An apology for harms to Indigenous Peoples

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. 

PAULA CASHIN: No. 

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. 

TANYA TALAGA: Sarah. 

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.

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.

Video Transcript

TANYA TALAGA: Boozhoo! Aaniin. 

Hi, everyone. My name is Tanya Talaga. I am a First Nations person. I am a member of Fort William First Nation. And I am delighted to be here with you today. I'm going to start this evening with a land acknowledgment. I'm here, in my home of Tkaronto. This is home to the Mississaugas of the Credit, traditional territory of the Huron-Wendat and the Haudenosaunee people. 

I would also like everyone to take a moment and pause and think of the lands in which they are sitting on-- you are sitting on right now. I want you to do a virtual land affirmation, if you will. Miigwech, and thank you for joining us. 

This is our very third and final "Fireside Chat on Indigenous Health." The CMA is hosting this series of discussions to hear from Indigenous patients, providers, health care leaders on how to move forward together as part of a commitment to tangible action on reconciliation in health care. In our first session, we discussed the importance of cultural safety in health care settings, for both patients and providers. 

Our second session focused on the work the CMA is doing to improve the health of Indigenous peoples, recognizing that First Nation Inuit and Métis continue to experience unacceptable health disparities due to the legacy of colonization and ongoing systemic racism. If you couldn't attend those first two sessions, recordings are available. A link will be in the chat. 

Today is the final conversation in this series, and the focus is the meaning and the importance of an apology to Indigenous peoples. To kick things off, though, I do want to go over a few housekeeping items. 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. And we will start with a moderated Q&A with our speakers, followed by audience Q&A. Questions will be text-based and can be upvoted, so please do that. And I will see them, and I promise to be fair and to notice all of the upvoted questions. 

And now let me introduce our speakers for tonight's session. First off, I am going to start with Dr. Alika Lafontaine. Dr. Lafontaine has been a health care leader for more than two decades and is a past president of the Indigenous Physicians Association of Canada, a board member with Health Care Can. 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 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. McLean's named him the country's top health innovator in their 2023 Power List, and he was the very first Indigenous physician listed in The Medical Post's 15 most powerful doctors. Dr. Lafontaine is Métis, Oji-Cree, and Pacific Islander ancestry. He continues to practice anesthesiology in Grand Prairie, Alberta. 

And now I'm going to introduce you to President Natan Obed. Natan is the president of Inuit Tapiriit Kanatami, serving as a national spokesperson, representing Canada's more than 70,000 Inuit. He was first elected in 2015 and was acclaimed to his third consecutive term in 2021. 

As president, he implements the direction set out by Inuit leadership from the four regions of Inuit Nunangat, the Inuvialuit settlement region of the Northwest Territories, Nunavut, Nunavik, and Nunatsiavut. He also serves as vice president of Inuit Circumpolar Council of Canada. President Obed grew up in Nain, the northernmost community in Labrador's Nunavut region. He is a graduate of Tufts University. Welcome, Natan. 

NATAN OBED: Nakurmiik. Thank you, Tanya. 

TANYA TALAGA: And we have President Cassidy Caron as well. She's the very first woman elected as a president of the Métis National Council, with roots in the historic Métis communities of Batoche and Saint Louis, Saskatchewan. She grew up closely connected to her tradition, heritage, and culture. From 2016 to 2020, she was elected to the Métis Nation, British Columbia, serving as the organization's youth chair and minister responsible for youth. 

Ms. Caron has also consulted on both provincially and nationally administered programs supporting Indigenous peoples. Her work incorporates innovative approaches to community development and nation building, which promote effective collaboration and deeper understanding between Indigenous peoples and for all Canadians. Welcome, Cassidy. 

CASSIDY CARON: Taanishi, everyone. Thank you. 

TANYA TALAGA: And finally, I would like to introduce Marion Crowe. Marion is the CEO of the First Nations Health Managers Association and a proud Cree woman from the Piapot First Nation in Treaty 4 Territory, Saskatchewan. In 2010, Marion launched FNHMA, a national family dedicated to honoring, maintaining, and upholding inherent ways of knowing, while balancing, managing priorities to bring excellence to First Nations communities and to health programs. 

She was appointed CEO of the organization in 2018 in recognition of her exceptional leadership and dedication to serving nations and communities to support quality and equitable health services across Turtle Island. Marion is a true trailblazer and renowned for her vision, commitment, and passion to uplift, educate, and lay a path for future generations. Marion, thank you for joining us. 

