Indigenous Health Lecture – @theU

On November 2, Dr. Evan Adams, MD, MPH, Deputy Chief Medical Officer of Indigenous Services Canada, spoke to a virtual audience as part of Mediversity Week 2022: Securing Health Equity for All. Dr. Adams, a member of the Tolamin (Sleamon) First Nation, has worked extensively with First Nations health programs in Canada. He served as Deputy Provincial Health Officer with the British Columbia Ministry of Health, and was the first appointed Aboriginal health physician advisor for the province of British Columbia. Dr. Adams spoke about indigenous health and well-being, which goes beyond a person’s physical health. To improve health outcomes today, Dr. Adams shared that Canada must address its country’s violent past—and present—toward Indigenous peoples. Below are highlights from some of his lectures, edited for detail and clarity.

great calculation

Some of you may have heard of the Great Reckoning, that the graves of thousands of Indigenous children have been found in dozens of former residential schools. He called them residential because indigenous students used to live there, although they weren’t quite schools. They were more like prisons, and the education they provided to all the children was very rudimentary. And this experience, which lasted for several generations in Canada, apparently killed thousands of our children. The rediscovery of these graves has caused much self-reflection among Canadians. How could a civilized country like Canada, or the United States—and there were many schools in the United States—do this to a particular ethnic group, especially their children? What was state-sanctioned and church-sanctioned violence against the most vulnerable, against our children, who are now adults. what does this mean?

Natives are natives. We have been here ever since, for many thousands of years. Mesopotamia was 5,000 years ago. Indigenous peoples in the Americas have been living here for at least 10,000 years, as many as 20,000 or more than 30,000 years. We have a long history here on this continent. We used to own everything, and now we own hardly anything. And we have the worst health of any ethnic group in this country. And is this by chance or is it possibly by design?

People’s health is linked to the past

I want to talk about people’s health – that’s my job. People’s health is not just their physical body—it is their mind and their body and their spirit. And they would say that our health and well-being are linked to our peace of mind, access to justice, access to opportunity, access to our own wealth, fairness, duty and culture. The social determinants of Indigenous health have been shown time and again to be directly related to community health. When we put it another way, if I can cure your cancer, but I leave you homeless, have I done all I can for your health and well-being? It is no coincidence that those who are rich are generally healthier, and those who are poor suffer and die more often…

I think some of us forget what a long history we have in these countries, in our own country. In Utah, you’re very close to settlements of indigenous peoples that still exist, or at least were there, for a very, very, very long time. And we still exist. I live in my home region where generations of my ancestors are just here. And I remember the story that was told to me in my childhood. My great grandfather was born in 1860. In 1862, a smallpox epidemic began in San Francisco, then struck the South, into Central/South America, and north from San Francisco to Alaska. And about a third of all coastal indigenous people died. One third of my village died. About 5% to 10% of them were blinded by smallpox, including my great-grandfather. But we do have stories of them being loggers. His daughters would take him into the woods and he would feel around for wood, and he would chop them by hand. And at the end of the day his daughters would come and fetch him, and sell the wood he cut along the way. Whenever I feel that I am living a difficult life, I think of my great grandfather.

My mother was in a residential school from 2nd grade to 12th grade. My father only went for a year. His mother had my father in 1936. He had tuberculosis and died at the age of 16 months, so he was raised in our way, which was raised by his grandmother to follow the ways of her people. He had to have cold showers, or douches with cold water, which we’re learning now in sports medicine is a really good way to build up stamina. He grew up with our knowledge, which was… well, we never called it conventional wisdom, it was just called wisdom. If you live here, you should know where the food is, you should know where the deer are, you should know where the water is. And with that physicality and that formal training, he could play very easily. And maybe he had some good genetics, but I think it’s mostly because that’s how he grew up.

political power to fight against casteism

For us, as indigenous people, it is a new day. In the olden days, say the 1960s, we had far less political power than we do now. And we refuse to be second class citizens in our own country, in our own territories. We would like to say something in our future. This may be hard for the settlers to hear, as they are used to not sharing power.

Here in this country a few years ago, we had a woman named Joyce Echakan. A First Nations woman in Quebec, the French-speaking region of our country. This young woman recorded a video while she was being humiliated by the hospital staff. The nurses were screaming at her as she was dying. And they were broadcast via Facebook Live. So, while she was still in the health care system, she managed to catch these racist acts against her. And that resulted in a pretty strong response from across the country. We essentially asked ourselves, how racist is our health care system? How safe is our health care system? How common is racism in the everyday workplace? And if racism is happening in our workplaces and health environments, what does this mean for health outcomes for Indigenous peoples?

