In 2011, Buss was one of the first doctors to complete a family medicine residency through UM’s Northern Remote Program. In 2018, she was appointed the first Indigenous health lead for the department of family medicine.

She recently won a Certificate of Merit Award from the Canadian Association for Medical Education.

But the Métis physician from Beausejour, Man., doesn’t think of herself as a trailblazer.

Buss, assistant professor of family medicine, says the department has supported her educational vision, which includes Elder teachings, sharing circles and other traditional teaching tools.  

During her undergraduate studies at UM, she recalls, the Access Program, which provides holistic support to Indigenous students, gave her a vital sense of belonging and community. And throughout her medical education and career, Elders and mentors have blazed a trail for her.

“There’s a teaching that when you’re the first person to walk through deep, fresh snow, it’s really hard,” she says. “But once you do, someone can follow your footsteps. And then over time, lots of people walk that path, and then it’s easy to walk on.

“I certainly wouldn’t say I was the first one to walk through that snow. I’ve just picked up the bundle and kept walking, so it’s even easier for the people who come behind me. Maybe I can make the path a little wider, so more people can fit on it.”

Buss practises and supervises residents at a Winnipeg teaching clinic, Northern Connection Medical Centre. We asked her three questions.

Why is it important for Indigenous patients to have access to Indigenous doctors?

Health care has been a very violent, unsafe space for Indigenous people, and it’s always been imposed on them, never with them. An Indigenous physician often has a better understanding of Indigenous patients’ lived experience and the community context. 

Not all my Indigenous patients use traditional ways, but they can talk to me about that without feeling like they’re going to be judged. If they have experienced racism in the health-care system, they can tell me, and I believe them.

The other day, I had a patient on the phone who said, “I’m going moose hunting. Do you want some moose?” They know I like to make moose tourtière. That’s the kind of understanding and connection we have.

You direct the Indigenous health curriculum for undergraduate medical students. What do students need to learn?

They need to understand how colonization has led to Indigenous people having the poorest health outcomes today. They need to understand that not all Indigenous communities are the same. They need to unpack stereotypes, and they need to look inward and self-reflect.

We all come into medicine to do good things. But we don’t always recognize when our good intentions are actually harmful for a certain group. What are our blind spots?

Health disparities are a product of racism. How do we use our power and privilege as doctors to interrupt racism and be advocates?

What would you tell all health professionals about providing safe care for Indigenous patients?

Offer an Indigenous patient the same options as any other patient. I had an Indigenous patient who had an amputation. She was never even offered a prosthetic limb. The assumption was that she would not be able to handle it.

We see this with Indigenous patients who have kidney failure and are never offered a kidney transplant or peritoneal (at-home) dialysis. It’s assumed that they won’t be compliant or won’t be able to manage.  

Give Indigenous patients time. Make them feel human. Listen to their stories. Treat everybody who walks in the door as if they were your brother, sister, mother or cousin.

Maté was joined by more than 1,000 attendees at the National Centre for Truth and Reconciliation’s gathering for residential school Survivors and regional health support and cultural workers in late August, where he delivered the keynote address. He also sat down with the Centre’s executive director, Stephanie Scott, and UM Today The Magazine.

“The average doctor doesn’t hear a single lecture [about trauma] in all of their medical training—not five minutes. You know? They should have a whole course on it. They should have a whole four years of courses on it, actually. Because when it comes to healing, if you can heal the trauma, you can heal the conditions that trauma causes.”

The retired physician shared worrisome stats with the audience of Survivors and support workers from across the country, including: Indigenous people develop diabetes up to 30 years earlier than the average Caucasian and have three times the rate of rheumatoid arthritis.

He also shared his thoughts on addiction, insisting it’s not a disease, nor is it inherited, but rather a manifestation of trauma, an unhealed wound. It is never the primary problem; it is an attempt to solve a problem, said Maté. He shared his mantra: “Don’t ask ‘why the addiction?’ ask ‘why the pain?’” It’s no accident there is a significant, disproportionate plague of addiction in Indigenous communities, he noted.

“They happened to be the ones who’ve suffered most in this country,” Maté said.

He spent more than a decade treating patients with drug addictions in Vancouver’s East Side.

“I couldn’t help but notice after a while that the people who got ill—it wasn’t accidental. It wasn’t random. There are certain things about them and how they lived their lives and how they thought about themselves, and how they related to their world that promoted the illness.”

