June 17, 2020
As I sit here now and reflect on my four years of medical school and cherish the unique opportunity to graduate virtually with my medical school class over a joint video teleconference – I am overwhelmed with thoughts and emotions on the opportunity and privilege that have led me to where I am today. I think about the community of mentors, friends, family, and importantly, patients and caregivers, that have been integral to my growth and learning as a medical professional entering my postgraduate training in the field of public health and preventive medicine. This is all taking place in the backdrop of a global pandemic caused by COVID-19 and the various unintended health and economic consequences of public health interventions (i.e. physical distancing, quarantine, self-isolation), as well as the exacerbated pre-existing social and health inequities disproportionately impacting racialized and marginalized populations and communities in Canada and around the world. There is also a concurrent reignited dialogue on the critical necessity to take meaningful action on racism and police brutality against Black and Indigenous peoples which forges on in perhaps a watershed moment for dismantling and unpacking systemic racism, colonialism, and discrimination including acknowledging and unpacking white privilege and supremacy.
I have listened to my fair share of convocation addresses, having recently attended my own virtual convocation with the University of Ottawa. I have also been watching old and new graduation speeches over these past few weeks thinking about the class of 2020 at all stages and various fields of training, entering a world that so desperately needs thinkers and doers to tackle inequities and injustices. The significance of education for young people in any form, that provides a foundation of knowledge or the skills and tools to critically think and approach complex issues, cannot be understated and is so urgently needed – as education is ultimately the guiding force and power for action by our future generation of leaders to help shape policy and decisions that protect and promote the health and wellbeing of our communities. Education is also a tool and platform for reinforcing and normalizing institutional racism and discrimination. Conversely, education can be a tool for dismantling pre-existing biases and prejudices for a more accepting individual and collective society that fosters diversity and inclusion in all of its forms and practices, acknowledging privilege and challenging the status quo.
Thus, I can’t help but think and wonder, that a significant piece of the puzzle has been largely left out of the equation in these past few weeks and months – the need to re-evaluate education at all levels so that we are better prepared for public health emergencies and recognize that preexisting and ongoing inequities and injustices are not tolerated and better yet, ought to be addressed urgently with compassion and courage. Only a few days ago, a discriminatory school assignment sent to Grade 7 students by a teacher in the Hamilton-Wentworth Catholic District School Board asked for students to write a speech from a colonialist perspective pretending to be a French colonist. The assignment asked students: “You are going to create a speech (as the French colonists) to convince the aboriginal people to let you stay on their land,” and “the more convincing you are the better your mark will be”. This is likely not the first time such an occurrence has happened in our educational systems, but it begs the question of how and if our educators are committing to teaching the true and unvarnished history of Canada and its relationships with Indigenous peoples and nations.
Reflecting on my own educational journey, I also think about the lack of teaching on the history of Indigenous peoples in Canada during my years in primary and secondary school. It was only until I was in my post-secondary or undergraduate studies at McMaster University, was I first exposed to concepts of social determinants of health and racial equity – and put this into the context of past and present racism, colonialism, and discrimination that is experienced by Indigenous communities in Hamilton and Six Nations of the Grand River. I was also able to learn about the resiliency and strength in self-determining and self-governing communities that were built upon their cultures and languages to support their future generations of young people, despite the historical circumstances of ongoing structural violence and oppression. However, all of this learning and growth was optional from a formal university curricular perspective, but for me as a guest of this land and as an immigrant, I felt it as mandatory learning as a Canadian citizen that has since benefited and continues to benefit from many privileges afforded to me based on the decisions and sacrifices of my parents.
Graduating from medical school feels surreal and looking back, it can be easy to see the experience through rose-coloured glasses. However, upon meaningful reflection, I am reminded of the reality of how I was again unimpressed with the lack of acknowledgement of the institutions and profession of medicine as a tool to oppress and discriminate in a historical and present-day context. I think of the nutritional experiments that doctors did on Indigenous children in residential schools. I also think of the forced sterilization of Indigenous women by doctors. Today, medical practice also continues to demonstrate negligence in how racialized individuals and communities are treated differently by doctors and have worse health outcomes and sometimes are more likely to die because of not their race, but because of racism. Such understandings and knowledge, I have come to realize and learn, had to come from supplementation on the side of the formal educational curriculum. Once again, as a special ‘interest’ or ‘nice-to-know’ from the perspective of medical education. And once again, I strongly feel this knowledge to not only be a ‘need-to-know’, but also a ‘need-to-act’. To cap it off, medical schools and leadership, for the most part, do not value teaching, leadership, and advocacy on social justice issues in the same way that clinical or scientific research is legitimized in the structure of the system. There is great work being done in the form of research to shine a light on inequity and injustice the healthcare and beyond, but if this information is not adapted and translated into educational material or practiced by our future and current healthcare professionals, then it is surely a lost opportunity.
I recall my conversation with Minister Carolyn Bennett a few months back when the global pandemic initially started, and I asked her of her thoughts and reflections as an experienced public servant, past family physician, and past Minister of State for Public Health – having held the role after the 2003 SARS outbreak in Toronto, and leading the creation of the Public Health Agency of Canada and appointing the first Chief Public Health Officer. Minister Bennett reflected on her attendance at a large public health conference the following summer with many public health professionals and experts in the room, but thought and asked, “Where are the teachers? Where is everybody?”. Having lived through a nightmare, one would imagine the lessons should be shared widely and students and youth be equipped with the knowledge and skills to build back better for our systems in Canada. As someone who has fought and advocated for much of her career to improving the health and wellbeing of Canadians and urging for the “need to actually move from healthcare systems to systems for health”, Minister Bennett sees that “we continue to use health and healthcare interchangeable. We want more health, so we actually need less healthcare”. And ironically, these understandings and ideas actually go back to Tommy Douglas, who was a major force behind Canada’s first universal health insurance plan in 1962 – a desire to keep people well and not simply just patching them up when they are sick. And yet, a ‘health-in-all-policies’ approach, investing in community wellbeing, investing in preventative care and measures, and addressing inequities and injustices in the determinants of health, continue not to be the obvious or go-to choices in our systems. The importance of prevention of crises and inequities ought to be taught in classrooms and ultimately more valued in society. In most recent weeks and months, we are reminded of what truly matters most in our lives – our relationships to one another and the land, our connection to community and society at large, and ensuring the most basic of life’s necessities and rights are accessible and provided for all. It’s about time that our educational systems, that shape the next generation, reflect these realities.