Congratulations Doctor Nadine Caron

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Nadine Caron wins the Dr. Thomas Dignan Indigenous Health Award

June 21, 2016

Nadine Caron, an Associate Professor in the Department of Surgery and Co-Director of the UBC Centre for Excellence in Indigenous Health, has received the Dr. Thomas Dignan Indigenous Health Award from the Royal College of Physicians and Surgeons.

VIDEO: https://youtu.be/M41eiGhiwbg


A general and endocrine surgeon in Prince George, B.C., she also teaches in the Northern Medical Program, a distributed site of the University of British Columbia’s Faculty of Medicine delivered in partnership with the University of Northern British Columbia.

Several accomplishments underpin Dr. Caron’s merit for this award, which celebrates devotion to Indigenous rights and a commitment to cultural safety:
She is the first Indigenous woman to graduate from UBC’s medical school and Canada’s first female First Nations general surgeon.

She is co-creator of UBC’s Centre for Excellence in Indigenous Health, which she has co-directed since 2014. The Centre’s community-based programming is empowering Indigenous populations to play a greater role in improving their own health outcomes. This approach espouses many of the same health values called for by the Truth and Reconciliation Commission of Canada.

She is an excellent role model and mentor for Indigenous youth. For example, she took the opportunity to enrol students from UBC and the University of Northern British Columbia in the courses she was teaching at Johns Hopkins University’s Centre for American Indian Health, enabling the transfer of new skills and knowledge to influence curriculum development in Indigenous health at UBC.

“Nadine embodies the values of role-modelling, mentoring and changing the status quo that define the Dr. Thomas Dignan Indigenous Health Award,” said Royal College CEO Andrew Padmos. “She has become a shining example for others, especially Indigenous girls and women, to aspire to higher education and careers in science and medicine.”

The well-being of Canada’s Indigenous Peoples is a top priority for the Royal College. The Dr. Thomas Dignan Indigenous Health Award was established in 2014 to recognize physicians who epitomize a zeal and devotion to the pursuit of rights and justice for Canada’s Indigenous peoples. The award distinguishes individuals like its namesake, Thomas Dignan, chair of the Royal College Indigenous Health Advisory Committee, who embrace cultural safety and understand the importance of the social determinants of health.

Meet Dr. Nadine Caron, Canada's first female First Nations surgeon
http://www.cbc.ca/radio/thecurrent/the-current-for-june-21-2016-1.3644974/meet-dr-nadine-caron-canada-s-first-female-first-nations-surgeon-1.3645029


Transcript

SOUNDCLIP

As Indigenous people we hear a lot about how we're not well, how we don't achieve, how we don't graduate from high school, how we don't want to put secondary education, and this was just such a different example for me to be surrounded by, that not only had other Indigenous women gone through medical school before me, but they had excelled.

LL: That was Dr. Shannon Waters. Today she is the medical director at the Vancouver Island Health Authority, but as a young Aboriginal woman working her way through medical school she didn't have a lot of people she could look up to, that is, except for Dr. Nadine Caron. Not only was Dr. Caron the first Indigenous woman to graduate from the University of British Columbia's medical school, she did so at the top of her class. Dr. Caron then went on to become Canada's first female First Nations general surgeon. Now, along with being a surgeon she's also an associate professor at UBC’s northern medical program and co-director of UBC Centre for Excellence in Indigenous Health. Today, Dr. Caron adds another accolade to the list. The Dr. Thomas Dignan Indigenous Health Award, given out by the Royal College of Physicians and Surgeons of Canada. Dr. Nadine Caron joins me now from Prince George to talk about her trailblazing career and her hopes for young Indigenous students. Hello.

DOCTOR NADINE CARON: Hello, Laura.

LL: Well, that is a lot of firsts. What does it mean to you to have all those firsts next to your name?

DOCTOR NADINE CARON: It’s, first of all, an honour, particularly when you're talking about something like The Thomas Dignan Indigenous Health Award from the college. I was really just blown away by that. Other things are a little bit more complicated though when you, sort of, dive into them and what they mean. And I've always challenged people when they come up and say, their immediate response is congratulations. And I wonder, is it congratulating me from graduating from medical school or finishing my surgery residency or is it really filling a gap where society has failed? There's nothing special. You know, I went through medical school with a whole class of incredible colleagues and friends and is it something where society just hadn't had a First Nations woman graduate from UBC School of Medicine yet or First Nations female general surgeon in Canada yet. And at some point I think we have to make sure that in order for it to have a true impact of being the first of something you have to make sure that you challenge those around you and those that ask to make sure they realize that not having someone before you may be something to ponder and to consider.