Now that we have that all out of the way-- and I apologize if I mispronounced anything-- totally my fault, and I know-- I know I didn't attend, and you can yell at me about that later on. But I wanted to-- I want to thank everyone for joining us tonight. Tonight really is a special evening for all of us. It is an evening of firsts, and I hope a continued conversation with Indigenous peoples all across this country. 

Alika, as the CMA's first Indigenous president, I really want to start by asking you to describe how the CMA has embarked on their journey thus far-- a journey of reconciliation under your leadership and those of your colleagues. 

ALIKA LAFONTAINE: Thanks so much, Tanya. I just want to take a moment just to appreciate the weight of this moment. The CMA has never had Indigenous political leadership that represent Indigenous peoples as part of our webinars before, and just acknowledge President Obed, President Cassidy, and a national advocacy organization that also does training for our health directors across First Nations here in Canada. It's a moment that I'm really proud of, and I'm proud of the CMA for helping to create this space. But even more importantly, I'm proud of our own Indigenous people for filling that space and really looking forward to the conversation that we're going to have. 

For those of you who've been a part of the CMA for the past three years, you may remember 2015 when Ted Quewezance was a past chief, a Keeseekoose First Nation-- came and spoke on the floor of our annual general meeting. And up until that point, there had never actually been a residential school survivor who acknowledged and addressed the gathering of physicians at the CMA in its 150-plus year history. 

And I remember sitting beside Ted as he gave his speech, and there wasn't a dry eye in the room, including me, as he stated, we're here as First Nations as Indigenous people, with our hands outstretched, hoping that you'll reach back. And since that time, at the CMA, there's been a lot of work to build on the path to reconciliation. And it's obviously hundreds and hundreds of steps. It requires space to be created. 

And I think today we're taking an important step that acknowledges that trust and relationships are at the core of reconciliation. That is why truth leads to reconciliation. And with that in mind, I will acknowledge, tonight, that the CMA is going to take a vital step in our reconciliation journey towards a formal apology to Indigenous people, rooted in an accurate shared history about what happened and what matters most to Indigenous people. 

The path to an apology will be informed by an honest examination of our 150-plus year history here at the CMA, and I expect it's going to take us to many uncomfortable and painful conversations. But the hope is that, through this process, the CMA can be a part of reconciling and transforming the relationship that the medical profession has with Indigenous peoples and actually bring us closer to true reconciliation. 

The profession's history is Canada's history. It includes the devastating impacts of Indian hospitals, forced medical experimentation on Indigenous people, disparate investment in infrastructure and health access, as well as systemic racism, neglect, and abuse. It's a past that remains present in the day-to-day experiences of Indigenous people across our shared lands. 

To be meaningful, this apology has to happen over time, building on aggregated moments that we gather together, with an end goal of rediscovering each other and our history and rebuilding trust between providers and Indigenous patients, families, and communities. As the first president of Indigenous ancestry to lead the CMA, I will tell you that I will stand resolute with this organization to take these steps in a good way. 

We are committed to an apology as a meaningful step towards reconciliation, and walking with Indigenous peoples towards our Indigenous health goal, which is transformed health systems that are free of racism and discrimination, that uphold Indigenous Peoples' right to self-determination, that 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. Thanks for the opportunity to share those words, Tanya, and I'll turn it back to you, 

TANYA TALAGA: Miigwech. I know that those are incredibly heartfelt words coming from you-- the CMA's very first Indigenous president, and those are heavy words. They're heavy words for all of us to hear, and I'm very grateful that you have-- that you've made them because, as we know, we have been, for the large part, as Indigenous people, shut out of the health care system. And it was not designed for us. 

The universal health care system that everyone speaks of so glowingly, all over the world, sadly was not designed for Indigenous people whatsoever. We have seen that time and time again. And it is very important-- I know I can say this, as a First Nations person, to hear an apology from yourself. And I know it does not come easy and that this is just a first step as well. It is a first step because there's a lot to discuss and a lot to fix. And for that, I'm going to ask all of our panelists-- I will go to each of you, to reflect on what an apology means. And I'm going to start with the very first person I see, and that is Natan. 

NATAN OBED: Well, thanks for that. And Alika, Dr. Lafontaine, I've appreciated being able to speak candidly with you in your role now, but also conversations we've had over time. Immediately, I think about the scenarios that lead us to an apology, and the government policies, systemic racism, the lack of humanity, perhaps, that has been attributed to Inuit by the medical profession over the past 175 years in this country, that lead us to this point in time. 

I also think about the way in which apologies can be meaningful and contrast them with the way in which apologies sometimes can seem insincere or miss the target, because it's never too late to apologize in any scenario where you have done wrong to another group. And when there are human rights abuses by particular institutions or governments, I think there is always space for those apologies to happen and a new path to be charted. 

