Article by Nadia Boachie and Laura M. Best

Graphic design by Ingrid Barany

Inclusion of Indigenous voices, perspectives and experiences is essential for achieving equitable and effective infrastructure in Canada. However, Indigenous people remain under-represented among health care professions and other STEM (science, technology, engineering or math) fields. When considering healthcare, specifically, it was reported that in 2016 less than one percent of the 93,985 specialists and general practitioners in Canada were Indigenous, despite Indigenous people comprising 4.9% of the population.¹

This deficit may, in part, be due to intergenerational trauma as well as other embedded systemic barriers. Entering a STEM or healthcare profession often requires a university education, yet the current learning environment remains disproportionately inaccessible and unsafe for many, including those of Indigenous heritage. As such, under-representation of Indigenous students is apparent among undergraduate degree programs in STEM fields, and only eleven percent of Indigenous people in Ontario have completed a university program.² This is in stark contrast to the almost thirty percent of non-Indigenous Canadians in Ontario who completed university.³

To learn more about the ways that the University of Toronto is investing in creating a more supportive environment for Indigenous learners, and to discuss his own experiences as an Indigenous individual trained as a medical doctor, The IMS Magazine recently had the privilege of speaking with Dr. Chase Everett McMurren. 

Dr. McMurren identifies as a queer, Indigenous individual. He exudes a humble, open demeanour and is devoted to fostering safe and inclusive spaces for Indigenous learners. A member of the Turtle Clan, he is training as a nâtawihôwêw* [not-a-way-who-ee-oo], or Medicine Man (*in Michif), while currently providing at-home care for long-living elders at Taddle Creek Family Health Team. Dr. McMurren is an Assessor and Clinical Supervisor for the College of Physicians and Surgeons of Ontario, the Medical Director of the Al and Malka Green Artists’ Health Centre at Toronto Western Hospital, and a supervisor for the Psychotherapy Training Program through the Medical Psychotherapy Association of Canada (MDPAC). At the University of Toronto, Dr. McMurren is an Assistant Professor in the Department of Family and Community Medicine, and the Theme Lead for Indigenous Health in the MD Program within the Temerty Faculty of Medicine.

When asked about the difficulties that Indigenous learners may encounter, Dr. McMurren described the numerous barriers that currently exist. Dr. McMurren explains how the healthcare system is based on colonial constructs. He describes how systemic racism is quite profound; the entire training that people receive to work in the medical field is really institutionalized. When asked about ways to reconcile with the past he answers, “I think the term stolen land also comes to my mind. It is hard to know where to start when our current society is built on subjugation and the attempted eradication of Indigenous people, it is kind of hard to repair that.”

Colonization contributed to the complete marginalization of Indigenous people from mainstream society and the disruptive effects continue to be evident in situations concerning access to healthcare and education. “For me, I think lately, in particular in my role as Indigenous Health Theme Lead for the MD program and as the chair of ISAP [the Indigenous Students Application Program for admissions], I am of multiple minds. There is a deep desire to make space for Indigenous voices and Indigenous people as well as a strong hesitation to welcome them into such a scary place. It can be quite unsafe, from a soul perspective,” he concludes.

To overcome some of these barriers, universities are working to develop more infrastructure to support Indigenous students. For example, the U of T is investing resources in dismantling forms of racism on campus. “We are very lucky at the University of Toronto,” Dr. McMurren says. He explains how U of T is working on improving several programs, like ISAP, to help Indigenous students along every part of the university journey, from admission to graduation. In the Temerty Faculty of Medicine, Dr. McMurren and colleagues, including Dr. Lisa Richardson and Rosary Spence (a Knowledge Keeper) are developing more inclusive resources and he explained how a change in the name of their office was a great start. Formerly the Office of Indigenous Medical Education, the now Office of Indigenous Health will “be inclusive of the MD program, the postgraduate and the graduate Health Sciences, and the Rehab Sciences.” Dr. McMurren continues, “We are also partnering with the Center for Wise Practices in Indigenous Health at Women’s College, which is really delightful. There is more space being made for an Indigenous perspective and it is very exciting. I think it is coming at a very important time.”

