The Decibel - ‘We are deeply ashamed’: The Canadian Medical Association

Episode Date: September 20, 2024

On September 18, the Canadian Medical Association issued an apology to Indigenous peoples. The group represents Canadian doctors and President Joss Reimer said that upon examining the organization’s history, they were ashamed by its record towards First Nation, Inuit and Métis communities. Dr. Alika Lafontaine was the first Indigenous president of the CMA, when he held the post in 2022 and 2023. He’s an anesthesiologist of Métis, Oji-Cree and Pacific Islander heritage. He discusses the apology, actions that come with it and how to improve healthcare for everyone.Questions? Comments? Ideas? Email us at [e-mail]

A warning before we start today's show that we'll be discussing incidents of abuse, including sexual assault. So please take care. To Indigenous peoples living in Canada, we apologize to you. We are sorry. Dr. Joss Reimer is the current president of the Canadian Medical Association. We are sorry we have lost your trust and for the harms that you, your ancestors, your families and your communities have experienced. We acknowledge there are ripple effects on future generations. On Wednesday, she delivered an apology to Indigenous people in Canada for the actions

and inactions of the CMA. The Canadian Medical Association is deeply sorry for the harms First Nations, Inuit and Métis peoples have experienced and continue to experience in the Canadian health system. The racism and discrimination that Indigenous peoples and health care providers face is deplorable, and we are deeply ashamed. The CMA is a national body that represents the interests of physicians and advocates for better patient care. But they now admit that for decades,

they failed the needs of Indigenous people. Dr. Alika Lafontaine was the first Indigenous president of the CMA when he held the post in 2022 and 2023. He's an anesthesiologist of Métis, Oji-Cree, and Pacific Islander heritage. Today, he explains the role doctors and the CMA played in historic harms against Indigenous peoples, how care today is still inadequate, and what specific actions can be done to improve health care in all communities. I'm Maina Karaman-Wilms,

and this is The Decibel from The Globe and Mail. Dr. LaFontaine, thank you so much for being here today. Thanks for having me. So you were, of course, in the room yesterday when the Canadian Medical Association issued the formal apology to Indigenous people in Canada. I just wonder, what was the mood like there? For myself, there were a lot of ups and downs as far as emotion. You know, the emotions you feel when you've worked on something for, you know, a really long time and it's finally happening. You know, memories of harm that my own family has experienced, an extended family has experienced. Those memories came back to me.

And I think for a lot of folks who were there, they were going through similar types of feelings. But in the apology itself, there was such a warm energy. I wonder what was the reasoning for this apology at this point in time? There's been a long history of things happening in Canada. Why did the CMA feel like it was an important step to have this apology now in 2024? The CMA has been around for 157 years. Over that time, the CMA hasn't acted in the interest of indigenous peoples. And so why did the apology not happen earlier? I think a big part of it was the CMA was not focused on Indigenous issues at the time, whether that was ignorance or exclusion or racism or colonialism.

I think there's a lot of different reasons why that sort of thing happens at organizations in Canada. This harm was not only real, but that a lot of the feelings and impacts that had happened as a result of the harm, they had not been worked through. And apologies are just promises for what you might do. They're not the moment of actually fixing the harm. They're the promise that you're going to try now to make people whole and stop the harm from continuing to happen. And we are going to talk about promises for the future for sure. But I do want to talk a little bit more about the apology and the reasoning for it. Dr. LaFontaine, you said that the CMA hasn't acted in the interests of indigenous people in parts of its history.