LL: So, if you were the first then and then I think that it is legitimate to ask what kinds of challenges or barriers did you have along the way?

DOCTOR NADINE CARON: Right. Well, I think it's a challenging road to go into medicine and to go into surgery. But I think that we've worked hard, particularly at UBC. We started a couple years ago the Centre for Excellence in Indigenous Health and one of the things we're doing is exactly that, sort of, taking a look at what was hard and how do we fix it for the next generation of students and trainees coming through. And one thing I know that we're doing is trying to make it so that when you are having challenges and you are having difficulties and you do want someone who can understand, particularly that side of things - being First Nations or being Indigenous or being a minority or having other elements in your life that you're trying to hold onto - to have someone to turn to, to have someone to talk to, to have someone that validates your concerns and your fears I think is really, really important in my year there was no other Indigenous student in the class. That was hard because you had to, sort of, looked out.

LL: But why was it hard? What were you facing that you would have liked to have had someone else to talk to about?

DOCTOR NADINE CARON: I think part of it is it's often when you're working with Indigenous populations. And my real link is with First Nations because, being Anishinaabe myself, that's where I sort of connect to and the lens that I looked through. When I saw, particularly first hand, issues in the health care system where it led our First Nations people down, our communities down, that when it really triggered me there was no one around that got triggered in the same way that it touched so personally and so passionately. And I was often told, like, Nadine, you’re overreacting or why does that always trigger you? Why do you always get upset about that? And even as a faculty member and in academia and out in the world there I often get told that that'll never happen. Don't dream so big. It's sort of a message that you get repeatedly throughout because there's not too many people that see it through your lens. And, like I said, at UBC, which is the world that I'm most affiliated with, they get it and they understand it and so I'm starting to see a difference now. And then I do look back and realize what I did not have.

LL: You are well aware and we've done many stories about the state of Aboriginal health care, both on and off reserve, big challenges, big problems - what do you say the major failings have been?

DOCTOR NADINE CARON: Oh my goodness. I usually break it down into sort of different elements. One is the access to health services. Another is the utilization of health services. Access means that a lot of our Aboriginal Peoples and communities have to travel significant distances. They don't have access to health services. They aren't aware of the health services that are there. And the quality of the health services that they get can be impacted. And, I'll say it, they can be impacted by culturally, insensitive, unaware, or frank racism within the health care system. I've witnessed myself. I felt it myself with family members.

LL: What happened?

DOCTOR NADINE CARON: Oh, it's just what you see when you walk down a hallway in an emergency room or you overhear what’s being said by other health care professionals in a in a doctor's mound or in a surgery.

LL: They’ve said things to you or about other patients?

DOCTOR NADINE CARON: You know what? No one's ever said anything to my face, partly because I'm so protected by the white coat. You know, why would you say that to someone with an MD after your name? But when you're around a corner or they don't realize who you are or they don't know that you're First Nations, then they open up with their thoughts and those thoughts can be incredibly shocking at first, hurtful, and just, in a way, sometimes unbelievable even though you hear them time and time again.

LL: I'm sorry. It probably isn't easy for you to say, but can you give a couple of examples of the kinds of things that you've heard?

