Fireside Chats on Indigenous health: ‘Cultural safety can happen today’

Video transcript

TANYA TALAGA: Boozhoo! 

Hi. Hello. My name is Tanya Talaga. I am thrilled to be here. [Introduction in Ojibwe]. 

I am coming to you today from my home in Tkaronto. I am here. I am here. This is where I live and where I work. This is the land of the Mississaugas of the Credit. This is the traditional home of the Anishnabeg, the Haudenosaunee, the Huron-Wendat people. 

This is the Dish With One Spoon territory. I am grateful to be here. I am grateful for all of the elders that I know, all of the people that I know, and for all that have come together to live here on Turtle Island in harmony and in truth. 

I am delighted to be here today with all of you. This is such, such an important event. These next three events are so important to the CMA. They're important to Canada. They're important to all of us. 

And I would like to say this is a first, the very first of our fireside chats on Indigenous health. As we know, health is a basic human right. But across Canada, First Nation, Inuit, and Metis communities have faced unacceptable health disparities due to the legacy of colonialism, due to racism. We have felt and experienced as a people so much in our existence here since the birth of Canada. 

Health is a basic human right. But for many of us, it just hasn't happened. Improving health outcomes for Indigenous people must start with Indigenous voices leading the way. 

The CMA is hosting this series of discussions to hear from Indigenous patients, providers, and leaders on how to move forward together as part of the CMA's commitment to tangible action on reconciliation and health care and allyship with First Nations, Metis, and Inuit people. This is important Indigenous-led reform. 

And today, for the very first of our fireside chats, we're going to focus our conversation on the importance of cultural safety in health care for both patients and providers. For the next hour, we're going to hear from two incredible speakers with insights into this topic. But before we do that, I've got to start off with a couple of housekeeping items. 

We're going to start with a 30-minute moderated Q&A with our speakers, followed by a 20-minute Q&A from the audience. Questions will be text based and can be upvoted. We ask everyone, of course, 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. 

I'm not sure if you heard me earlier because I think I was talking when I don't know if everyone was on. But I do want to acknowledge that I am coming to you from Tkaronto. This is the home of the Mississaugas of the Credit. It is home for myself and many other Indigenous communities. This is the traditional territory of the Haudenosaunee and the Huron-Wendat people. This the Dish With One Spoon territory. 

So I'm going to introduce our panelists today. This is going to be a really great hour. And I'm glad that you're here with us. 

And first is a man that needs no introduction, really, to everyone that is joining us on this webinar, CMA president Dr. Alika Fontaine. He has been a health care leader for more than two decades. He is the past president of the Indigenous Physicians Association of Canada, a board member with HealthCareCAN. And from 2013 to 2017, he coled the Indigenous Health Alliance. That 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. Maclean's named him the country's top health innovator in 2023 Power List. And he was among the first Indigenous physician to 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. 

And as the executive director of the Health Care Transformation and Capacity Building at Healthcare Excellence Canada, our second panelist is Denise McCuaig. And she helps leaders and teams make meaningful and sustainable improvements. Her focus includes patient safety and the lived experiences of patients, caregivers, and communities. 

Prior to her current role, she worked at Interior Health in the Thompson-Cariboo region of BC as a director of Aboriginal Health and Mental Health and Addictions. Recognition for many years, her many years of leadership in the not-for-profit sector includes a Champion Mental Health Award from the Canadian Alliance on Mental Health Illness and Mental Health. Ms. McCuaig is a Metis woman, a patient, and she is a caregiver. 

Thank you. Thank you both for being here tonight, spending your time with us and joining this conversation. 

Our first question, our first question for tonight is, what does a culturally safe health experience look like? How is it different from what we've got today? I'm going to ask Dr. Fontaine. 

ALIKA LAFONTAINE: Yeah, thanks, Tanya. I'm OK if you just use Alika, if that's OK. 

TANYA TALAGA: OK. 

[LAUGHTER] 

ALIKA LAFONTAINE: It just feels so formal. I'm really excited to be here with you and to be here with Denise having this discussion. 

I think I have two experiences. One is the side of being a physician and explaining the answer to that question is. And the other side is being a dad, being a brother, being a son, going in for health care myself. And I think that for those of us who have that mixed identity as someone who both provides care and receives care, this is sometimes two different sides of this experience that we have to understand and experience. 

So as a physician, I think one of the things that you realize shortly after starting to provide care is you hold a whole lot of power. And that power isn't something that you earn, actually. It's just something that's given to you because you have that title because people look to you for leadership because you get to make decisions that affect the person who's sitting across from you and their family and their community. 

