Path to reconciliation in health care needs Indigenous leaders

As a child, I travelled to Inuit and First Nations communities in Nunavut and northern Manitoba with my father Lorne, a legendary bush pilot. He showed me the beauty of Indigenous people and their land and taught me about the power, strength and resilience that comes from embracing this connection to the land, its spirit, its beings, and Creator.

As a Métis family doctor, I see the powerful kinship ties, knowledge and value systems in Indigenous communities I serve. They have survived generations of racism and genocide and continue to be a foundation of strength and purpose. These are the tools we need to heal the health-care system and its terrible legacy of racism.

As a medical student, I also learned the power of western knowledge systems and the ability to “save lives,” such as prescription medication and invasive surgical procedures.

Too often, though, the methods of western medicine come into direct conflict with my experience and values as a Métis woman and First Nations ally. Indigenous patients find diagnosis procedures intimidating and their previous experiences with this system are often traumatic. The deaths of Joyce Echaquan and Brian Sinclair while waiting for hours in ERs came as no surprise to Indigenous people who faced similar experiences.

Health-care leaders in Indigenous communities taught me how to bridge the impact of western medicine with the humility, values and teachings of Indigenous Ways of Knowing. Blending these knowledge systems in practice has allowed me to improve patient care and outcomes. My Indigenous patients tell me they feel heard, honoured and respected.

My joy at work, resilience to burnout, and happiness has been enhanced by this journey of better understanding these two knowledge systems. But in the bigger picture, combining Indigenous and western knowledge systems has the power to create space for reconciliation.

The first step toward ending systemic racism and daily discrimination targeting Indigenous people in health-care settings is focusing on inclusion and respect. The only way to move forward on this is through long-term partnerships with Indigenous communities and recruiting and promoting more Indigenous leaders in health care.

Kiikew (pronounced Kee-Kay-Oh) seeks to create partnerships between Indigenous health-care professionals and health institutions. Our mission is to build bridges of understanding between western medicine and Indigenous knowledge systems. The most important of these bridges is creating and strengthening networks of Indigenous health leaders that will provide a path to improve health outcomes for patients.

These leaders will not just be in primary care. To achieve reconciliation, we need leaders in ultrasound, medical records, nursing, dentistry, pharmacy, mental health, among other areas that touch Indigenous patients. Once Indigenous health-care professionals find a purpose in these fields, we can unlock so many other ways to further reconciliation.

As the dean of admissions at a major Canadian medical school, I know the barriers to Indigenous participation in the health field are high and discriminatory. I faced them myself as a student, and other marginalized people are telling similar stories. Equitable medical care for our First Nations communities depends on bringing down these barriers.

We cannot rely on health-care institutions to reform from within. The solutions will come from outside the current system, which is based on colonial principles of white supremacy that allow Indigenous people cry in pain for hours in ERs only to die from negligence while being subjected to racist taunts. They will come from collaboration with Indigenous doctors, nurses, administrators and other health-care professionals. They will come acknowledging the perspectives and understanding of health and wellness from Indigenous patients, children, parents and community leaders.

For example, there are innovative approaches to recruiting more Indigenous medical students, capable of becoming energetic leaders, to university programs. But we need to move faster.

Faculties and colleges training health-care professionals must take a holistic admissions approach to attract even more Indigenous students who have faced challenges in the past.

We are all aware of the importance of grades, test scores and evaluations to assess student capabilities. These are useful western standards, but these academic markers need to consider the context of the applicant's lived experiences: Were they raising a family while attending school? Did they have a full-time job? Did they come from a rural background? These factors indicate that a student was able to perform well at high school or in an undergraduate program while juggling adversity and may be more likely to succeed in our health professional programs.

In addition, they bring life experiences that help them to not only understand but also be better prepared to care for patients from communities not currently well served in our health-care system.

The only way to close the gaps in health care for Indigenous Peoples in Canada is to admit, train and promote First Nations, Métis and Inuit applicants into senior health leadership positions. It is the first step toward a new partnership honouring and incorporating Indigenous Ways of Knowing into admissions, training programs and daily operations of our health-care system. True partnerships like these will heal not only Indigenous Peoples and their communities, but the Canadian health-care system as a whole.

Dr. Sara Goulet is a member of the Métis community from the Red River Settlement with roots in Lorette, Man. In her youth, her father, a bush pilot, would take her with him, sharing the beauty of the Kivalliq region and the resilience of the First Nations and Inuit communities. Today, as a practising doctor and dean of admissions at the University of Manitoba’s Max Rady College of Medicine, Dr. Goulet mentors, advises, and advocates for Indigenous people. Her mission is to make health care and educational settings safe and representative. She can be reached at [email protected].