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CSPS Virtual Café Series: A Conversation on Indigenous Health with Dr. Stanley Vollant and Chief Ghislain Picard (Video)

Description: On December 1, 2020, the Canada School of Public Service was joined by Dr. Stanley Vollant and Chief Ghislain Picard for a discussion on the topic of Indigenous health care. Together, they shared their perspectives as leaders on this issue and explored the health challenges facing Indigenous communities today, including the impact of COVID-19 on the health care landscape.

CSPS Virtual Café Series: A Conversation on Indigenous Health with Dr. Stanley Vollant and Chief Ghislain Picard

Date: January 29, 2021

Duration: 01:02:18

Resolution: 1080p


Sony Perron: Hello everyone, I'm Sony Perron, Executive Vice-President of Shared Services Canada. Thank you to the Canada School of Public Service for inviting me to moderate this event. Before going any further, I would like to acknowledge that today I am working on the traditional territory of the Algonquin Nation and encourage everyone to reflect on and consider the history of the territory where you work. Now, I would like to invite Elder Claudette Commanda to share her wisdom to get this [Sound technical problems in the video] [Inaudible speech] off to a good start.

Claudette Commanda: Hello? Hello? Can anyone hear me? Yes, okay. Kwe, Grand Chief Picard. Kwe, Dr. Vollant. Kwe. [Indigenous language] Hello everyone, welcome to the traditional territory of my Algonquin people. I am going to say a prayer in my language and you are all included in this blessing. I invite everyone and all the participants who are here to join me in prayer as we give this blessing for this succession today and I acknowledge my ancestors. [Indigenous language] Back to you. Sony. [Indigenous language]

Sony Perron: Thank you, Elder Commanda. I would like to thank the 800 people who are joining us today for the Canada School of Public Service's 7th Virtual Café event, which allows us to meet with great leaders from a wide range of disciplines. The purpose of the Virtual Café series is to provide an opportunity to learn about issues that are very important to public servants. Today, we are honoured to be here to learn more about the health of Indigenous peoples, an issue where, unfortunately, even today, significant gaps still exist between the health indicators of the country's various Indigenous groups and the rest of the Canadian population. We are pleased to welcome two distinguished speakers who will speak to us about the strategic challenges and opportunities associated with the health of Indigenous peoples. I am pleased that they accepted the School's invitation because, for me, it is crucial for our learning to start with Indigenous experts and representatives. Our two speakers are well known and you may have already had the opportunity and the good fortune to hear them in the media or to meet them. First, Dr. Stanley Vollant, General Surgeon at Hôpital Notre‑Dame de Montréal and founder of Puamun Meshkenu, a non-profit organization created in 2016. Its mission is to inspire and support Indigenous peoples to chart their own path of the Thousand Dreams. Pescanu Meskanum, in Innu, is a historical way, mentally, spiritually, physically and emotionally. This organization supports Indigenous peoples so that each person can develop their full potential and contribute to the collective well-being with the support of their community. Dr. Vollant, welcome. We also welcome the Regional Chief of the Assembly of First Nations Quebec‑Labrador, Mr. Ghislain Picard. Mr. Picard has been Regional Chief since 1992. Like Dr. Vollant, Chief Picard comes from the Innu community of Pessamit on the north shore of the St. Lawrence. Early in his career, he spent most of his time in the field of communications. For example, in 1983, he participated in the establishment of a community radio network within his Nation and was one of the founders of the Société de Communication Atikamekw Montagnaise, which produces radio programs in Indigenous languages. He sits on the Executive Committee as well as the Management Committee of the Assembly of First Nations. Chief Picard is a Knight in the National Order of Quebec and was awarded the insignia of Knight in the Legion of Honour from the Consul General of France. Chief Picard, welcome. Before we proceed to our discussion with our two guests, a few logistical points. First of all, the session will focus on a few issues that we want to discuss with our two participants today, but afterwards you will have a chance to ask your questions. Therefore, I invite you to use the icon in the upper right corner of your screen that looks like a person with their hand up to submit your questions. We'll try to get to as many as we can at the end of our meeting today with Dr. Vollant and Chief Picard. So, let's begin our discussion with our two guests. Perhaps, today we are talking about extremely important subjects and I would like to know what you think are the important and essential facts that our participants today, who are federal public servants, must understand before delving into a subject as crucial as the health of Indigenous peoples. I would like to start perhaps with Dr. Vollant, if you want to maybe give us a bit of an introduction, and then I'll go to Chief Picard.

