Every child matters: truth, then reconciliation

Every. Child. Matters. On September 30, we acknowledge and reflect on the horrors of residential schools and honour the resilience of the survivors and their families across Canada. Please find a way to honour Orange Shirt Day (www.orangeshirtday.org).

Recently, we have learned the stark truths of those children who did not survive. They died at school, far from home, and were buried in unmarked graves. No chance for families to say goodbye. No chance to honour and celebrate their lives. The discovery of the graves was horrifying but not surprising to Indigenous peoples or anyone who has read volume 4 of the Truth and Reconciliation Commission report.¹ And there will be more such discoveries.

What should family physicians do to acknowledge and understand the tragedy of thousands of Indigenous children who died in such grim circumstances and translate sadness and anger into action toward reconciliation? I have committed to learning by reading Indigenous authors, listening to Indigenous leaders and colleagues, and working to keep an open heart and an open mind. I have no answers but a couple of suggestions. We can work to educate ourselves about residential schools and Indigenous worldviews, and we can amplify the messages and voices of Indigenous people.

The CanMEDS–Family Medicine Indigenous Health Supplement² from the Indigenous Health Committee is an inspiring and rich resource for learning and teaching by health care professionals, Indigenous, and non-Indigenous alike. It will enable healing and culturally safe care of Indigenous patients, families, and communities.

I encourage you to read the whole document, which includes detailed clinical examples and beautiful artwork by James Wedzin, a Tłįchǫ artist from Behchokö, NWT. Family physicians use a holistic approach to care, but this supplement challenges readers to look beyond psychosocial and family factors. We should also use a systemic and historical perspective in building a healing relationship with Indigenous people. Self-reflection on our own power and privilege also enables culturally safe care, which only Indigenous patients can gauge.

Among the many wise and practical approaches I learned from the supplement, 3 concepts stood out for me.

Structural competency is a concept that can direct family physicians in providing care that engages with broad social upstream causes of health outcomes. It is

the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases … also represent the downstream implications of a number of upstream decisions about such matters as health care and food delivery systems, zoning laws, urban and rural infrastructures, medicalization, or even about the very definitions of illness and health.³

A narrative approach is a culturally appropriate method for collecting information through stories. The premise is that we make sense of our world most effectively through telling stories. Many Indigenous cultures have oral-based storytelling traditions, and it is a relational method that respects Indigenous epistemology and ways of knowing through co-constructing and co-participating in storytelling.⁴

Healing-centred engagement is a holistic, strengths-based approach, advancing a collective view of healing and repositioning culture as central to well-being. It highlights the ways trauma and healing are experienced collectively. It expands how to think about responses to trauma and offers a more holistic approach to fostering well-being.³

The narrative approach, at the heart of family medicine, is explained in new and important ways. Healing-centred engagement and structural competency were new concepts for me that immediately resonated—that “a-ha” feeling of having a core belief articulated. Embracing Indigenous ways of knowing and healing practices can improve the quality of our work and our joy in doing it. I would love if you can find hope and practical ways to enable culturally safe and trauma-informed care in reading the supplement and contributing to reconciliation.

At her swearing-in on July 26, 2021, Canada’s first Indigenous Governor General, Mary Simon, said, “My view is that reconciliation is a way of life and requires work every day .… Reconciliation is getting to know one another.”

For more resources please see the article by Dr Funnell et al⁵ and the recently created National Consortium for Indigenous Medical Education (ncime.ca).

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