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CSPS Virtual Café Series: A Fireside Chat with Dr. Alika Lafontaine (TRN5-V33)


This event recording features a conversation with Dr. Alika Lafontaine on what it was like to be appointed the first Indigenous president of the Canadian Medical Association, how his background and upbringing shaped his professional aspirations, and the critical health challenges facing Indigenous Peoples in Canada today.

Duration: 00:57:43
Published: September 14, 2022
Type: Video

Event: CSPS Virtual Café Series: A Fireside Chat with Dr. Alika Lafontaine

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CSPS Virtual Café Series: A Fireside Chat with Dr. Alika Lafontaine

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Transcript: CSPS Virtual Café Series: A Fireside Chat with Dr. Alika Lafontaine

[The CSPS logo appears on screen.]

[Nathalie Laviades Jodouin appears on screen]

Nathalie Laviades Jodouin, Canada School of Public Service: Good afternoon and welcome to today's event, Virtual Café, a conversation with Dr. Alika Lafontaine. Thank you for taking the time to be with us today. My name is Nathalie Laviades Jodouin. I am Vice President at the Canada School of Public Service, responsible for Public Sector Operations and Inclusion Learning. And I'm really, really happy to be with you today. Before I continue, I do want to acknowledge that since I am located in Ottawa, the land on which I am broadcasting from is the traditional territory of the Algonquin Anishinaabeg people. And I would like to acknowledge their longstanding relationship with the territory, which remains unceded. Some of you today may be viewing this from various parts of the country. And so I do encourage you to take a moment to recognize and acknowledge the territory you are occupying.

In order to support your experience during the event. I do want to take a moment to go through some administrative details first to optimize your viewing experience. We do recommend that you disconnect from your VPN or that you use a personal device to watch the session, if possible. Please note as well that we do have simultaneous interpretation and CART services available. So that's real time closed-captioning. And please refer to the reminder email that you would've received from the School in order to access these features.

So with that, I want to kick off today's event and wish you Dr. Lafontaine, first of all, thank you so much for being with us today and welcome to our event.

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

Nathalie Laviades Jodouin: Before we get started, or as, as a starting point, I would say, well, many who are tuning in today, probably know some who you are and some have surely read your biography. I would love for you to begin by telling us a bit about yourself in your own words, sort of where you're from, where your journey has taken you and what you're up to today.

Dr. Alika Lafontaine, Canadian Medical Association: Yeah. So thank you for the invitation. It's a pleasure to join you today and be part of this Virtual Café.

[Dr. Alika Lafontaine appears full screen]

 Dr. Alika Lafontaine: I really enjoy being a part of these series, just because they're open conversations about things that are important, things like leadership and you know, solving problems, critical thinking, the big questions of how we actually address the challenge that we're facing right now. And in this increasingly polarized world. As was said, my name's Alika Lafontaine, I'm Métis with Ojibwe and Cree ancestry. My mom comes with the Pacific islands. My dad's here from Canada. I am an anesthesiologist. I work in Northern Alberta. For the past 20 years, I've been involved in indigenous health advocacy and health system transformation. Currently I am Facility Chief over in our regional hospital and I'm also going to be the President of the Canadian Medical Association come August of this year. So my journey has been a little bit eclectic, not really a direct line from where I was to where I am now and really looking forward to the conversation and some of the insights that we can kind of draw from my experience.

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

Nathalie Laviades Jodouin: So thank you Dr. Lafontaine for sharing that - I was wondering if you could tell me a bit more about how your earlier journey has led you to move into the healthcare field and become a doctor. What was that journey like?

Dr. Alika Lafontaine: I think a lot of people, when they start the journey to become a physician or work in the medical field, they kind of have that idea pretty early on in life. I actually didn't really figure out that I wanted to go into medicine until a lot later.

[Dr. Alika Lafontaine appears full screen]

Dr. Alika Lafontaine: When I was young, I was actually labeled as learning disabled. The actual label they gave me was developmentally delayed with the speech impediment and my parents after, you know, months of the teachers giving me speech therapy were, you know, called in to talk to the principal. And we sat there and discussed some of the challenges I was having. And at the time people who were labeled with this type of learning disability didn't have a lot of options in the opinion of, you know, the teachers and administrators within the school system.

And so the principal actually told my parents that I I'd probably never graduate high school and my folks, they they'd always thought of education as kind of this this path to a better life. You know, I was, I grew up in a middle to low class income home. My dad worked, my mom was at home. He was the first person in his family to get a Master's degree. You know, education was really, really something that we'd always talked about in our family as a way to that next step, you know, moving up

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

Dr. Alika Lafontaine: and, you know, finding more success and, you know, helping to bring our family up. And so we, we'd always been taught from a very young age that higher education, going to university was really important to my parents and it should be important to us as well.