Stanley Vollant: [Indigenous Language] Thank you, Chief Picard, for joining me to support me in this process. I think that what is important, what I have been teaching my medical students for years, is to recognize the diversity of Indigenous cultures and to remove this monolithic vision of Indigenous peoples. Because we often see Indigenous peoples as a monolith, but they are very different in Quebec: there are more than 11 different Nations, nearly 55 different Nations in Canada, who have different issues, who have different lifestyles, who have very different living conditions. Even within the same Nation, there is a big, big difference in terms of health, in terms of wealth. So it is important to recognize this cultural diversity and also to see Indigenous peoples not as a problem, but as a great asset, as economic partners, as partners in health, as partners in life for all Quebecers and Canadians. I think that if we are to be seen as allies, partners and equals, I think we'll have to decolonize our relationships. Colonization has put Indigenous peoples at a lower level in terms of the balance of power and I think that, if we put ourselves on an equal footing, if we recognize our differences, if we recognize our strengths, I think we will be able to build a great country for all our children, regardless of their origin, colour, religion, language and culture. So recognizing this great diversity is, I think, the most important aspect.

Sony Perron: Thank you, Dr. Vollant. Regional Chief Picard.

Ghislain Picard: Yes, thank you very much, Mr. Perron, for that wonderful introduction. It gives me great pleasure too. I feel extremely privileged to be able to share the screen with my colleague as well as my distant cousin, Dr. Stanley Vollant. Only about half a generation separates us: me, with a political involvement that goes back nearly three decades, and in his case, most certainly more than notable experience in the field of medicine, and we are extremely proud of that. I would also obviously like to recognize our sister Claudette Commanda for the invocation prayer. It's always appropriate to begin this way, and I am Innu, but today I am speaking to you from the Kahnawake Mohawk Territory, so it is already an example of the diversity Dr. Vollant was referring to. In Quebec, there are 11 Nations, including the Inuit, and a very, very broad diversity across the country. We feel that health is part of our contemporary context and, for many elements, well, that's probably true. But at the same time, health and well-being have always been part of who we are as a people. It's rooted in our governance structures as a people, and I think it's very, very important to remember that because we often feel that Indigenous peoples, it's as if everything we do is born out of a dream and that we are finally learning to position ourselves in relation to the challenges we face as a people. So I think it is important for the general public, and especially the federal public service—and I thank the School for giving us this opportunity this morning—to really, really understand the history. You see, history isn't 1534 or 1492. There is a history that belongs to our peoples that precedes the first contacts and I think it is important to remember that as well, and moreover, what I feel today is that everything is accessible. I don't think anyone can deny the fact that the issue of interest to First Nations, Inuit, Indigenous peoples, I mean, it's heard day to day, it grabs the headlines, it's in the news, especially with the reports that have been, I think, the most well known today, which is, well, the Viens Commission in Quebec, the Truth and Reconciliation Commission in 2015, the report on missing and murdered Indigenous women and girls, to name just a few. But there are many other reports that precede them as well: the Royal Commission on Aboriginal Peoples in the early 90s, which was released in the mid-90s as well. I think these are therefore extremely important compendiums, and I think it's important to remember that as well. The last thing I would like to add is that we must also know that we have never abandoned our responsibilities as a population with regard to the health of our people, and that is also important to know. And when we look at history, when we understand it, we understand that colonialism and attempts at assimilation have in the end also contributed somewhere to removing these responsibilities, taking them away from our own authorities. So there are these elements, I think, that will certainly also deserve consideration in the debate.

Sony Perron: Thank you both very much. Dr. Vollant, is there anything you would like to add?

Stanley Vollant: Yes. I forgot to mention that I was talking about the territory of the Kanyen'kéha, it's Mohawk territory, so I'm talking about Montreal. And just to give a little funny or maybe sad anecdote, right in front of my office, where I am now, there's a statue of Jacques Cartier. Jacques Cartier, who is considered the first official tourist, for Indigenous peoples. I have nothing against Jacques Cartier, we have nothing against Jacques Cartier personally, he is our first tourist. There are three sides. There is one side where he was born, in Saint‑Malo in 1492, the year that Christopher Columbus arrived, the other tourist who got us into a bit of trouble. The other side of the statue, there is another plaque that says "he left Saint-Malo on April 15, 1534." The other plaque, the third plaque, "he arrived in Gaspé on July 17, 1534." These are historical facts, we recognize that. But the fourth side, it says that "he took possession of these lands in the name of his master, the King of France" and that, I can tell you, is an insult every time I look up at the park in front of my house. This is really colonialism, things that still impact us today. Just a funny little anecdote, but still it makes me react every time I look up.

