茄子直播

With 'baby steps,' effort to Indigenize public health and preventive medicine program moves forward

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From left to right: Dawn T. Maracle, Angela Mashford-Pringle and Onye Nnorom are integrating Indigenous teachings into the curriculum of the public health and preventive medicine program (Mashford-Pringle photo by Pheasant Lane Photography)

The , an accredited post-graduate training program of the Royal College of Physicians and Surgeons of Canada, is taking its first steps to Indigenize its curriculum.

The effort is being led by a working group comprising University of Toronto Assistant Professors Angela Mashford-Pringle, Barry Pakes, Onye Nnorom and Professor Ross Upshur 鈥 all from the Dalla Lana School of Public Health. They are collaborating with consultant Dawn T. Maracle and resident Mary Choi.

鈥淲e hope to Indigenize or, at least, decolonize our curriculum,鈥 says Nnorom. 鈥淭his is a baby step.鈥

With Maracle鈥檚 guidance, residents incorporated relevant Indigenous knowledge in lectures with peers on standard public health content. The level of expertise and standards expected for the roles is significant as residents are often asked to prepare rounds for peers and faculty members across the province.

The project, which has involved nearly three years of consultations, began as a pilot last fall. Maracle, who is Mohawk from Tyendinaga Mohawk Territory and executive director at HOPES Indigenous Training Network (Healing Our Peoples through Education and Social Justice), and Mashford-Pringle, an Algonquin of the Timiskaming First Nation who is Indigenous health lead at the Dalla Lana School of Public Health, reviewed the curriculum and guided students throughout the pilot.

鈥淲e did a land acknowledgment field trip with residents last June,鈥 says Maracle. 鈥淲e talked with senior residents about positionality and going deep into land acknowledgements 鈥 how to enact them and why we do them.

鈥淩esidents were so moved by the experience that they initiated leadership steps to create their own document about what actions they can take through their land acknowledgements, including partnering with Indigenous organizations and institutions about Indigenous-led solutions and ideas.鈥

They also created a living document about their commitments that they plan to pass on to future residents.

Indigenous knowledge should never be siloed, Maracle explains.

鈥淪iloed topics is an old Western way to look at things 鈥 Indigenous knowledge needs to be integrated at every level,鈥 says Maracle. 鈥淚t鈥檚 so well documented that the health profession is underprepared to work with racialized populations. We鈥檝e seen stories of them being treated poorly in the system.鈥

Maracle marvels at Graham Hingangaroa Smith, who, as Auckland University鈥檚 former pro vice-chancellor, included Maori content in every course in the 1990s.

鈥淐anada is woefully behind,鈥 says Maracle. 鈥淧eople were fighting for one Indigenous course in a variety of programs and that was 30 years ago. We should be far ahead of that. There are Indigenous issues to consider in public health as well as in many other topics. So, while there are absolutely inequity and population health issues, there should be Indigenous health throughout the medical curriculum.

鈥淚t is the only way to prepare the health profession to competently do their jobs.鈥

The courses are not easy; Mashford-Pringle says that the subject matter is uncomfortable.

鈥淚t鈥檚 feeling like you鈥檝e got a wool sweater on, and you have a wool allergy,鈥 she says. 鈥淵ou will start to understand it鈥檚 not just Indigenous Peoples, but People of Colour, ableism, sexism. You鈥檒l start to open up that intersectionality piece and you鈥檒l say, 鈥榃ait a second, I鈥檓 complicit and I didn鈥檛 know that was a problem.鈥欌 

A grant from the Temerty Faculty of Medicine supported Maracle鈥檚 efforts to offer guidance to students in the fall, but more is needed, Mashford-Pringle says. 鈥淚 know there is a thirst for this knowledge, but we don鈥檛 have enough Indigenous people doing this kind of work at 茄子直播, or more broadly,鈥 she says.

Nnorom adds that, while the training and tool kits are useful, they remain a poor substitute for the lived experience and support from experts such as Maracle and Mashford-Pringle 鈥 and that additional support is key to truly Indigenize the curriculum.

Nnorom says her colleague at the University of Ottawa, Dr. Sarah Funnell, shares a similar point of view.

鈥淒r. Funnell says what we need to be aiming for is that our residents, when they graduate as public health practitioners, are trauma-informed, culturally safe and have an anti-racist lens to their practice,鈥 says Nnorom. 鈥淪o, for us, it was [figuring out] how do we weave in concepts of Indigenous knowing into the curriculum instead of it being a standalone thing like an Indigenous health lecture.鈥

The  in a Quebec hospital two years ago demonstrated how dire the situation can be for Indigenous patients seeking health care and how urgently changes are needed.

鈥淚鈥檓 sick of hearing community members tell me how poorly they were treated in different sectors 鈥 specifically the health-care sector,鈥 says Mashford-Pringle. 鈥淎nd these are public health professionals. These are going to be our future medical officers of health in public health units.鈥

Pakes, Nnorom and Maracle have met with other program leads in Ontario to scale up this initiative.

鈥淚f I had a magic wand, the whole thing [system] needs to be overhauled 鈥 with those in power behind us, resourcing the initiative, in alignment with the (Truth and Reconciliation Commission of Canada鈥檚) Calls to Action. There must be truth, justice and reconciliation and most people don鈥檛 yet know what that means,鈥 says Maracle.

鈥淚t鈥檚 going to take a long time. The Honourable Murray Sinclair said, 鈥楨ducation got us into this mess, it will get us out.鈥 But we have to work together.鈥

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