SASKATOON — Among Cree people, it’s said that a community functions like a living organism. Each component is vital, working in tandem to make it operate as nature intended.
Cut off one part, and the entire unit will run off balance.
Correcting imbalanced social systems that are numb to the nuances of society’s participants — at times lacking sensitive and respectful treatment while trying to heal people — is an arduous task.
Physician Janet Tootoosis has brought this assignment into her dossier of care and attention in her new five-year term as vice-dean of the Department of Indigenous Health at the University of Saskatchewan.
Dr. Tootoosis, who hails from Poundmaker Cree Nation and runs a practice in North Battleford, was appointed to the role initially as interim vice-dean in June 2022. Her mandate includes key consultations with the university’s governance office, provost office, and vice-president academic office. The Department of Indigenous Health and Wellness received University Council approval in April and was officially welcomed in October.
“The system is failing a lot of us, not just marginalized groups,” Dr. Tootoosis says. “It’s not serving our population, and so how are the rules and policies and constructs holding us back as a province, as a health system, and as health providers?
“Really, it’s not about changing the whole picture. It’s about changing the organization, supporting the organization to achieve the change they deem necessary.”
The new department is intended to provide Indigenous medical students the option of having their credentials recognized as specialized in Indigenous health. The Dean of Medicine, Dr. Preston Smith, hopes this will provide credentials that are not colonial within traditional academia.
“It’s a little colonial to say you’re an Indigenous practitioner, to say you have an MD … and nothing about that recognizes your Indigeneity,” he says.
Cultural parity in health out of balance
Dr. Tootoosis says cultural parity in health in Canadian society is out of balance.
Saskatchewan made national headlines in 2001 after missteps in providing care to a Cree woman who had just given birth to her sixth child in Saskatoon and was presented with a consent form for sterilization. She tried to wheel herself away from the operating room but the doctor wheeled her back, according to a government report that detailed the incident.
The woman, referred to as S.A.T., is one of 16 women who shared their experiences of sterilization in a report by a Senate committee on human rights. The 2021 report found about 1,150 Indigenous women were sterilized over 10 years.
While most provinces have repealed laws that mandate forced sterilization, it is believed that it happened as recently as 2019.
Racial prejudice against Indigenous people in health care was also well noted in the Quebec case of First Nation woman Joyce Echaquan, a 37-year-old mother of seven from Manawan, Quebec who filmed herself on a live social media feed as a nurse and an orderly made derogatory comments about her at a hospital northeast of Montreal. Echaquan died in hospital on Sept. 28, 2020.
A coroner’s report a year later found systemic racism “undeniably” contributed to her death and that Echaquan would likely still be alive if she were a white woman.
“Systemic racism in the health system has an impact on not just Indigenous individuals but marginalized individuals new to Canada,” Dr. Tootoosis says.
First Nations, Inuit and Métis people in Canada are more likely to experience persistent poverty, food insecurity and barriers to housing and education.
Indigenous groups experience barriers to ease of access to health resources, especially in remote communities that require medical transportation to reach major health facilities. Indigenous people make up more than 4.5 per cent of Canada’s population, but less than one per cent of the country’s physicians identify as Indigenous.
Working towards reconciliation
The Canadian Medical Association has put its weight behind what it calls a “Guiding Circle” to advance equitable health care with First Nations, Inuit and Métis people. The circle is a significant symbol in many Indigenous cultures, as represented through the medicine wheel. The Guiding Circle builds on the organization’s work toward reconciliation.
Its calls to action for medical communities are aligned with the recommendations made in the 2015 report of the National Truth and Reconciliation Commission. Eight of the commission’s 94 calls to action focused on health care, which includes requiring medical schools to facilitate training on Indigenous issues and recognizing the value of Indigenous healing practices.
Dr. Tootoosis was a founding member of the Saskatchewan Health Authority’s board of directors and is a former president of the Saskatchewan Medical Association. She left the SHA board in 2021, weeks before the SHA’s first CEO, Scott Livingstone, resigned, citing external pressure on the board causing fatigue and low morale.
Dr. Tootoosis is no stranger to adversity, having been diagnosed with thyroid cancer in 2007. That year, she underwent surgery and received radiation treatments. She was a mother of an 18-month-old at the time, and the experience cemented her responsibility to go the extra mile in advocating for her patients, she says.
“Physicians are ready for the change that this department represents and they’re supportive of it, and the university community as well,” she says, adding that the pandemic opened up dialogues and problem-solving.
“Now more than ever, I feel that leaders are recognizing that inequity, lack of inclusivity, lack of diversity is hurting not just the bottom line for organizations but there are many challenges in our society that we are deemed responsible to at least do our part in addressing.”
Even in our most trusted and seemingly assured systems, there is a power dynamic, she says. The goal of parity is not only to ensure fair and equitable treatment, but to foster a truthful and nuanced understanding of people and history.
Dr. Tootoosis continues to run her practice while at the university on a full-time basis. The easier route would be to let the status quo remain, with communities segregated and systems separate, she says. She could just as easily remove herself from the minority at the university and find solace in her community.
But that would not be progress. What would she like her department’s work to bring about in the next five to 10 years? “That there would be fewer marginalized people, including Indigenous people, harmed in our health system,” she says. “That the health system becomes safer for all of us.”