Sony Perron: Thank you for sharing that with us. For the 800 people who are with us, then, I think that gives an illustration of the things we don't see in our environment because we've taken them for granted, and which are important and offensive and deny part of history. I think that what Regional Chief Picard was telling us is that health and concern for health existed before the Europeans arrived in North America and it still exists, and community leaders are still involved in this issue. It wasn't invented with the arrival of the Europeans. That's important. Thank you very much for the message on diversity, the monolithic approach in thinking that we will have solutions that will work for everyone, you are warning us about that and that is extremely important. And that brings me to my second question for you today, which is, well, there is diversity, it is often simplified by saying that there are First Nations in this country, there are Métis, there are Inuit, and even though they are all referred to under the "Indigenous" label, there are many differences between the groups and there are many differences between the Nations and communities that make up these groups. Maybe, can you tell us a little bit about the main differences or the main commonalities or differences regarding the issue of Indigenous peoples' health? Are there elements that perhaps you are better able to talk about from your point of view in your context, but it would be useful for our audience to understand that, when we talk about this concept, there are probably essential differences that need to be considered in relation to the different groups, but you have already alluded, Dr. Vollant, to the differences between the people in the communities where they are located in Canada or Quebec and their socio-economic situation. So, maybe I'll start with Regional Chief Picard.

Ghislain Picard: Yes, thank you very much. This is an extremely important element, I would even say essential. It is somewhat similar to what my friend Dr. Vollant was saying a bit earlier about the public's overall perception that all Indigenous peoples are similar. It is clear to me that, both in terms of our general situation and our aspirations, we are all in agreement and, for me, the best example is undoubtedly the consensus created around the United Nations Declaration on the Rights of Indigenous Peoples. But that said, I do think that in the current context, which has prevailed for several months now, and this is an important element because not only do we have an Indigenous and Canadian opportunity to face a similar challenge, which is the pandemic, since last March, but it also highlights some extremely important aspects. For us, this is not new, we have been talking about a situation that has been very different from the rest of the country for decades. For example, in terms of... I was talking about, we were talking earlier about the territory, and then for us, the territory, it's everything, it also includes our responsibility to take care of it because the territory takes care of us. But that being said, in a slightly more contemporary context, there are in fact, all groups taken together, challenges that are relatively similar. Of course, where I am in Kahnawake, I am making a comparison with our Inuit sisters and brothers in northern Quebec. There is a difference because there is an issue of accessibility, of access to services, which is clearly different, but at the same time, because we are in Quebec, well, for Kahnawake, there may be another challenge related to language because the vast, vast majority of the population here speaks English as a second language. Therefore, we have to adapt to a health system that is managed by the Government of Quebec and that may not be adapted to the reality of First Nations who have English as a second language. But having said that, I think there are some features that everyone recognizes. I am thinking about overcrowded housing. That is one issue, I think, that has been raised by the pandemic crisis because, what we need to know is that it is true for Quebec, it is probably the same for the rest of the country, the occupancy rate of our housing is roughly double the rate for Quebec as a whole. This is very, very important. So, on average, we are talking about eight, maybe eight people per dwelling, whereas in northeastern Quebec, it is more like three or four people. So these are elements that I think are extremely important in the current context, not to mention the rate of chronic disease, much of it cardiovascular, it's extremely high, diabetes, it's been high tide for too long. And I think Dr. Vollant certainly knows something about it, and for me, there are... the differences relate mainly to access to services, so the reality that I would perhaps call slightly more geopolitical.

Sony Perron: Perfect, thank you. In terms of the determinants of health, what you're essentially telling us is that the same challenges exist for everyone, and accentuated depending on location. Thank you very much for bringing us a much broader approach than...often I think maybe we had people with us today who came to talk about health like we were going to talk about emergency rooms and ambulances and hospitals, but you're taking us back to a more holistic view of health, which is extraordinary. I also want to emphasize that you have talked to us about environmental health, which is a totally European concept, but something that existed among Indigenous nations before the Europeans came here, so something that we learned or were awakened to by our Indigenous brothers and sisters across the country, who were already very concerned about the connection between the environment and health. Dr. Vollant.