And so that was, that was pretty crushing to my parents at the time. And we ended up working through that over the next few years. I eventually actually was pulled out of public school and brought into homeschool for a few years. And the things that my parents did taught me to learn in different ways, you know, at the time homeschool is not homeschool now, you know, I have my children in online learning and it's more or less just like being in class except it's over Zoom. You know, it really had no structure back then when my parents were going through it. And it was, it was really a adventure for both of them to try and figure out, you know, how to provide those opportunities for me. I ended up graduating high school early, you know, at age 15.

I was 16 when I entered into my Bachelors of Science. I ended up having a friend who had a bit of a bet with me on writing the medical college admissions test. So I kind of wrote it on a dare to be honest. And I ended up passing and I applied to medical school and I ended up getting accepted as well. And that will be on the path of becoming a physician and, you know, along the way we had a lot of other adventures. We actually started a family musical group. We, more or less, were a boy band that toured across, you know, Canada and parts of the United States.

[Nathalie Laviades Jodouin smiles and gives two thumbs up gesture]

Dr. Alika Lafontaine: We were called the Fifth Generation. We started off with performing in schools and kind of community events eventually moved on to actually doing theaters. We were on the Inspire Awards for several years. I think the largest viewership we ever got for a show was two and a half million. So it it's been a very eclectic kind of non-linear direction to get to where I am today, but the adventure's been, been really fun.

Nathalie Laviades Jodouin: That is amazing. So I'll come back to the eclectic aspect of it in a moment, but I'm really taken by what you mentioned as the diagnosis that you received early in life. I know that in the Public Service, we're making concerted efforts to better reflect the diversity of the population we serve. And when we're looking at diversity and looking at it from, you know, multiple perspectives and internationalities, we're looking at diversity of, you know, experience of background, ethnicity, culture, gender, race, and we're making particular efforts as well to attract more neurodiverse candidates. It's an area that I think as a public service, we need to better educate ourselves on. There are a lot of biases, preconceptions, et cetera. But clearly these are not hindrances to one to be able to succeed as your particular example demonstrates. And so as public servants are hearing this and listening to your journey, I'm wondering what advice might you give or what message do you want to relate to public servants around as we look to diversify our workforce and what we might need to sort of focus on to help provide more opportunity as opposed to putting barriers in place.

Dr. Alika Lafontaine: Mm-Hmm <affirmative>, I think that's obviously a multi-layered question.

[Dr. Alika Lafontaine appears full screen]

Dr. Alika Lafontaine:  I think that there are a lot of things everyone can do. There are a few things that people can do well, and then there's a small group of things that people just do amazing at. And I think when you look at the different opportunities within the public service, it's important to differentiate between those things. I think when we talk about meritocracy we often conflate that with the actual necessities of the job itself, you know, the truth is even as an anesthesiologist, I could probably train you to do a general anesthetic, you know, in a fairly short period of time, I'd say less than a month, you know, and consider that I was in school for nine years to become an anesthesiologist, you know, working fairly long hours and kind of heavy, heavy clinical exposure.

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

Dr. Alika Lafontaine: That being said, that doesn't mean you can deal with the emergencies that come up with anesthesia. That doesn't mean that you can deal with the highly complex anesthetics, which are different than, you know, the more straightforward ones. And within our jobs, we often conflate kind of that higher end of acuity, that higher end of expertise with all the work that gets done. I think there's a place for people in the majority of systems, you know, and if we think of it as thresholds versus, you know, check marks or these hoops that people have to jump through we'll probably be better equipped to create those spaces for other people. And everyone, everyone has a different role, you know, not everybody wants to be the public speaker, you know, not everyone wants to be the one making the final decision. There are people who are happy to be role players.

There are people who are happy to, you know, do different things that maybe aren't as in front or behind. So I think diversity is really about finding those places for those individuals. You know, in my own employment history. I mean, I obviously was in the boy band. I've been a physician, but I've also been a bell boy at a hotel as well as switchboard. You know, I built websites for a few years as part of a startup. You know, I I've been a keynote speaker as well as a lot of things in between. And all those jobs, I mean, they all have a different mix of skills that I think many different people could fulfill. And if we come in with a frame where we're trying to find that fit versus kind of doing this arbitrary, you know, "you're in your out" type of way of looking at individuals.

I think we'll get a lot closer to the diversity that we're looking for. You know, I think diversity and inclusion within systems is really two parts. One is finding that place where someone can thrive, but then the other one is keeping in mind that when we serve, when we serve the public, you know, especially within the Public Service, having individuals who reflect who the public are, is really important, so people can see themselves. You know, I still remember the first time that I saw an indigenous physician, you know it opened my mind to different possibilities. I really remember this, this period of time that lasted for a few years immediately after I was labeled as developmentally delayed, and my parents had that conversation where my Mom, she was trying to get me out of this funk that I was in, where I was really just absorbing what people thought about me, and that really was my self-image. You know, I wasn't generating anything for myself. I was just taking in, you know, all that negativity and those limitations. And she gave me books to read. And I have to say, I really escaped into those stories because I was reading about people accomplishing things that I wish I could be a part of. And I started reading books of people who had experiences like me, who came from backgrounds like me, who were doing amazing things, you know, and that really unlocked in my mind this limitation I'd put on myself that I could only be this, or I could only be that, you know, and like I said, at the very beginning, we all, can't be, you know, the person at the top of the hill with, you know, the deepest level of expertise and, you know, the greatest ability to deal with acute crisis. But there's a reason why there's a tip to a peak. You don't actually need everybody there. You know, you just need everybody kind of moving up the mountain together. And I'm really excited to tell you the truth as just an average Canadian voter, seeing how the public service has evolved and how it's creating those spaces for people.

