Culturally Inclusive Care for Indigenous People with Dr. Mandy Buss
Join Dr. Tara Kiran as she learns about how the Northern Connections Medical Centre in Winnipeg is revolutionizing primary care for Indigenous communities. Dr. Kiran tours the facility and interviews Dr. Mandy Buss, who highlights the clinic’s culturally inclusive and trauma-informed practices, and the critical need for increased Indigenous representation in the medical field. Through real-life stories and discussions on systemic racism and historical barriers, this episode examines how a patient-centred and culturally competent healthcare system that honours Indigenous traditions can help address the significant health inequities and barriers to care experienced by First Nations, Métis, and Inuit people.
Resources mentioned in the episode: The Truth and Reconciliation Commission Health Calls to Action
Related articles you might like:
CMAJ Commentary: Ensuring incoming cohorts of medical students better represent the diversity of Indigenous communities in Canada
Research study: Changes in health indicator gaps between First Nations and other residents of Manitoba
Reports from the OurCare Community Roundtables
“The Unforgotten” - a five part film from the Canadian Medical Association about Indigenous Health in Canada
More about Primary Focus:
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Do you have an idea for an episode? Email primary.focus@unityhealth.to
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Culturally Inclusive Care for Indigenous People with Dr. Mandy Buss
Primary Focus Podcast — Episode #
Introduction: Arriving in Winnipeg
Dr. Tara Kiran (00:02) I'm just preparing to leave my hotel room here in Winnipeg. It's minus fifteen degrees outside and so dry. I am excited, though, to venture out of my hotel to visit the Northern Connections Medical Centre and learn more about how they've transformed the way they approach care — redesigning their spaces and service delivery to be much more welcoming and inclusive for people who are Indigenous, and addressing their very specific healthcare needs.
I'm looking forward to learning more about how they're supporting the Indigenous population living here in Winnipeg. All right — more soon.
Podcast Introduction
Dr. Tara Kiran Hi, I'm Dr. Tara Kiran. I'm a family doctor and researcher who's passionate about building a stronger, more equitable primary care system in Canada. In 2022, I launched Our Care, a national initiative to co-create a blueprint for primary care together with patients and the public. The people we spoke to were very clear: they felt every person in Canada deserved access to high-quality primary care — care that's timely and ongoing, delivered in a culturally safe way from a team, where community supports are integrated, where patients have access to their own medical record, and where the system is ultimately accountable to the community it serves.
Welcome to Primary Focus, a launching point for a national conversation we really need to have about the current primary care crisis in Canada and how we're going to solve it.
On this podcast, I'm going to take you with me as I travel the world to tour different health systems and innovative clinics that have lessons we can learn to help improve primary care here in Canada. Together, we'll visit the Netherlands, Costa Rica, Spain, Denmark, and places here in Canada to see what they're doing right and how we can use what's working for them to help improve our health system.
As we start on this journey, I want to set the context of where things are in Canada — a country founded on colonized Indigenous lands, where Indigenous people today have some of the worst health outcomes and poorest access to healthcare. There are huge gaps in life expectancy. For example, data from 2021 from BC notes that the average life expectancy for someone who was First Nations was 67 years, while the average for non-Indigenous BC residents was 82.5 years. That's a full fifteen-year difference in life expectancy. Shocking.
Or consider that one in five Indigenous respondents to a 2024 Statistics Canada survey reported experiencing discrimination or racism in healthcare. That's depressing.
If we really want to improve primary care in Canada, we need to improve care for people who are Indigenous. This means understanding and reckoning with our history of colonialism, the continued racism faced by Indigenous people, and understanding the unique considerations and approaches needed to make things right.
That's why our second episode features a conversation I had with Dr. Mandy Buss. But before we go there, I want to take you to the clinic where she works — the Northern Connections Medical Centre in Winnipeg, Manitoba.
Clinic Visit: Northern Connections Medical Centre
Linda Sindovich (03:23) Thanks so much for making time.