DOCTOR NADINE CARON: Oh, gosh. I've been all over the country in different hospitals, so I know that I'm not going to identify a particular hospital or clinic or office, but I hear people laughing at the inability for a First Nations person to understand what's been said. I hear people really frustrated with someone who shows up late or unprepared for an appointment or for a procedure and not recognizing that all you have to do is ask a simple question and ask them why and it will blow them away. It's heart-breaking, but it's so important I understand. And I think that's why, again, I'm fortunate in the sense that being a First Nations physician I can ask the why and I and I get these answers where I can understand and say, you did the right thing not coming in. You know, that funeral is really important to go to, or that's not your fault that that transportation wasn't organized. We’ll look into it. The system failed you there. It is hard. Some of them are so personal, literally personal. I remember this one time, it was many years ago, and I was at a hospital that I don't usually work at and didn't usually work at, but I had the crew of surgeons that I worked with and other colleagues that I worked with that knew me. So, I was sitting at lunch in the doctor's lounge with them and a surgeon came in. And he was, obviously, sort of, sweaty and had just finished a long case and he sat down and he's, like, “Phew, if I never operate on another Indian it will be too soon.” And it was interesting because all my colleagues around were very uncomfortable, obviously, because they knew that I was First Nations, but this individual did not. He didn't in any way target this towards me or didn't mean to hurt me. And so my colleagues were uncomfortable. It was very awkward. I did what my mom used to tell me when I was a kid, you know, count to ten before you do anything. And so I sort of waited a few seconds and then I said, “Well, you know, if you don't want to operate on an Indian when you get paid you probably don't want to eat with one for free.” So I slowly gathered up all my stuff and got up and walked away. Eventually what happened was, slowly, one by one my other colleagues at that same sort of big lunch table got up and moved away from the table too. And what was interesting is it was about four years later, I was talking to him and he came up to me and he said, “Do you remember that day?” And I knew exactly what he was talking about. And I said, “Yeah, yeah. I remember.” And he said, “I'm so sorry.” And I said, “Yeah, you know, what are you sorry for? Are you sorry because you hurt my feelings? Is that what you're sorry for?” And he said, “No. I knew if I said sorry right away for hurting your feelings that you would never have accepted that.” He said, “It took me a long time to realize every time that I saw a First Nations patient or an Aboriginal patient that I had to be so careful and I had to check myself and I had to realize that I needed to respect every person. I shouldn't jump to conclusions and I shouldn't make assumptions.” And he said, “It's taken me years and every single time I see an Aboriginal patient I think of that interaction that we had and so now I feel like I can say sorry, because I think I've changed. I feel like I can actually say sorry for more than hurting your feelings, but for the way that I used to be.” And I bring up that one, I guess, because in a way it came about with an apology. That whole apology that Aboriginal people in Canada are waiting for, I got one of those.

LL: I can hear in your voice the kind of emotion and pain that you can recall so vividly even though this happened such a long time ago. I know it was hard for you to share, but I thank you because I think it's something that listeners, people need to hear.

DOCTOR NADINE CARON: Well, if there's one person out there that is touched by it that maybe changes, then it was worth it.

LL: You vividly outlined what you see as some of the problems and challenges. So, what needs to change?

DOCTOR NADINE CARON: Well, I think, in a lot of ways, the pathway to changing, a lot of those are aligned in the Truth and Reconciliation Commissions calls to action. For example, we were just talking about issues in the health care system where it's really almost on one to one and how an individual is respected and valued and understood. So, in the TRC they called for cultural competency now or even moving towards a cultural of safety and cultural humility training for healthcare providers, not just nurses and doctors, but across the board, making sure that the actual quality of care that an individual receives regardless of their background is optimal.

LL: Do you think this Centre for Excellence in Indigenous Health at UBC can play a role in that?

DOCTOR NADINE CARON: We certainly hope so. That’s within our mandate. We targeted first the medical school because they were doing their new curriculum. And it was very exciting when the medical school took on absolutely mandatory training in cultural competency and cultural safety for their medical students. So, that's been going on now for two years and that was a big step forward for UBC and I think a real leading role in terms of how post-secondary institutions can take responsibility for the professionals that they're training. We're trying actively at UBC to increase the number of Aboriginal health care providers. So, we're out there and we're trying to recruit students that want to enter the health professions, whether it's medicine or other entities like nursing, pharmacy, dentistry, midwifery, you name it. We need more Aboriginal representation. So, these individuals can become leaders and they can show the Aboriginal youth out there. If it's a Métis doctor, they can say, look, you too can do it. A First Nations nurse, look at what I'm doing and I love what I'm doing - that role-modelling and mentoring.

LL: You've also set up this biobank. It sounds really interesting. What is it? What is the aim of it?

DOCTOR NADINE CARON: The Northern Biobank Initiative just underwent or it's just starting its phase two, recently, up here in the Northern Health Authority in BC. And what a biobank is is basically collecting biospecimens or, to make it easier, something that would otherwise be collected, such as a tumour after a cancer operation or blood, and we, instead of just sitting in the basement of a hospital, we bank it and we put it in a place where we know it's there and we have, what we call, annotated clinical data. We know it's from a 62-year-old man or a 42-year-old lady. It's all de-identified so we don't know who it was or any information that can identify that individual, but then if research questions come up, then, all of a sudden, if we can create that biobank, the Northern population will be able to be part of the significant research that's being done. Being a cancer surgeon I certainly see a significant change in how we diagnose and treat cancer patients because of this research and it's just been concerning that our Northern population hasn't had the opportunity to be part of it. A significant part is, the major partner in this entire initiative, is the First Nations Health Authority here in BC. And they're really exploring whether this is something their communities would want, is this something their communities would benefit from? And if it is, then how do their communities want this to be created?