Stanley Vollant: I'm also going to take a holistic approach, an approach that is specific to First Nations, where health is not only physical, it is also mental, physical and spiritual. It's a combination that contributes to an individual's health. Let me give you an example, what is holistic health? What effects can it have? Someone who suffers an accidental amputation is going to see some mental effects. Well, he's just lost a limb, he's just... he has to grieve, so it has an emotional impact as well. He's probably going to have frustration, conflicts with his brothers, sisters, parents, neighbours, and it may also call into question his spirituality overall. So the importance of seeing the individual as a whole, I am a surgeon, it's true that some of my colleagues operate on a liver, a lung, but forget the individual, so the individual is no more than a piece of meat. So that aspect is very, very important on a holistic level. And here I'm going to tell you an anecdote, a story that I've experienced personally, to show you a little bit about the determining role of health on the health of First Nations. I have been interested in First Nations' health since ‘84, since I entered medicine. I have read the statistics on First Nations, the rate of diabetes, which is on the rise, cardiovascular health, as Chief Picard said. Heart disease was unknown to our ancestors, and today it's one of the leading causes of death, and I was given, in the late 1990s, early 2000s...I read something, I take a newspaper of some sort, the CMAJ, the Canadian Medical Association Journal, and I look at it...I see an article and I go right to the conclusion. I had... I wanted to make it quick and I read the conclusion. It's talking about the diabetes rates of the peoples... Indigenous people—it was already in English—and the high rate of diabetes, the rate of heart disease, the rate of depression, the rate of violence in the communities, and I think, "this article doesn't say anything new. These are all things that are known." And then I turn to the first page to find out who the authors are and it was an article that was taken from an article on the Maori people of New Zealand. I took an interest in the health of Aboriginal Australians and it's the same thing, it's a pasted paper; the same health issues, three different continents, completely different ethnic and genetic backgrounds, because often people say "well, it's genetic, the Indigenous diabetes thing, the heart disease thing, the mental health thing..." But why, on three different continents, with three different genetic roots, do we have the same problems? And the common denominators are colonization, the Christianization of these peoples and the residential schools, because all three... in Canada we had residential schools, in the United States also, there were residential schools among the Maori and also in Australia, the British regime, it was a way of being able to... to kill the Aboriginal people, the Indian people, the Maori people, to make them become British or Canadian citizens or whatever to... to take away the Indigenous roots of these people. So, for me, it hit me. I really... my doctor side that thought it was all about the physical side... I started to think that the determinants of health were even more important: education, economics, systemic racism, we talk about it, we talk about it more and more, but the subject was on the table before the pandemic, before the Echaquan case, it has always been an important issue, and access to culturally safe care, and it has been for years. My grandparents, my great-grandparents had difficulties concerning safe access, we feel this insecurity, we don't feel respected in our health care, we have problems accessing health care. So, in a global way, here's what I think about what connects us as First Nations peoples and what connects us to the Indigenous peoples of the world, in fact, they are the same issues, they are the determinants of health and systemic racism.

Sony Perron: Thank you very much. It's an extremely interesting example that reminds us that we often tend to simplify problems by associating a problem with a genetic condition, and what you're showing us here is essentially that it's an assumption that is totally false and erroneous, and it's part of our education to change those paradigms, to adjust and to be very, very humble, perhaps even suspicious when the solutions and conclusions seem too simple like those to describe a problem. Thank you very much for that. You are both members of an Innu Nation in the Côte-Nord region of Quebec. Are there any particular issues or situations specific to the Innu people of Quebec that our participants today should be aware of? Perhaps how Nations have responded to the pandemic that we are still dealing with? Are there any situations or events that you would like to bring to the attention of our audience today? Maybe we can go back to Dr. Vollant?

Stanley Vollant: Regarding the Innu people, well, the Innu people are very diverse. Like I said, we can't be considered a monolith. The Innu people are very different. There are peoples, Nations that are close to urban centres, for example Mashteuiatsh which is near Roberval, Uashat mak Mani-Utenam, which is close to Sept-Îles, and Innu communities that are very far away, such as Pakuashipi where you have to go by plane, by boat or maybe, like me, by foot, by sled in winter... so the health challenges are very, very different. Access to health care can be problematic for some of our communities, and I think that... I've walked almost 7,000 kilometres, I've met all the Innu Nations, and what I can tell you, what I am told all the time, what I've heard people talk about is really the difficulty of getting care... access to health care that is culturally safe. Many times, I've heard about the problems of systemic racism encountered in health care settings, in hospitals, in clinics where people delay coming to hospitals or clinics because they're afraid to see people who don't respect them or who they feel don't respect them, so it leads to delays in diagnosis. And I can tell you that, when it comes to diabetes, if you don't go to your doctor for your... your... what we call a checkup because you're afraid of facing racism, it can delay the diagnosis of diabetes, and it's recognized in Canadian and American literature that the diagnostic delay among First Nations is a difference of 7 to 10 years and that can lead to significant complications in relation to the renal system. So renal failure is much higher, three, four times higher among Indigenous people, cardiac complications, amputation complications that are three, four times higher among Indigenous people with diabetes as those who are non-Indigenous. So, a delay in diagnosis because we don't feel safe and therefore where... and even the people who live in Mashteuiatsh, who are a stone's throw away from the Roberval hospital, don't dare go to the hospital because they are afraid of facing systemic racism. So, the same thing there, the diagnostic delay, hence the importance of... that the Government of Quebec, the Government of Canada recognize access to culturally safe care, and I'm going to add right away the concept of the Joyce Echaquan principle, Joyce's principle, which I think the Grand Chief spoke about earlier because it's a  cause. Well I think it's a very important principle, to have access to culturally safe care for all Indigenous people and for all Canadian diversity. I think that whether you're Muslim, whether you're from the LBGTQ community, you face... you face discrimination and I think the Echaquan principle, the principle that we start with First Nations, can be extended to all Canadian diversity, can be beneficial for all Canadians.

