Alika Lafontaine says the starting point for health-system change is the willingness to question our assumptions
Apr 08, 2018, By: Alika Lafontaine, MD, FRCPC
Years ago, I participated in a year-long group fellowship focused on developing leadership, with an eye to public policy. Notwithstanding our very different backgrounds, we connected through a deep desire to change Canada for the better. I attended several program conferences across Canada where our shared history was brought to light, illuminating new ways of seeing Canada and myself.
At our fourth conference, we discussed treaties and residential schools. In one breakout session, a smaller group of us met to share our personal perspectives. When it was my turn, I told a story gifted to me from my great-grandmother. In residential school, her class was escorted outside to witness the hanging of several men from a gallows constructed nearby. Some died quickly, their cervical vertebrae shattered from the force of the fall. Others had much slower deaths from asphyxiation. As the men’s bodies grew still, the teacher turned to the class and told them to remember the power of the Queen. They then returned to school and continued with their day. At the end of the story, I spoke of the need to acknowledge the impact of such trauma on survivors, their families and their communities. The other fellows then had a chance to express their thoughts.
All were sensitive to the fact that it was a horrible experience for anyone to go through. Little by little, however, a thinly veiled skepticism arose, which then gave way to an outright interrogation. “Are you sure that actually happened?” “Where’s your proof of the event?” “Perhaps this didn’t happen the way you were told.” Then, our senior advisor weighed in: “I’ve been in government a very long time. I can say definitively that this could have never happened in Canada.” Clearly, the discussion was now closed.
The group moved on to the next person, but my thoughts lingered on my great-grandmother. I had accepted her story as truth, and the fact that it came from my father and grandfather was proof of its veracity. I remained lost in my thoughts for the remainder of the night.
When the fellowship year ended, we published our findings and I continued on with my life. I buried this experience and, am ashamed to say, took the fellows’ comments to heart. I doubted my great-grandmother. It wasn’t until many years later, after I began reading survivor testimony from the Truth and Reconciliation Commission, that validation finally came. There it was in black and white: the event was recorded exactly as my great-grandmother had described it.
Despite all my accumulated privilege — as a physician, academic, advocate and medical leader — I could not stand up against the accepted narrative that night. Somehow, I lacked the credibility to overcome the incredulity toward my great-grandmother’s story. Any discussions that followed regarding treaties and residential schools became tainted for me. Our group’s articulation of the problems, solutions and implementation strategies for systems change were rife with false assumptions: the residential school system experience wasn’t so harmful; Indigenous Peoples needed to move on; resources were better allocated to areas other than healing from the experience.
Consider similar reactions to your own experiences in our health systems. Interrogation of your experience, dismissal of your concerns, minimization of problems and suggestions to move on. Once overwhelmed, many of us respond with silence. But the problems persist, and the harm continues.
If health-care systems are to change, we need a generation of health-care providers who are willing to share and accept the full truth of what is happening — a complete narrative that includes both the good and bad ways we structure and provide care. Acknowledging the truth will enable us to honestly confront it. In implementing change, I suggest you consider the following questions: When you talk about truth, whose truth are you talking about? What are you going to do about it?
Alika Lafontaine, MD, FRCPC, is an Alberta Health anesthesiologist and the medical lead for the AHS Aboriginal Health Program (North Zone), affiliated with northern First Nations and Métis communities. He is also a collaborative team leader with the Indigenous Health Alliance.
He will moderate the plenary panel session Nursing Leadership, Narratives and Accelerating System Change at CNA’s biennial convention.