Dr. Tara Kiran (03:26) Thank you so much for agreeing to let me record. This is Linda Sindovich — she's the manager of the clinic.
Linda Sindovich (03:39) I oversee the clinical team — more so the allied health and the administrative staff, the clinical support. So our history, why we ended up here — we, at 425 [uncertain: remainder of sentence not captured] —
Dr. Tara Kiran (03:54) The day I visited Northern Connections, Mandy wasn't there, so Linda agreed to be my guide.
Linda Sindovich (03:59) Do you want me to give you a tour?
Dr. Tara Kiran (04:03) Sure. And you can walk me through what we're seeing and how it helps to create the space that we're talking about.
I came to tour this clinic because what's become very clear to me in my research and my work with Our Care is that the fix to our primary care crisis is not going to be a one-size-fits-all solution — especially for patients who've experienced decades of trauma, racism, and erasure at the hands of our healthcare system.
Linda Sindovich (04:28) So you came in the front. The installation that you see —
Dr. Tara Kiran (04:31) I'm here to learn from Linda and her team about what they're doing to offer Indigenous patients the high quality of care they're known for.
Northern Connections was established in 2010, and was initially mandated to serve patients from the north coming into Winnipeg. Even today, about 80% of its clients are First Nations, Métis, or Inuit. Winnipeg is actually the Canadian city with the largest total population of urban and off-reserve Indigenous people.
The clinic has two locations, and I visited the one at Seven Oaks General Hospital. It's a temporary location while renovations are underway at their main clinic. When I walked in, in very many ways the clinic looks just like any other hospital clinic — but then there's the art.
Linda Sindovich (05:12) — to make the space more inviting and less sterile.
Dr. Tara Kiran (05:18) Indigenous paintings, a handmade quilt, a large orange-themed art installation in honour of Truth and Reconciliation Day.
Linda Sindovich (05:26) One of our physicians, Dr. Donna [uncertain: Lufelt], created this for Truth and Reconciliation Day, and we just felt it should continue to be here. It's beautiful.
Dr. Tara Kiran (05:40) On their team, they have nurses, an occupational therapist, a physiotherapist, a dietitian, and a pharmacist — so they're able to support complex needs and provide a lot of wraparound services.
Linda Sindovich (05:51) We have a multidisciplinary team. Within our complement, besides physicians and nurses, we have social workers, including a position funded through Indigenous Health Services. It's called a North-South Liaison.
Dr. Tara Kiran (06:09) What's wonderful to me is how Northern Connections is hitting one of the six Our Care standards — delivering care in a culturally safe way, specifically for people who are Indigenous.
Linda Sindovich (06:21) — providing education to the medical residents so that they are starting practice with an understanding of the importance of past trauma and current trauma that individuals are facing in the healthcare system, as well as the importance of building relationships so that you can increase the trust that individuals have — so they can come to appointments, receive the care they need, and talk about all of their healthcare needs. And so that we can reduce the barriers to receiving that care.
Dr. Tara Kiran (06:58) That's lovely. Yeah, that's really lovely.
[Note: Brief ambient interlude — Dr. Kiran navigating the clinic.]
Dr. Tara Kiran This is Dr. Ken [uncertain: Halwig]. He was the [uncertain: Senior] Medical Lead at Northern Connections for many years and he still practices there.
— those individuals, when they graduate, deciding to work in northern communities. And it's been shown to be the case that if you have some exposure, the barriers are less. It's a unique model here in that it's training residents to deliver care up north, but also to deliver culturally safe care to Indigenous people in urban areas — while also providing the service-provision aspect of the clinic, where you are providing trauma-informed, culturally safe care to people who are Indigenous.
I'm happy to be here to learn a little more about the unique program offerings and the way in which it is a welcoming space for people. This year, six of our residents are Indigenous.
Linda Sindovich (08:21) People who are Indigenous —
Dr. Tara Kiran (08:29) That makes a huge difference. It is. It just makes our hearts burst, right? But it's great.