In these times, there are always going to be dissenters, people who don't think this is the right thing to do, either from a risk perspective or from a historic perspective I think it's human nature to never feel like you have done wrong, individually, or you have perpetuated racism or you have participated in an institution that has been racist or has undermined human rights of a particular group of people, especially when the medical profession and the oaths that are taken to pursue this particular line of work are so in contrary to those breaches in conduct. 

But it's uncomfortable sometimes to hear what has happened. And across Inuit Nunagat, that our entire lives are still transformed, to this day, by the inequities within the health system and the foundations of the health system across our homeland. In the 1950s, the tuberculosis epidemic was approached not from providing care within our homelands, but we were taken from our homelands and put in sanatoriums, sometimes for years at a time. Sometimes our patients died. Patients were separated between mothers and fathers and children. And if anyone died within those scenarios, most likely, the next of kin was not notified. We were still trying to find out where some of these people are buried. 

That is just one example of how medical care to Inuit has been a traumatic experience for Inuit, and one that is completely outside of the norms for the way in which human beings care for one another. I do hope that we can have some of these conversations without pointing the fingers at anyone here at the helm today, but I think this is so important. 

When we understand what is happening today and we understand the inequities that are still happening today the idea that, say, in the jurisdiction like Nunavut, which is a territory with 85% Inuit population, there is no obligation for health services to be delivered to patients in Inuktitut, especially if they are done in a Federal way-- and that is within a jurisdiction that has a majority population of a language that is neither English or French. 

And yes, you can hide behind government policy and federal government policy. But when it comes to the expectation of care, the understanding of a patient on what care is happening to them, and the relationship between a doctor and a patient, it is quite obvious that the use of the mother tongue or the use of-- sometimes the only language that person knows is the only way to respectful care. 

Once we know these things, what are we going to do? And what are we all going to do together to close these gaps, not only in the way care is provided but also the gaps in outcomes for socioeconomic status between Inuit, in this case, and the rest of Canada? So there's lots of work to do. But I really appreciate the openness of the CMA to hold a forum like this and also to have the intention to apologize on such a devastating chapter of Canada's history and the role that the medical profession has played within it. 

TANYA TALAGA: Hm, miigwech, Natan. I'm going to turn to Marion Crowe now. Your turn, Marion. 

MARION CROWE: Thank you so much. And it was just an honor listening to you speak, and Alika. I'm emotional in hearing that apology and the path to reconcili-action and the journey that the CMA is on. 

I have to say this-- it's never too late for an apology, and this gives me hope. Hope, meaning, purpose, and belonging are the anchors of how we move forward. This gives me hope that hospitals all across Turtle Island will hear this and ask Indigenous patients to stand with them in creating a zero tolerance-- zero tolerance for any kind of abuse, mistreatment, or racism that a patient experiences. 

When we look at this from a quality perspective and from a patient experience perspective, I think about a racist institute, as the former speaker said-- when we participate in those actions, I, myself, am the very first Indigenous person on the Ottawa Hospital Board of Governors. I can tell you, by being in these spaces, in these places, people are hearing us. They're listening to us. 

And don't be a token on these types of boards. You can inform the system and help it be a better experience for the next seven generations that come behind us. And I'm going to send it back to you, Tanya, because I know you have a great deal of information to get through to our audience tonight. 

TANYA TALAGA: Hm, thank you very much. Miigwech, Marion, for your heartfelt words as well. Cassidy, I'm going to turn it over to you now. Your thoughts on the apology? 

CASSIDY CARON: Sure. Thank you, and thank you, Alika, for having us and for the incredible amount of work that you've done in the few months that you've held this position. I think there's been a lot of conversation in this last year-- this last year and a half-- about reconciliation and apologies and what that actually means. 

And one of the things that you said was it requires listening, and it's clear that you and others at the CMA have listened and now want to move forward on this path in a really good way. And I think having these conversations with Indigenous people is absolutely one of the first places to begin. Of course, Métis, Inuit, and First Nations people have had to work extremely hard, over decades, to reverse the harm that has been caused by colonialism, by denialism, and by systemic attacks on our people within Western and dominating systems, which includes the health care system. 

And for years, this work has been on our shoulders alone. It has taken a significant amount of advocacy, patience, and dedication of leaders who have come long before me. But it shouldn't have to just rest on our shoulders as Indigenous peoples. There's a role for everybody to be playing within reconciliation, within all of these systems, within all of these sectors, big or small. The role that you can play is significant. 

