Thank you for having me here on behalf of the Royal College. I'm the chair of the indigenous health committee there and one of the few indigenous physicians at the University of Toronto. I practice general internal medicine. I'm very actively involved in indigenous medical education and I really want to focus my opening on the role of education and where we should go following these terrible and very upsetting activities. Particularly since I am a health practitioner and an indigenous woman, that intersection makes this topic area extremely personal and difficult to talk about, quite frankly.

I want to provide some context and background for how we think about the experiences of indigenous peoples overall in the health care system. We have ongoing evidence of the mistreatment of our peoples within health care. They experience racism and this most egregious manner of mistreatment in the form of forced sterilization. We have ample evidence around that: the Health Council of Canada reports, our health council report, and the “First Peoples, Second Class Treatment” report, as well as all of the anecdotal evidence that we experience every day as indigenous health advocates.

For example, I received a phone call from my colleague in emergency saying, “You need to come down and deal with this. I have a patient who's just had a large acute myocardial infarction and did not have any lifesaving treatment for six hours because there was a thought that this person was inebriated.” This is the reality of our peoples within the health care system.

Second, there is the intersection of this with being an indigenous woman. For these women who've experienced the forced and coerced sterilization this is, of course, another layer of intersection. I appreciate my colleague's approach to intersectionality, because we know that the vulnerability of an indigenous person in the health care system is extreme. Add to that the experience of being an indigenous woman and everything that we know from the MMIWG report and the embodiment of colonial violence is actually compounded when one enters the health care system. That is the context in which we need to consider how we move forward on this.

One of our major recommendations is that there be a large commitment to and investment in cultural safety education for our health care providers. This is what we are actively committed to at the Royal College. In fact, we passed a motion in our council in 2017 to make indigenous cultural safety and anti-racism education a mandatory component of every subspecialty training program across the country, as well as a part of accreditation. That needs to extend to people in practice. There needs to be an understanding not only of the specific needs and how to have important conversations in a culturally safe way with all practitioners but also of colonial and historical practices and how they continue to play out in that patient-provider interaction.

Working with a wonderful team at the Royal College, we're really trying to pull together information and push this out, but that leads to recommendation two, which is that we need to have accountability measures in place. We need data. I'm a physician. I'm a scientist. We need data, but I would argue that we need to think about what counts as data, because we don't need a randomized controlled trial to elucidate the fact that there is a problem here. We have stories from people coming forward. What we need to do is to facilitate that coming forward for those people, the women who've experienced this or who are concerned about an interaction, in a way that is safe and that lets them know that they will be listened to and that their experience as an indigenous person is actually recognized and valued.

What are some mechanisms through which one might do that? I want to draw upon what I think are different layers as to how one might think about this kind of work. I'm very familiar with some of the mechanisms in Ontario. One could leverage some of the quality metrics and quality standards that exist at the provincial and regional health authority level, such as the Excellent Care for All Act in Ontario, under which we're asked to have quality improvement plans, patient safety questionnaires, etc.

How can we build on these experiences of indigenous patients and indigenous women and, in particular, have an understanding of what policies and procedures exist around sterilization practices? How can that be embedded within existing structures?

At a larger level, how can PHAC, for example, build on the amazing work that's been done with the opioid crisis to collect, gather data, and then report on it? What I love about PHAC and the opioid response is that you can go on the website and actually see what the data is and what the numbers are. That level of transparency is very important when you're working with our communities.

The third piece I want to speak about is that in our practice at the Royal College we recognize that we are a colonial institution. We're working very hard to decolonize, but we recognize that tension. We have amazing indigenous practitioners who are working there, but our practice is always one of self-determination and allyship. Even though I'm an indigenous person working at the Royal College, I'm still working within a non-indigenous institution. We support our colleagues and national indigenous organizations in their calls around the criminalization of this behaviour and of this practice.

I actually believe, and in hearing the earlier testimony, that the current system is not working. How can we look at changing the Criminal Code in order to make sure that these cases are being appropriately investigated and followed? Thank you.

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