He invited attendees of the gathering to explore if they have any of these reappearing characteristics: a compulsive concern for the emotional needs of others while ignoring their own; identifying with duty, role and responsibility at the expense of their own rest; repressing healthy anger; feeling like they’re responsible for how people feel and wanting to avoid disappointing anyone. 

“Those are the things that lead to illness,” Maté said. “Because what is lacking in all of these is compassion for the self…. You do have to find your own authentic self, which means knowing what you need and offering that compassion to yourself.”

Mandy Buss [B.Sc./06, MD/09], the Indigenous health lead for the department of family medicine in the Max Rady College of Medicine, Rady Faculty of Health Sciences, echoes Maté’s call for more trauma training in med schools. UM helped chart the path with a session developed seven years ago for undergrads about trauma-informed care. Buss oversees the initiative, which involves a Knowledge Keeper and has students walk through a series of cases with a trauma-informed lens.

But a two-hour session barely touches the surface, says Buss, who creates and implements Indigenous health curriculum.

“We don’t really dive into what skills physicians need and I don’t know of too many programs across Canada that actually even touch upon it, let alone talk about the theory.”

That prompted Buss to get involved in a research project on trauma-informed care curriculum in family medicine, with the intent of ultimately increasing its presence in the education of future doctors. “Not only to benefit the patients that we see, but also to benefit the physicians because it can be really dissatisfying when you’re trying to navigate trauma within patients and you feel like you’re not well equipped to deal with it,” says Buss.

“I think we don’t do it because people don’t know how to teach it. We need, really, a lot more research around how do we build those skills.”

Lisa Monkman [B.Sc./00, MD/04], an Anishinaabe family physician and co-chair of the Postgraduate Medical Education Truth and Reconciliation Committee in the Max Rady College of Medicine, agrees that trauma is a much-ignored topic and applauds Buss’ strides to ensure what Manitoba doctors are learning better reflects the needs of all patients.

“What she’s doing is unique,” says Monkman. “Most other medical schools do not have this robust or informed a curriculum that addresses the complexity of [realities]—like racism—and its impacts on Indigenous health.”

In Maté’s latest book, The Myth of Normal: Trauma, Illness & Healing in a Toxic Culture, he references a former trailblazing Harvard University professor and physician from the 1930s, Dr. Soma Weiss.

“Weiss told the medical school class that emotional factors are at least as important as physical ones in the causation of illness, and they must be at least as important in the healing of them,” he said.

More recently, a current Harvard professor who believes in this connection told Maté that to talk about mind-body medicine is to jeopardize one’s career. Another colleague at UCLA shared that she has started asking patients about their trauma and is effectively easing them off medications. She was afraid to use her name in his book.

“There’s a lot of doctors who are getting this information or picking up on this stuff a lot more than they used to be. So it’s changing. But it’s changing on the margins. It’s not changing in the mainstream medical schools. The resistance is incredible,” he said, noting a sweeping transformation is probably a century away.

Monkman suspects physicians’ reluctance to adopt a more holistic approach comes down to a few things: not having the background in trauma care and addictions, but also not having the time in an over-run health-care system.

“It’s poorly understood and also I think that it’s emotionally easier to focus on the physical body and disease processes,” she says. “It takes time to get to know people in the context of their own lives in order to know what’s going to help them in a meaningful way.”

***

LISTEN to a related podcast: What’s The Big Idea, featuring Dr. Marcia Anderson [MD/02], vice-dean of Indigenous health, social justice and anti-racism at the Rady Faculty of Health Sciences. In conversation with President Michael Benarroch, Anderson discusses how the University of Manitoba can further ground medical education in anti-racist practices and provide greater health equity for Canada’s Indigenous, Black and racialized communities. 

Read more about Maté’s visit to Winnipeg in UM Today The Magazine.

The brightly coloured artwork, which includes imagery of Thunderbirds, was inspired by Indigenous youth taking flight to attain their education and employment goals.

Angeconeb is a Winnipeg artist who is a member of Lac Seul First Nation in Ontario. EleV, a Mastercard Foundation program, commissioned the mural from him in partnership with UM.

“I hope this mural will inspire people and bring them joy,” the artist said.