When I asked a few of the team members at Northern Connections what makes their clinic special, I heard a lot of different answers: respect for traditional practices, the culture built by their very purposeful hiring, that everyone on the team has a voice no matter what their role.
Linda Sindovich (08:52) He was my boss once. I didn't like it.
Dr. Tara Kiran (08:58) But what really struck me — at its core — was their focus on relationships, both within the team and with the patients they serve.
Interview: Dr. Mandy Buss
Dr. Tara Kiran Today we're going to spend some time in conversation with one of those team members, a very special team member, Dr. Mandy Buss. Mandy Buss is a family physician at Northern Connections Medical Centre, and I asked her if she might introduce herself to us.
Dr. Mandy Buss (09:31) Sure. [uncertain: Bonjour. Ikwe Nedish Nakash Makwatorum.] The name given to me by Creator is Dancing Northern Lights Woman, and I am of the Bear Clan. The name my parents gave me is Mandy Buss. I am from the Red River Settlement in Manitoba, which is where I work, live, and play.
Dr. Tara Kiran (09:51) Now, Mandy has many other roles, including as the Indigenous Health Lead for the Department of Family Medicine at the University of Manitoba, where she's also the Director of the Indigenous Health Longitudinal Curriculum for the Undergraduate Medical Education Department. She sits on the executive of the Postgraduate Truth and Reconciliation Committee as co-chair of the Curriculum Development and Implementation Working Group at the University of Manitoba, and on the Indigenous Health Committee for the College of Family Physicians of Canada.
Importantly, she's also the former president of the Indigenous Physicians Association of Canada and continues to be involved with the association.
Mandy says that when she was young, she wanted to be a singer or an actor, but those weren't opportunities afforded to her growing up in a small town — and so she turned her gaze to medicine.
Dr. Mandy Buss (10:34) I remember my mom always asking me, "Do you want to go to university or college?" And I basically asked her, "Which one's harder?" She said, "University." So I said, "Well, then I'm going to university."
Dr. Tara Kiran (10:44) She ended up applying to medical school, intending to go into psychiatry.
Dr. Mandy Buss (10:49) When it came down to applying, there was a new Family Medicine program — the Northern Remote Family Medicine program — that had entered our options. I really wanted to work in northern communities and in Indigenous communities. So I applied for that program as well as the psychiatry program. It was really clear to me that the Northern Remote Program truly valued me as an Indigenous person, and the perspective and knowledge I could bring to the program. I didn't get that same feeling from the other interview. So needless to say, I entered the Northern Remote Family Medicine program, and that's what led me down that stream.
I'm glad I chose that program, because I got to spend a lot of time in community through my residency — in Nunavut, northern Manitoba, and various other communities.
On Being an Indigenous Physician
Dr. Tara Kiran (11:49) Here's my conversation with Dr. Mandy Buss.
It's wonderful to hear about your own journey to become a family doctor. As I was preparing for this podcast, I was reminded that about 5% of people in Canada are Indigenous, but less than 1% of physicians are Indigenous. You really are unique relative to our workforce. I wonder if you could speak to that — what was it like for you to be an Indigenous physician, what is it like now, and why is it important that we have more Indigenous physicians?
Dr. Mandy Buss (12:29) Well, here in Manitoba, 18% of our population is Indigenous. I'm not sure of our exact stats on how many physicians are Indigenous, but it's probably still only one to two percent — a very small fraction. And it is growing. I think we had twenty Indigenous students admitted last year, which is amazing, and it's growing every year. When I went in, there was usually one or two per year. That was challenging because there wasn't a lot of support, and there wasn't a lot of safe space for us in medical school. We had very different realities than our peers.
I think there's a lot more diversity today — in terms of ethnic and racial backgrounds, but also socioeconomic backgrounds. I remember it was like our first or second day of medical school. They asked for a show of hands: how many people had parents who were doctors? I think it was 50 to 60 percent. And how many had parents who were lawyers or other professionals? It was like a huge number of our class — probably 80%.
