Making a place for Indigenous voices at the health-leadership table

From left, U of A clinical faculty James Makokis, '04 BSc, and Alika Lafontaine, are two of five Alberta physicians on the docket for the presidency of the Canadian Medical Association in 2021.

This month, members of the Canadian Medical Association (CMA) who are practising in Alberta will vote to determine the president-elect of the CMA for the 2021-’22 term. Of the five candidates on the docket for leadership, two—Alika Lafontaine and James Makokis—have connections to the University of Alberta.

Lafontaine, associate clinical professor of anesthesiology, is an anesthesiologist in Grande Prairie, Alberta. Born and raised in Treaty 4 Territory in southern Saskatchewan, LaFontaine has Anishinaabe, Cree, Metis and Pacific Islander ancestry. 

Makokis, ’04 BSc, is associate clinical professor in the Department of Family Medicine, and a family physician practising out of the Kehewin Cree Nation just west of Edmonton. Makokis was born and raised on the Saddle Lake Cree Nation in northeastern Alberta.

The CMA was designed to bring together physicians from across the country toward the twin goals of improving both the profession for physicians and the care patients receive. Now more than ever, in the context of the ongoing COVID-19 pandemic, the CMA’s role is key in supporting the profession.

All provinces and territories are represented through a revolving approach to the CMA presidency, in which each takes a turn at leadership for three years, with the role shifting from president-elect, to president, to past president over the three years.

We spoke to Lafontaine and Makokis about their passion for advocacy and what motivates them to bring their voices and perspectives to the national table.

What inspired you to put your name forward for this role?

Lafontaine: To me, medicine is both political and personal. When I think of things like burnout and stress in the system, I see the faces and I hear the stories of my colleagues. And I want to make a difference for them.

I think that the president-elect position gives the opportunity to bring to the CMA the expertise of Alberta physicians in addressing what’s really important. For many years, austerity has been linked with sustainability in the language of health transformation, and today the health system doesn’t have the resilience it did a decade ago. 

The way our systems are designed, physicians have to shoulder the burden of care gaps, and I think the CMA has a role to play in not only bringing attention to where these gaps exist but also eliminating them. Unless you fix the working environments for physicians, you will never fix chronic burnout and other issues that detract from physician wellness. 

I personally feel that in addressing these issues, we won’t just help physicians—we’ll also be helping patients.

Makokis: I was doing a talk about Indigenous children’s health at the Canadian Association for Pediatric Health Centres a couple of years ago and at the end of it, I was approached by Gigi Osler, who was the president of the CMA at the time. It was inspiring, because she was the first woman of colour to be in that role and she was so engaging and relatable. I had never before seen anyone that I identified with at the CMA. 

As former first lady Michelle Obama has said, if you’re the first person from a group who has experienced years of oppression, and you are able to get into a space no one has been in before, you better reach behind and help others through that door and into that space, and not slam the door behind you once you get in. Seeing Dr. Osler did that for me, creating that sense of potential.

From our time on The Amazing Race Canada, we saw the importance that diversity and representation can have in opening dialogue and building bridges.

I was also encouraged to run by several Indigenous women physicians. In our culture, the women are the leaders and when they tell you to do something, you kind of have to!

How has the pandemic influenced your priorities as potential president?

Lafontaine:  In the midst of the pandemic, things like care gaps and burnout have been magnified. The system lacks the capacity to absorb the pressures of things like pandemics, and we’re seeing our colleagues go through very hard times. Many of my friends and colleagues have cancelled or postponed time off, worked extra shifts, put themselves and their families last during this time. There’s only so long that can be done until it’s no longer sustainable. And when patients finally feel the impact, that reflects a long period of time during which providers have already been feeling it.

The pandemic has also brought into focus how important it is for physicians to have mobility. The health system needs physicians to be able to redeploy themselves quickly and easily to meet emerging needs, which is why I believe we need things like national licensing, allowing physicians to move freely across provincial borders. This kind of freedom would encourage better job satisfaction while at the same time improving patient care.

For patients, the pandemic has magnified existing gaps in care; issues such as racism and access to care are more important than ever to call out and address.

