Dr Elly Jenkyns, ND
Decolonizing Medicine with Dr Johanne McCarthy ND
Updated: Jul 13, 2022
This spring, the Ontario Association of Naturopathic Doctors presented Dr McCarthy, who educated and inspired in 4 parts, and shared key resources in her Allyship Kit uploaded at the end of this article.
PART ONE: "THE PROBLEM" - Indigenous experiences shared
To this day, across Canada, medical racism continues to deny Indigenous peoples access to healthcare and the freedom to choose traditional and natural medicine.
Our ethical priorities are molded in our worldview. World view incongruences between Haudenosaunee, which stresses interactional relationships, cooperation, harmony in diversity, and different views to be taken into consideration, contrasts the Euro-American hierarchical principles, authoritarianism, individualism, unity by similarity and repetition, categorization, and one truth, have impacted how Indigenous Peoples experience so many obstacles to receiving appropriate care.
Health care goals, ethics, and commitment to care align with the Naturopathic Doctor's oath: First, to do no harm, to cooperate with the healing power of nature, to address the fundamental causes of disease, to heal the whole person through individualized treatment, and to teach the principles of healthy living and preventative medicine.
PART TWO: "THE CONTEXT" - The Colonization of care
Colonized medicine is the act of enforcing control or domination of one system of medicine over others.
In Canada, the Indian Act criminalized the practice of culture, ceremonies and medicine until it was amended in 1951 following the UN Universal Declaration of Human Rights. Knowing this history is important so that we don't simply appropriate traditional medicines without acknowledging what had to be overcome to keep these traditions alive.
Race is a social & political construct, and has nothing to do with biology. The human genome project revealed that we share 99.9% of our DNA sequence, and the less than 1% difference doesn't line up with racially stereotyped differences. Despite this, there is a long history of racialized justifications for behaviours and biology has been used to enact racism and validate false notions of one being superior over another. The idea of race concerns physical characteristics such as skin colour, and was created within the Institution of Medicine in North America from falsified brain volume data in efforts to prove that white Europeans were superior, and justify their perceived entitlement and oppression of others. These beliefs justified the enslavement of African Americans and the land theft and genocide of Indigenous peoples, and still influence systems and institutions.
Scientific racism was deeply embedded in the practice of medicine. Medical schools in Canada excluded anyone but men with European ancestry. The compulsory Enfranchisement policy prevented Indigenous Peoples from attending post secondary education without completely reliquishing their status & identity until 1959. Medicine on Turtle Island, the Indigenous term for North America, had been practiced for centuries before colonization, and when colonists arrived, they relied upon Indigenous healers. Over 400 different species of plants were shared by Indigenous Peoples and added to the Materia Medica taught at the institutions that excluded them and failed to give them credit.
Epistemic racism is the oppression of other ways of knowing due to the belief that one way of knowledge transfer is superior over all others. Colonial medicine is an ideology, founded upon notions of anti-Indigenous racism, that uses medical practices and policies to establish and maintain control, or advance genocidal colonial processes.
Indeed, the biggest genocide in human history didn't occur in Nazi Germany, but on North American soil. Over 100 million Native North Americans were killed and lost their homeland. Prior to 1492 there were an estimated 60 -112 million Indigenous Peoples; in 2021 that number was reduced to 1.67 million (4.5% of Canada's population). The United Nations Defintion of Genocide encompasses any of the following acts commited with the intent to destroy, in whole or in part, a national, ethnical, racial, or relgious group, such as: Killing members of the group; causing serious bodily or mental harm to members of the group; deliberately inflicting on the group conditions of life calculated to bring about its destruction in whole or in part; imposing measures intended to prevent births within the group; forcibly trnaferring children of the group to another group. A gruesome statistic from the Legacy of Canada's Residential Schools is that while the odds of dying for Canadians serving in WWII was 1 in 26, the odds of dying for children in Indian residential schools was 1 in 25. Studies show that childhood trauma often leads to PTSD and maladaptive coping strategies such as alcohol abuse. Up until the 1980s, to protect the non-Indigenous, Indigenous-only hospitals existed and provided opportunities for experimental medicine. As of February 2022, there are still 35 long-term boil water advisories in effect in 28 different Indigenous communities. Between 2015 and 2019, over 100 Indigenous women from six provinces and two territories have come forward to say that they were forced or coerced to undergo a sterilization procedure in Canada. Indigenous children represent 52.2% of kids in foster care; children are still being forcibly transferred since the Sixties Scoop that took kids from their parents from 1960-1990. Understanding the truth of this uncomfortable history is what will bring about change.