Nathalie Laviades Jodouin: And if I can just expand upon that, when we were preparing for this event, I recall you mentioning that in many spaces along your journey you were the only one that looked like you, and it's certainly an experience I can relate to as well. And I'm wondering, you know, there are probably some challenges with that, but probably also some opportunities with being the only one. And I'm wondering if you can talk about a bit of that experience.

Dr. Alika Lafontaine: Yeah. This reminds me of an experience I had early on in medical school,

[Dr. Alika Lafontaine appears full screen]

Dr. Alika Lafontaine: where I remember the first day of class walking in and realizing I was the only indigenous student that was within my class. And I actually found out that I was the only student across the whole four years that were in medical school at the time and University of Saskatchewan, where I attended it had obviously graduated indigenous graduates before. But for whatever reason, I was the only one in the, in all four years at the time. And I think when you have that "other" label, you know, when you're the only one who looks like you or comes from your background or, you know, speaks your language, or, you know, has kind of those characteristics that you bring into that space you bear this burden of "otherness".

You know, you have questions just directed at you. You don't have anywhere else to kind of share that burden. And I remember in that first year getting a lot of questions about, you know, how nice it must be to have all my schooling paid for, you know, how great it must be to have had, you know, a reserved spot just for me, and somehow I wasn't as academically robust or you know, somehow I was lacking because of this special stream. And it was a lonely time, you know, it was a very lonely time. And I remember in the second week of school we had this one exam. It was in histology and cell biology, which is a class I'd never really enjoyed <laugh>. And I, of course came from like a very high achieving background having gone to Med School.

So I was used to good marks and, you know, doing fairly well, walking out of exams and, you know, feeling pretty confident. And I remember having that exam and just not feeling very good. I got the mark and it was respectable. It was, you know, a B, B plus.

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

But of course I'm having a meltdown, right, because <laugh>, I'm coming in from, you know, this very different background where I was doing much better in, you know, my undergrad. And I went and sat down with the professor and I was asking them for additional, you know, mentoring and the professor actually never, never looked up while they were writing. And the only thing they said was if you have to repeat first year, it's not the end of the world. And then they waved me towards the door. And I remember walking out of that office and just thinking to myself, what am I even doing here?

You know, I know that I'm different. I know that I'm another, I'm "that other", I don't see anyone like me. I don't have anyone I can talk to. Everyone's asking me these questions I don't want to answer. I'm seen as something that's less than, and whether that was in my mind or what was actually going on, that's how I was feeling at the time. And I felt like crying. I was just walking out, down the hallway and luckily our indigenous coordinator, Val, saw me as I walked by the Dean's office and she stopped me and she told me to come sit down. And I mean, she's very good at picking up on people's, you know, visual cues. And she sat me down and she's just like, what what's going on? And it all just, it was like a dam breaking.

It all just came out. And I told her all the ways that I was feeling and what I was going through. And Val, she knew what I was going through. Right. She'd seen it in other students, she'd experienced it herself. And I actually ended up talking with her and then talking with the Dean, like pretty much every week or every two weeks from that time all the way to when I graduated from medical school. And I have to say those conversations actually saved me. Like, they really are the reason why I got through medical school. And I think what I, what I'd underline as, as the insight and lesson that I've taken away from that is that the internalization of what, how people look at you, know, is something that we don't often bring out into the front.

Like, we don't talk about it openly, you know - with indigenous medical students, obviously we talk with each other about it, right? But to people who don't understand that lived experience, it's not volunteered most of the time. And being aware that that exists is super important. But then the other really important part is having someone who is in a position of authority or position of influence telling you it'll be okay, you know, patting on the back and saying, you know, you may not feel like you're there yet, but I've seen people get there and you are one of those people. You know, I remember Dr. Albert, the Dean, you know, he always had his door open and I'd often just walk in. I mean, and looking back, you don't do that to a Dean, right? Like, <laugh>, you don't just walk into their office and, you know, start talking about random things.

But he was so generous with this time. And I think the other thing that happened with all of that was it set a tone for the people who were looking at us, you know, they didn't look at me as, you know, one of them, but they saw the Dean, and the relationship that we had, and that, that was a sign that, you know, maybe there is something different. Maybe I should, re-explore my bias, you know? And I think for myself, when I do mentorship, I actually spend a lot of time talking with people about how they feel and just reassuring them like that. That is a total normal human experience. You know, what you're going through is the same thing I went through and it's okay to feel this way. It will pass and it'll take you somewhere else.