Can you give us some specific examples of the things that the CMA has done that it is apologizing for now? So the CMA has either acted in ways that have not supported indigenous well-being and health, or it has failed to act in ways. And I think a lot of times when people give apologies, they give very high level abstract apologies. You know, folks will apologize for racism, but what should they apologize? Well, the actual racist acts that you were a part of or that you stood silent beside as things went on. What are some of those specific things then that we can look to? So I think the CMA has not advocated for Indigenous-specific issues until fairly recently

when segregated hospitals were put in place across Canada through the Indian hospital system, when folks were relocated thousands of kilometers away from their homes for TB treatment. You know, medical experimentation occurred on children and adults. There was obviously the racism and discrimination that people felt. When you look at how we built the healthcare system and, you know, folks often don't receive care from the rural communities as many First Nation and Métis settlements are, we made decisions on not to build infrastructure in

those places. And the CMA didn't say anything about it, even though it was at the tables of nearly every major decision in healthcare leading up until that point. So you mentioned a few different things in its history that the CMA is apologizing for this week. I want to ask you specifically, Dr. LaFontaine, about the Indian hospital system. You mentioned this a little bit earlier. Can you tell me more about this system and its history specifically? So the roots of our publicly funded system

really came out of, I think, a crisis that was happening in Saskatchewan in the mid-1940s where folks were accessing the system as it existed, which was this patchwork of nonprofit, charitable, and for-profit entities that weren't necessarily coordinated or connected, and then the small little sliver of publicly funded healthcare. And as a result, people weren't getting better. They weren't returning to their homes. And the public system stepped in and started to fund all these interventions because that was the way that we got people healthy again. Now, in parallel to that was a system of public healthcare that was set up by the federal

government to provide care to First Nation, Inuit, and Métis peoples. And while the root of the Saskatchewan system was to get people healthy and get them back to work, the root of the federal system, if you look especially at the early writings that surrounded it, was always rooted in kind of this charitable, we'll do what we can, but we're doing it out of the goodness of our hearts, so it doesn't really matter what we do. And theospital system grew as the public system grew. So just to be clear, this is a segregated hospital system then? This is a segregated hospital system run by the federal government separate from the publicly funded system that everyone else accessed. And just like residential schools, there's a lot of

stories and experiences of people having care that ignored autonomy, that didn't provide them opportunities to be informed about what care they were receiving. People were forced to do certain things. At times there was sexual abuse, physical abuse. One of the stories that we shared in the apology presentation that came out of the film, The Unforgotten, a feature film that the CMA funded back in 2021. A documentary, essentially. It's a documentary. It's a vignette of several different stories that were brought together, and just one was shared in the apology presentation. Right. You're talking about Sonny McDonald, right? He was seven years old when he had tuberculosis,

and he was in school in Northern Alberta and was then sent to an Indian hospital in Edmonton. So actually, we have a little bit of his story. So let's listen to that. And after the surgery, they took it upon themselves, the staff, I don't know who or what, that they should take my pajama bottoms off to prevent me from walking around and going to visiting and everything else. They put a cast just below my knee to just above my ankle on both legs. And they put a bar across about six inches apart that prevented me from walking. I was just like a prisoner. And on a few occasions, there was an orderly. He sodomized me.

I didn't have any schooling there at all. I had no visitors whatsoever in the two and a half years I was there. Loneliness come upon me many, many different times. I think Canadians don't appreciate just how widespread that was, how many stories are actually out there. And I do believe we're going to hear more stories about that moving forward now that this apology has given space to people that a major advocacy organization, the CMA, has validated that, yes, this is a part of Canadian history.

Yeah. I think that gives us a sense of some of the historic harms that you're referring to, that Indigenous people experienced in the healthcare system. Dr. LaFontaine, let's bring it to the present moment here. What is it like now for Indigenous people to access healthcare in our country? There's issues that Canadians, I think, can connect with. Folks are obviously having great difficulty accessing care right now. They're having long wait times. At times, they're not even able to get onto surgical lists or get consultations or other things. You're talking just generally healthcare in Canada? Just generally healthcare. Now, if the average Canadian takes that experience and makes it 10, 20, 50 times worse, that is what indigent people have been experiencing over the last few decades.