Sony Perron: Thank you, Dr. Vollant, for shedding light on the concept of cultural safety in health care. It may not be something that people naturally understand because they may have had very positive experiences in the health care system and think that we live in an ideal world. Thank you for raising this angle, which is very specific, and for illustrating that Indigenous people may not be the only ones experiencing a cultural safety issue in the health system. Thank you very much. Chief Picard.

Ghislain Picard: Yes, thank you very much for... it's actually an issue, but it's also, I think, a reminder that the challenges are huge, are immense and... but you know, the irony is that, as Indigenous people, we're very comfortable in adversity and... because... I mean, it gives us a reason to pursue a goal that, for us, is undeniable and I am... I remain extremely optimistic that we're going to... that we're not far from the goal. Having said that, I am... of course, I was born Innu and so I will die Innu, but at the same time, it's been my responsibility for too long to listen to the Chiefs and the Nations that I represent, so over time I've learned to try, depending on the situation, to think in Anishnabe, to think in Mohawk and to think... I mean the same way as the other Nations that form part of our great and beautiful diversity. And that's an important element because it allows us to finally have a better... to be able to really take the true pulse of our population, I think. And because we're talking about it, well, the Atikamek Nation tabled Joyce's principle two weeks ago now with the Government of Quebec, and we're facing a government that is clearly, clearly in total denial about systemic racism, and I find that extremely... extremely worrisome and disturbing for the future, because why should we come up against a notion that is finally unanimously accepted, even at the global level? And that is where I am struggling to understand the logic at the level... at the political level, and what I am saying increasingly often is that we are talking about the people of Canada and Quebec as being somewhat cynical about the political reality. I would say that we have even more reason than you, as Canadians or Quebecers, to be even more cynical because we have so many missed appointments. And look, I... because we're talking about it, it reminds me of the report that was made public yesterday in British Columbia, prepared by Mary Ellen Turpel-Lafond, who is a former colleague, a close friend, and who looked into allegations of racist acts committed by representatives of the health network in British Columbia who... the allegations go back to last June, it was said that staff were betting on the blood alcohol level of Indigenous patients. Although the report did not confirm or failed to confirm these allegations, the report still says that racism, and racism within the system, is prevalent throughout the province. So I think the Government of Quebec should make the effort to look at what is happening elsewhere and find ways to curb an evil that is far too widespread. And what happens is that it is our populations, in the end, with the rate of vulnerability, vulnerability and the rates of chronic disease, that pay the price for a health care system that does not recognize their specific traits. You talk about cultural security, that's the first... the first element that should really be guaranteed within the health network in Canada, in Quebec. I believe that's how it starts. So, on the political front, we are faced with this challenge: how to do this... how to condition government positions on this recognition of the system... of systemic racism without finding ourselves at the mercy of a political process that in the end systematically bypasses us. I think that's a bit where my thoughts are right now, and I want you to know that I think, if we were to say to the Government of Quebec today "well, look, we're going to continue to fight... we can't join a political process if there is not, at the outset, a recognition of systematic racism." I don't think anybody would see... so many losses if that was the political position that was being considered.

Sony Perron: Until the next incident where you would wonder what didn't happen once again, so the incident or the unfortunate situation around Joyce Echaquan created a shock wave, but it wasn't necessarily a surprise in the sense that the effects of cultural insecurity in the health system, you'd seen them before, they had been illustrated by previous incidents. Now, there's an opportunity to be seized. Maybe for our listeners..

Ghislain Picard: I would like to add something else...

Inaudible speech

Ghislain Picard: ... because you're referring to the situation we all witnessed in Joliette. I will remind you that, even today, the nurse who made the racist remarks about Joyce, she is still working. That is to say, there's nothing to take away her licence to practise. The same goes for Mr. Castonguay, the CEO of the CISSS Lanaudière. Even though it was shown that he was aware of the situation in Joliette two years ago, he is still working today. So that's where... I mean, as if it's not enough to take the pulse of this wave of racism that is rife in our country, well, there's... it's like adding insult to injury... or injury to insult, and I think that's important to remember as well, moreover, this is what led the AFNQL to table its own anti-racism plan because, in the end, we are calling for a public mobilization rather than a political mobilization because, at the political level, people are not being listened to.

