By Dr. Michael Dumont, family physician and medical director at Lu’ma Medical Centre

I am Anishinaabe (Marten clan) from Shawanaga First Nation and I also carry mixed-European ancestry. I practise family medicine on unceded Musqueam, Squamish and Tsleil-Waututh territory at Lu’ma Medical Centre and Musqueam Primary Care Clinic. At both sites, I am privileged to integrate Western and traditional Indigenous approaches to health in my work as a family physician.

I came into medicine through a series of discoveries about my family. My grandmother contracted tuberculosis early in her life, and encountered multiple reactivations of the infection in her adult years. Shortly after my father was born, the TB spread to her kidneys, and she was transferred to an urban hospital where she consented to a nephrectomy. During the surgery, without her consent or prior knowledge, they removed her uterus. No explanation was given. This was part of a pattern in which Indigenous women were encouraged, coerced or forced into birth control or sterilization procedures — a practice that continues to this day.

Hearing this story for the first time during my undergraduate years shook my whole world; it made me realize how profoundly the racism embedded in our healthcare system had impacted my own story. I saw how powerful the role of a physician is and how much capacity we have not only to heal, but to harm. I felt an urgent sense of responsibility to do everything in my power to make the health care system safer for us as Indigenous people.

Following my family medicine residency, I joined an effort to build a new clinic in Vancouver: Lu’ma Medical Centre, part of the Lu’ma Native Housing Society. They wanted to create a health centre governed and guided by Indigenous people in the community. This was an opportunity to address something I had noticed during my residency – the lack of integration of Elders, healers and traditional medicine at primary care centres serving Indigenous communities. We bonded right from the start, and envisioned a team-based model with Elders,  traditional healers, counsellors, social workers, physicians and nurses.

Once we opened, the community response was immediate, with huge waitlists right from the start. We built strong relationships with the First Nations Health Authority (FNHA), Vancouver Coastal Health (VCH), and helped form the First Nations and Aboriginal Primary Care Network: a partnership of eight Indigenous-owned and operated primary care clinics across Coast Salish territory (on and off-reserve).

When you walk into Lu’ma, you’ll see Indigenous art on the walls and traditional medicines – cedar, tobacco, sage, sweetgrass – right by the door for patients to smudge or take home. Patients have autonomy and self-determination – if they want to focus on traditional health and healing methods, we have Elders and healers with these gifts to offer. If they are looking for allopathic medicine, they can see a doctor, nurse practitioner or registered nurse. If they are looking for housing, we can connect them with navigators to address this and other vital social determinants of health. If they are in need of support for their mental wellness, we have a team of counsellors to provide both crisis intervention and longitudinal counseling. It is such an honour to be part of this incredible team, addressing mental, emotional, physical and spiritual aspects of health with our patients.

At the heart of our work, however, is building relationships — we come from the same communities as our patients and share similar lived experiences. We aim to embody Truth and Reconciliation Commission Calls to Action #22 and 23:

22. 22. We call upon those who can effect change within the Canadian health-care system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal healers and Elders where requested by Aboriginal patients.
    23. We call upon all levels of government to:
        • Increase the number of Aboriginal professionals working in the health-care field.
        • Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
        •  Provide cultural competency training for all healthcare professionals

There are a lot of stressors that make it difficult for family physicians to implement culturally safe and humble practices in their own clinics, but there are some simple key things that can help:

• Focus on the relationship with the patient: At Lu’ma, we introduce a new patient and their family to the whole team. We focus on getting to know them as individuals. The first question – “Where are you from?” – can be loaded. Many Indigenous people worry our response to that question (in disclosing our identity) will translate into worse care. Systemic racism is real, and we feel it each time we set foot in an institutional setting such as a hospital or clinic. We have experienced enormous disruption in our lives – residential schools, being taken into the foster system, being forced away from our land base, and the cumulative effect of colonization has negatively impacted our identity and self-worth. That’s why identity is a key focus of our healing. At Lu’ma, we try to build up that pride in identity by recognizing it, learning about it and honouring it. While we do that through the guidance of our Elders, through ceremony and through teaching, it can also be done through simple acts of recognition and validation in the context of a safe therapeutic relationship. Forming trusting relationships with your patients is a powerful tool for decolonizing our healthcare system.
• Make respectful introductions: I encourage our students and residents, when meeting somebody, to acknowledge where they are meeting, who they are and where they are from. If you are a settler, acknowledge that. It takes just a few seconds and it sets the tone of that relationship. It narrows the power differential so the patient can feel a little safer and more comfortable; it provides a message of affirmation of that Indigenous patient’s identity and starts the journey forward from a place of respect and understanding.
• Create more time for patient conversations: If we know one thing from anti-racism training, it’s that we have to treat people differently in order to reach the same outcomes – it’s not about equality, it’s about equity. It can be so hard for many Indigenous people just to get in the door of a clinic. One way to help us feel safer is to book more time for Indigenous patients and to allow time for narrative at the beginning of the visit. We are storytellers — it can take a bit of time for us to open up. You may think the conversation is going off on a tangent, but it will always come back to why we are there to see you. The stories we tell will give you 99% of the information you will need — you can take an excellent history simply by sitting and listening without interruption. At the end, ask the questions you need for clarification or expansion of the clinical concerns raised.
• Set a good example for students and residents: It is heartwarming to see how much further our students and residents are along this journey of truth and reconciliation — they have done some of the “unlearning” that those of us who have been in the profession longer need to undertake. I encourage other family physicians to engage in teaching students and residents and set a good example of how to work with Indigenous patients —you will learn from your students, too.

Among health care professionals, family physicians are in the best position to build healing relationships with Indigenous patients. As the gatekeepers of the health care system, we have an opportunity and a responsibility to be change agents in this crucial time of transformation and decolonization. I am heartened to hear the strong voices of my colleagues who want to be allies in this cause. I see great hope in us working together to break down the power structures that continue to disadvantage Indigenous people accessing care in this territory.

Chi Miigwetch (thank you).