Bringing an Indigenous perspective to internal medicine
A new residency training pathway at UBC is building capacity to support the diverse needs of Indigenous patients across British Columbia
From left to right: Drs. Keegan Marchand, Madeline Elder and Trudy Nasmith
Dr. Keegan Marchand, who is Syilx and a member of the Okanagan Indian Band, has always been passionate about Indigenous health. That’s partly what drew the fourth-year UBC resident doctor to internal medicine — a branch of medicine focused on caring for adult patients with complex and chronic conditions such as diabetes, hypertension and cardiovascular disease.
“A lot of the illnesses that we treat in internal medicine disproportionately affect Indigenous patients,” he explains.
So, when he began his internal medicine residency training and realized he was one of the only Indigenous doctors in his specialty, Dr. Marchand began advocating for change.
– Dr. Keegan Marchand“It’s really exciting to imagine what the landscape of Indigenous health care could look like 10 years from now.”
“I was seeing a lot of Indigenous patients but not many Indigenous physicians, and I could see how these patients benefitted from knowing they had an Indigenous person looking after them. Often, they’re carrying not only multigenerational trauma, but some negative personal experiences with the healthcare system. That shared connection helps to break down a lot of barriers,” he says.
Three years on, Dr. Marchand is helping to shape the UBC Faculty of Medicine’s newly launched Indigenous Internal Medicine Residency training pathway, with the support of Dr. Trudy Nasmith, a UBC clinical assistant professor of general internal medicine. The first of its kind in Canada, the pathway is aimed at creating greater equity in health care and expanding access to culturally safe care in internal medicine.
Dr. Marchand (pictured, with a patient) believes the Indigenous Internal Medicine Pathway has the potential to strengthen Indigenous health care throughout the province.
“You’re particularly vulnerable when you’re sick and needing to come into hospital, and there’s such a legacy of trauma from the historical Indian Hospitals. We want to make sure that our Indigenous patients have safe care in a way that respects their histories and their traditional ways of healing,” says Dr. Nasmith.
The initiative builds on the success of the Indigenous MD Admissions Pathway — which has graduated 152 Indigenous doctors since its inception in 2002, including Dr. Marchand. Resident doctors in the Internal Medicine Pathway will have the opportunity to participate in Indigenous public health courses and cultural workshops, equipping them with the skills and knowledge needed to provide care that takes into account the whole patient — the physical, emotional, cultural and spiritual.
Dr. Madeline Elder, a first-year internal medicine resident and member of the Lax Kw’alaams band, is part of the working group helping to design the Pathway. She sees the program as an important piece in the UBC Faculty of Medicine’s response to the Truth and Reconciliation Commission of Canada’s Calls to Action.
“TRC Call to Action 23 specifically calls on the government to increase the number of Indigenous healthcare providers, and I think launching this pathway will represent a significant step in the right direction,” Dr. Elder says.
At a glance
At a glance
150+ Indigenous MD graduates
Since the launch of the Indigenous MD Admissions Pathway in 2002, more than 150 Indigenous doctors have graduated from UBC and are now practising family doctors, specialists, educators, clinical faculty and more.
Specialist training in Indigenous family medicine
The Indigenous Family Practice Residency Program at UBC was the first of its kind in Canada. The program integrates Western medicine and Indigenous ways of knowing, and incorporates traditional Indigenous teachings and ceremony into academic activities. Since its launch, 82 doctors have graduated and are now providing culturally safe care.
Photo: Nisga’a Valley, Credit: Dr. Chelsea Monell
Enhancing Indigenous public health
Established in 2014, the UBC Centre for Excellence in Indigenous Health is advancing Indigenous people’s health through education and initiatives such as the Indigenous Health Administration and Leadership Program and Canada’s first Indigenous Public Health graduate certificate.
Dr. Marchand believes the new training pathway has the potential to strengthen Indigenous health care throughout the province. For the past year, he has been regularly visiting underserved Indigenous communities in northern B.C., and plans to continue delivering care to these communities as a fully licensed physician.
“Residents in the pathway will have opportunities to participate in clinics either in their home community or in another Indigenous community of interest,” he says. “We’ll give them support during their training so they can learn how best to provide that care, and take time to establish those connections in their communities. And the hope is that they’ll go on to provide that same support to the next generation of internists in this pathway.”
Dr. Elder is part of the working group that helped design the Indigenous Internal Medicine Pathway.
Dr. Elder is committed to being a part of that vision, and has been looking for opportunities to work in Ts’msyen territory during her residency.
“We have the potential to build really strong relationships with First Nations communities across the province. It’s hard work, but I think we’re uniquely positioned at UBC to build those relationships, and I’d love to be a part of that.”
The pathway has already received an overwhelming response to the first official call for applications, and Dr. Marchand is optimistic about what the future holds.
“It’s really exciting to imagine what the landscape of Indigenous health care could look like 10 years from now.”
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