The release in 2020 of the In Plain Sight report was a wakeup call about the need to address Indigenous-specific racism and discrimination in BC’s health care system. All health care workers have important roles to play in creating positive change, beginning by examining our beliefs, building our understanding of the past and present reality of health care for Indigenous peoples, and considering the role we can each play in building an equitable and inclusive health care system for all British Columbians.

Working towards this goal, VCH Indigenous Health, the VCH Physician Diversity, Equity and Inclusion Committee, and VPSA hosted the event, Honouring our Indigenous Physician Leaders. This special discussion and Q&A with three of our local and national Indigenous physician leaders took place on June 21—National Indigenous Peoples Day. The event featured Dr. Alika Lafontaine, 2021 president-elect of the Canadian Medical Association, Dr. Don Wilson, incoming regional medical director for VCH Indigenous Health, and Dr. Terri Aldred, medical director for primary care at the First Nations Health Authority. Dr. Brittany Bingham, director of Indigenous research at VCH, facilitated the virtual session, posing questions to each of the panelists.

Commenting on his lived experience of racism and how it has affected his work, Dr. Lafontaine recounted the story of his brother’s visit to an emergency department for abdominal pain. His brother was asked inappropriate questions and was not offered proper evaluation in terms of lab work or imaging. He phoned Dr. Lafontaine to seek advice on how to get a second opinion and after reassessment, underwent emergency surgery. His brother was left feeling that no matter how much he contributes to society, he was seen as “just another Indian.”

“We need to get to the point where all health care workers see people for who they are, not who they think they are,” said Dr. Lafontaine.

Dr. Bingham asked the panelists for their thoughts on physicians who deny there is racism in the health care system, or who are indifferent to it.

“There is incontrovertible evidence that racism exists if you’re willing to look,” responded Dr. Wilson. “The whole of Canadian society is set up to benefit white people… often at the expense of non-white people. People need to educate themselves and not rely on the “token” Indigenous person to do all the research.”

Many non-Indigenous physicians want to help and wonder how they can be part of reconciliation.

“It’s important to do your own work and continue to educate yourself,” said Dr. Aldred. “No matter how good an ally you are, it’s not the same as lived experience.”

There were different perspectives on whether anti-racism and cultural training safety should be mandatory.

“What are we really asking people to do?” asked Dr. Lafontaine. “We need to train health care workers on how to manage conflict as well as to understand the true history of Canada. These are not taught in medical school or in leadership courses. Eliminating racism will create a better work environment for everyone. A collaborative, open system that is based on trust in a better way to practice.”

“It’s challenging,” agreed Dr. Aldred. “Once you make something mandatory it can change the dynamic. It really depends how the training is set up and how people are called into it. It can be hard if people aren’t ready to talk about difficult things like trauma, poverty, and homelessness.”

“I see tremendous value in cultural sensitivity training,” said Dr. Wilson. “I don’t think it should be mandatory, but strongly encouraged. It gives a basic context so understanding can begin. A major advantage of such training is it provides tools and approaches that enable health care providers to improve cross-cultural interactions and care universally.”

All three agreed on the need for transformation. Our current health care system was developed from colonial roots and was designed to fail Indigenous people.

“There are overwhelming disparities caused by colonialism and it impacts everyone,” said Dr. Aldred.

“Colonialism is the theft of land and resources,” said Dr. Lafontaine. “There needs to be a transfer of resources or more resources need to be added, or there will never be change.”

“The focus needs to be on people,” concluded Dr. Wilson. “We need to build capacity in our own population and that’s happening now.”

Resources

Power and Privilege in Canada by Dr. Amy Tan

The Inconvenient Indian: A Curious Account of Native People in North America by Thomas King

So You Want to Talk about Race by Ijeoma Oluo

Caste by Isabel Wilkerson

The Deepest Well by Nadine Burke Harris

White Fragility: Why It’s So Hard for White People to Talk About Racism by Robin DiAngelo

My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies by Resmaa Menakem

21 Things You May Not Know About the Indian Act” by Bob Joseph, et al.