U of T has been extremely fortunate this year “because of the huge endowment of money to the Temerty Faculty of Medicine,”³ Dr. McMurren says. He describes how the unfortunate death of Joyce Echaquan happened shortly after receipt of the endowment, and this timing created transparency to the blatant issues of racism in healthcare.³ Joyce Echaquan was a 37-year-old Atikamekw woman who died on September 28th, 2020 at Centre hospitalier de Lanaudière in Joliette, Quebec. Joyce Echaquan recorded a Facebook Live video that showed her screaming in distress and healthcare workers abusing her. “There is a clear acknowledgement that racism is not some remote small issue. It is front and center,” Dr. McMurren explains. Money from the endowment is being allocated toward Indigenous causes such as establishing an Elder-in-Residence and a Circle of Elders, to support Elders working with the Temerty Faculty and ensuring Indigenous health education and leadership is supported in perpetuity.⁴

In response to preventable deaths like that of Joyce Echaquan, there has been a lot of recent attention to social justice issues in the media, specifically on the topic of racism in society. Calls to action are often emphasized but can also be overwhelming.  Dr. McMurren explains that “it sometimes terrifies me…there can be a lot of suffering and healing that is thrown to the side because people feel like we need to focus on action.” He calls for equal parts action, advocacy and “strong change making,” as well as clear attention to wellbeing. “If we are not well, and if our actions are not coming from a place of wellness, or even a desire for wellness, it feels like eating off of plates that haven’t been washed,” he explains. “We have to focus on healing, so that is something that is really coming up for me in my role as Lead at the Office of Indigenous Health,” he shares.

Dr. McMurren concludes by explaining that in medicine, but more so in society, we tend to make immediate judgments about the quality of something. While this behaviour can be beneficial, for diagnosticians for example, it may not promote an inclusive environment for the healing of learners or patients and, in this respect, medicine is a field that also requires humility, open-mindedness and kindness. Cultural Humility, specifically, is having a humble and respectful attitude toward people of other cultures; it is the willingness to learn from others.⁵ It allows people to recognize their own cultural biases, and is an important concept as the field moves forward.

“I will say that cultural humility is a very powerful medicine. People are generally not disagreeing or holding on to specific views because they are trying to be terrible people. It is usually because they are afraid and doing the best they can,” he explains. Dr. McMurren thinks that acting through a lens of compassion will benefit healthcare overall, and he works to spread these teachings, often derived from Indigenous culture, to educate his peers and to assist new learners. Cultural humility has proven elemental in treatment of patients, and it must become common practice in learning environments alike. This is just one essential step to help improve the inclusivity of STEM fields, and remove barriers that still exist due to irreversible traumas toward Indigenous peoples and other minority groups.

References

1. Statistics Canada [Internet]. Aboriginal Peoples in Canada: First Nations People, Métis and Inuit. 2017 May 25. [cited 2020 Dec 4]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025a-eng.htm?indid=14430-1&indgeo=0
2. IndeSTEAM [Internet]. Indigenous Perspectives in STEM & STEAM opening doors for all. [cited 2020 Dec 4]. Available from: https://www.indigesteam.ca
3. Canadian Federation of Students–Ontario [Internet]. First Nations, Inuit and Métis Education in Ontario. 2017 Jan. [cited 2020 Dec 4] Available from: https://www.cfsontario.ca/wp-content/uploads/2018/10/2017.01-Indigenous-Education-fact-sheet.pdf
4. U of T News [Internet]. University of Toronto receives single largest gift in Canadian history from James and Louise Temerty to support advances in human health and health care. 2020 Sept 24. [cited 2020 Dec 4]. Available from:  https://www.utoronto.ca/news/university-toronto-receives-single-largest-gift-canadian-history-james-and-louise-temerty
5. Yeager KA, Bauer-Wu S. Cultural humility: essential foundation for clinical researchers. Appl Nurs Res. 2013;26(4):251-256. doi:10.1016/j.apnr.2013.06.008