If you sit across from your provider and you feel like they're not taking you seriously, that they're not listening to what you have to say, that is literally the experience of many indigenous people across the country. And it continues to be the experience of a lot of indigenous folks across the country. There's other harms that seem remote, but they're not remote. Forced sterilization, for example, the last reported encounter with forced sterilization is from 2019. We talk about the 60s scoop and child apprehensions providers were a core part of signaling to child and family welfare services when a baby was delivered. These things are

actually still happening. You're talking about birth alerts there, yeah. Birth alerts and other types of communication. Folks still don't receive all options for care. We have these enormous health deserts, these places where there actually is no access to healthcare. I mean, a lot of the things that you mentioned there, of course, the forced sterilization, birth alerts, even just kind of generally about indigenous peoples feeling like they're not being taken seriously. I mean, does this come down to systemic racism in our healthcare system? How would you put it? You know, as a provider, bias is built into the way that we think. We're trained in a way where we're supposed

to filter through the stimuli that we receive and the things we hear from patients in order to make quick decisions. Now, when you talk about racism and discrimination and colonialism, I think what we're literally talking about is folks making the judgment calls and then just basing it off of their gut reaction versus any sort of evidence, this projected caricature versus what's actually going on in the real world. And what is the danger of that, that kind of caricature taking over? Well, it has very serious consequences. If you delay treatment for certain critical events, I mean, people can experience severe disability. You know, you have folks who could die.

If you look at the experience of Joyce Esherkwan, for example, you know. This was the woman who died in a Quebec hospital in 2020, yeah. Yeah, absolutely. To have someone make the decision to live stream themselves, that's not something you do when you first walk into the hospital. This is the result of repeated experiences where you were not taken seriously. And if you look through the reports that surrounded the investigation of that situation, folks were giving treatment that wasn't really the treatment for what she had. And they ended up missing the actual diagnosis of what she was experiencing because they didn't take her symptoms seriously. They just assumed

that she was a complainer or somebody who was addicted to drugs or other sorts of biases that they had. And so I think for providers, when I talk to folks about racism, the most important thing is that you pause and think to yourself, am I just making assumptions that are driving this care or am I actually asking the questions I should be asking? The same sorts of questions I'd ask any other patient that comes through my door. We'll be right back. So the Canadian Medical Association's apology also came with promises. So let's talk about this, Dr. LaFontaine. What is the organization pledging to do to show its commitment to Indigenous communities now? So one of the things that we've reflected on repeatedly over the last few years leading to this day is how do we make sure that this isn't an empty apology?

The CMA has announced specific things that it's going to continue to do and new things that it's going to do in the near term as it pivots from this more inward-looking investigation of what should we apologize for to this more outward-looking, how do we bring together folks to actually fix these problems? Because you need many hands to lift to change a health system. Do we have some specific examples of that then? more outward looking, how do we bring together folks to actually fix these problems? Because you need many hands to lift to change a health system. Do we have some specific examples of that then? Yeah. So the first thing that the CMA is committed to do is continue its support. There's been millions of dollars that have been vested in charitable and nonprofit activities within

indigenous communities across the country that the CMA has funded. When I was CMA president, one of the ways that this was expressed was in our government relations work. The CMA actually was the top lobbyist on the hill for healthcare, the two years running that I was around for the presidency. And that takes you into spaces where you have elected officials who are interested in hearing from the Canadian Medical Association about what's going on in the healthcare system. That's an enormous opportunity for us to amplify and support what Indigenous communities are asking for already. The CMA is also opening up the parts of the healthcare system that it has direct influence.

So there is a code of ethics and professionalism that the CMA has been the author of. And it goes back decades, but that underlies the modern practice of medicine for physicians. So every time that a physician is evaluated for whether or not they're acting ethically or professionally, they turn and quote that code of ethics. And the last time that it was opened up was with medical assistant in dying. It'll be opened up to look at strengthening provisions around racism and discrimination, which aren't contained explicitly within the code. Racist acts can sometimes be reframed as miscommunication or non-collegiality between folks. But if you include specific

wording and specific definitions, it provides the opportunity to deal with things as they really are versus having them colored as something that they're not really. And so I think that's going to have enormous impact. And then I think it's reaching out to communities and actually finding out what the priorities are that the CMA should focus on. Yeah. Okay. So there's a few different aspects there that we can now track going in the future, what the CMA is doing on. Yeah. Okay. So there's a few different aspects there that we can now track going in the future, what the CMA is doing on those fronts. I want to go back to the issue of the federal government. Dr. LaFontaine, you mentioned lobbying the federal government. So I wonder, when you're talking to the government, where does the issue of improving indigenous health,