LL: There is another area I want to address with you. The Truth and Reconciliation Commission, which you talked about before, made some other recommendations around Indigenous health. One of them is to recognise traditional healing practices and as a doctor and in the Western system, how does a move like that sit with you?

DOCTOR NADINE CARON: Right. You know, I get asked that a lot, particularly since I don't know if there's anything more concrete in the Western medicine than a surgeon where if there's a lump, you cut it out, kind of thing. And then all of sudden there's the traditional healing practices of our Indigenous people in Canada. I fully support that. I think it's so important to ensure that when you are working with an individual patient with, whether it's a disease or, in my case, often new diagnosis of cancer, that you're not-- You know, when I go to the operating room and I do an operation to take out, say, half of the thyroid or a thyroid because of thyroid cancer, I don't just take the thyroid to the operation. I take the entire person. I take their family, their community, everyone who wants this to be a safe operation, a successful operation. But, most importantly, that individual has beliefs, has values, and you have to ensure that all of that is respected so that they can trust you and you can trust that they know what they're going to the operation for and that it's safe. And so I completely agree that our First Nations people and our other Aboriginal people in Canada really need to be respected. If this is another area where they turn to for their health and for their treatments, then we need to work with them, in collaboration with them, to just make sure that what are they doing? What do we propose? How will it fit together? Instead of feeling like you have to choose.

LL: Well, but what if a patient does come to you and say, no, I don't want your treatment. I want to use traditional healing practices only.

DOCTOR NADINE CARON: And I do have patients that do that. I think part of it is that as a First Nations surgeon I probably get more First Nation patients referred to me and we have, I think, great discussions. My role as a surgeon is to share where my expertise is after decades of experience and training. But I'm not an expert in traditional medicine. So they often share what they're planning on doing to the degree they feel comfortable with and I tell them what the pros and cons are of the surgery. I let them know what my thoughts are. I always say, you know-- I very rarely have someone who says they don't want surgery, they're only going to do traditional medicine. And if they only want to do traditional medicine, our final thoughts are can we stay in touch? You can always change your mind and come back to see me. I think, overall, we have to realize that these are choices. Any health care is a choice. I don't have a right, particularly in an area where I am not an expert-- I have only to learn from my patients in traditional healing practices. My job is to do the best I can to explain what a surgeon can do and absolutely respect the individual behind that. They are so much more than a surgery patient and I can't lose sight of that.

LL: I have you ever had a patient who refused your treatment and survived on traditional healing practices?

DOCTOR NADINE CARON: I have some patients who have survived longer than I ever would have expected with traditional healing practices. And I don't know how to explain it except to be one 100 per cent honest and say I'm not an expert in traditional healing practices. But I can respect an individual’s beliefs even if they're different than what I've been trained in. And I think that's so important. I think it will help an individual trust the Western medical system and realize that we're not here to judge, we’re not here to force someone to change their mind or force them to choose between one or the other. We're here to do whatever we can, whatever they choose in the options that we give them and we're here to support them through a path, even if they end up not choosing our path.

LL: We've covered a fair bit of territory here, but I just wanted to ask you, with everything that you've talked about, how far away do you think Canada is from providing the kind of care and treatment and research that the Indigenous communities need?

DOCTOR NADINE CARON: You know what? It spends on the day and it's early back here in the morning in Prince George. I haven't even gone into my clinic. That's a better question to ask at the end of any given day because sometimes I'm so optimistic. I have incredible colleagues in the Western medical system that just wish they could work more with the First Nations communities or do go into First Nations communities in northern BC and are absolutely blown away by the health that they see in these communities because they see individuals in their own space. And then on other days I experience things in the hallways or hear things that are unintended to be heard and you just hang your head and you realise that it’s why thing like the Centre for Excellence in Indigenous Health exist. It's why the TRC is going to be such a powerful document. It's why, as an Indigenous physician, I celebrated when the Trudeau government said that they were going to adhere to those calls to action and they believed in them and they understood that they came from thousands of courageous voices. And so I think in the end it's just like anything else. We're not there yet, but we don't even have the right to stop trying to get there.

LL: Dr. Caron, congratulations on the latest first and I thank you very much for your time.

DOCTOR NADINE CARON: Thank you so much, Laura. A pleasure to talk.

LL: Bye bye.

DOCTOR NADINE CARON: Bye bye.

LL: Dr. Nadine Caron is being recognized today by the Royal College of Physicians and Surgeons of Canada with the Dr. Thomas Dignan Indigenous Health Award. She was in Prince George, BC. I'm Laura Lynch sitting in for Anna Maria Tremonti and you are listening to The Current.