The State of Indigenous Health in Canada — Dr Raven Dumont-Maurice

Alex Maheux:    

Hello and welcome to the Canadian Health Information Podcast. I’m your host, Alex Maheux. In this program from the Canadian Institute for Health Information, we’ll be analyzing Canada’s health systems with qualified patients and experts. Stay tuned as we’ll go beyond the data to learn more about the work being done to keep us healthy.

Today, we are speaking with Dr. Raven Dumont-Maurice from the Kitigan Zibi Algonquin community in the Outaouais region. Dr. Dumont-Maurice is a pediatrician in Kanesatake and an expert in First Nations, Inuit and Métis health. In these uncertain times, we have been meeting virtually from across Canada. CIHI would like to recognize the territories we all occupy, whether or not they have been transferred by treaty. And remember that our guests’ opinions and comments may not reflect those of the Canadian Institute for Health Information.

Hello Raven, welcome to the podcast.

Raven Dumont-Maurice:    

Hi, how are you?

Alex Maheux:    

I’m doing well. What about you?

Raven Dumont-Maurice:    

Yes, very well, thank you.

Alex Maheux:    

Raven, I’ll start right now. You are a doctor, a pediatrician to be exact, working in Kanesatake, near Montréal. First of all, let me ask you, the last 10 months have been very difficult for many people; how have you experienced them personally and also as a health care worker during a pandemic?

Raven Dumont-Maurice:    

It certainly presented particular challenges. I was very lucky to be on maternity leave during the first 3–4 months of the pandemic.

Alex Maheux:    

Congratulations!

Raven Dumont-Maurice:    

Thank you very much! It was fantastic, but at the same time, I still felt guilty and wondered whether I should go back to work, especially when all we were seeing in the media was doctors overworking. When work started again, the main challenge for sure was not seeing our patients in person. This was a big adjustment, especially in pediatrics where we are on the [inaudible], we always want to examine our patients in person to see the whole picture. But for several months it was all done over the phone. I’ve only been seeing my patients in person for the last few months. Many of them have left, it’s been about 18 months since I saw them. Those are big changes. It’s really nice to see kids in person again. The way we think about medicine and telemedicine has changed, and I think that’s going to stay. It was really hard at first, but now we understand a little better how it all works.

Alex Maheux:    

Babies all around you!

Raven Dumont-Maurice:    

Exactly!

Alex Maheux:    

You are an Algonquin woman from Kitigan Zibi where you were born and raised. Do you remember what made you decide you wanted to be a health care worker to help your community and make Indigenous voices be heard in the health care system?

Raven Dumont-Maurice:    

That’s a good question. It’s not something I thought about when I was younger. I remember my high school science teacher once suggested that I become a doctor, and I was taken aback. I had never thought about that.

Alex Maheux:    

It wasn’t for you!

Raven Dumont-Maurice:    

Not at all. I can’t say I had a career path in mind at that time. When I went to CEGEP later, I was more interested in nutrition. I used to play a lot of sports. I pursued a bachelor’s degree in nutrition for 2 years. And in the summer of my second year, I was able to get an internship at the Kitigan Zibi reserve community Health Centre. We were working with diabetic people, namely older people but also kids attending day camp. It was rampant. I liked my job, but that’s when I realized there were bigger medical issues and that I could do a lot more if I was a doctor.

This happened around 2007–2008, which coincided with the launch of the Quebec First Nations and Inuit Faculties of Medicine pilot program in 2008. So I enrolled in medicine through the program and I was able to get in. That year, there were 4 spots designated for First Nations people, in addition to those already allotted in Quebec. And 3 of those 4 spots were filled in 2008, and one of them was me.

Alex Maheux:    

Wow!

Raven Dumont-Maurice:    

It was perfect timing.

Alex Maheux:    

Yes, it worked well for you. So you left your community to pursue medical education. How was your experience as an Indigenous student? Do you remember having doubts about your decision?