And I think cultural safety is the proper use of that power to help people navigate towards what they need. And I think a lot of times we overcomplicate what cultural safety actually is. Cultural safety is the act of treating the person across me like a human. It's the process where you make sure that they feel like they're in control in times when their life is out of control. They feel powerful when they're at the lowest points in their life. And so that's the way I think about cultural safety from the side of a provider. 

Now, as someone who receives care or is with a family member, I think the way that I describe it is the absence of hostility in that patient encounter, feeling like the person across from us is seeing us, not this caricature that they've projected onto us. It's not having to argue with the person about what the facts of your own lived experience is, not having to point out that maybe you shouldn't frame it that way. Maybe you shouldn't treat my loved one this way because they don't feel safe. They don't feel like they're a part of the care that you're providing. 

And I think that at the end of the day, what is cultural safety? I think cultural safety is being able to receive the same sorts of opportunities and also have the opportunity to pause and reflect in the same moments that I think other patients who don't experience culturally unsafe environments take for granted. 

TANYA TALAGA: That's really well said. I'm curious, Ms. McCuaig, what do you think? What do you think a culturally safe health experience looks like? 

DENISE MCCUAIG: Thanks, Tanya. That's a really rich question. I think the key word in your question is "experience." And so if I bring forward the perspective of that of an Indigenous patient, I think a culturally safe experience is about choice. 

So much of our lives, our choice has been removed. If you think of residential school survivors, they had no choice in the clothes they wore that day. They had no choice in when they would eat or what they would eat. They had no choice in their expression of faith, their use of language, no choice about human contact. 

And so that's just one example of how choice has been removed from our lived experience. And so the idea that I could have health care where I would be given choices makes it feel more culturally safe, that it's trauma informed, and that we move away from this idea that trauma is about one experience or one traumatic event, but really acknowledging that our lived and current experience of colonization and also our historical experiences can create trauma. Living a life of microaggression after microaggression after microaggression can create trauma. 

And it's also about nonjudgment. So culturally safe is about the recognition that colonization is a contributor to my poor health outcomes and that it's not fully based on personal choices. And so when those things are at play, then I think we have a more culturally safe experience. 

And I guess what would be different from today is that there's more opportunity for health care providers to expand their understanding, their learning and unlearning of our lived experience as First Nations, Metis, and Inuit people in Canada. And as that has become more readily available, it should be that health care professionals and those providing care are more personally invested in growing their knowledge base and so that the burden-- what will be different today is that the burden of educating the provider won't be mine. 

TANYA TALAGA: That's incredibly well said and very true. I would like to take this opportunity, actually, to welcome everybody. I understand there was an issue getting people into the webinar. So attendees are now just with us. 

So welcome to those who are just joining us. And we apologize for the delays in you entering our meeting. But you've come in at a good time. 

I'm about to ask about trust in the health care system. Trust is suffering. Trust has always been an issue, I think, if you're an Indigenous person entering into the medical system. But access seems to have gotten worse, trust and access together. 

Can you talk about how Indigenous patients have been affected by just trying-- when it's so difficult, when we don't really trust the medical system, and then when you've got to try and access it because you really need that medical care, and then you've got longer waits and you can't-- you can't access it. How are Indigenous patients affected? We'll start with you, Dr. Fontaine. Oh, Alika. Sorry. 

[CHUCKLING] 

ALIKA LAFONTAINE: Yeah, I think that trust and access are both accelerating the downward spiral of where health care systems are going. So the first thing that I'll say is trust is freely given the first time. And then once you're betrayed, it's hard to come around to trust again. 

And I think at the core of most physicians' desire to get into medicine is trust. When I applied to medical school, I was thinking through the answer to why do you want to become a doctor because I knew I was going to be asked it. And what I settle down to is it's one of the few jobs in the world where you can meet someone who doesn't speak your language, the same language as you, comes from a different part of the world. They sit down across from you, and they know that you're a doctor, and they start telling you about their diarrhea. This is a very crazy type of level of trust and commitment. 

I work as an anesthesiologist. And we have people who come in from a motor vehicle accident. And within two or three minutes, they have to trust that, you're going to take them to a place where you'll make things better and not worse, when they themselves are very worried about them being able to survive or maybe something worse. 

And for Indigenous patients who come through the system, I mean, they've been betrayed over and over and over again by systems that were supposed to be trustworthy, whether it was historically from first contact or any of the things that have happened over the last 100 plus years when it comes to commitments and follow through on a variety of different things, including in health. That trust has been broken over and over again. 