The incident inspired a report called In Plain Sight which addressed Indigenous-specific racism and discrimination in British Columbia health care. BC, my province in which I live, had an extraordinary, but very ordinary collection of stories of racism in health care, in which thousands of people came forward and said, “Yes, I had a racist experience while I was very young. and seeking help within the BC, or British Columbia, health care system.” And they were logged, they were analyzed and a number of recommendations came out of that report. I suggest you take a look at it and ask yourself the question: How secure is my system? And what would people say if I asked, “Have you encountered racism within my health care system?” Where would that report point you? Which action do you need to focus on the most?

For us, as Indigenous peoples, one of the things that helps me most to imagine a new and better system that is more fair, more egalitarian, more secure and accessible is to imagine that people’s There is a circle of care all around. Including indigenous peoples, including minorities, including people of color.

So when you look at coverage, or look at the health care system, my thoughts are not just about improving those who are in coverage, but expanding that coverage so that we There should be more people out there who should do this. Let’s expand the circle. Let’s open the door. Let’s invite people in. Let’s expand our view of who is helpful, and let’s make a circle, not a hierarchy, but a circle. And as many of you know, it’s not just doctors and nurses who bring us goodness. This can be a family member. It can be those who help our elders. It can be a teacher. It can also be a coach who helps the younger members of our family. So, I’ve talked about the social determinants of Indigenous health, and how we’re not just looking at physical bodies and diseases. We’re looking at community health.

coping with the violence of the past

Canada’s Truth and Reconciliation Commission collected the bodies of children who died in residential schools and discovered many thousands of graves… and I think it will change our country to examine our own history Forced how we find ourselves today. How do we deal with situations where we know that settlers have committed violence against us in order to obtain our land? And now we find ourselves in this time of uneasy peace between us, where we can’t make up stories about past crimes, we have to tell what really happened.

And a part of him is angry. I do get angry. Even though I have been called an intergenerational survivor, the descendant of two residential school survivors, even though I was a formal honorary witness to the Truth and Reconciliation Commission and spoke out about residential schools and what happened in Canada. The Pope met with Canadian leaders to apologize for what happened in the residential schools. And it meant a lot in Canada and got a lot of discussion in the States. what does this mean? How can we fix this?

The way forward is clear for me. We need to sit down and have a conversation and make sure that the students are learning the truth of what happened. Another part of the answer is to create cultural safety and what I call cultural humility, which is for health care professionals to get to know your community in which you work. Important health care professional, and I’m going to be the boss of you, no matter the patient or member of the community. I’ll approach with humility and say, “I’m trained in my own way. I want to be helpful. I have prejudices, for example, I don’t know what it’s like to have children as a man. A cis-gender As a man, I don’t really know what it’s like to have a child physically. But I do have empathy, and so let’s work together on this issue. It’s a polite tradition, but it’s a cultural politeness.

There needs to be accountability in the healthcare system to say what are appropriate and inappropriate actions, what is the quality of our actions and how we can improve. And you cannot improve the quality of our Service unless we acknowledge that we can improve the quality of our Service. But it’s amazing to me how many health care professionals don’t acknowledge that they can do better.

Improving healthcare for indigenous people

Fortunately for us in Canada, we have our first Indigenous president of the Canadian Medical Association, and he is promoting policy and system change, engaging Indigenous communities for greater inclusion. And that really brings up the concept of friendship. So friendship to me is really a combination of an anti-racist stance that doesn’t just involve personal racism. The kind of racism that many people think is personal racism, when in fact it is institutional and structural racism. Through the National Association for Indigenous Medical Education, we asked Indigenous people what they want, what they think is important. He said it is important for us to be strong as indigenous people, not just smart. So, be the person with not just the brightest degree, but the one who is well versed in our philosophy and methods…

Sometimes well-being is related to resistance. And so, I think that anger is present sometimes when we’re trying to understand equality and try to lift everybody up. This is a very normal and healthy part of resistance. So even something as simple as collecting data about indigenous peoples is not done. I sometimes have to feel angry or take an angry stand to ensure change. It is not meant to be destructive. It is not meant to be aggressive. But to say that I am frustrated by a colonial system that does not collect data about Indigenous peoples is essential to change.

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