Raven Dumont-Maurice:    

Absolutely. Of course, it was many years ago and I had very little experience back then. I’m not the same person today at 34 (I just revealed my age!) than when I applied. I understand much more now why the program was created and the importance of representation. But it wasn’t always easy. Not so much for my mental health, but there were some difficult times and issues that were hard to grasp. Some people said I got in through the back door, others questioned my R score, things like that. It did make things harder, especially at the beginning, because there were huge classes. I went to college in Hull, which wasn’t a very big CEGEP to start with. It was bigger than high school, but nothing like this. I was in a class with 200 people from all over. At first, I always sat at the back, I didn’t have a lot of confidence. And over time, it got better.

There have been ups and downs. In the last year, especially with what happened with Joyce, I personally thought a lot about my studies and the effect medical training has in terms of what we are exposed to. I realize that and I’ve shared these stories in the past as well. There is a lot of racism that is not always obvious to the naked eye. There are a lot of microaggressions in medical school, especially during the clinical years. The first 2 years of the medicine program are spent at school and the last 2 in hospitals. We’re working in teams, we’re on the floor. We hear a lot of comments about the patients.

I myself have already been excluded, once, from my peers. It was about a very complicated patient and the team explained that I would never see something of that nature on a reserve, and that I could go home early. So there were moments here and there that erode my self-confidence, but hey.

Alex Maheux:    

What was your reaction when it happened?

Raven Dumont-Maurice:    

Initially, I sort of believed it. I stayed, but I was a little upset. You’re also constantly being evaluated at that stage, so you always want to perform. And yes, it has on effect on self-confidence. There were certainly times during my training that were more difficult.

During this past year, we have had several opportunities to talk about this and we did a lot of staff outreach to avoid it. And there are more and more Indigenous students now across Canada, but also in Quebec. Every year, more students enter the program this way within the 4 faculties of medicine. It is becoming increasingly important to talk about these things when they happen to prevent future generations of students from repeating history.

Alex Maheux:    

Absolutely. You mentioned that in the last year there have been many learning opportunities for everyone in Canada. I would like to mention that this year, we observed the first National Day for Truth and Reconciliation on September 30. It was an important step, but it also came during a very difficult time. Many people still have trouble coping with the many mass graves found over the summer, and more generally with the suffering that Aboriginal people in Canada have experienced. I still can’t quite grasp the fact that these residential schools were still operating in Canada when I was a child. Can you tell us a little bit about the impact that residential schools have had on survivors and their families, either from your personal or professional perspective?

Raven Dumont-Maurice:    

Of course. Thankfully, because I am a pediatrician, my patients were born after the year 2000 and the last residential school closed in 1996. So my patients have not experienced it first hand. On the other hand, we shouldn’t forget and we shouldn’t ignore the fact that trauma is multigenerational. This year has been very hard, especially on teenagers. I’m sure a lot of it is related to COVID, but it’s been a really hard year nonetheless. For me, with what happened with Joyce, it’s about trying to see how we can make education better, how we can make a difference.

Every time the media announced a new count, like the 215 unmarked graves found in Kamloops, a shock wave hit the country. A lot of people who came to see me, either here in Montréal or elsewhere, were asking me how this could have happened, saying that those 215 deaths were unthinkable. Each time, these communities had been saying they knew for years.

Alex Maheux:    

They already knew. We already knew.

Raven Dumont-Maurice:    

We knew it and we were just waiting for the numbers to grow. And obviously, they did. It opened up old wounds, as they say, which are still very sensitive. From a clinical point of view, I don’t think about it all the time, but viscerally, I can see it’s been a really hard year for the families and the kids that we see.

Alex Maheux:    

And how do you help your patients and even yourself heal these wounds?

Raven Dumont-Maurice:    

Honestly, resilience is one of the most beautiful things in the world. For me, who is often outside the community, it’s about spending a lot of time back home. When I was in college, I would go back every weekend. Nowadays I don’t get to go as often. But reconnecting with my roots, remembering why I do what I do, and going back to the basics allows me to recharge my batteries. And working within communities also, because despite all of this, some communities are beautiful and thriving, and seeing this really has a restoring effect.