Sony Perron: Thank you. Maybe for our audience, we still have three, four minutes before we start taking people's questions. Would you perhaps like to illustrate for our people what cultural safety means in everyday life, in access to services and the places where we can build that? You, as a teacher, Dr. Vollant, you, as a political leader, there are employees in institutions, there are institutions, there is the organization of health systems, I know that, systems because we don't have a single health system in the country, there are very different components... Where do we start? What are the key steps that could be taken to build this cultural security in everyday service? Dr. Vollant.

Stanley Vollant: Just to give you a bit of background on cultural safety, it's a concept that was developed by the Maori people in the early 90s. In fact the Maori Nurse Practitioners Association had developed, because they too are experiencing the same problem and established criteria for moving forward. In fact, cultural safety is beyond... we can have knowledge about First Nations statistics, know a little bit about the health structure. We can be sensitive, I think, it's important to be sensitive to this difference. We can develop skills, but cultural safety is the combination of all these elements that defines culturally safe health care facilities where an Indigenous person comes to a clinic knowing that the secretary, the people who work there, the doctors, the nurses, the people who support them are people who recognize the difference, who are sensitive, who are respectful. So that person comes and the interactions are positive on all levels. The people who work there learn about First Nations culture and First Nations people, Indigenous people, benefit from that. So it's really an environment that is safe, and we should go beyond health and we should develop culturally safe environments in education because, when I was in school, I was called a "savage" almost 2,000 times and more, all the names under the sun. The same thing for Ghislain, racism is experienced in all of our living environments and, even today, cultural insecurity in education causes children to drop out of school. When you get insulted every day, well maybe you will go back to your community instead of building, persevering in your education. When it comes to the law, it's the same thing So all living environments should be culturally safe, not just health. So… and how can we establish that? By having better training for people, so training for nurses, doctors, secretaries, support staff. In medical school, we've been doing it since 2005, but we're doing it... I think we could do even better. There are courses that are given to future doctors so that all Canadian doctors can have positive interactions with First Nations. Obviously, in Joliette, it did not work well. And I think it's... we need to invest in that as well, and I think perhaps to monitor whether the institution is culturally safe, that an ombudsman needs to be engaged, who makes sure that everything is done to ensure that the culturally diverse clients, Indigenous people, can be treated safely. So these are some elements, and I think there's another thing that needs to be mentioned: in towns and cities, 50% of Indigenous people in Quebec live in towns and cities, almost 60% in Canada, so we no longer live only in remote communities, in less remote communities, we live in towns and cities. There are more than 20,000 Indigenous people in Montreal. So, perhaps the importance of developing urban Indigenous clinics like in Ontario. In Ontario, there are more than 14 provincially and federally funded clinics, the best known of which is the Wabano clinic in Vanier, near the Montfort Hospital, which is an example to follow, I think, and in Quebec we have no clinic on that scale. I think the provincial governments should invest more in the care of people who are in cities because an Indigenous person, well that's it, there's always... there are difference between federal and provincial responsibility, but when an Indigenous person is sick in a city, well, they go to the hospitals, to the clinics. So we really need to, like, remove that boundary between provincial and federal funding, so I'm going to stop there. I will let Ghislain finish up.

Sony Perron: Thank you very much. Chief Picard?

Ghislain Picard: Yes, well, that allows me to add exactly to what Stanley describes so eloquently, the fact that, simply put, the principle of cultural safety, it's... it's really how... how the health system adapts to our reality rather than the other way around. It's... it's very basic. And that's what we need to guarantee, meaning that's what we need to achieve as... as an ideal. And, in the end, this also involves a lot of fighting, perhaps that's not the right word, but engaging the provincial, territorial and federal governments with a balance of power that is not there today. While we... we're fighting policies that were not designed by us, by the government too often, and we're still in that reflex whereas we're really trying to ensure all the necessary conditions, and I come back to the United Nations Declaration on the Rights of Indigenous Peoples, which, I think it's in Article 19, finally, gives us that right, recognizes rather that right, to create our own institutions, to maintain them. And these are elements, I think, that are extremely essential, and it involves, we are talking about, I think we are maybe two days or one day away from the tabling of a bill, a federal bill on the recognition of the Declaration and its implementation. So it is also these conditions, if they are met, that will perhaps ensure that our notions take their place. Look, ironically, I remember a time, many years ago now, when in some hospitals in Quebec, it was possible for a First Nations Elder to receive an interpreter service. I know Stanley knows what I'm talking about because he did it himself, in addition to being a doctor-surgeon. Not only was it possible to receive interpreter services to facilitate communication between staff and the patient, often an Elder, it was even possible for these people in the end to provide them with the opportunity to access a traditional diet, a diet with which they were much more familiar. And it's been a few years now. In my view, it should have been a given that would have allowed us to add to that today, whereas I think we're in... instead of making progress, there's been a regression, and I find that extremely, extremely worrisome.