An apology-- it really acknowledges-- it acknowledges that a harm has been done, and that requires being truthful about the past. And it requires thinking about the future where Métis and other Indigenous peoples are respected as the peoples of these lands, as the unique peoples with recognized rights under Canada's Constitution. And it truly is-- an apology is a first step. It's opening a door to rebuilding trust if it is done in a good way because trust is just not simply handed out with a few words. It's really earned through a process of relationship building and rebuilding. And I think that the process that the CMA is looking to roll out is one that is really honorable, and I do look forward to seeing how this goes. So thank you so much. 

TANYA TALAGA: Miigwech, Cassidy, for those wise words, as always. And I want to make a special mention, at the moment, for the role that Alika is playing here. I think that we should all take a moment to recognize the strength and the importance of what Alika is doing, especially since he is an Indigenous person. Alika is Oji-Cree, and he is Métis. And he is also a doctor and head of the CMA. 

By virtue of his blood, of who he is, he is connected to this land. So I want everyone on the CMA to think about that for a moment. Reconciliation is something that Canadians must do with us. The onus is not on ourselves to be the ones reconciling. Yet here is Alika, doing something that is really quite incredible and bringing the institution forward I just-- I think it's important that we acknowledge that fact here today. Alika, do you have any thoughts on that at all? 

ALIKA LAFONTAINE: Yeah, I just want to say, first off, I think the burden on my shoulders is a lot lighter than the burden on Natan's, Cassidy's, Marion's and every other Indigenous leader out there. Tanya and I were having a conversation about dual identity not too long back. And I I'm often asked in interviews-- when was the first time that you witnessed racism in the health care system? And I remember every moment of that clear as day. I had experienced racism myself, prior, as a patient, but it was the first time that I was on the other side of the curtain. 

I was a medical student, and I watched two men come in in a short period of time of each other. And one of them was clearly Indigenous, could have been Métis. He could have been First Nation, and had similar presenting symptoms-- slurred speech, unsteady gait. They were having trouble standing up, and a change in their level of consciousness. 

And one of the men was moved over to a bed and had a full workup that I was a part of. We tested for a variety of different things that it could have been. It included things like alcoholism, but it was also-- we checked for stroke and heart attack and all these other things. And the other man was taken over to a room. The light was dimmed. He was given a sandwich and a blanket. And everyone said, we'll just let him sleep it off. 

And in that moment, I think there was something that turned in me where I realized that I had signed on to be part of a system that often creates a lot of harm for my family and the family and friends that I've grown to love across this land. And I think, for Indigenous physicians, Indigenous teachers, Indigenous social workers-- anyone who are in these systems where this-- this an unreasonable treatment happens to Inuit and First Nation people. 

We struggle because we're both part of the system that creates this harm, but we're also part of the people who experience that harm. And I think that puts, sometimes, an unfair burden on a lot of us. But until we reach the point of reconciliation, it's a necessary burden. 

I remember, shortly after being inaugurated as president last summer, my mom gave me a hug, and she said, if it wasn't you, it would have been someone else, to be the first Indigenous president, but treat this year like it should have been you. And I've tried to move forward, with every step, over this past year, with the idea that I could make a difference, not because I'm unique or special but because I'm here. 

And I think, when I listen to Natan and Cassidy and Marion talk, I think to myself, thank goodness they're there, standing where they are and lifting where they are. And I just see all of my Indigenous colleagues who work in the medical profession-- physicians, nurses, pharmacists, other colleagues. We have a real opportunity, today and then moving forward, to really make a difference for our people, for ourselves, and to really use that dual identity to push things forward. And we have to carry that burden because if not, who's going to? 

TANYA TALAGA: Mm, so well said. We've heard-- this was in the last year-- this has been-- there's been a lot of apologies. I'm thinking of the Pope's apology last summer and the importance of apologies. So how do you begin to build trust? An apology has happened. How does trust happen for Indigenous people once they've heard this word or the words, I'm sorry? Natan? 

NATAN OBED: In many ways. I just think of my friends and family, myself , and what that means. Do you ever go to an Inuit community? A lot of people are going to welcome you. People are going to ask you where you're from. They're going to ask you if you're rich. They're going to ask if you're married, if you have kids. This is just like the 8 to 12-year-old on the street. 

Other people will offer you a meal, will make sure that you have whatever you need during your time. If it's in the winter, perhaps people will be saying you need-- you need better minutes. We're, to a fault, very welcoming. And I think when we go into medical care facilities and we have interactions with doctors, there's another history that's side by side with our openness and willingness to bring people in and welcome people into our communities, versus the way that we've been treated over the past 70 or so years, especially within health care delivery. And that is that we are subhuman, that we really don't matter, and that we are, in many cases, administrative footballs. 

