Fourth-year medical student Jordin Fletcher hadn鈥檛 met a practicing Indigenous physician until she encountered Dr. Brent Young in 2021 when she began medical school as an Indigenous learner.
She had been working as a nurse for five years.
Dr. Shant茅 Blackmore, a recent family medicine graduate who grew up in Millbrook First Nation, hadn鈥檛 worked with an Indigenous preceptor 鈥� an experienced practitioner who provides supervision during clinical practice 鈥� her entire medical training.
In the spring, this all changed.听
For the first time, they found themselves working side-by-side with an Indigenous staff physician.
Dr. Young, who is Anishinaabe and a member of Sandy Bay First Nation and clinical lead at Wije鈥檞inen Health Centre and Sipekne鈥檏atik Health Centre, says it was a first for him to supervise an Indigenous medical student and resident together and likely the first time this has ever happened in Mi鈥檏ma鈥檏i.
鈥淚t was a very interesting and fulfilling experience for me,鈥� he says. 鈥淭he biggest thing I noticed was the shared understanding we already had as Indigenous people in medicine. Being able to sit down with these learners and do more one-on-one mentorship, especially on how we can approach issues like racism in the health-care system, was very valuable for both their learning and mine.鈥澨�
Thanks to the hard work of Dr. Young and the Faculty of Medicine, learners have the opportunity to rotate through Wije鈥檞inen Health Centre and up to 50 other wrap-around services offered by the Mi'kmaw Native Friendship Centre, which partnered with the Faculty in 2022 to provide primary care services to the urban Indigenous community of Halifax. At the Sipekne鈥檏atik听 Health Centre, which is located in Indian Brook, learners visit from across the province for electives in family medicine, psychiatry, and other health specialties providing care at the clinic.听听
Culturally relevant care
Dr. Blackmore, who is Mi鈥檏maw and African Nova Scotian, plans to stay in Nova Scotia and practice in Indigenous communities. The last two months of her residency were spent at the Wije鈥檞inen Health Centre, an elective she chose with the motivation to have a consistent experience with Indigenous patients.
鈥淕rowing up on reserve has made me aware of the inequities that Indigenous Peoples face and while I anticipated this work to be challenging, it has been even more rewarding,鈥� says Dr. Blackmore. 鈥淚 really wanted to get more experience working directly in community. It has been a valuable experience that I otherwise would not have had in my training.鈥�
Both the Wije鈥檞inen and Sipekne鈥檏atik Health Centres provide multidisciplinary primary care with a focus on services that are anti-racist and culturally relevant. This includes access to traditional medicines, Elders, and cultural programming such as drum-making, dancing, and language classes. This care model addresses barriers in the health-care system, providing longer appointment times tailored to patient needs, particularly for chronic issues previously neglected.
鈥淭he key is that the learning and medicine we practice is of high quality,鈥� says Dr. Young. 鈥淥ur patient population can be hesitant to seek care in hospital settings or with other specialists, so we have to problem-solve in the primary care setting. This provides valuable learning experiences.鈥�
With many patients presenting with histories of trauma, the clinics focus on trauma-informed care. Learners receive guidance on communication and how to approach the apprehensiveness or mistrust they might notice with some patients. With an emphasis on well-rounded primary care, learners also benefit from the experience of point-of-care ultrasound, EKGs, and other minor procedures.
Listening and learning
Jordin Fletcher applied to medical school recognizing the racism, harm, and overall structural violence Indigenous people regularly face in health care. To then be in an environment where work is done to support Indigenous patients and communities, and the opportunity to work with Drs. Young and Blackmore is nothing short of extraordinary.
鈥淚t鈥檚 a really special space to be welcomed into, and you have to recognize that as an honour and treat it that way,鈥� she says. 鈥淭here's a lot to learn and a lot of listening.鈥澨�
Jordin is a member of the Missanabie Cree First Nation and Mi'kmaw through her grandfather, who is a member of Millbrook First Nation. Her grandmother is a survivor of Shingwauk residential school in in Sault Ste. Marie, Ontario.听 Jordin finished her medical school rotation at the Wije鈥檞inen and Sipekne鈥檏atik Health Centres in June.听
鈥淚 had never worked with an Indigenous staff physician before, so it takes some of the work out of it,鈥� says Jordin. 鈥淚 could focus on my learning because we're at a different baseline with Indigenous experience and health. I don't have to try to explain things to Dr. Young; he knows, so I can just focus on learning.鈥�
Both the Wije鈥檞inen and Sipekne鈥檏atik Health Centres are embedded in culturally rich Indigenous communities. The teams that practice there develop trust and long-term relationships with more than just the patients accessing care, but with the wider community in which the clinics reside.
"In the health centres, many staff are members of the community, and that is impactful for the relationship between the health centre and community members, I can feel the difference just being in the space,鈥� says Jordin. 鈥淲hen it's truly community-run, it meets the needs of the community and helps shift that power dynamic between physicians and patients.鈥澨�
In 2022, Dalhousie Medical School announced the听Indigenous Admissions Pathway听to address the barriers that have prevented Indigenous applicants from entering medical school at pilipili漫画. This fall, the second cohort of 12 students will be admitted under this initiative.听听
Dr. Brent Young, who in addition to his clinical responsibilities, also serves as academic director of Indigenous health at pilipili漫画, believes that despite frequent discouragement and negative news in health care, the trajectory is improving with a new generation of Indigenous physicians emerging in the profession.
鈥淚f you had asked me in 2015, when I started medical school, if I would see this in less than ten years, I wouldn't have thought so because there weren't many, if any, other Indigenous medical students with me at the time,鈥� he says. 鈥淎nd so, to see that progress from then to now, it speaks to some of the work that's been done and the way that pilipili漫画 Medical School has been much more open to change and making things b