Most of our Indigenous medical students don't have that reality, because it was actually legislated that we weren't allowed to go into medical school or law school if you were First Nations. You had to give up your identity as a First Nations person. You had to leave your communities. And there often wasn't a lot of educational support prior to that to even get to that point. So we don't have those generations after generations within those fields.
Last year's graduating class here at the U of M [University of Manitoba] actually had two second-generation Indigenous doctors for the first time ever. 2023 — first time having a second generation. And if you think about that, that was huge. But it's also sad to know that it's not until now that we have a second generation of Indigenous doctors, when there have been generations after generations for other Canadians who've gotten there.
Dr. Tara Kiran (14:30) An important point. And I think it goes back to what we heard through the Our Care consultations when we spoke to people across the country — principally, they wanted a workforce that represented the diversity of the communities it serves. There are many studies that show that health outcomes and care are better when people are receiving care from someone who looks like them, who's from the same cultural background.
It's of course also important to note that the Truth and Reconciliation Calls to Action include one that relates to increasing the number of Aboriginal health professionals working in the healthcare field. A really important piece we need to get right. And kudos to you for being the first in your family to be a family doctor.
We've been talking about this history of Canada being on colonized Indigenous lands — and the decades, the centuries of erasure, displacement, cruelty, and institutionalized racism that I think is really at the heart of the disparity in health outcomes we see between people who are Indigenous and people who aren't.
On the Roots of Health Inequity
Dr. Mandy Buss (15:38) Yeah, health and wellness are complex. For a really long time, we've talked about health within this kind of biophysical perspective, and that's really important. But when we only talk about it that way, we don't fully understand what makes people healthy and well, and what leads to biophysical wellness — because it's more than just the body.
The impacts that colonization had for Indigenous people — losing their way of life, their ability to practice their ceremonies, their wellness practices, their governance practices, their lands, their hunting — all those things that kept them healthy: picking medicines, being out on the land, connecting. Those practices actually encompassed all parts of health — spiritual health, physical health. When you're moving and on the land and bending, it's good for the joints, good for the body. When you're on that land, it's really good for your emotional and mental health. And when you connect to spirit through those practices, all of that contributed to wellness.
Through residential schools, the Sixties Scoop, day schools, relocation, the TB sanatoriums — all those ways of being well were disrupted. Kids were taken from families. I can't even imagine what that would do to me if someone just came to my house and took my son away. That would destroy me. And it would destroy him too. Those things were happening until the 1990s, and now they've just taken a different form. We see it through child apprehensions through child and family services. We see food insecurities. We still see lack of traditional foods in communities. And we're seeing higher rates of things like diabetes.
We didn't see diabetes in First Nations, Métis, and Inuit people before the 1930s. Sometimes we don't recognize how the processes of colonization actually led to disease states such as diabetes. And we know diabetes is also a risk factor for coronary artery disease, heart attack, and stroke — all of which reduce life expectancy.
We also know that access to health in First Nations, Métis, and Inuit communities is much less — screening for cancer, for example. Indigenous people have less access to those things. They're caught later, and usually at a non-reversible stage. Those things all impact the statistics.
As a family doctor, I think one of the important things is that we're often the first line of healthcare that people interact with. If we can create safe space for people to come, then they're more likely to come for preventative care, so we can turn some of those stats around. I mean, it's not the whole picture — that's only one piece of the determinants of health — but I think it's a starting place, and it's where we can work in primary care.
On Creating Culturally Safe Space
Dr. Tara Kiran (19:09) I'd love to know more about how you think we can create that safe space, Mandy.
Dr. Mandy Buss (19:15) Well, I think one — as you mentioned earlier — having more Indigenous doctors. I think people feel like they don't have to explain everything when they see someone who understands. They don't have to explain the impacts of residential schools, whether it's first, second, or third generation. Having more training for other staff so that they understand some of the limitations and barriers. Having representation of other ways of wellness — Indigenous ways of wellness — so, elders, knowledge keepers. Having space that people can smudge in if they want to. Even the way we ask about those things — we can't assume that everybody practices that way, but we should be asking about it in a way that's non-judgmental and non-stigmatizing.