where does that fall specifically on your list of priorities? I think that the space that's filled by Indigenous priorities isn't necessarily like a separate area. You know, when you're talking about access to care, for example, one of the big challenges that we have right now is we don't have people doing the things that need to get done. And so there's a huge opportunity, I think, with these new models of care and these new ways of performing the things that people need for the problems that they have to be explored in different ways with Indigenous communities. For example, First Nations with the treaty right to health and their own sovereignty over the way that their health systems run, they can be a lot more creative than the town down the street that is framed in in a different way by provincial

legislation and federal legislation. But communities would not be aware of that unless someone told them about it, right? And so I think the lobbying is educating the federal government about the opportunities, provinces and territories about the opportunities, but then also communities themselves so they can use different language and can have an expanded view of what's possible outside of the constraints that they think are there. Just in our last few minutes here, I do want to ask about the CMA's role too broadly in addressing the calls to action from the Truth and Reconciliation Commission's work. There are, of course, 94 calls to action, seven of those related to health. And specifically, I want to talk to you about number 22. So I'm just going to read this out

and we can discuss it. So number 22 reads, we call upon those who can affect change within the Canadian healthcare system to recognize the value of Aboriginal healing practices and use them in treatment of Aboriginal patients in collaboration with Aboriginal healers and elders where requested by Aboriginal patients. So I think the CMA certainly has influence here, right, as some body that can affect change in this sphere. What is the CMA doing to incorporate more traditional medicines and culturally aware care, I guess, across Canada? Well, you know, first step is sitting there and acknowledging the reality that these medicines are not always placebos. The medicines actually work.

You know, a lot of the derivatives that we create into pharmaceuticals, and I give drugs every day as part of my work as an anesthesiologist, a lot of these drugs have their roots in traditional medicine. Now, how do you incorporate it? I think that's a big question that requires indigenous medicine practitioners to be a part of it. Some folks believe that you can have two parallel systems. Other folks believe that things should be integrated. But I think in the place that we're in right now, what the CMA can do right now is making sure that the conversation starts in a position of acknowledgement and strength that we're talking about these medicines, not because of some very abstract impact that they could have, but we're talking about these medicines because

they work. People actually do get better as a result of that, and then have that guide the conversation moving forward. Just very lastly here, Dr. LaFontaine, I want to talk about some potential positive action for the future. What is one, I guess, one concrete thing really that you can see improving in the next decade when it comes to the quality of healthcare for indigenous people? Is there something that comes to mind? I think that unlocking the health and wellness of indigenous communities is, it's going to come in two sides. The first is empowering communities to do the things that have kept them healthy prior

to the introduction of public health care. You know, we often medicalize a lot of interactions. You know, mental health, for example. How did we treat mental health in First Nation, Indian, and Métis communities prior to the introduction of antidepressants and other types of medication? Well, it was social connection. You know, making sure that there were gathering places and a ceremony that people did together, and they felt connected to land and culture and other things. Now, there definitely is a role for medication. But I think the other side is preparing the healthcare system, particularly physicians, which is really who spoke this apology,

to play their part. And so I'm really hopeful that moving forward, people within the healthcare system, particularly physicians, will realize that the knowledge that they have about how the public system works can inform communities to enhance the good things they're doing already. So it's really then putting the burden on physicians and healthcare providers to open up that communication and that level of understanding then is what you're saying. Yeah, absolutely. And that's the burden that I think we're going to have to carry as a result of opening up this apology. And I do think that there's enough physicians across the country that we can start a movement to help communities carry the burden

that they've been carrying alone for so long. Dr. LaFontaine, thank you so much for taking the time to be here today. Thanks for having me. That's it for today. I'm Mainika Raman-Wilms. Ali Graham mixed and edited this episode. Our producers are Madeline White, Michal Stein, and Ali Graham. David Crosby edits the show. Adrian Chung is our senior producer, and Matt Frainer is our managing editor. Thanks so much for listening, and I'll talk to you next week.