Sony Perron: Excellent. Thank you very much for that. We see reactions from people in the audience who are sending us questions, and one issue that is somewhat related to the concept of cultural safety, but which is upstream, is the issue of historical trauma. And can you perhaps talk a little bit about how historical trauma—and even what historical trauma is—affects access to health care? Dr. Vollant, you said earlier that there are people who are hesitant to seek a consultation because the services are not adequate, but there are also reasons why they hesitate. Perhaps I'd like to hear from you briefly on that concept, because I think it's important for our audience to understand that there's a history in the relationship between Indigenous people and public services. Dr. Vollant, would you like to start this one?

Stanley Vollant: Yeah, I'll jump in. So, historical trauma, I think the... one instance of historical trauma that has been ignored for a long time, and even by me, because, well maybe Ghislain is just a little bit older than me, but for years the... the trauma of residential schools, I didn't know what happened at residential schools. I knew my mother went to a residential school. I knew my mother's generation went to residential schools, but we didn't talk about it. It was like... it was unspoken, and there were things that weren't said. My mother died of alcoholism because it was her way... her way of kind of drowning out everything she went through at the residential school. She was sexually abused twice when she was young, and it was her way of being able to self-medicate. So, when I learned in the 2000s about the residential schools and everything that went on in the residential schools, I understood a lot of things about my mother and I understood a lot of things about the people I knew, about the trauma they had experienced. And this is still going on and there is a trauma that is transgenerational, that occurs from generation to generation. When you've been raised in violence, well there's a good chance you're going to raise your children in violence, it's like... it repeats from generation to generation and our role, and my role, is to stop that violence that is being passed on from one generation to the next. I'll give just one small example: I was in a residential school for four days in the 70s. I wanted to play for the Quebec Indians. I was a hockey player. I was in La Tuque and for four days I went to the residential school, and then after four days I called my mother, I said, "get me out of here." There was violence that was institutional, there were fights between Indigenous youth over who was the strongest, who was the strongest in the gang. I'm sure that after five years I would have become quite a bit, quite a bit more violent than I can be, and it would have changed me. So, and without even being... being physically, sexually, psychologically abused, the atmosphere was... it was conducive to this... this type of thing. So the young people were taken out of the community, as far away as possible, and became people who were changed. So, we still have residential schools, we are still living it today in 2020, and we will be living it for generations to come. I think this is a very important thing to know and recognize, and also to continue to heal.

Sony Perron: Chief Picard, would you like to add to that point?

Ghislain Picard: Yes, yes. But not... not much to add. I think it's very, it's very comprehensive, very informative as... as an answer. Before 1992, there was no one who talked about residential schools. It was... it was taboo. It was... there are many... many, I would say, chapters of Canadian history that are like that today, eh? We... but for the past few years, we've been burying these taboos and we're finally getting to know the true face of history, and you were talking earlier about... the great Prime Ministers, the great names in history who... look, I'm fifteen minutes or so from Montreal, we have, with the City's cooperation, changed the name of a street in Montreal. We packed away Colonel Amherst and replaced him with a name, Atateken, which is... which is Mohawk and which is a collaboration between the Mohawk-Anishinaabe and the City of Montreal. So, I think that, that's... that's... that's adding to the... to the healing process in our communities. Residential schools, I mean, it's been proven in every possible way that trauma is intergenerational, it passes from one generation to the next. And that's where it's important to understand the healing process. We have to give it the time it needs and we're talking... we were talking earlier about the fear our people have about seeking a consultation. How many stories I've heard of people who... who endure their pain, who tolerate their pain because they're afraid. They're afraid to go to a health centre. But the worst thing about it, for me, is the fact that, today, well, I'd say, with colonization, we are normalizing certain situations. It is very, very, very ironic, what I am saying here is that patients who are going to go to a hospital or a health centre and who are going to be treated differently from Canadian or Quebec patients and who are going to say, "well, okay, that is fine. It's normal," they are like that. I find it extremely sad and painful to hear this kind of testimony, and I think about the Baie-Comeau hospital, which is the closest hospital to our community, and I have heard testimony like that. And so there's a lot, I think... Stanley was talking about the importance of education, I think it's an extremely important aspect for all the people who are ultimately called upon to work not only in the health care system, but more generally.

Sony Perron: Thank you very much. Your contributions are very generous. It is now 11:53 a.m., we have a few minutes left, so perhaps I'll call on you for your closing remarks, the message you want our audience to take away, while stressing that we have some... they are federal public servants, who are therefore somewhat removed from the day-to-day operations of the provincial health systems, but not all of them. So, just to tell us, perhaps to remind us of the things you would like the 800 people who are with us today to remember and the contribution they can make to improving things and health systems in the future to better serve Indigenous peoples and Nations. Maybe I'll start with you, Chief Picard, and I'll end with Dr. Vollant.