Nathalie Laviades Jodouin: Hmm. So you listed throughout your schooling, some examples of comments we'll call them what they are, microaggressions. And you mentioned that it was a very lonely time, and I'm wondering how, in addition to some of the supports you just listed now, and I do want to delve into the role of mentorship in the role of allyship in this space, but how did you stay the course? Like, how did you, where did the resilience come from? Where did you find that to sort of keep on keeping on despite feeling lonely and despite the microaggressions?

Dr. Alika Lafontaine: Mm-Hmm <affirmative> so I will say just off the top, I don't think that I'm any better, any less than, you know, anyone else going through the same sort of situation, you know, I don't actually think there's a whole lot of things that are unique about what I went through. There's just different contexts and, you know, talking a little bit about things that happen outside of medicine. I mean, you often have people who excel in other areas outside of the places where they feel those microaggressions. And I think that's one of the reasons why it's sometimes confusing to people who don't understand that lived experience that well, how can that person have those experiences? How can they have those feelings? I mean, I'm performing in front of a crowd at the Forks in Winnipeg of like 40,000. And then, you know kids my age, like keep in mind, I'm like 18, 19, like they're lining up for about, I think one of the shows was like a hour of just girls lining up to hug me, right?

Like that that's obviously like something that <laugh>, you know, is a bit of an ego booster, but that, that doesn't translate into the resilience that you feel within that environment. You know, I've often heard it described as, you know, this armour that you try and put on as a person who's been "othered", you know, and you dress yourself up with it over life. You know, you try and accomplish things and, you know, receive awards. So that's like a layer of armour. You have your familial relationships and you have your close friends who believe in you, that's a layer of armour. You have things that you've accomplished, you know, degrees, certifications, you know, titles, et cetera. That's a layer of armour. But in those moments where people really cut you to the core of who you think you are or want to be that armour just dissipates, you know, and I've heard it said by a colleague of mine, Barry Lebelle, he's like an amazing physician leader out in Manitoba that at the end of the day, persons who are "othered" have to take off that armour and then wake up and put it on again, you know?

And so the big difference, I think with persons who have historically been excluded from things is that armour just has different characteristics. Like it's a cloak that we eventually have to take off, or that can be ripped off of us, you know? And so when, when I think about resiliency, that armour is an important element of it. The other element is that people can shield you from those things. And I actually think that the resiliency for me early on actually wasn't inside me, it was outside of me, you know? I have no doubt that Val and, you know, Dr. Al Berton advocated for me behind closed doors, they did a lot of things that I wasn't even aware of, you know, and in the moment, I didn't even think to be aware of them because I didn't actually know how things worked, you know?

I'm sure, after I told Val about that experience, she actually went and talked to the professor, you know, and I think it's those things that happen behind the scenes, that in those moments of indecision and vulnerability made a huge difference for me. And that I only appreciate after it's past. And I think that that's a struggle sometimes for people who are trying to be allies in this space is you're expecting that immediate gratification. You know, you go do something and immediately after the person who you're trying to help says, oh, well, that's amazing. And it had this impact and all these things, there's a time delay that happens often with this. And one of the things that I've learned about resiliency is that in the moment of vulnerability is not the time that you develop that resiliency it's after that you develop the resiliency. And that resiliency for me at least comes from an increased knowledge of what was going on in the time. And realizing that there really was this community of people that grew over time, that, that are really doing their best to help me out.

Nathalie Laviades Jodouin: Wow. There's so many places I want to go here. Okay. So I'm going to switch gears for just a second. For those who know me, they will tell you that in my earlier years, like I had a thing for boy bands. And so while I was into boy bands, you were in a boy band and which it just blows my mind. I love it. What would you say were some key lessons you learned through that experience that still support and accompany you today?

Dr. Alika Lafontaine: So I will say that there's no greater lift for a teenage boy than having girls, like, very interested in whatever they're doing. So, you know, that that was a great source of self-worth in certain places. You know, at the time when we were touring we would go to school and then, you know, get in the van and go drive sometimes you know, 7-10 hours in order to get where we were going. We were our own roadies. So we'd set up, we'd take down, early on, when we were doing community events, like we'd cater, we'd do workshops. It's really what taught me how to public speak, to be honest, like those, those 20 years in, in the band really, really taught me to talk and communicate.

[Dr. Alika Lafontaine appears full screen]

Dr. Alika Lafontaine: But I would say that if I had to share one lesson from the entire thing, it was that people come sometimes to meet you, not to not to learn things, but to feel things. And there was something I noticed within performances, and we built our sets around this, where, you know, you you'd get a sense for a journey that people wanted to kind of walk through and you don't always have to say out loud your problems to go through the feelings that will take you to a different place. And I know at our shows like there were people who were coming in happy. There were people who coming in sad, there were people who were coming in confused. And, you know, we we'd build these sets where we'd take people on this emotional journey where, you know, they'd laugh, they'd cry, they smile. And I think that really led to that human connection at the end. You know, it's a very surreal feeling to be involved in something where you could reliably at the end of it, know that people would come up to you and say, you know, you just really made my week.

