'I wanted to do something to make a difference,' says Canadian Medical Association's 1st Indigenous president

Story Transcript

The first Indigenous president-elect of the Canadian Medical Association (CMA) says he wants to help change the culture of medicine so all Canadians feel safe accessing health care.

Dr. Alika Lafontaine is an anesthesiologist in Grande Prairie, Alta. He hails from Treaty 4 territory in southern Saskatchewan, and is of Cree, Anishinaabe, Metis and Pacific Islander ancestry.

He's expected to have his nomination confirmed by the CMA General Council in August, and will serve as CMA president from 2022-23.

He spoke with The Current's Matt Galloway about his new role, the need for systemic change in Canada's health-care system, and what we can learn from the pandemic.

Here is part of their conversation.

Why did you want this position?

I didn't really map out my leadership journey to arrive here. But I think in the past year with the pandemic, it's been pretty clear that the weight of a lot of the pressures within the system have fallen on top of the shoulders of physicians. And looking around to my colleagues and my own experience, I really felt like I wanted to do something to make a difference.

You are also the first Indigenous doctor to lead the CMA. What does that mean to you?

I think that it's a moment where people get to reframe expectations for what the Canadian Medical Association is. Any time that you get a person who has a different type of lived experience, and for those who are Indigenous [and] can see their own people within these leadership positions, I think you trigger an opportunity for people to hope for something different. And I think that's the real promise of, you know, diverse and inclusive leadership positions, is we can imagine a different future.

Let's talk about your lived experience. You come from Treaty 4 territory in southern Saskatchewan. What was it that made you want to become a doctor?

When I was young, my mom used to talk to me lots about her experiences within the health-care system, and as I got older, things became more specific. I have a memory of my mom actually coming on the very first day I officially became a doctor. She had come by to see me walking around the hospital with, you know, my white coat and my stethoscope, seeing patients and other things. And she shared with me just how scary it is sometimes to come into the health system, and how relieved she was that if she got sick, she'd have someone that she could trust to help her navigate a system that's often very complex and at times unfriendly to patients. 

And I think for me, becoming a doctor was really a way to circle back and make sure that my family felt safe and was safe when they navigated the system. Now, that's obviously scaled to including patients who experience racialization and other types of disempowerment — so not just Indigenous, but other people who experience "isms" like sexism and ableism, etcetera. And I think that that's one of the focuses that I really want to have in my role as president-elect and moving on to the other roles in the CMA. 

What did she tell you about what she'd faced in the health-care system?

She shared some specific experiences where she felt like trust and communication wasn't at the levels that she would have expected. She talked about feeling like she didn't have the same sort of choices as other patients. And, you know, as a provider, I have a perspective to kind of layer on top of that experience, where I know that in the ways that we talk, in the ways that we present information and in the ways that we accept truth that comes from patients, often we can frame the relationship in a way where patients do feel these ways. 

I never say to any of my colleagues that any of us ever come to work wanting to harm patients. But because of the things that we've inherited through this culture of colonization that, you know, has been a part of Canadian history, and because of the way that medical culture is just starting to tap into understanding this disempowerment, I think it's a real risk for patients and something we need to address. 

So how do you go about addressing that? 

One of the things that the Canadian Medical Association has been working on, and part of the work that I want to carry on is, you know, changing the culture of medicine — you know, what we feel is reasonable, what we believe is normal. 

One of the things that came loud and clear out of the experience of Joyce [Echaquan] was that there was a normalization of this behaviour. You know, within systems, people do things that they feel are reasonable and they feel that they don't have to be afraid of repercussion, you know. So when we're mean to patients, when we're hostile to patients or their families, it's because we feel that it's OK for us to do that. And part of the cultural change that needs to happen is to reset those expectations.

And I think more broadly, it's important to really communicate and translate to the general Canadian population that if one patient is disempowered, that means everyone can be disempowered. You know, having those abnormal expectations eventually bleeds into everybody's experience. And that's something that we need to make sure that we protect our system against. 

You are taking this role as we come out of, hopefully, this pandemic that we've been in for the last year. And I just wonder what you have learned about the state of health care in Canada through COVID.

I think the pandemic has accelerated the inevitable end of a lot of decisions that we've made over the last 10 or 20 years. You know, one that's been weighing heavily on my mind is this idea that austerity would eventually lead to sustainability, that somehow if we cut costs and, you know, shrunk the system, we'd be able to reach that point where we'd have a better-functioning system. And the pandemic has really shown that that wasn't true. You know, it was an idea that I think at the time was worth exploring. But we've cut too much and decreased our resiliency too much that our health-care system actually can't provide the promise of what it's supposed to provide.

And so we have a couple of options here. We can either reinvest within the system, or we can change what the system is and what people expect from the system. And that's a social choice that we're going to have to make.

This has been a hard year for so many people…. From inside the medical system … what is giving you hope right now?

What gives me hope is seeing my colleagues in the midst of an extremely challenging year and a whirlwind of transformation, really still providing good care for patients. And I think that, post pandemic, when people get the chance to slow down, providers across the system are going to realize just how much they sacrificed of their own lives in order to make sure that patients — when they came through the system — didn't fall into those cracks that we know are there. 

It gives me hope that patients are starting to understand the complexity of health care, and it gives me a lot of hope that people care. You know, people are speaking up and talking about issues that really matter to them, and engagement is a byproduct of hope. And so I'm very, very hopeful going into this post-pandemic phase. 

Written by Kirsten Fenn. Produced by Kate Cornick. Q&A has been edited for length and clarity.