I'd love to see community hosts who welcome people and help them navigate the system.
Dr. Tara Kiran (20:22) I think some of this also comes down to ensuring that our healthcare spaces are culturally safe. We heard that in Our Care — free from racism and discrimination. And it goes back to the Calls to Action from the Truth and Reconciliation Commission: that we need to provide cultural competency training for all healthcare professionals, and of course need to increase the number of Indigenous healthcare professionals.
I actually had a chance to visit Winnipeg a few months ago. I was at a primary care day with a number of different presentations, and the one that stuck with me was from a mobile health clinic that had just started up in Winnipeg. They presented how it's structured — and it's exactly as you say. There's a team. Importantly, they're going to patients; they're not asking patients to come to them. They're breaking down even the transportation and geographic barrier in an urban setting. They have an Indigenous social planner as an example of a unique role. And they talked about the value of relationships.
At the end of the day, we're also working in a cash-strapped system that always seems to not have enough resources. So it feels hard to provide more time when we're supposed to be more efficient. I wonder what your thoughts are — in this time of scarcity, how is it that we can simultaneously ensure we provide resources to those who need it most?
Dr. Mandy Buss (22:00) It's hard sometimes to connect an intervention to distal outcomes — and I'll explain myself. We at our clinic do a couple of outreach clinics: one is a teen clinic, and one is to a program that supports people in the downtown core. These are people who often have a lot of trauma — colonial trauma, for the most part — and houselessness, and all those things.
So we go there. And it's not scheduled appointments like a clinic, so I don't see as many people when I go. I sit down, have a coffee, talk to people, introduce myself, and say, "Do you need to see a primary care physician?" Some of them want to see me, and we go and talk. Many of them don't have primary care doctors, and I always offer for them to come see me at my clinic. I've had a couple of people from those community events follow through and come.
It was really hard for one person, though. She said it was one thing to see me in community — and when we sat in ceremony together — but it was another thing entirely to come into a clinic that feels very institutional, because it really brings up a lot of trauma. So I think one of the things we have to consider is: how can we provide care in spaces that feel safer, maybe in spaces that aren't clinical? We tend to make everything center around that Western model, instead of asking how we can do things where we're not the centre, but just one piece of it.
That's one thing I appreciate about the outreach clinics: we're not the centre of it; we are just a small part. And you really get to meet people within the community. It takes a bit more time at first — but there were a couple of times where, had I not been there, or one of my other doctors not been there, the outcome would have been worse. They would have ended up in the emergency department, possibly the ICU.
But it's hard to say definitively: me spending that time there meant that person didn't end up in emergency care. Because many of them also have multiple comorbidities, so they'll probably need emergency or urgent care for other things anyway. It's really hard to measure.
Dr. Tara Kiran (24:13) What this conversation is highlighting for me is how important it is, as we think about improving the primary care system, that we realize it can't be a one-size-fits-all solution. In particular, for people who have experienced decades — generations — of trauma, we need to take a different approach: meet them where they're at, not just psychologically, but physically. Go where they are, be embedded in community. And be humble — humble enough to understand that there is a lot we don't know, and that we're not coming in with the answers.
Our Care Survey (Mid-Episode Announcement)
Dr. Tara Kiran Hey, it's Tara. I just wanted to pop in with a quick opportunity for you to have your voice heard. Something you hear me talk a lot about on this podcast is the Our Care standard — a clear outline of what every person in Canada should be able to expect from the primary care system. The standard was shaped by feedback from nearly ten thousand people in Canada back in 2022. Now we want to hear from you.
Whether you have a family doctor or not, we want to know how your healthcare stacks up against the Our Care standard. It only takes ten to fifteen minutes to share your story. It's completely confidential, and it'll help researchers like me understand what's needed for a stronger and more equitable healthcare system in Canada. More importantly, it will help us all hold our governments to account to deliver the system we all want and deserve. You can take our survey anytime between now and July 9th.
