OMATalks panellists examine causes and solutions to inequities in access, treatment
The medical community can talk openly about racism now, but concrete work is required to end health-care disparities faced by Indigenous Peoples, said panellists at a recent OMATalks virtual event.
Award-winning journalist Tanya Talaga moderated the discussion with four Indigenous physician experts on the eve of this year’s National Day for Truth and Reconciliation.
Talaga framed some of the discussion around the stories of Joyce Echaquan and Craig Neekan, two cases in which Canadian health care failed Indigenous patients.
Echaquan livestreamed staff directing racial abuse at her as she lay dying at a hospital north of Montreal in 2020. And in 2019, 21-year-old Craig Neekan was turned away from the Thunder Bay Regional Health Sciences Centre after being brought in by paramedics for mental health care. He had a history of suicidal ideation. He killed himself not far from the hospital.
Dr. Alika Lafontaine, president of the Canadian Medical Association, said in the two years since Echaquan’s death there has been little action, despite a newfound openness in the discussion of racism in the health-care system.
“As far as those big moves, like the ones that you lean in and actually make a difference in people's day-to-day life, we have a very long way to go with having Joyce's life make the change that I think it needs to,” he said.
He said it reveals that Echaquan felt the need to livestream her abuse so people would believe her story.
“It's a reminder that we still don't honour the stories of people who are going through these horrible experiences,” he said.
Dr. Lafontaine added that instances of racism are underreported because Indigenous patients fear losing their health-care provider if they report abuse. Reconciliation requires trust, he stressed.
Dr. Suzanne Shoush, Indigenous health faculty lead at the University of Toronto’s department of family and community medicine, said Indigenous Peoples anticipate racism in the health-care system and, to mitigate that, they may self-medicate, leave mental health issues untreated or delay care.
Health-care workers may have negative biases against patients they perceive to be on substances, homeless and Indigenous. “When you allow that bias to trigger …that disdainful, contentious, contemptuous reaction, you’re going to make a decision that will actually kill the patient. And we're seeing that play out again and again,” she said.
Referring to the Neekan case, Dr. Shoush recommended a community-based model of care. “Why was there not a place where a team of aunties (would be) looking out for him — somebody to talk to, somebody to make him tea, accompany him to the hospital, sit there with him?”
Dr. Benjamin Lalonde, chief of staff at West Nipissing General Hospital, said racism is less likely to occur at his hospital where the chief of staff is Indigenous and the board and staff do the educational work, such as bringing in elders and doing land acknowledgements.
While he is in a position to inspire people, he acknowledged barriers to Indigenous participation in the medical community.
“If you’re worried about trying to get drinking water… If you're worried about trying to just manage the basics of life, you’re not worrying about trying to make applications to medical school. You're not worried about trying to become a physician or nursing leader.”
Dr. Chase McMurren, family physician and theme lead for Indigenous health in the MD program at the University of Toronto, said only about one per cent of physicians across what is called Canada identify as Indigenous. He said it’s important to acknowledge the work of Indigenous physicians and to support Indigenous medical students.
He called for a different approach to medical care to increase equity. When serving patients impacted by and experiencing intergenerational trauma, physicians need to focus on the person, not only their symptoms, asking respectfully how they can support. The patient is the expert in their life, not the physician, he said.
Dr. Lafontaine said he hoped health-care professionals watching the panel would do a deep dive into their own biases and beliefs about the Indigenous community.
“Take some time to reflect on what you actually think about Indigenous Peoples ...There are a lot of beliefs that we pick up through the things that we saw growing up, the things that we experienced in school, our own personal interactions with First Nation and Métis people and then in training.
“Unless you come to grips with yourself and what you believe, you can have all the education in the world, and it won't change anything,” he said. “So, if I could have one wish, it would be for people to take a really hard look at what you believe, and then decide if you still want to believe that.”
And Dr. Shoush urged the medical community to welcome solutions Indigenous communities can offer to address inequities.
“First, we learn nothing for a very long time about Indigenous people. And then we just learn the disparities. We're in this very deficit-based view of Indigenous people without understanding the strength of kinship systems, knowledge systems and the strength that we have within our community.
“We need to remove the word no from the vocabulary of anybody that Indigenous care providers speak to … I think that we can start trying to shift resources to these Indigenous communities who do have answers.”
She further challenged the medical community to assess its efforts to solve disparities.
“Imagine that an incredible investigative journalist like Tanya might one day come looking at you. Are you going to be proud when your organization is picked apart? Are you going to be proud when your patients are interviewed? What are you actually doing to change the status quo?”
OMA CEO Allan O’Dette said he hopes the panel discussion will spur more discussion and action on these issues which are very important to the OMA.
“There is also an opportunity to learn more about Indigenous issues and reflect on how we, as allies within the health-care system, can do better. And we can do better,” he said.
“Our Prescription for Ontario: Doctors’ 5-Point Plan for Better Health Care aligns with the call-to-action released by the Truth and Reconciliation Commission of Canada. Specifically, our recommendations: Improve equitable access to care; ensure health care is culturally and linguistically safe; address social determinants of health; address the impact of the opioid crisis and mental health issues; focus on innovative collaborative and culturally sensitive training for physicians in rural and remote communities. And address among the most significant issues, and that is safe drinking water for everyone.”
This panel is the latest OMATalks event, a thought leadership initiative the OMA launched in 2019 to promote discussion of key health-care issues and showcase doctors leading the way as Ontario transforms its health care. This is the OMA’s sixth OMATalks.
Katherine Kerr is an Edmonton-based writer.