The Healthcare Divide – Episode 6

How do you bring together two philosophies of medicine: Indigenous and Western? And is that even the right question to ask? We talk to two doctors who are re-imaging ways for Canada’s healthcare system to work better for Indigenous patients. They talk about their hard won successes and the challenges they faced along the way.

Dr. Danièle Behn Smith, British Columbia’s Deputy Provincial Health Officer for Indigenous Health

Dr. Barry Lavallee, CEO of Keewatinohk Inniniw Minoayawin

The Healthcare Divide

Episode 6 – Two Worlds of Medicine

Barry Lavallee One of our leaders was speaking about his brother-in-law or brother who had a central nervous system injury that didn’t allow him to swallow. And so he watched his brother die of starvation because a physician refused to put a feeding tube in.

Dr. Alika Lafontaine Canada’s healthcare system should provide equal access to everyone. But in reality, it’s a system of haves and have nots. I’m talking to the people who have experienced these inequities firsthand, and those who are working to create change.

Danièle Behn Smith I’ve been there for eight years now, so I’ve realized, oh, changing a health system actually isn’t that easy.

Dr. Alika Lafontaine For years, physicians and advocates in Canada and many countries around the world have been trying to make healthcare more accessible and more effective for Indigenous people. For some, this includes a rethink of what healthcare is. In this episode, we’ll talk to two people who are bridging the gap between Indigenous and non-Indigenous approaches to medicine. We’ll hear about the struggles and hard won successes along the way.

I’m Dr. Alika Lafontaine, an Anesthesiologist and the first Indigenous physician to have led the Canadian Medical Association. From the Canadian Race Relations Foundation…this is The Healthcare Divide.

Dr. Danièle Behn Smith is proud of her heritage. 

Danièle Behn Smith I’m Eh-Cho Dene from Fort Nelson First Nation on my dad’s side. I am Michif from the Red River Valley on my mom’s side. I grew up in Winnipeg. I live on Lekwungen Tung’exw, on Lekwungen territories in Victoria. And today I’m actually calling in from Saanich territories at Tsawout First Nation and very grateful to be calling in from these beautiful territories this morning.

Dr. Alika Lafontaine But growing up, she wasn’t connected to her culture.

Danièle Behn Smith I grew up a child of the ‘80s, so at that time the language that was used more commonly was “Indian.” And so when people would ask me about my background, I would often say, well, I’m half-Indian. And that was sort of the extent to my self-reflection. And because of, you know, the intense racism that still exists in Manitoba, but existed at the time of my grandmother and my mom being raised in childhood, there was quite a lot of effort put into passing.

Dr. Alika Lafontaine In the ‘80s, avoiding racism meant leaving behind parts of who you were. But even before she renewed that connection, she was upset by how Indigenous people were treated in the healthcare system. This was well before 2020, when the nation saw Joyce Echaquan die at a Quebec hospital after recording a Facebook Live video that showed her being insulted, ignored, and screaming in pain. The coroner called the incident, quote, “an undeniable case of racism”, calling on the Government of Quebec to recognize and eliminate systemic racism in the health system. This wasn’t new; Indigenous communities in Quebec and elsewhere have long been familiar with misdiagnosis based on racist assumptions. Danièle also saw that Indigenous people have much worse health outcomes, including higher rates of diabetes, hypertension, substance abuse, mental health issues, and lower life expectancy. So, she decided to study medicine. 

Danièle Behn Smith I just, to be honest, naively thought, as a young person in my late teens, early 20s, that a way that I could be a part of making things right and supporting and improving Aboriginal health would be to go into medicine to become a doctor. And I say, ‘naively thought’ because over the last two decades now I’ve really immersed myself and tried to grasp a deeper understanding of what are at the root causes of the disparities that are on the surface that so many of us see, that are so obvious to us. And so now, 20 plus years on in that journey, I can see that actually going into communities with our, in my case, family medicine doctor toolkit is really not equipped to deal with the deepest root causes of what’s creating ill health and disease and those disparities.