But I will say that patients walking through the door means that they're willing to trust you again. It doesn't mean that they trust you, it means that they are willing to trust you again because that's really the only thing that patients have control over, is whether or not they come or they go. 

And so as providers, I think it's really important for us to recognize that trust is something that we have to earn not something that we have to draw out from folks. Trust will come as a result of us giving people space. Sometimes patients are very angry about the experiences that they've had in the past where their trust has been broken. And sometimes you are the only person that gives them space to actually get upset. 

So sometimes when I hear patients being frustrated or being upset about care that they've received in the past, and they unleash that anger, frustration on me, I always try to keep in mind, it's not really about me. It's about creating an environment where they can get to the point where they can trust again. 

I think what the link that it has to access is that it takes a lot more time, effort, and resources to help someone who does not trust the system work their way through the ups and downs of whatever they're going through than it does if there's a high degree of trust. People share things that they normally wouldn't share immediately. They're very open about concerns, about frustrations. 

Maybe you're suggesting something that they just don't believe is going to work. Or maybe there's another option that you didn't bring up that they could contribute some information that will help create a better treatment plan or other things. So having that two-way trust is really important for maximizing not just the experience of the patient in front of you, but also making sure that other patients get access to that clinical bandwidth that we have within the system. And working on trust, it ends up helping everyone. 

I've yet to meet a physician or provider who enjoys coming in to a low-trust environment. People don't like coming into situations where they feel like the person across the table from them doesn't trust them. And to a great degree, we do have control over creating those environments and making that better for patients. 

TANYA TALAGA: Denise, I wanted to ask you about this, too. When we talk about trust, I'm curious, what are some of the current experiences of Indigenous patients and providers in the health system that you're seeing? 

DENISE MCCUAIG: Well, I think the challenge I see around trust is actually quite foundational to the definition of cultural safety. So cultural safety is defined by the receiver of the service, not by the intent of the provider. And so when I think about things like trust, I think about how one of the ways we can build trust is to be less defensive and more focused on what we as individuals can actionize to make a difference. 

I think about things like wait times in ERs. We've all heard about the long wait times in ERs. Quite often as a First Nations, Metis, or Inuit person, it feels like you're being overlooked because of your ethnicity. Many people have heard of Brian Sinclair, who through the inquiry was identified as passing away in an ER after over 36 hours of not being cared for. 

If that is the context that you're coming through the doors with, then a provider who says it wasn't about your ethnicity, we have Canadian triage standards, and you were waiting because based on the information you gave me, that's where you are in the queue, that doesn't speak to trust. You need to be more relational than that. Also, when we raise our concerns to not hear that it's not me, the practitioner, but it's the system. 

So there's lots of challenges in the system. Having been a provider on the other side, I know, for example, that they're very focused on surgery wait times related to hips and knees. But when they're focusing on that, they're focusing on the population in our country over 65, right? 

We as First Nations, Inuit, and Metis people, we carry a burden of illness that's greater. And so we're more likely to see those hip and knee needs at 45 and 50. But we're not entering the conversation statistically, right? So that's a systems issue. 

But if the provider simply says, well the system is the barrier, without acknowledgment of the role they can play in actionizing our concerns, it contributes to the environment of distrust. And so anything that we can do, I think, as providers to truly listen to our patients and to think about how we can actionize change within the system and acknowledge that we're part of that system, I think that goes a long way towards building trust and relationship moving forward. 

TANYA TALAGA: Very true. Very true. And so in keeping all of that in mind, Alika, what needs to change? How do we make this happen? Sometimes it must feel like turning the Titanic around. But how do you create culturally safe spaces in health care for our people? 

ALIKA LAFONTAINE: I think the first thing that I've come back to many times is that we're kind of going through a cycle over and over again. You look at what happened to Brian Sinclair. The impact of that experience broke through the consciousness of Canada. And, suddenly, we were talking about racism. We were talking about being ignored to death. 

And there was positive change that happened across the country. But then other things started to kind of bite away at the edges of the progress that we were making until we moved into this period, where people were starting to accept some of the things that we're talking about today as normal again. And Joyce Echaquan was another example of a patient experience that kind of broke through the noise and helped us all realize we haven't actually solved this problem. 

I think there's two things that I'd really focus on. The first is that education, if it's just education, it doesn't change anything. People can be very aware that something's going on. But if they don't sit back and, like Denise was saying, reflect on whether or not they have a part to play in fixing the problem, we don't actually get any closer to solving the problem. 