Just head to ourcare.ca/survey or click the link in the show notes. The Our Care Survey is a research study led by me, Dr. Tara Kiran, at the MAP Centre for Urban Health Solutions at St. Michael's Hospital, in partnership with the Canadian Medical Association.
Interview Continued: Racism in the Healthcare System
Dr. Tara Kiran (26:01) All right, back to the episode.
You talked about your own clinic, Mandy, and I did have a chance to visit Northern Connections Medical Centre in Winnipeg. I love that it's a training model that's supporting people to deliver culturally safe care for Indigenous people in lots of different environments, while also providing those services to people. We've spoken a lot about creating culturally safe space, and I think sometimes people actually have a hard time recognizing that racism and discrimination — interpersonal racism and discrimination — continues to exist. I'd love to share a clip from a conversation I had with your clinic manager. She was telling us a story about something that happened to a patient and how the team supports them.
Linda Sindovich (26:53) One of our nurses took a patient to the lab, and part of the issue was the lab not wanting to accept the person's requisition because they didn't have a Manitoba Health Card. A lot of our clients don't. They've lost it, or it's gone to a different address, and just the process of trying to get a new one is too overwhelming for them to try to navigate. So we help them with that — but in the meantime, if they have made it to an appointment, we want to seize that moment and provide whatever care we can: any treatment, any diagnostics, whatever, in that moment.
The staff person went with them to the lab with the requisition, to vouch for the person. There were barriers — "No, no, they have to come with their Manitoba Health Card." Back and forth, and finally it was accepted.
Then there was also to be, I think, an ECG. And they were told, "No, you can't do that here. You have to go back to register the person at the information desk." So the staff person went there, and again there was pushback — "No, no, that's not their ID card" — and then apparently some eye rolling and some nonverbal communication that was experienced by both the staff and the client as being dismissive.
And the client said to the staff person: "This always happens. It's okay." Well, it's not okay that this always happens — to this person or to anyone else. And the staff person also saw it through her own lens, as she herself is Indigenous, and was experiencing it again through her client. There are lots of those stories.
Dr. Tara Kiran (28:46) Yeah, what's your reaction to that, Mandy?
Dr. Mandy Buss (28:49) Sadly, this is a common thing that we experience. Two things tend to happen: either our patients just accept this as their norm when navigating the healthcare system, or they stop navigating the healthcare system altogether because of it.
Not too long ago, a patient came in and was seen by our nurse. They were assessed as quite sick and needed to be seen in an urgent care setting. They refused to go. They said they had already tried to go, and some of the staff had said negative things about them being a First Nations person, so they had left and wouldn't go back.
So the nurse talked to them and said, "Okay — I can send you for blood work and an X-ray. Can you come back tomorrow? Go get it done now, and come back tomorrow." When they came back, the nurse came to me and explained the situation. She was really worried. They seemed dehydrated — something was clearly going on. We didn't have all the results back, but we did have some blood work, and it was obvious there was an infection somewhere in their body. They probably needed IV antibiotics, IV fluids, and more investigation to figure out what was happening.
The nurse asked me if I'd come talk to the patient. I went in and started by acknowledging: "I'm sorry that you heard those things and that that was your experience when you tried to get help." And then I had to basically negotiate with them. I said: "Look, I cannot help you here in this clinic right now. You need more help than I can give you at this moment."
Luckily, I knew who the doctor on urgent care was that day — someone I'd gone to school with. I said, "I will call them personally, let them know what you need, and tell them about your experience, to help buffer what you go through there." They agreed to go on that basis. I was able to call and say: "This was their experience. They left because of this." And they went back. As far as I know, they stayed — they were admitted. They were really sick.
But I had to negotiate with them just to go. And this is what I mean: because they didn't want to go, had they not come to our clinic — or had I not taken the time, and the nurse not taken the time to talk to them, acknowledge their experience, and try to buffer it — they would have gotten really, really sick. They still would have ended up in the emergency department, but the outcomes might have been worse.