Dr. Alika Lafontaine Was there a moment where you realized that your expectations of what you were going to learn maybe weren’t going to lead to the positive impact that you actually wanted to have for your community?

Danièle Behn Smith Oh, yeah. Absolutely! No, I can pinpoint it to one very exact moment. I was doing a locum in a remote community. And it was a particularly challenging locum for many different reasons.

Dr. Alika Lafontaine A locum is a doctor who’s visiting a community temporarily, like a substitute teacher.

Danièle Behn Smith And I just remember leaving that place and just sobbing. And I prayed to the creator in the middle of my sobs, and I don’t pray like this today because I’ve learned better ways, but at that time I was so bossy. Alika, I was like a newly minted family doctor, so it was like, I knew what was right. And so I just told the creator, I was like, that’s it, I’m done. I can’t do another day of this. I was, of course, saddled with close to $100,000 of debt from my medical education. And I didn’t care. I was like, I’ll do anything, but I can’t do another day of medicine, not in that way. And that was when I cried myself to sleep. And I woke up the next morning and that’s when I had this email sitting in my inbox from an Australian television production company that was looking for a female Canadian Aboriginal physician.

Dr. Alika Lafontaine The producers of the show were creating a documentary series about traditional medicines around the world. They needed a host.

Danièle Behn Smith My first reaction was, oh, creator, you didn’t hear me. Like, I can’t do medicine. And this is still medicine-related.

Dr. Alika Lafontaine But she took the job. And it ended up changing her perspective and, ironically, keeping her in medicine. Through hosting that show and talking to people around the world, Danièle started to see beyond what she’d been taught in medical school. There were alternative ways of thinking about health.

Danièle Behn Smith I remember Lewis Mehl-Madrona was one of the people that we met and he was really, well, you know, so many of our elders and knowledge keepers, they’re funny and they really like to tease and kind of, you know, that’s one of the ways that we connect. I think he just, like, said, point blank, he’s like, there’s no room in medicine for our teachings, and our ways. Like, there just isn’t. And he could see, like, I was crestfallen. You know, I was thinking, oh, like, that’s a hard truth. And then he had this little kind of, like, twinkle in his eye. And he said, there’s so much room in our ways for biomedicine and Western medicine. So I thought, yeah, that’s right. It’s about just a slight shift in the way that we approach things. And all of a sudden, you know, we can move mountains. 

Dr. Alika Lafontaine I want to pause here for a second. I’m always struck that when we talk about traditional medicine or knowledge among Indigenous peoples, we forget that when settlers first came to Canada, they often had a very primitive understanding of health. Many believed that an imbalance in the four humours—blood, yellow bile, black bile, and phlegm—was why physical and mental diseases occurred. Popular treatments included bloodletting, a practice that persisted into the 19th century. When we talk about the history of medicine, we use a revisionist mental model. We take what we see in medicine today and project it onto the past. But if you compare what was popular at the time, it’s hard to avoid the conclusion that the Indigenous approach to sickness and health was much more advanced when compared to its settler counterpart in the 1600s. A holistic approach to mind and body, versus treating the body like a machine. Indigenous knowledge contains many natural medicines linked to specific symptoms: willow bark contains Aspirin, pine needle tea is used for Vitamin C deficiency, and echinacea treats infection. Maslow’s hierarchy of needs was based on Blackfoot teachings. My dad has told me stories about collecting senokot from fields near his home for the pharmacist to repackage as a treatment for constipation. History has written out a lot of the contributions traditional Indigenous medicine practices and training has had on modern medical practice. But perceptions are changing. In 2015, the Truth and Reconciliation Commission released multiple calls to action about reforming healthcare, including measuring and closing gaps in health outcomes, better training in cultural competency and cultural safety for medical practitioners, and recognizing the value of Indigenous healing practices. Even the World Health Organization recently noted the growing demand for traditional medicine and the need to integrate the practices into mainstream health systems. That’s the type of work Danièle wanted to do. After the documentary series, she went to work in Dawson City, Yukon, and found her love of medicine again. 

