Time to transform the medical curriculum in Aboriginal Health

Picture_MRajaprakashMeghna Rajaprakash is a medical student at the University of Toronto (class of 2016)

 

The recent Truth and Reconciliation Commission (TRC) report (2015) called upon medical schools “to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of res­idential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices.” As I read the details of the report, it resonated greatly with my experience of a gap in my formal education and the drastic need I felt when I worked with Indigenous patients during my clinical experiences.

My early exposure to Aboriginal health issues was during my graduate work on prenatal alcohol exposure, when I learned of Indigenous children who were separated from biological mothers, placed in multiple foster placements, and who suffered from poor physical and mental health. Many of their histories reflected poor socioeconomic conditions and inadequate healthcare in rural and remote areas. It made me wonder why so many children were suffering from a preventable condition with such a high social cost. As I delved further, I uncovered troubled histories of their biological mothers, who themselves were victims of childhood neglect, abuse and other adversities. It was then that I grasped the magnitude of the situation, which extended beyond the children and their mothers to an all-encompassing social milieu.

In medical school I was privy to similar stories, such as that of a very young child removed from his family in one of the Territories due to alcohol abuse and brought to a facility in in a Southern city for treatment of severe depression. He was remarkably talented and bright but his social situation had driven him to several suicide attempts. His parents both suffered from mental health problems and substance abuse on account of many years of trauma. Many such histories painted a vivid picture of the intergenerational effects of abuse, which not only affected the children but also their antecedents. As I noted the patterns I felt compelled to adopt a more global approach to their care, which included paying attention to the influences of history, intergenerational effects, and culture in shaping their health.

The origins of many patients' conditions became painfully clear to me as I read further about Canada’s role in separating Aboriginal children from their families and sending them to residential schools, where they were denied any proper form of attachment to their caregivers or culture. Ultimately, this treatment of Aboriginal children by governments denied children basic rights, impaired their capacity for developing resilience, and put them at risk of later post-traumatic stress disorder and other mental and physical health conditions, perpetuated through subsequent generations through socially learned behaviours. I wished that my previous education had emphasized this legacy as part of the curriculum and I began to see how the institutions that surrounded me contributed to my lack of knowledge.

Very recently, as part of an elective experience in medical school, I was fortunate enough to be able to immerse myself in the study of Aboriginal culture and traditions. During this elective, I gained valuable insights through my experiential learning of the spiritual, mental, and emotional aspects of the Medicine Wheel, which was never previously emphasized in my training. My most transformative learning happened through participation in drumming circles, where I truly connected with people through song.  As the drumming circle members explained the meanings of the lyrics and their origin, I learned of strong women fighting against social pressures, Aboriginal teachings on traditional healing, and the Aboriginal communities' reverence for the Natural World. I began to feel connected, and humbled, by the endless depth of respect and kindness shown to me to make me feel as one among the group. I was most impressed by the great strength of the community as members of all ages attended gatherings each week to support each other.

My participation in cultural activities also opened my eyes to the critical role that culture and community plays as a protective social determinant of health, and in the strong therapeutic aspects of traditional practices and ceremonies. The act of smudging with the traditional medicine of sage had a cleansing effect, which I was able to experience personally. During drumming circles, I felt my own heartbeat slow down with an associated sense of calm and peace of mind. Emulating dance steps and participating in Native artwork were similarly liberating to my mind. I realized the beneficial effects of these spiritual and cultural activities in improving my overall health within a span of two weeks.

My experience deepened my awareness of how the promotion of Aboriginal spiritual and cultural practices contributes to the healing of patients within the realm of clinical practice.

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