Status quo not working for the health of First Nations people
“Our stories are so out of norm and removed from others experience that those others have a hard time believing that these things could happen. They believe these experiences are extremes. This is our status quo. For those of us that live this reality, the status quo is no longer an option for us, our children or our communities.” – Cree Elder
By Marci Becking
SAULT STE. MARIE – Normally anesthesiologists are supposed to put you to sleep, but Dr. Alika Lafontaine’s keynote at the Mosaadan Mino Bmaadiziwin (Walking the Good Life) conference hosted by the Anishinabek Nation health department, was anything but sleep-inducing.
“You already know what has to happen. The real thing is to reclaim that power,” said Dr. Lafontaine about Health Transformation.
He says that because of the treaty relationship, First Nations people should be the healthiest people in Canada. The opposite is true.
“Change is not easy for any individual or organization. Non-Indigenous health systems have been going through their own changes; in Anishinabek Nation territory there’s been a shift in Provincial systems that used to be organized by Health Regions, then to Local Health Integration Networks (LHINs) and now to Ontario Health Teams. Every time we reorganize governance, there is the fear that new governance will lead to a shift in infrastructure and services available to Anishinabek Nation patients, families and communities. I always emphasize to the communities that our Design Lab works with that this fear is real. Sometimes when you get a change in governance, past understandings and Agreements change as well,” says Dr. Lafontaine, (BSc, MD, FRCPC).
“The most important question for any Nation to consider is ‘What are we trying to accomplish?’ Ownership should never be an end in itself. The real goal is making sure there’s accountability to patients, families and communities. It is making sure there’s access to the services that Nations use regularly. It is monitoring and enforcing high-quality care and cultural safety in each and every patient encounter. In order to achieve this, a deeper understanding of how existing levers of change can move accountability, access and high quality at all times can help alleviate the concerns that can accompany negotiating new Agreements and the fear of change.”
“Our Lab has a project with the Saulteaux Pelly Agency Health Alliance (SPAHA) where we’re moving forward health transformation that is community-led and community-centred. We are close to securing new health infrastructure and programs, not only with Indigenous Services Canada but also with the Provincial health system. When SPAHA did their early consultation with their First Nations membership, the definition of health transformation they settled on was “the empowerment of patients to fully exercise their Treaty, constitutional and legislative rights to health care. In tripartite agreements, we often focus on Treaty rights— rights that Treaty Peoples are entitled to because of a value exchange where Nations provided Canada access to land and resources. There are still other constitutional and legislative rights that individuals, families and communities are entitled to outside of Treaty agreements. This means that those agreements aren’t the end, they are only the beginning. The more that Nations can fully exercise the full spectrum of rights to health services for their members, the better off the health of those members.”
He says that when he visited the Anishinabek Nation territory, it was obvious that there are talented and motivated leaders and providers in the territory.
“Looking beyond Treaty agreements and creating a strategy for not only transforming Anishinabek Nation health systems, but influencing non-Anishinabek Nation health systems, will help to alleviate the fear of change. The message I always bring to the Nations I work within health transformation is that we are only at the beginning of what can be available if we focus clearly on outcomes and have every decision we make centred around expanding the individual, family and community rights of patients. There are many pathways to do this and include public relations/media, political advocacy, litigation, quality improvement, quality assurance and patient self-navigation.”
Dr. Lafontaine, through storytelling of real patient encounters and his own experience, shares his knowledge across Canada on the role that bias, discrimination and racism has on patient care and why addressing these issues is at the core of improving the health of First Nations, Métis and Inuit Peoples.
“Limited options mean that patients are forced to deal,” says Dr. Lafontaine. “Many argue racism does not exist in our health care system. Racism is sometimes harder to see. Racism is rarely reported – even when the allegations are shocking. Our Elders shouldn’t be scared and should feel safe.”
“Public education is part of the answer, but education can only take us so far. Canadian identity is built on a foundation of colonialism and though Canadians are seeking for a new path, history weighs heavily on any solutions that eliminate racism. When we change what we believe, we learn what we should do and also have experiences where we feel that we need to change.”
Dr. Lafontaine says that cross-cultural training should be a core part of every health professional’s education and ongoing medical practice.
“I sit on the council of the Royal College of Physicians and Surgeons of Canada where we recently passed new requirements for Indigenous Health competencies. These new competencies will include education on Indigenous cultural safety, ways of knowing, traditional medical knowledge, among other initiatives. The Anishinabek Nation could reach out to the Royal College to ask about implementation and work with the Indigenous health advisory committees within the Royal College and your local Ontario medical schools. Within your territory, there’s the Northern Ontario School of Medicine (NOSM), Western University and University of Ottawa medical schools.”
Dr. Lafontaine says that nations can be ready to advise and guide as Canada takes its path towards reconciliation.
“Education about residential schools, forced relocations, Indian hospitals, disparities in health services, the lived patient experiences of Anishinabek Nation patients, families and communities all move us closer to changing the beliefs systems that racism is built upon.”
“When I put on the hospital robe, I am just another Indian. This is health transformation. Taking people from a position where they feel they have no power to where they feel they have all the power. Create opportunities for them to create their own path. We cannot continue this cycle where we are not included.”
Dr. Lafontaine became CBC’s “Canada’s Next Great Prime Minister”, winning the competition with a platform focussed on reconciling the Treaty relationship between Indigenous Peoples of Canada and Canadians. He was born and raised in Treaty 4 territory and has Cree, Anishinaabe and Polynesian ancestry.