Danièle Behn Smith It was a great little place to work. It’s on Tr’ondëk Hwëch’in territory. So, you know, a large First Nations community there coming to the clinic. And so lots of spaces to try and figure out, okay, how can we blend all of these worlds together?

Dr. Alika Lafontaine She then moved to a teaching post in Edmonton, excited to share what she learned with Indigenous and non-Indigenous students alike. But soon, that plan was derailed.

Danièle Behn Smith While I was there, at the University of Alberta, I got really, really sick with an autoimmune arthritis.

Dr. Alika Lafontaine Danièle suddenly found herself in the role of a patient, an unexpected perspective that forced her to reflect on all her training and experiences up to that point.

Danièle Behn Smith I was off work for about six months. I was really quite incapacitated. My joints were so inflamed all over my body that I couldn’t walk. My now husband, then boyfriend, had to wheel me around in a wheelchair. I couldn’t see out of my left eye because I had an inflamed cornea. And that went on for months and months and I didn’t know if I was going to get better. 

Dr. Alika Lafontaine Suddenly, everything she’d learned became personal.

Danièle Behn Smith Okay, Danièle, how are you going to integrate all of these different medicines that are around you from biomedicine to, you know, traditional Chinese medicine to working with Indigenous healers from these places to get better?

Dr. Alika Lafontaine In the midst of a particularly harsh round of treatment, Danièle had a surprising mental breakthrough.

Danièle Behn Smith One of the treatments that I was on was methotrexate. So I had to give myself weekly injections. And for anybody that’s ever taken or prescribed methotrexate, you know that one of the side effects is having really bad nausea and just feeling really crummy. And so I think it was maybe the second or third week that I was getting ready to give myself this injection and I was holding this medicine in my hand and I was just so mad at biomedicine and my Western training and how full of racism it was. And it just kind of struck me. It was almost like, you know, sometimes elders kind of give you that tap, like, hey, like, smarten up! And so I was holding it and it was almost like that kind of shock. And I looked at that and I thought, oh my God, this is medicine. Like, this is the same as if I were out picking yarrow or any other medicine. Like, I need to be…have a heart full of humility and gratitude and respect. And so I did. I held that medicine and I apologized and it makes me emotional to think about it, because then I was able to say thank you and… in that small way bring in the teachings that I’ve received, so I was able to honour the people who had shared those teachings with me. And from that point forward, I didn’t have any nausea or any of those crummy feelings.

Dr. Alika Lafontaine Today, Dr. Danièle Behn Smith is in a new role, trying to create the system she wants to see. She’s British Columbia’s Deputy Provincial Health Officer for Indigenous Health.

Danièle Behn Smith I’m, like, a pretty naïve person because I thought it was like, oh, I can just kind of rock up at this Ministry of Health and, you know, start talking to the people in charge and talk to the deputy minister and let them know about this functional medicine model. And like really, if we invest in food as medicine and we empower people, that it can have these, like really profoundly transformative impacts. And I’ve been there for eight years now, so I’ve realized, oh, changing a health system actually isn’t isn’t that easy.

Dr. Alika Lafontaine What does traditional medicine offer that Western medicine doesn’t? You know, the World Health Organization recently noted their growing demand for traditional medicine and the need to integrate it into mainstream health care systems. What do you think is driving that demand?

Danièle Behn Smith Well, it brings in all of the missing pieces, for one. And it resists that reductionist approach that we push in Western medicine that silos things and narrows things down. So it brings in the mental, emotional, spiritual aspects of health and healing. I think traditional medicines grounds us in our identities. It allows us to access healing spaces and energies that we can’t through just Western medicine, and through kind of a small pill, because it connects us to who we are. It connects us to our lands and our waters. It connects us to our ancestors. Western science is trying to catch up. And so there are areas in Western science that document, for example, the positive impacts on health of park prescriptions or forest bathing, like being out in nature. Well, that’s stuff that we just know in our families and our medicine people tell us. They can take care of all of us going forward.