I think the second part-- and, Denise, you alluded to this, I think-- it's tough for a provider to sit back and realize the-- realize the harm that they caused. It's tough for someone who's on their second or third night of shifts that they weren't planning to work as a nurse or the 30th hour of call as a surgeon or anyone else in between who's working really hard within the health-care system to keep things going to recognize that they truly did create harm because they treated someone in a way that was culturally unsafe. 

And there's a process that I've seen people go through, where they recognize that becoming culturally safe, really getting into the space where they change, requires them to change the way that they look at the world, requires them to change the way that they look at themselves. There are a lot of things that Canadians just take as normal, the idea that First Nation, Metis, and Inuit patients walk in those doors and they don't care about their health. They're not invested in understanding, that they don't have the capacity to understand if it was explained, the idea that I'm making a decision without full consultation, but it's for your own good, this paternalistic kind of frame. 

These are all things that are our inheritance that's come from decades and decades of colonization. There's a lot of unlearning that has to happen. And some of that unlearning requires us to confront some really painful truths that in the midst of trying to do something good, we've actually created some harm at the same time. 

TANYA TALAGA: Very true. I have one question left. And then we're going to have to shift to questions from the audience. And I would say to the audience, if you do have a question that you'd like to ask us, please put it in the chat. And submit it with the Q&A button. And you can also upvote questions. 

This is a good one. Is cultural safety different from reconciliation? I'm going to do a rapid-fire answer and question-and-answer here because we've got five minutes to answer, is cultural safety different from reconciliation? That's going to be masterful if you can do it. But I'm going to go to both of you. Denise, I'm gong to start with you, and then I'm going to go to Alika. Yeah. 

DENISE MCCUAIG: OK. I would say yes, they're different, and there are parallels. So I think both cultural safety and reconciliation are a journey. So they're not an outcome. They're not a target you're attempting to achieve, but a lifelong process of the journey. 

So when I think about cultural safety, you have awareness, which is recognizing difference. You have sensitivity, which is recognizing your own place in that relationship, so your own culture, worldview, privilege, unconscious bias. You have competence, which is taking the knowledge of difference and the knowledge of where you are situated and putting those into some kind of action. And so all of those are a journey towards cultural safety. 

And for me, reconciliation is very much the same thing. It's about the repairing of relationship. And I think where we need to move from is the idea that the reconciliation is simply between you as the provider and the patient in front of you. 

It's not necessarily a one-on-one reconciliation, right? It's more about acknowledging that the systems and the society and the institutions that you have been brought up in have created a biases and a privilege for you. And when you are able to acknowledge that and unpack it, you move towards reconciliation and being relational. 

And so parallels, but yes, very different. And we need to quit thinking of them as a place that you can reach, as a destination or outcome, but really focus more on them as an ongoing process. Thanks. 

TANYA TALAGA: Well done. They are really parallel, aren't they? Yes. Alika, how about you? Cultural safety different from reconciliation? 

ALIKA LAFONTAINE: Yeah, I do agree with Denise that they're different. I'd explain it in a slightly different way. I think cultural safety can be achieved right now. Reconciliation will be achieved tomorrow. 

Cultural safety is the absence of harm and hostility, which is something that we can introduce immediately, even if the biases and the attitudes and the discrimination and the racism don't necessarily disappear from the people that we live and work with. 

Reconciliation requires us to change and actually see each other as friends again. And I think, just like Denise was saying, that's more a societal thing. Suddenly, the things that are normalized that are harmful to Indigenous patients, in reconciliation, those attitudes are actually changed. They're not normal anymore. 

TANYA TALAGA: Very well said. Very well said. I'm curious, Denise, since we have here and you can give us a perspective from the West, and just honoring where you're based, and we are approaching the-- well, it's May, the end of May. Two years ago, the missing [INAUDIBLE], the 200 were discovered-- well, rediscovered, I should say-- at the Kamloops Indian Residential School. 

So you must be seeing a lot that's different in these last two years and with yourself and talking about cultural safety. And one of the things that we're seeing with all of the discoveries across Canada and all of our First Nations communities is a lot of wounds are opened. This is hard stuff. What are you seeing from where you sit? 

DENISE MCCUAIG: Yeah. I guess, Tanya, I appreciated your reframing of the idea of discovered. I like to use the word "confirmed." So 250 graves of children that were unmarked were confirmed, right, because we've heard the experiences of our residential school survivors. They told us they were there. 