You really made me think about things in a different way. We'd have times when in the, in the sets where we'd go out and sing to individual people, like we always tried to find people that seemed like they needed to be sung to, you know, people that needed to feel that connection.

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

Dr. Alika Lafontaine: And that's really transferred over to a lot of the work that I do right now. Where, when you're talking, I think people who haven't had a whole lot of experience with keynotes, or, you know, that sort of broad connection, sometimes feel like they're a failure if they don't have the whole crowd kind of vibing with them and connecting with them, the truth is at those events, you really just need one or two people to deeply, deeply connect with you to change things, right? And I think that that's an amazing thing about public service, is that what you're trying to do is influence society, but to influence society, you actually just need to focus on a few people, you know, and especially in the way that we communicate right now with social platforms and the elevation, I think of communication there's of course more polarization, but there, there's never been a time that a single thought could be spread across a large amount of people faster or more effectively, you know, and taking time like we did in the show to really fashion those moments where people could experience those intense feelings and walk away with different perspectives about how they saw themselves or saw the world. I mean, that was an amazing experience.

Nathalie Laviades Jodouin: And clearly one that resonates in so many aspects still today. So I'm going to fast forward us to today. I mean, you are very much an advocate for, you know, improvements in Indigenous healthcare. And I know that through this work, you've mentioned to me in a previous call that you've had some encounters with the bureaucracy, with government. And I'm just curious if you would share with us some of the lessons learned or experiences with interacting with the bureaucracy, and also some of the parallels that you make between the healthcare system that you're very familiar with and the bureaucracy of which the Public Servants watching you today are navigating.

Dr. Alika Lafontaine: So I'll tell you two stories. One is about Paul Martin. The other one is about Jane Philpott. So <laugh> I ended up getting to the finals in this competition called "Canada's Next Great Prime Minister". And Mr. Martin was one of the four past Prime Ministers who were sitting there as part of part of the judges. And, you know, in the final part of the show we were supposed to have back and forth, they'd ask us questions. We give answers, they kind of give comments. And then in the crowd was a distribution of people that were supposed to mirror the different provinces and territories of Canada. And so they'd vote, whoever won, received a cash prize in kind of this title of Canada's Next Great Prime Minister. And I made it to the final three, and we were standing there getting our different questions.

And Mr. Martin asked me a question about the Clarity Act. And he said, "if Quebec had a vote and it was 51% that they wanted to succeed, would you let them succeed?" And obviously this is a multi-layered question, but I'm a kid and I'm from the West. And I have this idea about what democracy is, which is 50% plus one. And I told him, yeah, of course I'd let them succeed. And he was, his face got red. He slammed his fist down on the table and he actually stood up and said "over my dead body, would Quebec ever leave Canada!" And I'm standing there just knowing what I've done. And I remembered a bit of advice from my brother, who's a lawyer. He was in law school. I was in med school at the time that, that we were competing. And he had told me if you get in a fight with one of the prime ministers, just say something super patriotic.

And so I'm sitting there thinking to myself, what am I going toa say? And I took a few seconds just to collect myself. And I said, "Mr. Martin, if Quebec wants to leave Canada, we should not be thinking of all the ways to force them to stay, but instead ask ourselves why would they want to leave the greatest country in the world?" And the crowd went wild. You know, people actually gave me a standing ovation. I think I captured the Quebec vote at that time.

And I ended up winning the competition and you know, me and Mr. Martin, chatted after the show, and he shakes my hand and says, you know, "if I'm just being blunt, you don't have a whole lot of policy experience, but man, can you work a crowd."

[Nathalie Laviades Jodouin smiles broadly and gives thumbs up gesture]

Dr. Alika Lafontaine:  <Laugh> and, you know, obviously like my experience has gotten a lot deeper. I'm not that same person that I was, but me and Mr. Martin have been, you know, partners in different projects and we've kept in contact and, you know, are good friends now. But that was one experience of, you know, obviously not having the policy depth to confront the problems, but taking, you know, the societal frame of how we look at these problems, you know, and bringing that into, you know, the actual discussion because to tell you the truth, that's how the west looks at, you know, being a part of Confederation, right? The second experience is with Jane Philpott and shortly after she was elected and was appointed as Minister of Health, I contacted her office. I was President of the Indigenous Physicians Association of Canada at the time and said, you know, let's sit down and have a chat.

And I had a lot of experiences within, you know, First Nations and Inuit Health Branch, which at the time was in Health Canada, Indigenous Services Canada hadn't been created. That was still like something that would come later. And I remember sitting down with her, there were two people with her. I had no idea who these people were. They were Associate Deputy Ministers, I found out later <laugh> and I just kind of ripped into the system because it was doctor to doctor, right? I was treating her more like Dr. Philpottt than Minister Philpott. And I, you know, these ADMs, they were coming up with answers to everything that I was saying. And so I'd ripped that apart with, you know, other kind of constructs and, you know, just to be honest, ISC has, has made leaps and bounds towards better ways of delivering care.