Ghislain Picard: Yes, well I'm going to go because... because we have a few minutes left with maybe a little commercial and just to finally promote a plan that... that we made public on September 29 and... and another irony is that, the plan was made public the day after Joyce Echaquan passed away and I think it reinforced the idea that... that, ultimately, if we don't take things in hand, and we've seen it with George Floyd, the kind of popular wave that's been going on for several months now, which is still going on, and the plan is the First Nations' Action Plan on Racism and Discrimination. And it's a plan that calls for the creation of alliances. Look, as I speak to you, there are many... we get many, many calls from people, sometimes individuals, who don't see the importance of their initiative, even if it's on an individual basis, but there is also the health network, the university network, the education network, the municipal environment in Quebec, which is also highly mobilized, and all that to say that... I mean, we're not talking about... the political class, it's not to avoid it, but I think we owe it to ourselves, to each other, to engage as a society. And it really is our responsibility to make things change, and it is in that spirit that the plan was announced on September 29 and we are following our path. We had a webinar with the municipalities two weeks ago. There will be a webinar in two weeks with the media community, an extremely important partner, and for us, that's also how it happens, our change. I think that the willingness, and the ultimate goal is to live together peacefully. And it happens through greater self-awareness.

Sony Perron: Thank you very much. Dr. Vollant.

Stanley Vollant: I'm going to add something to what Grand Chief Picard said. I think that education... I think that, I'm talking to the 800 people who are here, so I'm asking you to continue your education on First Nations. There are many great things to read on the web. In terms of health, there is a very, very interesting document from the Society of Obstetricians and Gynaecologists of Canada (SOGC) on First Nations' health, an extensive document. It teaches about history, culture, impacts of colonization, residential schools, and therefore holistic medicine. So, continue your education and become partners with us, First Nations. Talk to those around you. Of course, I would have said to you "at Christmas dinner, talk to your folks about it," but it won't be possible, my dear friends, we're going to have to be alone, but I think you should share this interest in learning to get to know one another and becoming equal partners, and I think that, when we can be equals, once we have decolonized our relationships—decolonizing our relationships means treating each other equally, as equals, no more superiors or inferiors —then we will be able to develop a country that will be rich, that will be able to give all these young people, regardless of their skin colour, their language, the opportunity to develop their full potential. So open up, try to be more sensitive to First Nations. Become advocates for us, because we need you so that we can move forward and we can... one day, I have... I have a vision, I have a dream that will not come true in my lifetime, which is that First Nations can have the same economic, health and social status as all other Canadian men and women. My children might see it; help us make that dream come true.

Sony Perron: Thank you very much. You have been extremely generous today with your time, and with your comments, your invitations, I remember the political message, the doctor's message. We had a balance, a very balanced panel today, which complemented each other very well, it was extraordinary. I retain three things: humility, we have a lot to learn, we can be allies, the road is long, but we should not be less ambitious than Dr. Vollant's dream in what we would like to accomplish. I hope that in twelve months, so in December 2021, we could do a session like that with you again, with other panelists, to talk about the same thing and then to talk about what we have accomplished in the last year and whether we are able to say "well, there have been things that have changed drastically," because if we want to achieve socio-economic outcomes, health indicators that are favourable and equitable, there is work to be done ahead of us and I hope that our colleagues who have joined us will take up the invitation. Thank you both very much. For those who are listening today, I would like to point out that on December 3, in two days' time, at 11 a.m., at noon, there will be another Virtual Café that will focus on polling, everything you want to ask about polling. We will have Anil Aurora, Claire Durand and Nik Nanos joining the School of Public Service for that session. So I encourage you to sign up if you're interested. The last point I have left is to invite our Elder, Commanda, Claudette, to give us the closing prayer. Thank you very much to you both, our panelists. Thank you, Claudette, for agreeing to be here with the rest of us for this session. Until next time. And, everybody, the holidays are coming up, there's still a few more work weeks to go, work hard, but stay safe at home, and you heard the... our guest who is a doctor today, the signal "we're going to celebrate, but alone," so let's respect the public health orders, that will protect everybody across the country. Claudette, we're all yours.

Claudette Commanda: It was a very, very interesting discussion and learning so [Indigenous language] Grand Chief Picard, [Indigenous language] Dr. Vollant and you too, Sony, [Indigenous speech]. I'm going to say a prayer, a thank you prayer. It's like my grandfather, Chief William Commanda, always said: "when you begin and you ask the creator and the spirits for help, we must close that circle and give thanks to say thank you to our creator for helping us" and I invite everyone to give words of thank you. [Indigenous language] Take good care everyone. [Indigenous language]

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