And so what I'm seeing is different, is there was something about maybe perhaps the idea that it was children that really had people responding in ways that I didn't ever think I would see in my lifetime. And so I remember the day after Tk'emlups te Secwépemc made the announcement. And I'm sitting in my house. And I live about a block and a half in Kamloops from an elementary school. 

But I was sitting in my house looking out the living room window. And there were a sea of orange T-shirts-- parents, the bus driver, the children walking to school. I went out into the community. I got grocery. There was orange shirts. I went to the bank. There was orange shirts. It was like nothing I had ever experienced before. The entire city of Kamloops was just suddenly woke. 

The other experience I had is I had personal friends and colleagues suddenly reaching out to me to ask questions. And I have to be honest, my first response was kind of one of anger. I sort of thought, jeez, 30 years I've worked in Indigenous health care delivering cultural safety training. You all know that this is what I live and breathe. And it took this for my family and my friends and my colleagues to pick up the phone and start to ask me questions. 

But once I got through the process of feeling hurt that no one had bothered to ask those important questions prior, I really thought, these children have given us a gift. They've opened a door in a way that, for whatever reason, we weren't able to get society to open before. And I find the conversations I've had in the last two years to be much deeper, much richer. And I'm happy to report many of my colleagues are walking through their fear of political correctness and asking me challenging questions they were afraid to ask before. And so I applaud them for that. 

And I hope that as they do that, if they are met with anger on our side, that they are patient and that they come back around. Don't shut it down. Don't quit asking. Just know that each person that you encounter is at a different place in their healing journey. And maybe they're not going to respond the way that you would hope. But if we're ever going to move closer together in doing this in a good way, we need you to keep walking through that fear. 

TANYA TALAGA: Miigwech for that. I think that's something that people might not often think about when dealing with an Indigenous care provider, right? I mean, we are all our people. And these are our communities. And we are experiencing this on a different level and then expected to treat, expected to help, and to show the way, too, for others. 

Miigwech for your work. I spend a lot of time in Kamloops. I've been there about five times over the last two years. So I appreciate that. And I'm thinking of everyone in Kamloops this time of year. 

So we have a question right now, the first question from the audience. Trust is earned. And unless you are about to be put under GA after an MVA, can you comment on methods a non-Indigenous physician can use early in an encounter to gain trust with Indigenous patients? That's a good one. I'm going to turn that to you, Alika. 

DENISE MCCUAIG: Yeah, so I actually think in both those situations, trust is earned, to be honest. I think it does require us as providers to develop a skill that we don't really learn in med school or in other medical training, and that's how to manage conflict. And one of the challenging parts of managing conflict, just like you mentioned, Denise, is actually managing ourselves, our own feelings. 

It's tough when you're tired and overwhelmed to meet somebody who's going through their own pain and suffering. You kind of push that down because it doesn't-- there's no pragmatism to having that in the space that you need to be in order to provide people best care. I'm a big believer that patients have first impressions of you, just like you have first impressions of them. So if you come looking angry, if you come looking frowning, if you're not warm when you talk to folks, if you seem hurried, if you don't pause and live in the moment, those are all things that dismantle trust for patients. 

And I think the most impactful advice that I can give to anybody who's listening right now is look around at your institution and identify the behaviors of folks that you yourself would feel would be culturally unsafe. And then try not to do those things. And there's things that we can identify-- being sharp with patients, interrupting them before they have the chance to share. Not reflecting their concerns is real. And I think one of the most harmful things we can do is providers is to have someone start to talk, interrupt them, and then tell them that what they're saying doesn't matter. 

And I think really communicating to folks the plan for what's going to happen-- the scariest part of medicine is that you don't understand what's going on. And within five minutes before a general anesthetic for an emergency case, it's not-- it's impossible to actually have someone fully understand what's going on. But you can paint broad strokes of what's going to go on. You can tell them the stages of what they're going to be going through, how you're going to support them going through. 

And I think for folks who are truly feeling culturally unsafe, what they're hoping for is that warm light that they can kind of hold on to and to feel like they're not going to be abandoned after you're done doing your part. And so you add all those things together, I think can really create a better experience for patients that are going through what often is the lowest point in their life. 

TANYA TALAGA: Here's another really good question. As an Indigenous medical student, how does medical education create more space for teaching of Indigenous ways of knowing and healing in our training? I think this underpins the question of how are we as training providers supposed to make the health care experience more inclusive and safe for our Indigenous patients, if there is a major gap in competency, in our medical education programs, in teaching this knowledge. Denise, you're nodding. So you're it. 