In our communities, there are health centers with nurses. Largely, our systems are to refer people into major Canadian centers. Governments have service agreements with provinces and territories, and so most of the care happens with people who know nothing about the lived reality or even the geographic place on a map where this person is coming from. And often, it is thousands of kilometers away for this person sitting in one of the most difficult times in their life, being serviced by somebody who is not part of their community, and can't speak their language, and has vastly different cultural norms about communication. 

So what I hope for the system is for-- that those types of things to be recognized and incorporated into care and for people to be humans first and to care for fellow humans, rather than, in many cases, where either it is a frustration with the burden to care at all for these patients, because they're not part of the system, the local system, or then the considerations, in many cases, for payment, which often are negotiated between the federal government and interjurisdictional issues. 

And it is, going back to Jordan's Principle-- it is, provide the care that a person needs, and figure everything else out somewhere else. And think of them as your neighbors and people that you have to have empathy for. I think it's a huge challenge for the medical establishment to do that. I think, as Alika mentioned, there is systemic racism and cultural prejudice. And there's also this understanding-- sometimes this baked-in belief that somehow Inuit cannot understand what is being told in these encounters. 

But ultimately, we're not stupid. We just are coming from a very different place and speak a very different language. And if medical doctors had to come into our communities and speak our language to deliver care, it certainly would be a very different reality. And I think there would be a greater appreciation for what we go through when we go to places like Ottawa and Winnipeg and Edmonton. 

TANYA TALAGA: Extremely well said, Natan, as always. Marion, as well. Now that you've heard an apology, an apology is on the offering, how do you build trust? 

MARION CROWE: Well, I think trust is 1,000 cups of tea. It's getting to know the patient population in which you're serving. And I think right away about not just an apology but the hope of reconcili-action. As somebody who gets to lead an amazing organization of health directors in my role at the hospital, I start going into operations mode, and what does that mean? How do we become allies in getting rid of racism? How do we acknowledge the territories that we are on? 

And I don't mean performatively, like a check mark. I'm talking about, how do we put into the system spaces that reflect us, that create space for us to practice ceremony? Some day, I picture a hospital that has signed on to rise above racism, like the CMA. I'm putting a plug in there for folks who are looking for a roadmap. 

If you go to the RiseAboveRacism.ca website, you'll find an amazing campaign on eliminating racism in the health care system. You'll be able to see the reconcili-action journey that the CMA is on, that the Ottawa Hospital is on, and many other pan-Canadian health organizations. I hope that one day I can walk into a hospital and I am prioritized in emergency, just like I was during COVID. I know I'm dreaming, but I think we're getting closer to seeing us prescribe traditional medicines in the hospital from an Indigenous physician. Those are my dreams. And it's possible. We see this happening in Toronto, by the amazing work of Dr. Lisa Richardson. So again, I know that this is such a heavy and traumatizing conversation, but let's talk about the steps in how we eliminate racism in health care. Thank you for the question, Tanya. 

TANYA TALAGA: Miigwech, Marion, and I applaud the work you're doing. Rise Above Racism-- please google search it. Check it out on Marion's website. And I know that every little bit helps, so I urge you to check out Rise Above Racism. Now, Cassidy, you've heard the apology, the beginnings of an apology. How do you build trust? 

CASSIDY CARON: I think what we've learned and what we've heard over and over again in these last number of years when talking about apologies is that, of course, it has to be followed with action, and action that is actually creating real systemic change. I have an elder who has told me time and time again that we have a closet full of, sorries, but not enough action to follow those stories, and that we don't have a word in our language for reconciliation. 

But the word that closely translates to reconciliation actually means, setting things right, and that's what's needed right now. We need to set things right because, for Métis communities, similar to Inuit and First Nations, we've long faced significant barriers in accessing this quality health care that is free of discrimination. And it's resulted in severe health disparities for our people. So moving forward, there has to be a significant amount of action to change that system. That takes a lot of work. It's ingrained in a system. 

So the health care system has to commit to providing and actually doing it-- providing culturally safe and accessible care to our people. As Natan was saying, it requires recognizing and respecting our unique worldviews, our traditions, our healing practices, and ensuring that health care services are also geographically and financially accessible, recognizing the social determinants of health for our people, or, in our case, we've done a lot of work to understand what the Métis-- the determinants of health for meaty communities are, and really applying that and taking those into consideration so that we can make sure that health care actually addresses the unique needs of our people. 

