Last summer Randal Mason received a gift. It wasn’t wrapped in pretty paper; it wasn’t adorned with a bow, nor did it come tied with a ribbon.
The gift — a single eagle feather — may have come without pomp, but it has left a lasting impression on Dr. Mason, a PGY-1 resident with UBC’s Aboriginal Family Medicine Residency Training Site.
“It was a very powerful experience,” says Dr. Mason, who, alongside nine other family medicine residents from UBC’s Aboriginal and Nanaimo Residency Training Sites, was given an eagle feather during a territorial welcome by the Snuneymuxw First Nation last July.
The event, which included everything from an address by the Snuneymuxw Council and Chief to traditional drumming, singing and lunch with community members, marked the start of a new journey for these physicians — many of whom are completing their two-year family medicine residency training in regions encompassed by Snuneymuxw territory.
At the close of the territorial welcome, each resident was handed an eagle feather — a symbol of great respect and a gesture that has caused Dr. Mason to pause and reflect upon its greater significance.
“It was overwhelming because we had just started our residency training and it felt like we didn’t deserve it,” he recalls. “But, being given the eagle feather made me think about the desire the Snuneymuxw First Nation has to work with us, and reinforced my tie to the community.”
Having grown up in Nanaimo, near the Snuneymuxw reservation, the experience of coming home to complete residency training has been rather surreal for Dr. Mason.
“I never thought I would move back home. But I’m not the person I was when I left,” he says, reflecting on his journey through medical school in Calgary, where his interest in Aboriginal healthcare was sparked during a work placement.
“Even though I grew up near the Snuneymuxw reservation and I had a lot of friends in the community, until I left home, I hadn’t really thought about disparities in healthcare, and the greater prevalence of certain health issues among these communities,” says Dr. Mason. In fact, it wasn’t until I went to medical school and I worked in one of the Aboriginal healthcare centres that I began to really learn more about the past, and what First Nation communities have faced.”
Teaching residents to provide culturally safe care
Dr. Mason is one of ten residents completing training with UBC’s Aboriginal Family Medicine Residency Training Site, which was first established in 2002 with the goal of giving physicians the tools they need to provide culturally safe care to Aboriginal peoples, families and communities.
“UBC’s Aboriginal Family Medicine Residency Training Site is a great example of how, through meaningful learning experiences, our residents are learning social accountability and working with health professionals, organizations and communities to affect change,” says Dr. Roger Wong, associate dean of postgraduate medical education.
The Aboriginal training site has grown over the years and is now disturbed across four regions — Vancouver, Victoria, Ladysmith, and Duncan.
Since 2011, Danièle Behn-Smith has served as the Site’s director.
“The health challenges that Aboriginal peoples face are a result of colonization and the fact that our ways of being, our families, our traditions, our lands, and our food have all been disrupted,” she says. “The experiences of residential schools, dramatic shifts in diet in a short period of time — all of these factors continue to affect us and we’re seeing high rates of cancer, diabetes, alcoholism and addiction as a result.”
Site director Dr. Danièle Behn-Smith (far left) with residents during an academic day spent with T’Souke First Nation youth in 2013.
As the former director of Education for the University of Alberta’s Indigenous Health Initiatives and as a member of the Eh Cho Dene of the Fort Nelson First Nation, with Metis roots in the Red River Valley, Dr. Behn-Smith is uniquely situated to serve as the director of UBC’s Aboriginal Residency Training Site. And, her experience goes beyond the borders B.C. and Alberta — Dr. Behn-Smith has travelled the globe, visiting Indigenous communities and learning from traditional healers — a life-changing journey, captured in the documentary series, Medicine Woman.
According to Dr. Behn-Smith, the training site fosters the development of cultural competencies and enables residents to work effectively with Aboriginal patients and communities. But, she’ll be the first to acknowledge that giving residents the tools they need to provide culturally safe care isn’t a cut and dry process.
“We try and support our residents to be ready to practice in Aboriginal communities in a culturally safe way by embracing the ‘messiness’ of it. We have a lot of discussions, we have a lot of debriefs, and we share our struggles and share the immensity and complexity of the issues that our clients face,” she says. “Sometimes, we have to surrender and recognize the limits that we have to affect change, but we also have to celebrate the small victories.”
