the amount of support I've had from those leaders in this organization, and in particular from the board chair right now, I just think that it was something that they wanted it and they wanted to work and they certainly put in the hours and the effort to make it happen. And now it's just become part of the organization and part of Impact 2040. And as I said, it sort of permeates all the organization now. So it almost seems like it's always been there looking back from where I sit now but I'm not sure it was a tipping point so much as people saw the need for change and they worked really, really hard to make that happen.


TANYA TALAGA: I'm going to move on to one more question because we only have a few more minutes left. And this is a good question. And I'm going to start with you, Sarah. And it's about ombudspeople. So what are your thoughts, and I'd love to get all of your thoughts on this one, on having an ombudsperson position. Saskatchewan has introduced one for anti-Indigenous racism. Do we need a national one?


SARAH WILLIAMS: Yeah. I welcome it. I love this question because I think it could conserve such a significant role in many ways. It can show that the country is dedicated to this work by having that position. And I think that position can make change. And it allows-- it's another part of this process of everything that we're talking about but I really see this being significant because it is-- I'm imagining it on a national scale. It's really showing that as a nation, Canada is invested in this and Canada cares about the health of Indigenous people.


TANYA TALAGA: Absolutely. Alika, what are your thoughts?


ALIKA LAFONTAINE: Having been someone who's gone through the complaint process and having helped others go through the complaint process, and then also being a past department head over the North zone of Alberta for anesthesia, having actually been one evaluating complaints, I'd say that the ombudsman position really depends on their ability to speak truth to power, but then also the ability for folks other than the ombudsman to shepherd change.


Ombudsman's are symbolic. And just like Sarah said, they're a manifestation of people saying, this is actually important. We should focus on this. But by themselves, they don't create change. I think one of the things that I've realized about the stories we tell ourselves, whether it's in racism or whether it's about pan-Canadian licensure or team-based care or anything else that we're trying to change in healthcare is it depends what we do when we walk away from the conversation.


And so are Ombudsman's an important part? I do think they are, but we should not forget the power that we have to make change and that at the end of the day that's actually what changes systems. It's all of us together moving in a new direction and responding to the stories that maybe we'd never heard before in a way that we didn't act before.


TANYA TALAGA: Also, just an addition onto this too as well, and I'll ask Paula this, do we need one for every province? Does every single province need an ombudsperson position or is it-- should there just be a national one or should we do a national and also provincial?


PAULA CASHIN: So my thoughts on this are a little bit different. I actually don't think an ombudsperson is going to really change anything so I can just-- whether it's in provincial or whether it's national. So I had an ombudsman report done when I experienced my workplace issues and I can say that the behavior towards me actually escalated after that because the ombudsman report doesn't really have any teeth. So there's no mandate that you have to follow that ombuds recommendations.


So if you're working for an organization, they're in an echo chamber themselves. They don't believe that their behavior is wrong in a lot of cases and they don't see it. So when they get this report, they're like, OK, well, that person obviously didn't have all the information. Or they just don't agree with it and they don't have to agree with it. So in my situation, I feel like it made things worse in a lot of ways.


I think what we need is a national physician dispute resolution process, and a process that involves mediation and education as well as a process that if mediation doesn't work, that someone is in place that can make a final decision and make enforceable recommendations that will actually protect the person that's being harassed or the person that's experiencing discrimination because right now we don't have that and an ombuds report is not going to provide that.


So I have very strong feelings just because I've been through that myself personally. And I have a master's of law and dispute resolution. And when I've studied this, I don't think, given the power dynamics that currently exist in healthcare, that the ombuds is going to make much difference. But I think we need a national program. It just needs to look a bit different in terms of dispute resolution.


ALIKA LAFONTAINE: And I think going back to what we've talked about earlier in this conversation too is that it's just not safe to report.




ALIKA LAFONTAINE: And so I think that if an ombudsperson makes it safe to report, which obviously did not happen in your case Paula because the risk of retaliation actually got worse, it could be a part of the solution. But the core issue has always been people see things that are wrong. And when they report them, worse things happen to them. And so that's actually what we have to fix. And whether it's an ombudsperson or someone else, I think that that's what we have to get down to.


TANYA TALAGA: Thank you very much for those honest answers and for a variety of perspectives, lived and theoretical. So it's very good to hear. We have two minutes to thank everybody for being a part of our conversation today and thank the audience very much for all their questions. And I'm sorry we couldn't get to all of them. But I did want to give the final words to each of you, Alika, Sarah, and Paula. And of course, we have to be both 30 seconds long. So Alika, I will start with you with your final closing thoughts.


ALIKA LAFONTAINE: Yeah, thanks for joining us tonight. I think you can see with these chats, it's part of a journey. And I hope you join us on the third chat. We'll continue building on what we talked about here. And I'm just very excited to be a part of walking this with the CMA.




SARAH WILLIAMS: Sorry, wasn't ready there. It's just been a really great pleasure to hear and converse with my colleagues about this important topic. And then it's also nice to know that the community, whether it's Indigenous or non-Indigenous, is listening and paying attention. And I think, again, that's how we move together ahead on this journey.


TANYA TALAGA: Thank you, Miigwech. And Paula, your closing thoughts.


PAULA CASHIN: Yeah, so thank you, everyone, for joining. And I hope particularly if there's leaders out there, that you take some of the ideas that the CMA has been doing in this area and how we've been doing this work and use it as a model to create change in your own place where you are. I think that's very important going forward.


TANYA TALAGA: Miigwech, thank you very much for everyone joining us. And I want to remind you that on June 12, we have our last fireside chat to discuss the meaning and importance of an apology to Indigenous Peoples. There is a link to register. If you haven't already done so, please do so. And that's in the chat. I look forward to continuing this conversation with everyone in June. And I'd like to say baamaapi. It means that we will talk again soon, not goodbye. So have a good evening, everyone. Miigwech.

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