Privilege. Blame. Allyship. Reflecting on reconciliation as a non-Indigenous physician

I am a doctor who works in the hospital where Brian Sinclair died after waiting over 30 hours for care. Systemic racism and structural barriers failed Mr. Sinclair and led to his preventable death.

And the health system continues to fail many others. Every day when I go to work, I reflect on the experience of Mr. Sinclair, or think about Marcia Anderson’s story, a physician who has spoken about her father’s traumatic near-death, or the many others I have heard. We have taken some steps to improve our systems, but many more remain.

During National Indigenous History Month, we have the opportunity to reflect on the history, heritage and contributions of First Nations, Inuit and Métis Peoples. It’s also a time to consider our personal journeys of reconciliation and question how, collectively, we can do better.

I was recently installed as Canadian Medical Association (CMA) president at a time when we’re grappling with systemic inequities that continue to perpetuate anti-Indigenous racism and discrimination in health care.

Last year, Alika Lafontaine – the first Indigenous president in the CMA’s 150-year history – announced our commitment to an apology for the harms caused to Indigenous Peoples. As the national voice of physicians, this public apology is a vital step to advance meaningful change in health care, and improve relationships between physicians, medical institutions and Indigenous Peoples.

During the announcement, Lafontaine spoke about the importance of trust coming before reconciliation. It’s a shared sentiment among Indigenous Peoples that I continue to reflect on in my clinical practice, advocacy work and beyond.

Working in Winnipeg’s core, I’m a health-care provider for many Indigenous patients. When they share their stories of why they are afraid of physicians and medical institutions, I think about trust – how it’s been broken many times over and how we need to mend it.

I’ve heard from Indigenous mothers who don’t come to prenatal appointments because they’re terrified of their children being taken from them; I’ve listened to patients share their experiences of being dismissed by health-care providers; and I’ve learned how Indigenous patients continue to face far too many barriers when they seek health care.

The structures we’re part of have harmed and continue to harm Indigenous Peoples and those same structures continue to benefit us as settlers.

I have served obstetric patients from small communities in Nunavut who are flown down for care a month before they’re due – facing a monumental life event in a city they’ve never known, where the culture is different, the food is different, where they are living out of a suitcase in temporary housing while dealing with all the symptoms of pregnancy and often leaving other children at home. We set up this medical system this way.

I’ve also heard from Indigenous colleagues about their experiences in medicine, and how they are constantly battling assumptions from non-Indigenous patients and peers while also facing the same systemic barriers faced by their patients.

Some non-Indigenous physicians may wonder why an apology to Indigenous Peoples should matter to them. They may feel blamed for past and present harms. But this apology isn’t about individual blame, it’s about acknowledging how the structures we’re part of have harmed and continue to harm Indigenous Peoples and how those same structures have benefitted and continue to benefit us as settlers.

These are the realities of the medical profession: its history aligns with Canada’s history. The doctor’s oath to “first, do no harm” has been violated. This includes the devastating impacts of Indian hospitals, forced medical experimentation on Indigenous Peoples, forced sterilization and forced relocation to tuberculosis sanatoriums, as well as the systemic racism, neglect and abuse continuing today.

The CMA’s commitment to an apology is part of our response to the Truth and Reconciliation Commission of Canada’s (TRC) Calls to Action. It is also a specific recommendation made by the CMA’s first Indigenous Guiding Circle, 16 First Nations, Inuit and Métis Elders, leaders and Knowledge-Keepers convened to shape our Indigenous health goal.

An apology by itself is words. It’s a very important first step, but it must come with action. The CMA will be implementing a long-term plan to advance our Indigenous health goal.

On an individual level, I now understand how becoming a doctor – and then succeeding in this career – was supported by my privilege as a settler. But I am still learning how to be a culturally sensitive health-care provider and an Indigenous ally. As individuals, we may not be responsible for what happened in the past. But we are responsible for what happens in the future. Together, we have a responsibility to keep learning, to help right the wrongs that have happened, stop ongoing harms in their tracks and build a better future.