DENISE MCCUAIG: [LAUGHS] Oh. I'm going to learn not to do that. No, that's a question that really resonates for me. I actually think there are skills that we could be teaching and that too often, we stay in the theory without practical examples. So you'll hear things like, "It's important to be strengths based." Well, what does that actually mean, right? 

It's a skill that can be learned. And I think about something that's quite common in psychology, appreciative inquiry. So emergency medicine aside-- let's take more of a family physician setting, I guess. But if you are trying to assess whether I'm taking the prescriptions you prescribed to me in the last visit and you simply say, "So, Denise, are you taking your medication," you're assessing immediately my deficits, right? 

But if you actually approach it with appreciative inquiry and you say, "So, Denise, in our last visit, I prescribed you some medication. Can you tell me if you're experiencing any relief?" You're moving it more to a strengths focus as opposed to a deficit. And then if you actually take the time to chart my strengths-based response and I don't go to my electronic health record and later simply see "patient prescription noncompliant," because then you're going to undo all of this great trust and strength relationship that you've built with me. But appreciative inquiry would be an example of a skill that we can train for, that we can learn. 

The second piece is around the idea of not looking for the Coles Notes version, I guess. So, again, I see this quite often, where you want to be helpful. So you immediately want to move to questions about my spiritual practices and my cultural understandings. 

But you haven't invested in building relationship with me. You haven't even given me enough information to know that you've taken the time in your own educational journey to build your understanding of my lived experience. And so to suddenly be asked to share something so personal, something that I had been so persecuted for in the history of this country isn't going to go very far. So it's about being realistic about what skills can we provide to medical students? What experiences can we give them to build those skills, to do the things we're asking them to do on the outside of medical school? 

TANYA TALAGA: Alika, how about you? What would you say to an Indigenous medical student? How does medical education create more space for teaching of Indigenous ways of knowing and healing in training? 

ALIKA LAFONTAINE: Yeah, so I'm going to give a very pragmatic answer. You're not going to get what you need at out of medical school. You're not going to get what you need out of residency because no one is really doing it that great right now. 

Now, that being said, I think Denise led to two really important parts. The first is that the knowledge of traditional medicine-- I think with the way that we treat knowledge in the Western frame is that if knowledge is available, then it should be equally accessible. A lot of this knowledge, I mean, it's been earned, right? It's been earned through spending time with folks to develop their trust. It's been earned from being out on the land. It's been earned from showing up day after day until you actually come across some of these plants and herbs that don't just grow everywhere ubiquitously. 

It's picking medicines in certain parts of the year when there's peak potency. It's participating in ceremony when it's a part of how a community celebrates and heals and other things. So I think some of this knowledge doesn't actually belong in medical school. You have to leave medical school to go find it, right? And so that's kind of the first point. 

I think the second point is that traditional medicine is all throughout medical school. A big part of this is knowing our own history. I mean, when settlers first came to Canada, Europeans believed in four humors and bleeding whenever you were sick. Indigenous folks, like First Nations, Metis, and Inuit, I mean, they were creating poultices. They were creating teas to concentrate medications. 

Atropine and scopolamine that comes from the belladonna plant, I use that all the time in anesthesia. Aspirin came from willow bark. Half of the things that I use in my day-to-day pharmacological practice are actually sourced from traditional medicines that were taken by pharmaceuticals and isolated and then sold. 

And so the separation between traditional and Western medicine to me, if you know the history, is a bit more artificial than I think it truly is. Many of the advances in Western medicine are the result of Indigenous knowledge. And understanding that helps you to see how a lot of traditional medicine is already within medicine. It's just labeled as something different. And the history has been rewritten in a way that's not fully true. But I would say that if you truly want to learn about traditional medicines, you probably will have to leave the Academy and go to the places that it's actually taught. 

TANYA TALAGA: That's a really truthful answer, isn't it? Education reform is so needed and noted, right, and especially when it comes to medicine. Just listening to both of you talk and what you're learning in the classrooms and the theoretical end is probably light years behind you and where we need to be. 

I have a good question, keeping on the Indigenous knowledge vein here. What are Indigenous cultural beliefs about preservation of the body? I'm a vascular surgeon and, unfortunately, see Indigenous patients with end-stage vascular disease who require amputation and see differing views about this in different vulnerable populations. Unfortunately, as it pertains to vascular diseases, we are reactive downstream at the tertiary and quarter [INAUDIBLE] centers and not much prevention going on in these highly vulnerable populations. Do you agree that's true? Denise? 