Dr. Alika Lafontaine Danièle’s journey represents one approach to bridge two worlds and make change, a voice in a growing chorus of people across the country making healthcare better for Indigenous patients, families and communities. Another voice is Dr. Barry Lavallee—someone who had a deep impact on how I view health, healthcare, and how health systems need to change. 

Barry Lavallee It took me a long time with my leadership to change this country, to accept Indigenous-specific racism. That’s about 25 years of work that I did trying to influence these systems.

Dr. Alika Lafontaine As a trainee in the early 2000s, Barry was well known for speaking clearly and plainly about colonization and anti-Indigenous racism in Canada. That’s more remarkable when you consider colonization and racism wasn’t something we talked about at the time, except in very careful and restrained ways. As a Metis medical student trying to find a place to belong, Barry helped me get closer to finding myself. He did this for many other Indigenous students across the country. Today, Barry is Chief Executive Officer of Keewatinohk Inniniw Minoayawin, otherwise known as KIM, an organization founded to transform Manitoba’s healthcare delivery system in Northern Manitoba. Manitoba has the highest percentage of Indigenous peoples of any province.

Barry Lavallee Now, as scientists and strategists and technicians, we’ve got to figure out a way to change this system that was never made for us to make it work for us with a specificity to First Nations only. And that’s the path and the dream that we take over here.

Dr. Alika Lafontaine He joined me from a boardroom in KIM’s office in Winnipeg. Behind him is a display titled “Our First Nations Health Governance Journey,” a detailed timeline of health system change, past and future, in Northern Manitoba.

Barry Lavallee You see this thing over here?

Dr. Alika Lafontaine I do.

Barry Lavallee The top is a lot of text. That is how First Nations people since the signing of the treaties have embarked on their own vision about health. At the bottom, you see very little text. That’s the province and what they’re doing with First Nations. So our leaders asked us to flip it over and not be so government-centred, but centred on the actions of our communities. I won’t give you the details about the resolutions, but this has been the mandate and dream for First Nations for a long time, since 1870. And what we’re doing is we’re detailing all the actions, the resolutions, you know, Wahbung times, too, all of that kind of stuff on here to honour that journey. Okay. And that’s what we do. Indians are active and projecting and theorizing and taking the risk to take something back that the colonizers have taken from us for well over 100 years with the poorest health outcomes. So this is a defining moment for 23 sovereign states, and that’s why we’re here.

Dr. Alika Lafontaine Like Danièle, Barry went into medicine to try to improve what he saw as a flawed system that was hurting his people instead of healing them. And also like her, Barry had had bad experiences in the system.

Barry Lavallee And so when I left medical school, I was really angry for a lot of reasons, because I didn’t know what the experience of a residential school was. But in the time since then, and speaking with people who’ve been imprisoned in their life, actually materially, right? Their body’s imprisoned. I realize now, in retrospect, even though I had a warm bed to sleep in, I wasn’t on the street, medical school for me, I would imagine, was a residential school experience, where I wasn’t allowed to identify myself as a half-breed or as an Indian or anything like that. Nor did I feel I could celebrate the incredible stuff my parents, who went through lots of trouble, brought to me through my grandparents, etc. And so I left really angry, Alika. And so I told them, do not take a picture of me. Do not invite me to anything, you just give me my M.D. And so, at the end of my residency, I didn’t want to take care of little unwell white women and white men because I was training to take care of our people. 

Dr. Alika Lafontaine Barry did something unprecedented. He requested to move his residency training to Northern Manitoba for the last six months, to live and learn with Indigenous communities.

Barry Lavallee What I did was I opened up a residency program in Northern Manitoba, and I sat there for six months and I had physicians train me to provide care and to be able to provide care to First Nations people. And that, Alika, defines my whole career.

Dr. Alika Lafontaine So, from the very beginning of your career, you were creating spaces for the type of care that you wanted to provide that, you know needed to be provided. Can you tell us a little bit more about that transformation that happened as you transitioned from being a resident into kind of early clinical practice and..?