Fostering relationships with Aboriginal communities
For Dr. Behn-Smith, one of the key ways residents can learn to offer culturally safe care is by fostering strong relationships with Aboriginal communities.
Dr. Lori Schramm, a PGY-1 family medicine resident with the Aboriginal Site in Duncan.
In fact, part of what makes this particular training site so unique is that, in addition to gaining experience working with family physicians and specialists in their designated home base (Vancouver, Victoria, Duncan or Ladysmith), residents are not only encouraged, but expected to spend dedicated time working in First Nations communities. Some will spend a month living and working amongst the Namgis First Nation in Alert Bay, off the northern coast of Vancouver Island, while others may fly in to First Nations communities based across northwestern B.C. for one week each month, over a period of several months.
Dr. Mason, who travels to various First Nations’ reserves as part of his clinical work, recognizes that these visits are not just opportunities to provide care, but share knowledge and build ties with the community.
“You can’t approach healthcare delivery the same across all people — and you can’t impose your beliefs and views of healthcare delivery,” says Dr. Mason. “They have unique cultural practices and beliefs and in order to deliver health care effectively, you really need to understand that. I can teach them about healthcare, but they can also teach me.”
According to Dr. Behn-Smith, many residents who are attracted to this particular training site have had a personal, or what she refers to as a “lived experience” with Aboriginal peoples.
Lori Schramm, a PGY-1 family medicine resident with the Aboriginal Site in Duncan, spent six weeks living on a reservation in northern Saskatchewan as part of an undergraduate initiative during her medical training in the prairies. For Dr. Schramm, who grew up on a farm in Goodeve, Saskatchewan — a hamlet so small “it doesn’t always show up on all the maps” — the experience of living on a First Nations reservation while completing her medical degree was transformative.
“When I spent time on the reservation, it was the first significant exposure I had had to an Aboriginal community — the experience was just so inspiring,” she recalls. “As students we were welcomed with open arms and the people there were showing us anything and everything we wanted to learn. But then we also got to see the flip side of things — just how unique their health challenges were and how much more in need they were of health services, yet receiving the least consistent of the health services.”
Future advocates for Aboriginal health
UBC medical student Darcy Good. Photo credit: Dave Bodaly
It’s Dr. Schramm’s hope to see these kinds of healthcare disparities eliminated, and she plans to take an active role by incorporating frequent visits to Aboriginal communities when it comes time to transition into practice as a family doctor.
It’s attitudes like Dr. Schramm’s that have people, like Darcy Good, a member of the Snuneymuxw First Nation, excited.
“Having a training program that introduces future physicians to Aboriginal culture and tradition is helping to reduce barriers,” says Good. “It’s also creating a really unique opportunity for future advocates for Aboriginal health. Doctors have a really strong voice in our society and having people who are getting into these communities and learning about the culture can have a really positive impact for Aboriginal health in the future.”
Good is well on his way to become an advocate for Aboriginal health as well. In September, he kick-started his own medical career as a student with the Island Medical Program, one of four distinct geographical sites of UBC’s distributed MD Undergraduate Program.
Moving forward
As the site director, Dr. Behn-Smith is incredibly proud of the maturity and wisdom her residents have displayed over the years.
“These residents are people who are open-minded, who have open hearts, and who are humble, who are open to the Indigenous world view and who are comfortable walking that tension-filled space between Aboriginal and non-Aboriginal ways of knowing,” she says.
And despite all the partnerships she’s helped build and successes she’s witnessed as the site director over the past few years, Dr. Behn-Smith is only looking forward to the possibilities that await.
“Our little site has big dreams,” she says. “We’re looking forward to partnering and collaborating with preceptors and clinics to spearhead innovative ways to improve and enhance primary care service for First Nations peoples. Ultimately, when the time comes, we would love to see the Aboriginal Site residents affiliated with all of the different training sites across the province.”
Until then, Dr. Behn-Smith is happy to be part of the journey and witness those first eagle feathers land.
Aboriginal Student Support
UBC’s Faculty of Medicine is committed to providing support services and programs for prospective and current Aboriginal medical students.
Aboriginal Student Initiatives Coordinator, James Andrew, works with undergraduate and postgraduate students who have an interest in Aboriginal health, and acts as a faculty advisor to the Aboriginal Health Initiative, a UBC medical student organization. Please click here for further information.