The mural was unveiled at an event organized by Ongomiizwin, the Indigenous Institute of Health and Healing, to mark the National Day for Truth and Reconciliation (Orange Shirt Day) on September 29, 2022.

At Orange Shirt Day events on both UM campuses, participants commemorated the tragic legacy of residential schools and called for reconciliation. Speakers emphasized the Rady Faculty’s commitment to its Reconciliation Action Plan, developed in response to the health-related Calls to Action made by the Truth and Reconciliation Commission.

Marcia Anderson [MD/02], the Cree-Anishinaabe physician who is vice-dean Indigenous health, social justice and anti-racism of the Rady Faculty, said the Brodie Centre atrium is the ideal setting for Angeconeb’s mural because it is the heart of the Rady Faculty.

“This artwork is a hopeful symbol of how we are decolonizing the university and bringing Indigenous knowledge into the heart of our education, research and service work,” Anderson said.

Here’s a look at recent initiatives that are supporting Indigenous inclusion, equity and advancement across the Rady Faculty:

The College of Pharmacy has increased the number of places allocated for Indigenous applicants to 10 in each incoming class of 55 as part of its new Canadian Indigenous Applicant Pool for the Doctor of Pharmacy program.

The Dr. Gerald Niznick College of Dentistry has a proposal, currently awaiting UM Senate approval, to increase the number of places allocated for Indigenous dentistry students to five in each incoming class of 29.

At the Max Rady College of Medicine, which has a process for supporting admissions of Indigenous students, representation in the incoming class of 110 has included 15 Indigenous students in 2020, 17 in 2021 and 13 in the most recent class.

“The inclusion of Indigenous practitioners and leaders in our health-care system is key to honouring reconciliation and creating a system where First Nations, Métis and Inuit patients feel safe to participate and access the care they need,” said Sara Goulet [B.Sc. (Hons)/97, B.Sc.(Med.)/05, MD/05], associate dean (admissions) of the medical college.

At the College of Nursing, Mahkwa omushki kiim: Pathway to Indigenous Nursing Education (PINE) provides a supportive community for Indigenous students who are preparing for, or admitted to, the bachelor of nursing (BN) program.

PINE provides access to Knowledge Keepers, student advisors and academic coaches. Since the program’s inception in 2008, 51 participating students have gone on to graduate from the BN program. Currently, 69 pre-nursing and BN students are enrolled in PINE.

At the College of Rehabilitation Sciences, a two-day, in-person retreat with First Nations partners was held in October. The partnership is named Kiga mamo anokimin onji minoayawin/Kamamawi atoskatenow minoyin, meaning “We will work together for health and wellness.” Its goal is to bring the college’s rehabilitation services to communities.

The partnership started in 2016 with five First Nations communities and has grown to include 10. It has included initiatives to help people who are frail and people who have dementia, as well as projects to build playgrounds and walking trails.

At Ongomiizwin – Education, a mentorship program for Indigenous students in the health sciences has been launched.

The program is called Gekinoo’amaaged, which means “Teaching each other.” It pairs Indigenous learners with Indigenous student mentors who are further ahead on the university journey and can offer guidance and advice.

Evan Loeb, a third-year Métis dentistry student, is one of those who signed up as a mentor. “I would like to give back to students because I know Indigenous people are under-represented in health-care fields,” he said.

Ongomiizwin – Research recently hosted its 10th annual Indigenous Health Research Symposium. One of the speakers, Métis rheumatologist Cheryl Barnabe [B.Sc./99, B.Sc.(Med.)/03, MD/03], discussed what it means for researchers to work in true partnership with Indigenous communities.

It’s essential, she said, to establish relationships, respect the research priorities of the community, hire local people for research roles, build on community strengths, use an Indigenous lens to interpret findings, and follow the community’s wishes as to how research results are shared.

Recognizing Indigenous Achievement 

Monica Cyr [B.Sc.(HNS)/15, M.Sc.(HNS)/18] is one of two inaugural recipients of UM Indigenous Doctoral Program Fellowships. Cyr, an Indigenous dietician, is pursuing her PhD in community health sciences. She is studying Indigenous women’s self-image before and after giving birth.

Wanda Phillips-Beck [M.Sc./10, PhD/22] earned a 2022 UM Distinguished Dissertation Award for her doctoral research. The Anishinaabe nurse holds Manitoba’s first Indigenous Research Chair in Nursing and is an adjunct professor in the College of Nursing.