Barry Lavallee Sure. So I finished at The Pas, my residency, and so I got my family medicine. And then I went into emergency in order to elevate those specific skills because I knew I had spent a number of years in isolated communities providing support there. And I landed in Tataskweyak First Nations, which means Split Lake. Split Lake embraced me as kind of one of their own. And I provided the care. And I fought like a warrior getting care at Thompson General Hospital. And so we developed a team within Tataskweyak of Indigenous providers to direct care that was First Nations-centred and direct care that was trauma-informed. They didn’t have it at that point in time, but we knew a lot of people were the product of incarcerations. A lot of people didn’t know where their mom was because she apparently had died in one of the TB institutes and they’d never seen their mom again. So dealing with a lot of people with multi levels of grief that was, unattended to grief. I knew earlier, before I started my academic career, that the health behaviour presented by First Nations is different than the health behaviour presented by people who had never been colonized nor incarcerated. And the problem with medicine is that they try and fit us into their mold of what they think health behaviours should be. And so even like in the concept of mental health diagnosis, depression or psychosis and all those kinds of things that we learned growing up in medicine, it doesn’t fit generally for First Nations because you’re looking at a group of people, intergenerationally, who present health behaviors that appear to be undefined by the colonial medical system. But in reality, that’s about mental unwellness as a consequence, this continual consequence of racism on the soul and the mind and the body of First Nations people. So if you are perceived to be an Indian and you go into a health care system, there are stereotypes attached to your body. They’re resistant. You know, Indian men beat Indian women. Indian men are sexual predators. Indian women are not good mothers. You know, Indian women don’t care about their health. Indian men are all drunks. And you go on, and on, and on. People in medicine, like junior doctors and medical students, they are coached into stereotyping Indigenous people. And by coaching and putting within the mind of these providers, these stereotypes about Indians, and then you become a doctor or a medical student or resident, you already have power. So power plus stereotyping equals racism.

Dr. Alika Lafontaine All of these experiences prepared Barry for the role he’s in today. 

Barry Lavallee And so I’ve been here I don’t know how long. I never know. Two years, three years. A long time anyway. But the culmination of all the stuff that I did at the university and all the frustrations at the university and all, you know, the challenges of practicing in deficit poor environments and things like that come to me today. So it’s like my ancestors had kind of set these things for me to come here and use leadership. You know, the team that we have here embraced by Indigenous people. And so I’m in a position that most physicians would dream to be in. Our ancestors have an idea that people are, the chiefs I work with, and all the leaders I work with, have an idea and a vision about us taking a system and making that system accountable to our wellness and making sure that in 30 years we have reduced dialysis needs, we have reduced suicidality, we can take care of and manage the trauma that our communities have gone through for 150 years by using harm reduction, by not judging, and by loving and by caring. We have a really important document here called the agreement in principle, but it’s not an agreement in principle. It’s a culmination of our dreams, our aspirations and to try and use English to convey love and caring and forgiveness. And that’s really what transformation is about. And so we recently had a meeting with our leaders, and they’ve endorsed that document. So Alika, you find me in a happy mood. You find me in a mood that I acknowledge that I am only but a tool for all the studies and all that kind of stuff to support communities’ aspirations that they’ve had for 10, 20, 30,000 years before colonization came here.

Dr. Alika Lafontaine In September 2022, KIM, the advocacy organization that Barry leads, along with Manitoba Keewatinowi Okimakanak, which represents Northern Manitoba First Nations, partnered with Manitoba’s Northern Health Region. The goal was to eradicate all forms of racism and prejudice in the healthcare system. Ultimately, Barry wants to see the Northern Health Region under the governance of Indigenous communities.

Barry Lavallee We are going ahead. And I don’t care if this is public. At some point in time, we’re taking over the Northern Regional Health Authority because our community wants us to do that. I could bring Alika to do my anesthesia. I could get surgeons over here. We have advanced care nurses. We have our traditional people who could come and do integrated and parallel systems. And that’s where our dream is going. But in general, the overall dream is to make the systems accountable to wellness. Period. Because we get surgeons, five surgeons up here. It’s not going to change anything for Indigenous people because the real issue and the real denominator is access to care. And within that denominator is racism and all kinds of things, but it’s access to care. So even if I have 20 Alikas up here, I have 20 surgeons, health for Indigenous people will not improve because access is diminished. So that’s our fundamental equation as we move forward on transformation.