And so a lot of this is going to require cultural competency training for health care professionals. It's going to require the recruitment and retention of Métis health care workers-- speaking Métis-specific here, the integration, like I say, of traditional Métis healing practices into these mainstream systems, and finding a way to actually make it work and not just-- putting an infinity sign on it doesn't make it culturally relevant. 

It also means including Métis voices and perspectives in decision-making processes that shape the health care policies and practices, just like what Alika is doing right now-- holding these leadership positions, not just on the ground positions but the ones that are making decisions. There's so much that can be done. There's so much work that our institutions have done to understand what the unique needs of our people are-- the Métis National Council, ITK, AFN. All of those institutions-- we know what our people need. We've done the research. And now it's looking for equal partners to actually roll this work out and create the systems change that's needed to take care of our people the way that they deserve. 

TANYA TALAGA: Amazing. Thank you very much for your words, Cassidy, and I encourage everyone to put their questions in the chat. We'd love to listen to what you have to say. And please submit your questions for the speakers to the Q&A button, and you can upvote questions as well. And I have a couple of questions in there. As soon as we put the call out, they came. But Alika, I'm going to switch to questions, but I-- is it possible to quickly answer the question that I posed to everyone else, in, how do you build trust now? 

ALIKA LAFONTAINE: Yeah, I think trust starts with relationships. And I know one of the things that was really important to myself and other folks in the CMA who've been pushing for this work-- the Guiding Circle, Indigenous staff, our senior executive, and our CEO was making sure that we engaged in proper ways. This year, we engaged with the AFN, ITK, and MNC all through proper protocol. Before this conversation, we actually sat down and we talked about what was important. 

And I think that, at the beginning, we actually will lean pretty heavily on Indigenous folks inside the health care system-- advocacy organizations like Marion's and our political organizations, like the organizations that President Caron and President Obed lead-- in helping us to understand how to develop that trust. And I think folks on the ground-- patients, families, and communities, who see the movement of people that they trust-- trusting the CMA is a big part of starting that journey. 

And I think our job at the CMA is not to let them down. Just like Cassidy was saying, we have to make sure that we follow through with these conversations with action, and that we make a difference in the lives of patients. I know, when I was speaking with President Obed and when we were having our first meeting, we talked about how everywhere else in Canada, there's an expectation that you'll be introduced by your name, that there'll be a bit of your conversation at least in the language that you speak fluently, but that's not true for Inuit people. Sometimes providers don't even attempt to pronounce Inuit names. 

And I don't understand how you can train and understand a complex procedure like a Fontan but you can't spend three minutes to try and learn how to properly pronounce someone else's name. And I think that a lot of what we do in medicine-- we get used to doing it that way. I don't think it's necessarily rooted in trying to create harm. But I think we have all these norms where we focus on one area and try our hardest. And then when we try and humanize each other, we fall short. 

And I think this process gives us an opportunity to line those up better. And I think it will not only be better for patients. It'll be better for us as clinicians as well. Wouldn't it be wonderful that, in every encounter that you have with an Indigenous person, you feel the trust, you feel the closeness, and you can move forward in helping them with their path through the health care system so they can return back home? 

TANYA TALAGA: Miigwech. I'm moving on to the Q&A, now, with our participants, and I've got a really good question here from Dr. Emmett Franco Francoeur. The doctor asks, for many physicians across Canada who are choosing to be committed to this kind of reconciliation, the frustration is that we do not come in contact with many or any First Nations people. How do we make a difference? So that's an interesting question, and I am going to turn that over to Marion first. 

MARION CROWE: I knew you were going to pick me. I'm not sure why I knew that. Well, I would definitely say, I'm pretty sure you do come into contact with First Nations, Inuit, or Métis people, and you don't know. So here's one small step, and it's an easy one. Read Indigenous, buy Indigenous, shop Indigenous. But it really is about being an ally and an advocate for-- I hate the word, underserved, and, marginalized, for a whole host of reasons. 

But we need allies in this space. We need you to be informed about our Indigenous ways of knowing, of ceremonies that we might be practicing. We need the compassion of allies like yourself. So I would just encourage you to start opening the books. We have an author who has an amazing book right here I would start with that one. 

TANYA TALAGA: Miigwech, thank you. I appreciate all plugs for my books. Thank you very much. Yep, new one coming out shortly. So I'm going to-- I'm actually going to ask this question, as well, to Cassidy, actually. It's a tough one, but it's interesting, right? It's interesting, too, that physicians think that they're not coming across Indigenous people when, in actual fact, they are. 

