Dr. Terri Aldred doesn’t recall her time in medical school altogether fondly.
“I grew up in a very remote place. I was very poor. I’m indigenous and I’m a woman,” said the member of Tl’Azt’En Nation who practices primary care medicine in Indigenous communities in northern B.C. “I didn’t have an easy go of it.”
Particularly demoralizing was the so-called ‘soft racism’ or microaggressions. “It was kind of from all angles, in a lot of ways.”
One incident that sticks occurred when she was 24, while pulling an evening shift at a busy hospital emergency room in Edmonton. “The emerg doc said, ‘Oh, you should go help your drunk relative in Bay whatever,’” said Aldred. “So I did. And, you know, they had been drinking but they were not even drunk. Not that it matters.”
The ‘drunk Indian’ stereotype is one of the most harmful in health care settings, according to a study led by UBC professor Dr. Annette Browne, which found, “Indigenous peoples experience individual and systemic discrimination when seeking health care despite efforts within the health care sector to promote cultural sensitivity and cultural safety.”
Last Friday, allegations of racism in healthcare hit the news when Health Minister Adrian Dix revealed a complaint he’d received about hospital emergency room staff playing a game to guess the blood alcohol level of Indigenous patients in the waiting room. Hours after learning of the complaint, Dix marshalled a press conference to announce he’d appointed Mary Ellen Turpel-Lafond, a Saskatchewan provincial court judge and B.C.’s former Representative for Children and Youth, to investigate. “If it’s true, it’s intolerable, unacceptable and racist,” said Dix, who referred to the allegations as ‘beyond disappointing.’
Turpel-Lafond will have the authority to investigate as she sees fit, the report will be made public, and the recommendations will be followed, Dix said.
Witch hunt or system change?
Aldred hopes it won’t devolve into a witch hunt. Pulling out the ‘bad apples’ won’t solve the situation. “There’s a system problem,” she said, “and there’s a way-that-we’re-trained problem.”
According to a 2015 report First Peoples, Second Class Treatment, “racism against Indigenous peoples in the health care system is so pervasive that people strategize around anticipated racism before visiting the emergency department or, in some cases, avoid care.”
The Métis Nation British Columbia condemned what it called a ‘Price is Right’ type game commonly played by hospital emergency room staff in B.C. to guess the blood alcohol concentration (BAC) of Indigenous patients. “The winner of the game guesses closest to the BAC – without going over,” according to a press release issued yesterday.
“We are in the process of trying to make systemic change,” said Dix, citing ongoing cultural sensitivity and humility work with the First Nations Health Authority, the First Nations Health Council, the Metis National Council, friendship centres, and others. “Those efforts have to be redoubled and tripled and quadrupled for whatever it takes.”
Racism and stigma require persistent chipping away, said Dr. Carmen Logie, a social worker and University of Toronto associate professor who holds the Canada Research Chair in Global Health Equity and Social Justice with Marginalized Populations. The core of stigma is ‘othering:’ creating a separation between yourself and somebody else which includes the need to devalue, construct, and portray them as less than us, less worthy of dignity, value and respect, she said.
“Part of othering is separating you as being a healthy person from those sick people and then blaming sick people for their own issue,” Logie said. “Because you want to believe that that can’t happen to you because you’re a good person.”
Turning the Tide
Dark humour is something most physicians have fallen into, said Aldred, taking care not to condone the behaviour outlined in the allegation. “We depersonalize people to try and find some lightness to get ourselves through.”
Depersonalizing others, emotional exhaustion, and a reduced sense of accomplishment are all signs of burnout, said Dr. Jane Lemaire, director of wellness at the University of Calgary’s Cumming School of Medicine, and author of several papers about physician burnout. “We really need to tackle… some of the more toxic aspects of our profession,” she said, including the stigma around mental health issues, and the valour of 12, 16, or 23-hour workday.
Aldred says it also comes down to training.
““It does not make it right and I'm not trying to create excuses," said Aldred, "but as somebody who walks in both worlds, medical students weren't trained properly in cultural safety and humility.” Training was aimed at creating confident practitioners who knew their stuff, she said. “They didn’t want the soft-spoken, tender-hearted person necessarily.” She recalls some of her fellow medical students as exceptionally caring and altruistic whose demeanour changed dramatically after going through medical training.
Nearly 10 years out of school, Aldred is helping change the system from within. Besides her primary care practice with Carrier Sekani Family Services, she is site director with UBC’s Indigenous Family Medicine program, managing 10 medical residents in Victoria, Nanaimo and Vancouver. These days, residents get five times more Indigenous health content than Aldred did, and time spent working in Indigenous communities.
“It’s kind of like changing the tide on a tsunami.”
She said the medical residents are a secret army to alter its course.
“These are the people who are going to make the changes.”
As for the investigation, Aldred said any real shift will require health professionals, policy-makers, academia, patient partners and industry to come to the table and make commitments.
“Otherwise, people are going to walk on eggshells for a few months (until) they get tired and burnt out again, and it’ll just be something else.”
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