Dr. Alika Lafontaine It’s amazing to hear you talk about things in this frame because we often talk about racism taking years and years. You know, in another lifetime we’ll be able to fix these problems. But you’re talking about stuff that’s actually making a difference today. So, you know, health care organization is tough for anyone to understand, right? If you take well known First Nation-led health systems like First Nation Health Authority, you know, it provides some programs. The health regions in BC provides some programs. The Provincial Health Services Authority does some stuff as well. Everyone’s kind of crossing paths, other things. Can can you try to explain and unwind to listeners how the Northern Health region and KIM work together and just kind of the vision for what KIM will expand and do? Because it does sound like providing direct care is something that KIM eventually wanted to do, even to the point of starting to take over some of the functions of the Northern Health region.

Barry Lavallee Currently, in, you know, 2023, right now, KIM is not a service delivery organization, dot, dot, dot, dot, yet. We have to focus a lot of the time on the legality of transfer of 200 to 400 to 600 million dollars into the arms of 23 sovereign states that will define within the racial border of between the feds and the province defining what’s going to happen. What do we look at? What’s wellness? How do we centre things? And not, you know, not like pathology, lungs, you know, all this kind of thing, but centred based on the love and support and our ancestral knowledges that always took care of us. It’s been a rocky path, Alika, with the Northern Regional Health. But I could tell you that working within these systems, there are people in the bureaucracy who are allies. There are. But the leadership doesn’t show itself as allyship. You know, Alika, something sad really happened. The Northern Regional Health, they hired a CEO without our participation. When we had offered our participation to say that we certainly want a First Nations person leading our region. And they ignored us and they hired somebody from Toronto without any participation. At the same time, the two white leaders who are no longer there, said that, you know, we should have participated, like they were blaming us for their lack of things, right? It was really troubling because I brought our Grand Chief, as well as some of our senior chiefs and senior leaders, to a meeting with the Northern Regional Health board of directors. And I had never experienced in my 61 years that level of racism that was so obvious. So obvious, Alika, it’s those moments when you can’t say anything. It’s like, wow! One of our leaders was speaking about his brother-in-law or a brother who had a central nervous system injury that didn’t allow him to swallow. And so he was transferred to St. Anthony’s Hospital in The Pas. And Frank was talking about that really, really important and critical moment for him, how he watched his brother die of starvation on day 95 because a physician refused to put a feeding tube in. Just so you can have a prolonged assessment to, you know, because we have swallowing technicians in the South there that could kind of figure out some way, but he died of starvation in modern history in Northern Manitoba. And suddenly Frank had said, we even tried to use cannabinoids to try and improve his ability. And then suddenly somebody burst out giggling. So this man had tears in his eyes. He’s a leader for us for a long time and shared from his heart how painful it was to see his brother die of starvation in a modern hospital. And on the whiteboard side came a giggle. And so what Frank said, “It’s not funny.” So you have to think of the depth of that kind of violence. And then after that, I spoke to Frank and I said, Frank, I said, let me write a letter. He said, no, it’s always been that way.

Dr. Alika Lafontaine Wow.

Barry Lavallee Yeah. So we have a lot of work to do. Does that define our relationship with North Regional Health? No. That was two bigots among weaker bigots. So what we’re going to do is, we certainly stand beside the Northern Regional Health, analyze their programs with the ultimate function of, is there access to care that is safe, is loving, and complete? That’s all we do. And we’re going to change that system to make sure that occurs.

Dr. Alika Lafontaine Before I left Barry, I wanted to hear more of his thoughts on reconciling two approaches to medicine—the non-Indigenous system he was trained in, and Indigenous medicine. I wondered how he saw these two systems working together in his ideal future.