CASSIDY CARON: Mm-hmm. Yeah, I was going to say the same thing as Marion. It's very likely that you have come across an Indigenous person in the work that you do. For Métis people specifically, were not phenotypically distinct. We don't all look the same. You can't just look at a person walking in a room and say, oh, that's a Métis person. So unless that person self-identifies, you wouldn't know. 

And a lot of Métis people don't self-identify within the health care system because they know the horror stories of Indigenous people and how they are treated within the health care system. So if somebody is able to walk into a doctor's office and not automatically look like what people think an Indigenous person looks like, they may not choose to self-identify because they think that they will get better health care service, and it's likely that they will. So part of that is, again-- just being aware of that is an extremely important factor. 

Just treating everybody with humanity is the other thing. If somebody feels like they're being treated in a very good way, they're going to open up a little bit more. And if they have a good experience, that goes a long way. So it's just treating everybody with absolute humanity and decency. 

The other thing, I guess, is-- if it is, in fact, that you haven't ever come across an Indigenous person within your practice and you are looking for something to do to contribute to this conversation, read up on the work that we are doing. For us, the Métis National Council, specifically, read up on the research that we're doing that shows data on how many people are not getting the health care services that they need and the work that we're doing to advocate at the federal level, at the provincial level to make sure that that changes so that you can be aware in your own way and be an advocate just from the work that you're doing. So there's a lot that you can do. Just raising your awareness is step one, I think. 

TANYA TALAGA: Mm, yes, thank you for that. I want to get to this one, and I'm recognizing that we've got 9 minutes left, but it's a good one. It's loaded, too, here. Is there any examples of physicians being held accountable by their organizations or institutions or regulatory bodies for racism, causing harm? This one doctor said that, my experience is that they are protected on every front as a profession. And recently, the doctor was in a meeting with Indigenous leadership, and the leadership of the hospital said that if-- any physician causing harm through racism will be fired. But this doctor said that they have yet to see a real example, despite many complaints coming through the patient experience or on social media. 

Now, I'm unclear as to whether or not that means this doctor has not seen many examples of racism or how doctors are held accountable. I'm going to turn it to Alika first. And then I'm going to ask Natan of any examples he might have heard of physicians being held accountable. 

ALIKA LAFONTAINE: Yeah, I think this is a really valuable question and one that I really hope that we dig into and unpack over the coming months, as we go through this apology process. The reality is that you don't see what you don't measure. And if you don't see something, you never solve it. And I think that it's very clear that racism has existed across Canada, but we're unsure where it's a big enough problem that we have to do something about it. 

And I think, in medicine, we're very good at reframing situations to mitigate responsibility. When a person has a hostile experience and they choose not to pursue further medical care because they don't trust the folks that are providing that care and that leads to harm, whose fault is that in medicine? 

And I think that aspect of the experience of racism in the health care system can't be underestimated. There are many folks across the country who are Inuit, Métis, and First Nation who delay presentation to care until they have no other choice because they're afraid or because they've had previous bad experiences or they're worried that they will actually have something worse happen to them, as a result of stories that they've heard or stories that they've experienced personally. 

And I don't think that, in general, our way of dealing with patient concerns and complaints has done a great job at addressing racism-- not only Indigenous-specific but also racism felt by many other persons of color across Canada. That means that we have an enormous opportunity to hear these stories and change the way that we look at these experiences. And I think-- the final thing that I'll say is that it's important to recognize that, in many places where people experience these harms, there's not a lot of physicians who go there. 

So just to the previous question, if you don't see a lot of Indigenous people in your practice, go to places where there is Indigenous people. Sign up to do a locum in Nunavut. Sign up to do a locum in the Métis settlements here in northern Alberta, where I live and work. Go to an underserved community. They need your skills so they can have access to these things. 

Don't just read about things. Go and meet the people. That's the most important part of reconciliation, honestly. It's the most wonderful part of reconciliation, is-- we understand and create accuracy in our history, and we create new memories moving forward that are things that we can be proud of and that bring us joy and happiness. 

TANYA TALAGA: Miigwech for that. I'd like for Natan to spend a couple of minutes as well, quickly-- if you can quickly, as well, talk about-- have you seen physicians being held accountable? And should they visit Nunavut? 

NATAN OBED: Well, physicians are a self-regulated profession, unlike many other professions. That doesn't mean they're not above the law and legislation that governs the practice and also criminality within the practice. I'm not aware of any physician that has been held to account for simply being racist. 

And then, immediately, we're still back in the place where I immediately then think of-- for forced sterilization or for misdiagnosis or for the lack of interest in pursuing medical care-- the self-regulatory part of the medical community. And the ability for the accountability from within I hope will be a foundation of this reconciliation movement within the medical community. 