PART THREE: "THE PURPOSE" - Ethics and EDI (Ethics, Diversity, and Inclusion) in Systems of care
Learned Helplessness is the condition of suffering from a sense of powerlessness, arising from trauma, or persistent failure to succeed. Repeated uncontrollable events lead to a perceived lack of control, the development of generalized helpless behaviour, and the loss of motivation to even try. It's an adapted response and a control problem, not a competence problem. It's what happens to our patient when they experience trauma or when our suggestion doesn't align with their culture. When we see patients struggling to make recommended changes, rather than labelling them as "non-compliant", we can decolonize their care by supporting their learning and return that spark that they have control over their healing.
Access to medical care is an important determinant of health, and extremely complicated for Indigenous peoples. Only 23% of those living in rural communities or on reserves have a regular MD. Jordan's Principle is a legal ruling from 2007 to ensure that First Nations children get the services they need when they need them, after Jordan River Anderson died while waiting for the provincial and federal governments to decide who should fund the homecare required for his disabilities. Canada has failed to comply since 2016 on this ruling. Ontario has committed to supporting integrated, culturally relevant care but is impaired by colonial thinking of what integration of care means, and does not include naturopathic medicine because it isn't "evidence based", even though it aligns with traditional views of health and healing. This is despite the calls of a variety of reports and commissions that have shown that cultural continuity greatly improves the health status of Indigenous communities.
Evidence based medicine should integrate clinical experiences and patient values and cultures. Only about 100 researchers world wide are highly active in their area of medical study. A small number of people are actually producing most new scientific knowledge, and people of colour are not well represented.
The placebo (a beneficial effect due to the patient's belief in their treatment) and nocebo effect (a negative effect due to the patient's negative expectation of their treatment) don't just reside in the patient; if the health care provider has positive expectations, patients do much better. If left unchecked, unconscious biases can influence health outcomes with the phenomenon of the nocebo.
Harmful stereotypes continue to be transmitted in healthcare education. Recent cultural competency curriculum has been shown in studies to create rather than eliminate bias. Decontextualized statistics on mortality/morbidity of marginalized, socially constructed categories of people without an understanding of relationships of oppression and domination reinforce racism and bias.
PART FOUR: "THE SOLUTION" - The Psychology of Decolonization
Decolonization is the process of examining and dismantling harmful, power based, capitalist-motivated relationships of domination and subjugation, and acting to change those systems to support rather than obstruct inclusivity, equity, and belonging. One of the things we can do to decolonize is to learn more about Indigenous culture, to fear it less and embrace the reality of what happened. Inclusion of Indigenous perspectives is Decolonizing Medicine. It's about equalizing care and providing access to healthcare to people who have been denied it for a long time.
Dismantling racism in medicine begins with an understanding of relationships of oppression and domination, communicating concepts of group dynamics, fostering value for diversity, and eradicating the luxury of obliviousness.
Within the doctor-patient relationship, those of love and care, not domination and control, are essential to the healing process. We are shifting models of care, from reductionist medicine that saw the doctor as authoritative over their patients, to moving towards person-centred care, with the doctor being less in charge. We're moving towards systems of care that are based on meeting the needs of the individual patient, aligning with their values, and being respectful of their choices as the "guiders" of the clinical decision making process.
