Anderson, Marcia

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Canadian	Medical	Education	Journal	2018,	9(4)		Correspondence:	Marcia	Anderson;	email:	Marcia.anderson@umanitoba.ca	e142	Canadian	Medical	Education	Journal	Comments	and	Responses	An	Indigenous	physician’s	response	to	the	settler	physician	perspective	on	Indigenous	health,	truth,	and	reconciliation	Marcia	Anderson1		1Indigenous	Academic	Affairs,	Ongomiizwin	Indigenous	Institute	of	Health	and	Healing,	Rady	Faculty	of	Health	Sciences,	University	of	Manitoba,	Manitoba,	Canada	Published:	November	12,	2018	CMEJ	2018,	9(4):e142-e143		Available	at	http://www.cmej.ca	©	2018	Anderson;	licensee	Synergies	Partners	This	is	an	Open	Journal	Systems	article	distributed	under	the	terms	of	the	Creative	Commons	Attribution	License	(http://creativecommons.org/licenses/by/2.0)	which	permits	unrestricted	use,	distribution,	and	reproduction	in	any	medium,	provided	the	original	work	is	properly	cited.		Jaworsky’s	 recent	 article	 “A	 settler	 physician	perspective	 on	 Indigenous	 health,	 truth,	 and	reconciliation”	provides	excellent	suggestions	for	her	peers	 on	 allyship.1	 The	 Anti-Oppression	 Network	defines	allyship	not	as	an	identity,	but	as	the	“active,	consistent	and	arduous	practice	of	unlearning	and	re-evaluating,	in	which	a	person	in	a	position	of	privilege	and	 power	 seeks	 to	 operate	 in	 solidarity	 with	 a	marginalized	group.”2	Jaworsky	demonstrates	this	by	acknowledging	 the	 Indigenous	 people	 and	 medical	educators	that	she	has	learned	from,	by	referencing	Indigenous	scholars,	and	by	amplifying	the	voices	of	Indigenous	people.	She	begins	the	piece	by	 locating	herself	and	her	position	of	privilege,	the	same	way	I	would	introduce	myself	according	to	our	protocols	in	the	language,	by	my	nation	and	community	links.	I	am	a	Cree-Anishinaabe	woman	who	grew	up	in	the	North	End	 of	Winnipeg	with	 roots	 to	 Norway	House	 Cree	Nation	 and	 Peguis	 First	 Nation.	 The	 Cree	 and	Anishinaabe	lines	of	my	family	have	always	been	on	Turtle	Island.		Jaworsky	provides	four	separate	suggestions	for	her	peer	settler	physicians,	acknowledging	that	they	are	not	comprehensive	or	 sufficient	and	cannot	 replace	the	critical	dialogue	led	by	Indigenous	physicians.	If	I	were	 to	 offer	 a	 critique,	 it	 would	 be	 that,	 as	physicians,	 we	 too	 often	 rush	 to	 the	 action	 steps	without	 considering	 the	 how,	 and	 in	 the	 case	 of	reconciliation	 the	 how	 is	 particularly	 critical.	 	 She	suggests,	 for	 example,	 	 that	 we	 honour	 Indigenous	expertise,	by	including	Indigenous	Health	Experts	and	Knowledge	Keepers	on	our	medical	education	teams,	but	she	needs	to	further	elaborate	and	build	upon	this	concept.	The	Truth	and	Reconciliation	Commission	of	Canada	(TRC)	 has	 provided	 us	 with	 a	 roadmap	 of	 how	 we	should	 move	 forward	 in	 resetting	 the	 relationship	between	Indigenous	people	and	Settler	Canada.3	The	first	 principle	 of	 reconciliation	 is	 that	 the	 United	Nations	 Declaration	 on	 the	 Rights	 of	 Indigenous	Peoples	(UNDRIP)	is	the	framework	for	reconciliation	at	all	levels	and	across	all	sectors	of	society.	It	is	thus	imperative	 that	 Settler	 physicians	 and	 medical	learners	have	a	working	knowledge	of	UNDRIP,	its	Canadian	Medical	Education	Journal	2018,	9(4)		 e143	key	 themes,	 and	 their	 responsibilities	 in	 a	 rights-based	approach	to	reconciliation.	Two	of	the	relevant	major	 themes	 are	 the	 right	 to	 be	 self-determining,	which	 is	 related	 to	 Jaworsky’s	 point	 not	 just	 of	honouring	 Indigenous	expertise	but	actually	making	space	 for	 Indigenous	 leadership,	 and	 secondly,	 the	right	to	be	free	from	racism.	As	 we	 work	 towards	 understanding	 and	acknowledging	 the	 truth	 before	 reconciliation,	 we	need	to	be	deliberate	about	 identifying	and	naming	the	 ways	 racism	 operates	 in	 our	 health	 care	 and	medical	education	systems.	Jaworsky	has	started	this	with	the	example	of	Brian	Sinclair.	In	the	subsequent	paragraph	 on	 paternalism	 and	 cultural	 superiority	within	medicine	this	could	be	appropriately	identified	as	epistemic	racism:	the	privileging	of	one	knowledge	system	over	another.	Sustained	critical	reflection	on	how	 evidence-based	 medicine	 can	 conflict	 with	Indigenous	peoples’	rights	to	receive	equitable	health	care	and	to	use	traditional	medicines	as	they	decide	best	 for	 them	will	 be	 an	 important	 part	 of	 moving	forward	together	in	a	new	way.	Discussions	 about	 reconciliation	 are	 useful	 only	insomuch	as	they	result	in	improved	health	and	social	outcomes	 for	 Indigenous	 peoples.	 The	 critical	 self-reflection	 called	 for	 in	 the	 paper	 provides	 an	important	foundation	for	action.	However,	this	must	be	 translated	 into	 individual	 and	 collection	 action.	Only	 when	 Indigenous	 peoples	 are	 receiving	equitable,	 high	 quality	 care	 and	 we	 are	 making	progress	on	closing	the	persistent	gaps	in	Indigenous	health	should	we	consider	the	job	well	done.		Conflicts	of	interest:	There	are	no	conflicts	of	interest	to	declare.			References	1. Jaworsky	 D.	 A	 settler	 physician	 perspective	 on	Indigenous	 health,	 truth,	 and	 reconciliation.	 CMEJ	2018;9(3):e101-6.		2. The	 Anti-Oppression	 Network.	 Allyship	 [Internet].	Available	 at:	https://theantioppressionnetwork.com/allyship/.	[Accessed	August	24,	2018].	3. Truth	and	Reconciliation	Commission	of	Canada.	What	we	have	learned:	principles	of	truth	and	reconciliation.	2015	 [Internet].	 Available	 at:	http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Principles_2015_05_31_web_o.pdf.	[Accessed	August	24,	2018].										

An Indigenous physician’s response to the settler physician perspective on Indigenous health, truth, and reconciliation

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An Indigenous physician’s response to the settler physician perspective on Indigenous health, truth, and reconciliation

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