And at the time I truly do believe that FNIB and I think the ADMs knew this too was, was in a bit of a rut. Like they were doing things that they knew weren't working, but they didn't know how to get out of it, right? And I remember walking away from that meeting, thinking to myself, "oh, that was a great meeting." And then looking back, I was like, wow, that was a really bad meeting. <Laugh>, you know, based on the interactions that I had with the ADMs. And we ended up starting up a project soon after and by we, I mean myself, a small group of people in 150 First Nations from, you know, across three Provinces, it was called the Indigenous Health Alliance. And we ended up interacting with these ADMs more regularly and meeting more people in the bureaucracy.

And, you know, I think looking back those ADMs can probably laugh about that initial meeting. But along the way we developed relationships and we started having honest conversations. And one of the things that I realized the ADMs and the bureaucracy was struggling with within FNIB was this pervasive feeling of hopelessness, you know, that things couldn't change. You know, no matter how much money was poured into a problem that that end state, that people wished for - and there's so many people within the bureaucracy that are just good people, you know, who want the best for Canada and Canadians and Indigenous people. They were really frustrated. And I think what I was talking about earlier with the experience of the boy band and being able to tap into how people were feeling and kind of taking on that emotional journey, I think served us really well when we were working with the bureaucracy, because the challenge was not that people didn't have the expertise or insight of what they could do differently,

it was that they had feelings that they were trapped in, that they couldn't get out of. You know, if you have hopelessness, when you see an opportunity for change, you filter that through the feeling of hopelessness and you think to yourself, well, that's just going be more of the same, you know, and if it's more of the same, then you take less risks. And if you take less risks, then you support your status quo, which then just makes you more hopeless. And I think that emotional journey that we went through with, with members of the bureaucracy, but then also just the generosity of spirit that they had, and actually sharing with us these feelings, you know, which was a huge risk. It's, it's a huge risk for doctors to communicate with patients, how they feel. It's a huge risk for the bureaucracy to communicate, to, you know advocates, how they feel as well.

You know, that's a risky space to really put who you are kind of out there. it taught me the importance of roles within system change. You know, I think sometimes people interact with the government and think to themselves, well, I'm going to force the government to do this. I'm going to, you know, blow up this system. You can hear it in the polarization that happens that, you know, the theatrical political level where people are saying, well, these systems don't work. Let's just burn the whole thing down. The truth is that doesn't work because then we have no system, you know, and it's, it's the same thing when you compare it to medicine where, you know, racism is obviously a problem throughout the medical system, is it a problem that's big enough to create harm? I think that's different from place to place.

And then does it reach a threshold where you have to manage it with outside resources that you can't just manage it through better team building? I think that's another nuance that you have to figure out, but if we eliminated all racism today, by just firing everyone, we wouldn't actually have a health system anymore. And so there's a line that I often share in, in training sessions that I do for leadership or when I talk to boards, which is if you're going to burn down on the forest, have a plan on what trees to plant next. You know, and I think that's a lost art in advocacy that I think we all have to get back to. You know, I'm all for burning down things. You know, I have no problem in blowing up systems that don't work, but if there's no strategy on what to replace that with, we're all just going to lose at the end.

And I think that's no more important than within bureaucracy and government itself. You know, there's this feeling I think out there now where government isn't satisfying the needs of the population. And so the population is then turning to other places, right? And whether that's true or not, I think it's different than the feeling that that's there. And I see that a lot in medicine where people talk about public versus private and they think, well, I'm going to turn to the private and that's going to solve all my problems. The reality is there will never be a system that's better positioned to advocate for our interests than government. And if we elect better leaders and through that, you end up having a better functioning bureaucracy, you will never be able to manage the challenges of society in a better way. You will never have a higher authority that can go in and, you know, confront these consolidations of power in a way that you can with government.

Like you can't, you can't depend on private industry to deal with your interests because private industry have their own interests. You know, the bureaucracy should be aligned with the needs of its population. And sometimes the population doesn't necessarily know exactly what it needs, because it doesn't have the 360 view that the bureaucracy often has, right? And I think that interaction really helped me to understand the nuances of that and to give people space to grow and change. I think the, the part of our interaction with the bureaucracy, with the Alliance that really accelerated the relationship and made it deep enough to actually have resource allocation - you know there were 6 to 8 million that minister Philpott allocated to, you know, members of the Alliance for Health Transformation, for example, that's a big chunk of money for, you know, something that was really in it's early stages.

And to have that depth of trust, you had to be able to communicate that it was going to be win-win, you know, you had to have the government come forward with its needs, the bureaucracy come forward with its needs and have the community come forward with its needs. Have people see each other as human, you know, talk truthfully and honestly about what the actual issues were, you know, have an understanding that the other side actually cared that you got what you needed, you know, and then you met in a place that took you to your actual outcome. And I think I see that more and more with government, especially within indigenous health where I interacted. And I think if we continue that direction, I mean, we are going to solve problems. Like we will reach that end point where these problems actually change into the solutions that we're hoping for.

