Northern Healing: medical student reflects on time spent in Mistissini
by Andrés G. Griborio-Guzmán, as told to Ana P. Castillo-Méndez
As a medical student at McGill University, I knew I would go to Mistissini for my rural family medicine rotation in January. Besides the wintry weather, I was not sure what else I would find there. I was excited to learn as much as I could while giving back to patients and the community in general. The day of my arrival, while in the taxi from Chibougamau to Mistissini, sharing the ride with healthcare professionals who were also new to the Cree Territory eased my anxiety. Experienced and rookies alike, everyone was very excited about this opportunity.
Dr. Justin Ross welcomed me that first afternoon. He is the McGill Family Medicine Mistissini Site Director for under- and postgraduate medical education and has been working at the Mistissini Community Miyupimaatisiiun Centre (CMC) for four years as a staff member, having rotated there as a trainee. While explaining the expectations, he emphasized that as students we were there to learn and not to “run the show”, in contrast to the academic hospitals in Montreal where so much relies on the students and residents. He mentioned that the only challenge of being in Mistissini is to be away from the family. Many doctors find it to be the hardest part of working in remote communities. However, he assured me that there are no professional downsides and that he is very passionate about working at the CMC.
I also met Dr. Rosy Khurana, who has worked in Mistissini for more than 10 years. As chief of medical services at the CMC, she believes that there is added value in having medical students exposed to Indigenous culture, issues and health. She told me that “The relationship between the specialist and the patient is completely different because that doctor understands the context where that patient comes from. It makes a huge difference in terms of the care that you can offer and the psycho-social aspect of an illness that can make a tremendous change.”
According to Dr. Ross, the program creates a link between the community and students at McGill by helping them to build cultural sensitivity towards patients, and that having trainees is probably the most important source of recruitment for doctors in the Cree Territory.
Dr. Khurana feels that she and her patients walk a journey together and that unlike in urban communities, they have deeper connections with the patients here. She said that it “is not always about medicine, sometimes it’s sitting down with an adolescent and planning what they want to do in five years.” Dr. Ross said that sometimes doctors get invited to family events. Once he was asked to speak at a patient’s funeral whose family he knew very well, something he thought he would never do; in Mistissini, it fosters trust between the doctors and the community.
Regarding healthcare, one of the most significant challenges in the community is the burden of chronic illnesses, such as metabolic syndrome (obesity, cardiovascular disease, diabetes). Dr. Khurana believes this is a global phenomenon, not exclusive to Indigenous communities, but acknowledges it is more prevalent among First Nations. However, the way the CMC treats patients is different from the city approach. They work in collaboration with nurses, other healthcare professionals, Indigenous knowledge keepers, and patients.
“I’m not here to tell someone what to do but to inform, and we make a decision together,” said Dr. Ross. He considers it essential to empower the patients to choose, as long as it is safe and doesn’t pose risks to them. There are also formal programs that try to incorporate Indigenous medicine for the patients of the clinic.
Dr. Khurana said she was honoured when three patients confessed that she had been the first person to whom they opened up about their residential-school experience, calling it is a reflection of the trust people develop with time. “As a doctor, what people want is for you to respect them, it doesn’t matter if you are Indigenous or not; it is really about the care that you offer,” she said.
In Mistissini I felt very welcomed, and everyone inside and outside of their beautiful clinic, Indigenous or not, was very kind and warm. The only noticeable mismatch was the absence of First Nations physicians working at the CMC, a fact that both Dr. Ross and Dr. Khurana recognize. Even though there have been three Indigenous medical students who rotated in Mistissini, it is still a challenging situation. “I see myself as a placeholder. This isn’t my land but I’m here to help, and I’m looking to be replaced by somebody from the community,” said Dr. Ross.
They do what they can to encourage the youth to go into healthcare professions. “If someone feels very motivated, we allow them to shadow us, and we give them advice,” declared Dr. Khurana.
Personally, I had one particular experience with a school-aged patient. He was very energetic and a bit tired of being with me. While still in the examining room, I playfully let him use my stethoscope and asked him if he could hear my heartbeat. His answer was an enthusiastic nod while his eyes were shining brighter and brighter.
As I left the Cree Territory one month after my arrival, I was looking at the sunset from the airplane, pondering everything I had received, on how welcoming the people were under those starry nights, and how the fiery red of that sky would be an everlasting reminder of the calling from that magic land.
Andrés G. Griborio-Guzmán is a McGill University M.D., C.M. candidate in the class of 2019.