Barry Lavallee I think they can work together. One of the things that’s been on my mind for about 20 years now is the fact that we don’t want to make a circle fit into a square. And I hate to use a simple analogy like that, but the dominance of medicine and its structures, philosophies, etc., we have to counter in the work that we technicians over here are going to do. Because making space for Indigenous knowledges and practices is possible. In James Bay Area, they had set up Indigenous knowledge clinics and Western knowledge clinics. And over time, people went to the Indigenous and less to the doctors. In the beginning, Alika, because these systems have been imposed on our ancestors and we’ve not gotten back in a real way to say, who do you really want to see? What are you comfortable with? And even to help people conscientise about that.

Dr. Alika Lafontaine So it really sounds like the path forward that you think isn’t…well, for lack of a better word, assimilating traditional knowledge keepers and traditional practitioners into kind of this non-Indigenous system, but having people really work side by side.

Barry Lavallee Yeah. Or even a mile apart, it doesn’t matter. But the issue for us is the right of Indigenous peoples to gain access to a provider of their choice. And if a provider of their choice is a knowledge keeper, so be it. I don’t want doctors or medical associations making comments about that. But the other thing, Alika, that’s central to our work is that any First Nations people have a right to a second and a third doctor visit. Okay? That’s it. You know, and should they choose to go to two or one or both. And I’ve been fighting this for a while. I mean, one of my obstetrical patients didn’t want to take a blood clot thinner. She was at risk for, I think, a DVT or whatever at the time. And her white obstetrician kicked her out of the practice because she went to a knowledge keeper who gave her a medicine. And so I went to the department head in obstetrics. Well, well… I said, that’s how racism looks. It’s none of your business, nor the business of the obstetrician to judge an Indigenous person who chooses our knowledge systems. You don’t own it, baby. Okay, you don’t own it. Don’t pretend you own it. You don’t own it. Okay? And so I’ve been doing that all my career.

Dr. Alika Lafontaine It sounds like to me that the end point of what First Nation patients want is very similar to just the average Canadian, which is, they want access, they want choice, they want to have whatever they experience to be free of hostility, full of warmth, and they want it to make a difference in their disease process.

Barry Lavallee Yep. You know, I did that Masters in Family Medicine at Western, and one of the papers we studied was, what do patients want in the therapeutic engagement with a provider, with a physician, right? And so I used that as part of my basis of analyzing, what do Indigenous people want in the therapeutic environment? When I examined ten First Nations people in a immersion crystallization process for understanding that therapeutic relationship, every participant burst out crying. And part of my research was understanding the source of that pain. And the source of that pain, and I haven’t published that yet, is the unintended theme that an Indigenous person, an Indian person wants to be Indian in the sanctity of the therapeutic relationship with the provider. But they were actually let down by the providers because they weren’t concerned about their Indian medicine or this or that, and they harmed those patients deeply. So when we’re asking physicians and nurses and other healthcare people, be centred in who a First Nations person is in their environment, in their context, be it in B.C. or wherever. And do no harm. And the only way you do no harm is becoming aware that you are a product of settler Canada with intentionality to take our lands away and we’re in the way of those lands. We’ve got to change this whole structure. And that’s what I embrace. And that’s what our communities embrace. They embrace it, Alika, and it’s powerful.

Dr. Alika Lafontaine Danièle and Barry’s experiences mirror many of my own. And while we have graduated hundreds of Indigenous medical professionals over the past 20 years, folks currently in training still feel that who they are isn’t always expressed in what they’re training to become. We shouldn’t confuse this as an argument about preference or identity. In real world practice, when your providers are like you—sharing similar experiences, culture, language and philosophy—there are major differences in health outcomes. Seeing racism and navigating the power structures that maintain its presence requires a mix of lived experience and insider know-how. In one of Danièle’s low moments, she held a Western medicine and found a way to accept it in the same way she accepted Indigenous medicines. That might be where the bright future of Western and traditional medicine lies. An acknowledgement and mitigation of harm, with a recognition that we can build up something better together. We had the promise of that future when explorers brought things they learned from Indigenous cultures from around the world back to places like France and England centuries ago. Maybe we can do it right this time around, letting everyone take their place in a future we build together.