Alex Maheux:    

Certainly. You are a doctor and you also mentioned that you do a lot of health awareness for First Nations, Inuit and Métis. What are the hardest and easiest things you do to advance the interests of the communities you work in?

Raven Dumont-Maurice:    

While there is still much work to do, this year has given us an unprecedented opportunity to talk about Indigenous health and systemic racism, and this is largely thanks to Joyce Echaquan’courage. So at the university level where I teach medical students, there is tremendous openness. Students want to learn. We even went to visit the community this year as a small group. 24 first-year students from the Outaouais campus came to learn from members of the community, and the event was a success.

So in the short term, it would be important that we recognize the humanity of our peoples and in essence learn the reality, the social determinants and the federal relations that shape Indigenous health today. History and the present are very much related to Indigenous health, and this is not something that students are tought in high school or elementary school. In the short term, it’s about teaching the new generation and in the long term, the way I see it from my training and residency experience, it’s about teaching the older generations. They don’t have the same Indigenous health training as we do. There may be gaps in that regard. It’s not something that they learned in school.

So in the long run, we would need to provide continuous medical education to really bridge the gap with the next generation of graduates. I think there is a lot of catching up to do for the older generation, or those that have been practising for a longer time.

Alex Maheux:    

What would your message be to those doctors who are still practising and who may not have had the same training as your students?

Raven Dumont-Maurice:      

I would tell them to keep an open mind. They have to challenge preconceived notions, we don’t always know where they come from and where we learned those behaviours and stereotypes. Often, we don’t have the answer because we haven’t looked for it. And now we have ongoing training. My mentor, Dr. Saylor, hosted a webinar series. He said he was starting to look into Indigenous health. Now, he encourages people to find resources, to seek ongoing training by Indigenous people, because there are more and more Indigenous people in medicine and other practices. And this can help challenge the colonial narrative and see things from another perspective. It’s important to learn that point of view and to see the world through their eyes to really understand Indigenous health.

Alex Maheux:    

Absolutely. What would you like our listeners to know about Indigenous health in Canada that may not have been discussed yet?

Raven Dumont-Maurice:    

We talked about history earlier, and the classes I teach at McGill really go back in time. We talk about contact and about the creation of the Indian Act. How do we build relationships given these social determinants? We look at things like Jordan’s principle, for example, which wouldn’t exist if there was this relationship with the federal government for First Nations.

For a new student, understanding that story is really the first step. Only then can we start understanding the present. As I said, these 2 things are inseparable for me, it’s like a continuum.

Alex Maheux:    

It’s very important to keep learning where you’re coming from to know where you’re going. For my last question, you mentioned that you have a little girl. What are your hopes for her in the future?

Raven Dumont-Maurice:    

Honestly, it’s about a more inclusive world. I often talk about Joyce, but that’s because I think about her story a lot. She has shown us to recognize the humanity of Indigenous people and the effect of systemic racism. In her report, the coroner issued a call for action to recognize systemic racism so that we can work together to eliminate it. This is true not just for Indigenous peoples, but for everyone. I hope that hospitals and services become more inclusive and that racism becomes a thing of the past. I hope we can put it behind us for good, like a problem that we looked into and solved.

For now, though, it’s still very much present. Despite what happened to Mrs. Echaquan, we still see racism every day. Yes, there are conversations, yes, there is an unprecedented desire to learn, but we are far from it becoming a thing of the past. I hope that when my daughter grows up, whether she wants to work in health care or not, we will have built bridges so we can start putting racism behind us and moving in the right direction.

Alex Maheux:    

That’s very well said. Raven, thank you so much for joining us. I hope, for all who listen and for everyone in Canada, that we can continue to build bridges as you said and to have more compassion in the world.

Thank you for listening. Come back next time when we will be discussing other exciting health topics. For more information about CIHI, visit cihi.ca. If you enjoyed today’s discussion, please subscribe to our podcast and follow us on social media. This episode was produced by Sushanna Smith and by our executive producer, Jonathan Kuehlein.

This is Alex Maheux, see you next time.

<End of recording>