I have these experiences quite regularly where I either have to try to navigate caring for people in a less-than-gold-standard way because they don't feel safe going into those other spaces — which is an uneasy feeling — or I have to convince them, or they just don't go and they don't get the care they need.
Dr. Tara Kiran (32:03) These stories illustrate how racism and discrimination persist in our healthcare system — how they are a barrier to even walking through the front door. One of the things in Our Care that's really stuck with me was something we heard in our Indigenous youth panel in Manitoba very early on, from a participant who said that they go to the emergency department expecting to be discriminated against.
Every time I hear that, I feel awful. Because that's the place people should feel safe going to — it's supposed to be the place you go when you're most in need. And in fact, so many of them are going to the emergency department because they don't have access to primary care. So it's just layers of discrimination and barriers on top of one another.
And the other piece that struck me in Linda's story was how it also hurt the Indigenous healthcare worker who witnessed it — because she was being re-traumatized by watching it happen in front of her, and feeling unable to do a lot about it.
Dr. Mandy Buss (33:20) It can be really disempowering. For Indigenous people who enter healthcare — especially when we want to work in our communities, which I think most of us do, because we grow up seeing those gaps — it's not just our job. It's personal. It's very personal.
Dr. Tara Kiran (33:39) And so creating a culturally safe space means recognizing what the space is like right now, and the reality of it for many people today. And then you've talked about some of the beautiful things you can do — about team members, team building, and culture.
On the Role of Elders and Knowledge Keepers
Dr. Mandy Buss (34:01) We had a grant for a while and had an elder and knowledge keeper — it was really amazing and helpful. Our patients really appreciated it. They had gifts that I don't have — they could help my patients in ways that I can't. We also have a social worker, physiotherapy, occupational therapy, and pharmacy. They get to use their skills to help patients so that we can work together, and so that I can do what I'm trained to do as well. But everybody on that team also has to be culturally safe for those patients, so that when they come in, they feel welcomed.
Dr. Tara Kiran (34:43) Despite the challenges, there are ways that we know we can design the system to support the people who are most in need. Some of that includes creating the time and the space for people to feel comfortable sharing and feel welcomed into a space where they traditionally haven't been welcomed.
I actually had a chance to hear from Dr. Ken [uncertain: Halwig] at the clinic. He talks about the impact that the knowledge keeper and elder had on patients and on his relationship with patients.
[Clip from Dr. Ken (uncertain: Halwig):]
"They are a part of the clinical team, right? As equals, integrated into the care. So if I had a patient who is Indigenous, I would often just casually ask: 'Did you grow up with traditional practices? Is that something you're interested in or practice currently?' And if so: 'We do have a knowledge keeper now, and a mental health worker. We also have medicines — sage and sweetgrass — to help facilitate your ceremony.'
"And it was amazing just to see the faces of our patients. People I had known for a decade or more — all of a sudden, I felt like I was seeing them for the first time. There was this palpable sense of a barrier dropping. It truly was amazing. We were just so heartbroken at the end of the funding. I was hoping that [uncertain: WRHA] would see they needed to continue this. I mean, they have it on their website — how they want to fulfill the TRC Calls to Action."
Dr. Tara Kiran (36:32) Tell me about having the knowledge keeper and elder at your clinic.
Dr. Mandy Buss (36:38) For me, it was so valuable. I remember when we were talking earlier about being in medical school and feeling very alone and unsafe. And then when we finally got a space — I think I was in my second year — we had an elder come in. It just changed how I felt in that building. I felt like there was a place I could go that was safe. I could go talk to the elder, I could smudge if I was having a bad day. Just having that warmth.
When we had that at our clinic, it started feeling like that a little bit. Then we brought on the knowledge keeper, and it was just another thing we could offer patients. Even before we had the knowledge keeper, I used to have patients all the time ask where they could access elders and knowledge keepers, or medicines, or other things. Sometimes I knew community resources, but they're limited — and it's not always open access to everyone, or people can't always get to those places.
So I think the presence of the elder and knowledge keeper really created a space that told our patients: you belong here. We're actually thinking about your ways of healing outside of the Western biomedical model. I think that creates safety.