Nathalie Laviades Jodouin: What I really, really love about that experience as you related it is the sense that it started off with interacting, you know, a system interacting with the bureaucracy, bureaucracy interacting with the system. But when you talk about words, you know, going on this emotional journey, the fact that trust needed to be built, you needed to sort of, you were talking to people, there's people behind the bureaucracy, there's people behind the healthcare system. And it seems to me that evolving to that place where you start to relate to people is where you can really start, I think, to really unpack the issues at hand and kind of build the kind of environment and trust that's needed to be able to have those conversations and move that yard stick forward in a meaningful way. Doesn't mean it's easy, but I think it's too easy sometimes to label it all like a system, which seems to me very overwhelming when you look at bureaucracy and system seems big, overwhelming, can't change it, burn it down, get rid of it, but really at the end of it, it's the people, the people behind it. Yeah.

Dr. Alika Lafontaine: Yeah, absolutely.

Nathalie Laviades Jodouin: Last time you spoke, you mentioned to me, and as I'm looking at the time is passing by quickly. So in this space, again, a lot of work being done in the Public Service to sort of better ourselves in the broader equity, diversity and inclusion space, and you shared with me a mental model that you've found really, really helpful. So I'd love to take the opportunity here for you to share it with Public Servants today.

Dr. Alika Lafontaine: Mm-Hmm <affirmative> yeah. the mental model is really focused on understanding problems and kind of the abstraction or concreteness of how those problems can be broken down. So one of the big challenges with something say like racism, is unless you've lived and experienced it, it's kind of this amorphous unknowable type of thing that remains an abstract concept to you.

[Dr. Alika Lafontaine appears full screen]

Dr. Alika Lafontaine: And often what we do in solving problems in areas like this, where there's a high degree of abstraction is, you know, we either jump straight in with solutions that are generated by, you know, those who already have control over, over resources and kind of authority, or those people step back and say, well, just fill the space with people who do understand it. And that goes back to that phrase "Nothing for us without us" Right? I think originally the phrase was intended as "bring us to the table and let's figure this out together", but more and more, it seems to be applied like, well, "I don't know what's going on, so you just go do it yourself." <Laugh>, you know, and especially with you know, issues within health and, you know, healthcare for indigenous populations and, you know black and other persons of color as well as all these other, you know, intersectionalities of, you know, gender and sexuality and, you know, socioeconomic status, et cetera, et cetera. You're getting the ceding of space and, you know, some resources getting put towards it, but for the most part, people who still have that authority still that those positions of power step back and are just kind of hands off, they just do whatever they're told, which I personally don't think is what nothing for us without us means. And so there's a challenge of taking those amorphous abstract concepts and making them concrete.

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

Dr. Alika Lafontaine:  And I think that there's a continuum as you move from that abstract to concrete where, you know, something is unknowable and solvable to it becomes knowable, but it's knowable "out there". It's not a problem here, you know, so you acknowledge that the problem exists, but it's not a problem within the place that I have authority or influence. And then you get to a point where you start to realize, well, actually that is a problem here, you know? But you're still not quite sure how to solve it. And so you provide supports or you give the responsibility for solving it to the people who are actually going through the problem, you know, and I think that this is the space where you start to bring out like tokenism or, you know, bringing in members of, you know, that part of your diverse group and saying, well, this is a problem. You're going to be the team who's going to solve it. And then you kind of walk away while they try and figure it out.

And then I think at the most concrete stage, you have problems that you can fully articulate, that you can differentiate whether or not they exist in a place. And then you also understand the different factors that you need to influence in order to control the intensity. And so truly concrete problems really just have three parts. The first is that you can explain it, but that explainability needs to reach a level where you can predict where it's a problem and where it isn't. And with that predictability comes the ability to then differentiate where to allocate those resources. You know, I talk a lot in conversations like this, about thresholds, you know, that problems are everywhere, but is it a problem that's high enough that you need to do something about it? And so that predictability helps you to differentiate between situations where you should intervene in those that shouldn't.

And if you can start to tease that out, then you can start to figure out the factors that make up, you know, the calculus of the problem. You know, what variables do I need to dial up or down in order to manage the intensity? And if you can explain, predict, and then control those variables, you actually can mitigate a problem as much as you can, dial it down as much as you can. I personally think, you know, racism has its root in power structures and power structures exist to allocate resources - that's just a human experience. So whether we call it racism or classism or sexism or other things, it will always be expressed to some degree, we'll have these peaks and valleys where it'll be a huge problem, then less of a problem, but that sort of thing can never really be eliminated fully.