Repairing relationships and damaged trust in healthcare means conveying respect, considering our patient's uniqueness, using active listening, giving sufficient time to answer questions, being flexible, and providing consistency.
Person-centred, empowered medicine helps to motivate behaviour change. In clinical practice, consider empathetic case taking with patients and supporting them where they're at, including in their relationships, without taking over. Instead of the Western line of questioning "what is your chief complaint?, consider asking in a decolonized way, "what happened to lead you to this?". Help patients recognize their purpose, and reveal their spark. "What brings you here? What do you think you can do? How might you go about it in order to succeed? How important is it for you to make this change and why? What are the 3 best reasons to do it?"
OTHER ACHIEVABLE WAYS WE CAN DECOLONIZE:
Grow our own medicine.
Craft a local Land Acknowledgement.
Change our intake and tracking to give power back to the patient.
Modify our fee schedule so that all patients who require our services can access them.
Put pressure on CONO to implement the Truth and Reconciliation Commission's Calls To Action.
Dr McCarthy shared the 94 Calls To Action from the Truth and Reconciliation Commission of Canada with us and asked us,
"What Calls do you think you can achieve in your life or practice?"
#18: Instead of labelling Indigenous patients as "vulnerable", become curious and learn about their treaties and health care rights.
#22: Reach out to local Indigenous communities to make connections with the elders and traditional healers that our Indigenous patients may want referrals to.
#24: Seek out cultural competency training that includes Indigenous voices and perspectives.
RESOURCES TO SHARE:
Please do share... sharing knowledge and understanding is how we create empathy... and empathy is essential for healing!
Dr McCarthy passed on her anti-racism video below with her permission to share it. It's listed as private, so although you can't search it on YouTube, you are free to share the link.
We all perceive things differently (and that's okay!).
We have conscious and unconscious biases that influence our perception. A bias is a shortcut that inclines us to see the world in a certain way, based on our experiences and culture. A fixed and unchecked bias can lead to overgeneralization and stereotypes. For example, Western education continues to use the terms "racialized" or "vulnerable groups" interchangeably and predominantly when referring to people with black or brown skin, or those with diverse cultures. Dr McCarthy tries to use the terms "socially excluded groups" instead, to shine a light on society's responsibility for constructing this exclusion, instead of blaming the marginalization on the perceived "vulnerable" or "inferior" race. Stereotypes can lead to prejudice, which can lead to discrimination, or differential treatment.
Racism requires 3 things: Prejudice, Discriminatory behaviours, and Domination. Discrimination becomes racism only if there is domination, or a desire to control, the perceived inferior group. People of colour who have a negative judgement of all white people, not just white supremacists, are expressing prejudice, but cannot be"reverse-racists".
Systemic racism is when systems privilege one race over another.
Epistemic racism is the domination and assumed superiority of one knowledge system over another. It is how we ignore these relationships of oppression that have left Indigenous and African Americans in lower socioeconomic realities.
We need to move from cultural awareness to cultural humility, which teaches the importance of self-reflection in order to redress the power imbalances that have set up systems of oppression.
Dr McCarthy has also shered her land acknowledgment basics handout and video so that we can craft our own for our area.
As an act of reconciliation, Land Acknowledgements centre our gratitude for our place on Turtle Island, the Indigenous name for North America. We are to walk gently on this Anishinaabe and Haudenosaunee territory, which is governed by the Dish with One Spoon Wampum agreement. This agreement asks all that come to this place to commit to sharing and preserving the environment for future generations; taking only what is needed to survive, and not coveting resources for personal gain. We are also governed by the Two Row Wampum agreement, which outlines the Indigenous sovereign identity, and the promise to travel in peace, love and respect on this river of life together. Both of these agreements predate colonization, are protected in the Canadian Constitution, and need to be honoured.