DENISE MCCUAIG: Yeah. I don't know that there's not a focus on prevention. I think a lot of the challenge has to do with the resources for prevention. So I happen to, for example, I live as a diabetic. I live with diabetes. And diabetes is often a precursor to vascular disease and amputation. 

And so I get sent to a diabetes education program at the time of my diagnosis, where I spend a considerable amount of time with other people recently diagnosed and a dietitian, where they're there teaching me portion control, and they're teaching me what I should eat. None of that takes into consideration food security. None of that takes into consideration if my food is coming from the food bank. None of it takes into consideration if I'm in the north, where I spend $9 on 4 liters of milk and $8 on a head of lettuce. And so really well-intentioned diabetes educational opportunities, which could be considered prevention, but not set in the context of my reality. 

And so on day two, when I decide I'm not going back because they're wasting my time, it becomes, again, about the patient's noncompliance, right? And so I think the more we can engage Indigenous patient voice, Indigenous community perspective into the helping services that we are providing for the purpose of prevention, the more success we might actually see down the road in reducing vascular disease. But as long as we continue to deliver programming that is based on the society norm and doesn't take into consideration the lived reality of First Nations, Inuit, and Metis people, we'll be continuing to have this conversation 10 years from now. 

TANYA TALAGA: Do you have any examples of feedback provided by Indigenous patients of when a non-Indigenous provider did something right? Alika, you can go first. 

ALIKA LAFONTAINE: Yes, I actually have a lot of examples. I think sometimes in the discussion of cultural safety, we forget that there's really, really great people out there. There's amazing patients that, regardless of the frustrations that they run into, they are still happy. They still can make jokes. 

I mean, if I hear laughing in a waiting room in Grand Prairie, I almost always know that there's an Indigenous person, an Indigenous patient that's involved, cracking jokes and other things. In the midst of adversity, First Nation, Metis, and Inuit people, they tend to be happy. That's how we work our way through the stresses that we have in life in our lowest times. 

And I think, for the most part, the majority of people who practice in medicine actually do mean very well. They want to go to work. They want to help people. They want them to walk away feeling whole and better than when they first came in. 

I had an experience years ago, where I had a colleague who worked in cancer care call me and expressed some frustration that they were starting chemotherapy at the same time that this patient was taking medication with a traditional knowledge keeper. And they were really frustrated because they weren't sure how the medications would interact. And we were having discussions. And they were really honestly trying to find, how can I bridge the gap between the two? 

And at the end of the conversation, I actually told her, well, why don't you just send the patient home with the information regarding the chemotherapy drugs for the traditional knowledge keeper to review? And it was something they never thought of. They don't have to be the person who decides what's right or wrong, healthy or not. They can cede that power to someone else. 

And the patient took that booklet away. And I caught up with the colleague a few weeks later. And they said they were having a very open conversation with the knowledge keeper and the person that was being treated. 

And they were surprised. In treating the person who is the healer as a colleague instead of as someone that they needed to educate or protect them from harm or other things, they actually drew the three of them together. And the colleague actually said that it was one of the best experiences they had had over 20 years of being in cancer care. They really felt like they made a big impact in someone's life. 

TANYA TALAGA: Denise, do you have any examples of when-- 

DENISE MCCUAIG: Yeah, I do, actually. And like Alika, there's many, many. But one that really sticks out for me is that we had a 24-year-old First Nations quadriplegic patient at the hospital. And, unfortunately, he passed. 

And the family asked if they could bring in their spiritual support, but also if they could bring their home care nurse from the reserve where he resided, who had been so instrumental in supporting his daily living to remove the IV and feeding tubes and other things and help them to prepare his body. And I watched that hospital staff bend over backwards from everything that they needed to do in their procedural process to create the space for that to happen. And I really believe that that changed the trajectory of the grief process for that family. 

And it was heartwarming to watch the entire team on that unit, from housekeeping to physician and nurse in charge, come together and say, OK, how are we going to do this? And let's be respectful and find a way to meet their wishes. It hasn't always been what I've witnessed. But that day, it really warmed my heart. 

TANYA TALAGA: That's a beautiful story. 

ALIKA LAFONTAINE: You know what? One more quick thing. In our hospital that we recently opened, they arranged the whole engineering of how ventilation works in each room, where you can now smudge in every room. And that actually was the reason why they reorganized it, was so First Nation and Metis patients who wanted to smudge could do it in their own private space. So there are a lot of positive things happening. 