Makokis: COVID has really brought out the injustices, inequities and institutional and systemic racism we’ve always known are there, and I want to do something about that. I think one way to tackle anti-Indigenous racism is to bring together Indigenous physicians who work in those nations and communities and who have a strong identity as Indigenous people, who understand our medicine, culture, healing practices and our own health system. Allies are also very important in this work; we cannot do it alone.

The pandemic has magnified pre-existing inequities for other underrepresented groups, as well, whether it’s people of colour or gender-diverse groups. It has shown so clearly how during a crisis, we need people who are part of those groups to be part of decision-making, to ensure that everyone has an opportunity to be included in the process to make the best possible changes for the entire profession.

What pressing issues are you most passionate to address if you become president?

Lafontaine: As we build a post-pandemic health-care system, we must ensure that physicians from academia and rural and urban centres, specialists and generalists all have their voices heard, so they can share their perspective on how to improve the things they see every day in their work. Because our health system is complex and multilayered, frontline providers who work within that system must be part of decision-making groups. 

We can’t keep being aggressive in cutting, even as things are falling apart around us. And we can’t be afraid to say things like this that don’t necessarily make people feel good; there are things we need to acknowledge, even if it’s uncomfortable.

I would like to reframe the social contract between physicians, patients and the system, based on honest discussions about what it means to be a physician in today’s society.

I also want to encourage honest discussion about “isms” such as racism, sexism and ableism. I was labelled with a learning disability as a child and I’ve experienced racism all my life; I come from a disempowered background so I know what it’s like to be seen as a one-dimensional character and to have someone else write your story.

For patients and providers, if we don’t face these issues, care gaps, burnout and moral injury will only get worse.

Makokis: I currently work with a group of Indigenous physicians, meeting regularly with a federal minister and senior federal government representatives to talk about inclusion and anti-racism in the health-care system. We started meeting at the beginning of the pandemic and after the death of Joyce Echaquan in a Quebec hospital advocated for the first national anti-Indigenous racism summit in the health-care system, bringing together key leaders across the country to listen to how pervasive this is. The followup to the first summit happened late last month, where these health leaders shared their plans on how to make the health system safer, because as we have seen, racism kills.  

If I was CMA president, I would want to keep doing this kind of work, looking at how the profession is represented nationally. There are only three Indigenous physicians in the 185 physician-dedicated board positions across all the provincial, territorial and national physician bodies and I would say that is not a success. We need to be proactive in making this equitable for all underrepresented groups. We all have gifts and potential. 

I also think what we need in medicine is more humanity, seeing people on a personal level and opening doors for each other, opening hearts and minds.

What would it mean to you for an Indigenous person to be in this role?

Lafontaine: What I was mainly focused on when I decided to run was what my colleagues are going through, and how my unique skill set and lived experience could create a different path to work out some really entrenched and complex issues.

It would be great to be a part of history, but I think even more important, we need to choose the right person. The stakes are way too high when it comes to what physicians are dealing with day to day. 

Having an Indigenous president would signal a shift in the ways that we look at our colleagues and how Indigenous physicians see ourselves. A big part of reshaping our biases comes in seeing people in these positions. It would create space for leadership and contribution. 

The first Indigenous president cannot be the last, so we need someone who not only brings in their own lived experience but also can understand and make space for everyone else’s.

Makokis: When I went to medical school and saw pictures of previous medical school classes, I never saw anyone who looked like me. That was one of the reasons why I started growing my hair out and wearing braids—so that when I graduated, younger Indigenous people could walk by and say “There’s someone who looks like me; maybe I can do that, too.” Indigenous young people need to at least see that things are possible. If they don’t see that, they can never envision themselves in those spaces.

There’s never been an Indigenous physician president in the history of the CMA, and one of the things that I hear about when I’m at tables around leadership and hiring is that there’s never enough qualified candidates. Indigenous physicians have been graduating for the past 40 years, and I would say that career-limiting racism has prevented them from moving into positions like this.

Even if I don’t win, for the first time in the history of the CMA there were Indigenous physicians that the physicians in this province had the opportunity to choose from. And nobody will be able to say that there aren’t enough qualified Indigenous candidates for roles like this.

Go to CMA Nominations and Elections to read about all five Alberta candidates for the CMA presidency, including the full platforms of Lafontaine and Makokis.