So that might just be a problem that we could mitigate, but then there's other things like safety-related things, you know having people feel that they're included in conversations, these things we can actually get to the point that we can fully solve, you know, but unless we can get to the point where we make those issues fully concrete, through explanation prediction and then control, it will be hard to kind of get there. And that's a lot of the work that I'm doing right now in health transformation is helping people understand that's the steps that we have to go through to get to that end state of actually managing the problem as best as we can.

Nathalie Laviades Jodouin: So you said it yourself, what's next for you as you're looking at health transformation overall, what's next? What can we expect? What are you focused on? Where's it going next?

Dr. Alika Lafontaine: So I I'm really excited about the year of being President of the Canadian Medical Association. You know, we represent more than 90,000 physicians with the voice of physicians in Canada. I think there's a lot of great partnerships that the CMA has made with government. We want to deepen and strengthen those. I look at the CMA as, you know, obviously an advocacy group, but also a group that has a special connection with people on the frontline. And we could have different conversations, you know we recently had a conversation about, you know, integrated health human resources plans. And I mean, we, we've all seen the diagrams from like the world health organization where there's like boxes and puzzle pieces and stuff like that. But what I really love about my role with the CMA right now, and I'm really excited about with being the president is you can connect with people in a different sort of way.

You know, you can shorten that time between the hello and this is actually what's going on. You know, it reminds me of a question that every medical student or every applicant to medical school gets asked in their interview. And I remember reflecting on this. It was, you know, why do you want to be a doctor? And I was sitting down trying to think of a really good answer. And it eventually dawned on me that the reason why I wanted to be a doctor was the same reason why I loved performing. It's the same reason why I love to do keynotes. It's why I ran to be, you know, president of the Canadian Medical Association. As a physician, you can have someone who doesn't speak your language, who's not from the same culture or country or social experience as you.

And they sit across from you and strictly just because you have the title of Doctor, they start talking about their bowel movements, they start talking about, you know, that ulcer or scab that they pick at and have for the last eight years, you know, like it's, it's people just open up to you and they, they tell you what they need to say to solve the problem, because they believe that you can help them solve their problem. And that, that honestly is what makes me so excited about everything that that's going on in kind of my, my own career direction. You know, there's another kind of side project that I've been working on with my brother, Kamea, it's an anonymous reporting platform for harm and waste within healthcare systems. We're mainly focused on racialization. We're kind of building up the network in Ontario, we'll have six sites kind of board, you know, places like Wabano Center, you know, Anishinaabeg Health Toronto, like these are parts of the centers that are a part of the pilot that we're running.

[Dr. Alika Lafontaine appears full screen]

Dr. Alika Lafontaine: But one of the things that I think I can do differently is address the actual problems versus repeat the same cycles of behavior that we seem to be trapped in, that aren't taking us to where we need to go. So when you hear anonymous reporting, what you often think is, oh, well, I wonder what extreme situations are going to come out there? What salacious details are going to happen from these things that are going to get reported, but that's actually not what the network's about. The network is about sharing patterns, so people can make better decisions and prevent those horrible things from happening. And so I think that that's really been a theme of my life is how can, how can I develop, you know, the expertise and competence to have people give me that trust so I could actually help them, you know,

[Nathalie Laviades Jodouin and Dr. Alika Lafontaine appear in video chat windows]

Dr. Alika Lafontaine: and I think that that's hopefully where my life continues to go, you know, with the CMA, there's that opportunity, you know, with the other side projects that I'm involved in, you know, I've always had that opportunity. And like I said, at the very beginning, my life paths been very eclectic. So I, I'm not really sure where I'm going to end up next <laughs> , but I do feel that it'll carry on that theme.

Nathalie Laviades Jodouin: Honestly, Aika - Dr. Lafontaine, on behalf of the School, on behalf of Public Servants, watching today and on my behalf, just thank you so, so much, I could be here for hours. Unfortunately, we don't have hours. You need to get back to your very important work. But I do want to take a moment to sincerely thank you for sharing both many amazing insights in terms of your journey, telling us about some other very cool facets as well. Like yes, being in a boy band, I have to say it - I never get to say this in events and also winning the "Canada's Great Prime Minister". I mean, it's just so eclectic and I love it. But honestly, thank you for your leadership, of course, in your field, your leadership when it comes to equitable healthcare for indigenous peoples, but I would say leadership overall.

And I think as a model that all of us can seek inspiration from, and I think we all can't wait to see where that eclectic journey will continue to take you in the future. So thank you so much for that. And I'll also take the opportunity for those who are watching us today to thank you for being with us today.

[Nathalie Laviades Jodouin appears full screen]

Nathalie Laviades Jodouin And just a reminder that your feedback is really, really important to us. And so we will ask that you please complete the questionnaire that you'll be receiving after this event. And to let you know that we have other great School events coming up. And so we encourage you to check regularly and often our website to look at future events and learning opportunities that will be coming up. So with that, thank you to everyone. Thank you again, Dr. Lafontaine, and see you all next time everybody. Thank you.

[The video chat fades to CSPS logo.]

[The Government of Canada logo appears and fades to black.]

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