TANYA TALAGA: As doctors, as members of the CMA, you also have such a say, really, in what can happen in your hospitals. And to make that happen, that patient experience happened that Denise just talked about for a room for smudging, culturally sensitive care, you guys can throw your weight around with stuff like that, right? And it would be nice to hear more of those stories, absolutely, absolutely. 

And we have one more question. We have one more question, just time for one more. Our health systems are designed to be provider centric in many or most ways. What are the most significant steps we can take to overcome this and further the commitment to cultural safety and humility? Denise? 

DENISE MCCUAIG: Well, I think truly being patient-centered care would move us a lot closer to that, acknowledging the power construct that Alika spoke of at the beginning, just by virtue of putting on that white coat, moving more towards patient voice, Indigenous patient voice being embedded. 

And I'm really meaning ongoing embedding, right? Don't come to us like a focus group, minus for information, and then leave thinking you can change the system without our presence because you've got what you need. That's not embedded patient voice, in my mind. Embedded patient voice ensures that there's that perspective in all of the planning and services that you provide. And then maybe something that academics would call plural leadership, so doing what you can to flatten the hierarchy and accept that everybody in the patient's journey has equal value and importance in that process. Thanks. 

TANYA TALAGA: Alika? 

ALIKA LAFONTAINE: Yeah, I think I'll make one small modification to the question. I don't actually think we have physician-centric systems anymore. I think we have cost-centric systems. 

I think that we focus so much on lowest cost, highest throughput, having the most patients seen at the lowest dollar amount, that the system is really not centered around patients anymore. It's not centered around providers anymore. It's purely centered around what's the cheapest way for us to provide the most care? 

And I think a shift towards patient experience, just like Denise was saying, that patient-centered type of care, what are we actually trying to create for people? I do think you can have lower costs with higher quality, but you have to be focused on the higher quality. It's not a primary outcome for you to have the dollar amount decrease as a result of the high-quality care. It's just an inevitable result of providing high-quality care. 

And anyone who's listening to this can pause the next time that you feel like you're in an environment where you feel it's culturally unsafe and just listen. And then think, what can I do in this moment to make things better? Brian Sinclair would have survived if a single health provider had paused during those 30 plus hours and said, this doesn't feel right. Joyce Echaquan would have survived if a single person who was on shift would have paused and asked that question. 

And you will save a life. You will save someone's functioning or their trust in the system by having that pause. And so, like we said at the very beginning, I think cultural safety can happen today if we all take the time to reflect on what we're doing and what we can do in the moment. And sometimes as a provider, that can be a little bit scary. But it's even more scary for people who don't actually have any power. 

TANYA TALAGA: Well said. Listening to both of you and your experiences and the need for change and the quest for change, it reminds me that we all have to do it ourselves, right? Each one of us, each one of you in your health-care settings, you have to be the one to push for the change and to make the changes because we can't sit around and wait for hospital boards or for governments to change policy. 

You can do the humane thing, the right thing in your own spheres. And I think that that's something that really came through today listening to Denise and Alika, the importance of cultural safety and understanding what those words mean, that they're not just words. They have deep meaning. And if we're going to go to the heart of what reconciliation looks like in this country, we have to examine our roles. And you as health care providers, you're really examining your roles as to the history of what's happened in this country, from residential schools to Indian hospitals to substandard care that our people still face, because there are no doctors or nurses. There's no wait time because there's just no place to wait. It's different, isn't it? 

But I'm encouraged with the CMA making the change in trying to be that change. And I think we heard a lot today. And if you had a chance to check out the chat, there was also some really great suggestions and articles to read and programs in Alberta that have-- I was just quickly reading something about how culturally safe care can be at your doorstep in an hour, apparently. That's incredible in Alberta. I'm thrilled to hear that. 

But there is much going on. And forums like this are so important to bring about that change. And so I really want to thank everyone for taking the time out this evening or this afternoon. I want to thank, miigwech, Dr. Alika LaFontaine. I want to thank Denise, Denise McCuaig. 

This has been a really important conversation. And it's the start of many conversations the CMA is going to have. We're hosting another one of these webinars. The next one is going to be on May 24. We're going to be talking about-- discussing improving the health of Indigenous people. 

And you can find a link to register if you already haven't done so in the chat. And we really truly hope that you join us for the next session. It's important that all of you participate in a forum like this to understand a little bit more what words mean when we say "cultural safety," when we talk about trust and how to build trust in a medical system that hasn't necessarily always been there for us. 

And so with that, I say chi-miigwech to all of you. And I look very much forward to speaking with you again on May 24. Don't forget to register. Miigwech and baamaapii See you soon.