Even though we don't have that anymore, we're still in conversations with the WRHA [Winnipeg Regional Health Authority]. I'm hopeful that in the future we'll be able to reintroduce it. I'm still in contact with our knowledge keeper, and she does want to come back to our clinic, which says a lot, I think. We're not a perfect space either — we still have growth to do — but we're trying to get there. I think having the elder and knowledge keeper also changed how our staff think about those things, even our students. It's had profound impacts that are lasting, even in their absence.
Dr. Tara Kiran (38:28) Impact on patients, but also on the service providers, the physicians, and the other Indigenous healthcare workers. I think it's worth reading out the Call to Action that really addresses the specific point you tried to address in your clinic. It says: "We call upon those who can affect change within the Canadian healthcare system to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients, in collaboration with Aboriginal healers and elders where requested by Aboriginal patients."
I have to say, I think your clinic is one of the first I've heard of where this is actually taking place. Kudos to you for your vision in making it happen. I hope you do get the funding to continue with it.
Final Reflections
Dr. Tara Kiran As we wrap up, Mandy, I wonder if there are any last reflections you'd like to share. This is a podcast for listeners who are engaged and interested in improving our primary care system. What would you want to share with them?
Dr. Mandy Buss (39:30) One thing I want to add about the elder and knowledge keeper in our clinic — because there have been other clinics that have had elders — is that I really wanted to make sure it wasn't just an elder there for patient care in a siloed way. The elder and knowledge keeper actually needs to be embedded within the clinic: as part of the faculty and team building, part of resident feedback and education, part of the meetings where we decide how we approach harm reduction and trauma-informed care, and part of patient care. So that it's woven into how we function as a clinic — not just someone in a separate room seeing patients in only one way. For it to work, it really needs to be woven into those processes. And I think that's why we have some of that lasting impact.
For other listeners generally: when you're trying to do this work — and I hope people are committed to this work — when you're starting to think about how to provide safer primary care, how to look at your clinic or yourselves, don't think about one little thing that fits into neat little pieces. Think about how it works and functions as a whole.
Think about the patient experience: How do they walk in the door? What do they see? What do they smell? What do they hear? Who do they see? How are they greeted? How does the flow work when they leave? Who do they interact with as they come through the clinic? When they leave, are they rebooking? How is the continuity? How are they engaging with other people?
Then think about what your staff know and what they need to know. How do we look at the social determinants of health, and how do we start addressing them even from our micro and meso level? And then how do we advocate for those larger systemic things as a clinic?
I think if we do that, and if we all do our little pieces, it's going to make bigger impacts in the larger system.
Dr. Tara Kiran (41:37) I love that — the whole-person approach and the whole-clinic approach to serve the whole person. Thank you, Mandy, for helping show us where it is that we need to go in this space.
Dr. Mandy Buss (41:51) [uncertain: Miigwech] for having me.
Credits
Primary Focus was created by Dr. Tara Kiran and is made possible by a grant from the St. Michael's Foundation. Maryam Danesh is our research assistant. Seema Marwaha and Emily Holton are our creative advisors. Our producer is Avery Moore Kloss.
If you'd like to read more content from Dr. Kiran about Canada's primary care system, join the Substack newsletter at primaryfocus.substack.com, or visit the website at primaryfocus.ca.
For more information on the Our Care standard and the public's vision for a better primary care system, visit ourcare.ca.
The information shared in this podcast is for educational and informational purposes only. It is not intended as medical advice and should not be used as a substitute for professional medical care, diagnosis, or treatment. Always consult with a qualified healthcare professional before making any medical decisions or changes to your health routine. Views expressed in this podcast are those of the speakers and do not necessarily reflect the views of any organizations the speakers may be affiliated with.
Side effects of listening to this podcast may include: a strong impulse to help fix the primary care crisis in Canada; a feeling of anger over how many Canadians do not have access to primary care; increased feelings of empathy toward primary care professionals who are just trying to make it work; and intermittent visions of hope that we can find a better way.