I also hope that there would be more accountability within the system to identify incidences of racism and then to properly address them. I don't think that we're there yet either. And as far as medical professionals coming to Inuit Nunagat, there are very few communities where you can actually practice. But there is a huge need, and they're usually general practitioners. There are a few doctors that are resident doctors that stay, their whole careers, in places like Iqaluit or places like Kuujjuaq. But if a part of your career overlaps with, or if you are at a particular expertise that you can provide service to a particular portion of Inuit Nunagat, please, let's find a way to make that happen. 

TANYA TALAGA: Miigwech, I know that was a difficult curveball of a question there, Natan. But I'm going to make a plea here for access, for the CMA to continue their work in trying to access our underserved communities, as you've heard from all three of our peoples here tonight. I'm going to make a plea, as well, for Northern Ontario, who-- we hardly have any doctors whatsoever. In fact, barely any in a lot of our communities. So there's a lot of work to be done. 

And I want to give everyone a minute to say closing response, and I know that's tough-- it's a minute. But I'm going to start with you, Cassidy, and then I'm going to go around my little circle and end with Alika. 

CASSIDY CARON: Sure. I guess I'll just close just by saying, thank you again, to the CMA and to Alika for hosting this, and to Tanya as well for guiding this conversation. A big part of reconciliation is just ensuring that the conversation continues, that we don't stop talking about the injustices that Indigenous people face in this country and the solutions that we can apply. 

It takes-- again, like I said, it takes dedication. It takes patience. It does take time. It will be frustrating. But I do hold a lot of hope that we can change systems from within to better serve our people within this country. So I'm thankful for the time that we have to discuss this today, and I look forward to continuing to work with you with your last few months, Alika, and then again into the future as well. So thank you so much. 

TANYA TALAGA: Miigwech. Marion. 

MARION CROWE: If you see something, say something. Remember all of the ads and the airports, all over the place? Please. I know it's a really hard experience to report racism, but please find a patient navigator. Find the Indigenous person in the hospital. And put forward the complaint. I have witnessed where somebody has been fired-- security guards have been fired from a hospital for their actions and their response and racism. And if you're a hospital administrator, deploy safe spaces. Thank you. 

TANYA TALAGA: Miigwech. Natan. 

NATAN OBED: Well, I look forward to the future conversations with the CMA with you, Alika, on making good on this pledge to apologize. Perhaps the one thing that I'd say-- a piece of advice-- is to try your best, all of you who provide care, to work in an anti-racist way. And that means be very careful about how you word questions-- your unconscious bias, some of the things that you might want to say or ask. 

Let the patient lead in those cultural conversations. They expect you to lead in the medical conversation. But don't think, because you read a book or you watched a movie about our communities, that then you can-- then, that you have the license to be able to just cast your judgment or filter and expect the patient to reflect what you think you know. Just simply learn. And it took you seven or eight years to get a medical degree. Just imagine how long it will take for you to truly understand our language and culture. And have that respect for it, and you'll do really well. 

TANYA TALAGA: Mm, Miigwech. Alika. 

ALIKA LAFONTAINE: Yeah, and the only piece that I'll say-- and I'm so grateful for the wisdom that Natan, Cassidy, and Marion, and you, Tanya, have shared tonight. Don't get too focused on tomorrow when we have stuff we can do today. It's true that we need more investment, that government needs to create programs, that we have a system that just is not designed to provide great care to Indigenous people and really supports a lot of the bias and racism that we see. 

But don't forget-- we do workarounds every day as providers in the health care system. We keep things stuck together. And if we turn our attention to doing the same thing for Indigenous people, we can make a difference right now in the care that they receive, while we try and work towards that better tomorrow. 

TANYA TALAGA: Miigwech. I'd like to Thank all of the panelists-- Alika, Natan, Marion, Cassidy. You are all incredibly wonderful. You're all leaders. And the work you do is so important. I urge you to keep going. I know it's hard, but don't stop. These Fireside Chats have helped inform the path forward. And together, the CMA is committed to continuing the reconciliation journey. 

Now, if you would like to participate in any further future conversations, the CMA would like you to attend its upcoming Health Summit in August, both in Ottawa and online. A link for more details will be in this chat. I want to thank everyone for joining us, and I apologize for keeping you three minutes over time. But this is one of those conversations that we could have for an incredibly long period of time. There is much work to be done, but I'm confident that, working together, it is going to happen for the betterment of all of Canada. So with that, I'd like to say, good night, and I was delighted to host you through this webinar.