Phillips-Beck’s research focused on the policy that requires Indigenous women from rural and remote communities to travel to urban hospitals to give birth. The study showed that being forced to leave the community is associated with increased odds of inadequate prenatal care, lower odds of breastfeeding and higher odds of having a small baby.

Margaret Lavallee [LLD/22], Elder-in-residence at Ongomiizwin, was honoured with the official naming of the Dr. Margaret Lavallee Boardroom in recognition of her many contributions to mentorship, education and health service.

Four Rady women received 2022 Indigenous Awards of Excellence from UM for their work as community builders and trailblazers:

Mandy Buss, Melody Muswaggon, Mélanie Morris and Charisma Castel.

Mandy Buss [B.Sc./03, MD/09], Indigenous health lead in the department of family medicine; Melody Muswaggon, health innovations lead at Ongomiizwin – Health Services; Dr. Mélanie Morris, surgeon and Indigenous health lead at Winnipeg Children’s Hospital; Charisma Castel, a bachelor of health sciences student whose roles have included communications coordinator of the UM Indigenous Students’ Association.

Ishkode Catcheway, a student in the bachelor of health sciences program, received a 2022 Emerging Leader Award from UM. Catcheway has served as a peer mentor in the Neechiwaken program and a participant in the Indigenous Circle of Empowerment. She is the first in her family to attend university.

“What inspires me to continue my academic journey is being able to not only take up spaces where my mom and grandma weren’t ever wanted … but also to give my younger siblings and cousins something to look at and draw from,” Catcheway said.

“They were so little when they became ancestors,” said Leslie Spillett, a Knowledge Keeper in the Rady Faculty of Health Sciences, about the thousands of Indigenous children who were stolen from their families and did not survive at Canada’s residential schools.

The empty shoes were displayed inside a ring of protective cedar sprigs that encircled a spirit chair. Objects arranged on the chair included a star blanket, bowls of berries to feast the spirits of children, a chocolate treat to symbolically feed today’s children, a crown of sage wrapped in orange cloth, and a willow branch with an attached eagle feather.

“These little people had communities that loved them,” said Spillett. “When I think about how best to honour our little relatives, it’s by making the world better for the ones today.”

Those at the ceremony who wanted to offer a prayer each took a small bundle of tobacco wrapped in orange cloth, smudged it and cast it into the sacred fire that burned throughout the gathering.

The event was the first of two Honouring Our Children ceremonies organized by Ongomiizwin, the Indigenous Institute of Health and Healing, in the circular Medicine Garden next to the Basic Medical Sciences Building.

The second ceremony, open to all, will be held in the Medicine Garden on Wednesday, Sept. 29 at 9:30 a.m.

The gatherings are among many commemorative events connected to the National Day for Truth and Reconciliation (also known as Orange Shirt Day – Every Child Matters), a federal statutory holiday to be observed on Thursday, Sept. 30. The day honours the lost children and Survivors of residential schools, their families and communities.  

Referring to the devastating recent discovery of unmarked children’s graves at the former sites of residential schools, Melanie MacKinnon, head of Ongomiizwin and executive director of its health services branch, described the ceremony as “one way to collectively ensure that this never happens again.”

Dr. Mandy Buss (L) and Dr. Lisa Monkman

Dr. Lisa Monkman and Dr. Mandy Buss, both Indigenous physicians, offered an Honour Song “for all the children, and all of us who carry this trauma deep within us,” Monkman said.

Joby Kakegumick, assistant to Elder in Residence Margaret Lavallee, said the ceremony was about “taking the time to remember and reflect on the Survivors, and the ones that couldn’t be here today. I think it’s very important to honour them in a good way.”

Dr. Marcia Anderson, executive director, Indigenous academic affairs of Ongomiizwin and vice-dean, Indigenous health of the Rady Faculty, was unable to attend in person. In written remarks, she called on faculty, staff and learners to build a future in which the health and health-care rights of Indigenous Peoples are fully realized; to address systemic racism and provide culturally safe care; and to stand in solidarity with Indigenous Peoples.

“Reconciliation is a journey that we must walk together,” Anderson said. “As you stand here and feel the collective energy and the safety of this place, I encourage you to take courageous action to make every space of this campus feel like this.

“This is our responsibility to honour the Survivors, as well as the children who never made it home.”