By: Kayla Cropper, Candelaria Aristizabal Londono, Lucas Fisher & Graham Beresh 

Making the links gave us the opportunity to expand our understanding of health both through theory and practice. The program works to provide us students with the information needed to understand health and health determinants within our community and well outside of it. The practical components work to reinforce the knowledge acquired through the theoretical courses. Additionally, the practical aspect of the certificate is rooted in reflective practice which not only helps to apply the theoretical knowledge, but it additionally works to further our understanding of health in our own community and in communities that differ from our own. The certificate helped to broaden our perspective on health outside of the walls of our own hospitals. It  provided us with valuable knowledge and the opportunity to live and practice in different settings. Overall, this experience helped us to develop an understanding of health that is difficult to shake and sparked a desire to give back and do better. 

In Saskatchewan, the Westmount and rural placements provided us with opportunities to engage in discussion around community needs. Our time at Westmount Community school gave us a first-hand exposure to the inequities that lower-socioeconomic neighborhoods frequently experience. One example that greatly impacted us was the lack of access to safe drinking water at the school as it was in an inner-city neighborhood that continues to use lead-galvanized pipes. Other impactful realizations were the quantity of food that students received from home and the lack of knowledge surrounding one’s health. Although the specific needs of the communities were different in our rural practicum, the struggles and lack of government support appeared to be similar. In Île-à-la-Crosse and Kawacatoose First Nation, two primarily Indigenous communities, we noticed difficulties such as limited access to healthy foods, poor access to healthcare, and gradual generational deterioration in cultural identity. Our practicums provided us with a deeper understanding of the needs of our Saskatchewan communities by learning directly from the community members through relationship-building and personal stories.  

We spent time in the classroom on theory-based lectures and readings so that when we entered a community, our experiences were guided by an understanding of the social and structural determinants of health impacting the people we were working with. We learnt about structural violence perpetuated through strategic economic development for example, and how structural neglect of the northern part of a country can translate to a North versus South health divide. This is something we recognized in Ghana, but also back home in Saskatchewan where northern communities face significant barriers to healthcare access due to factors such as poor road infrastructure. We also engaged in guided reflexive practice with our mentors during our experiences to analyze our self-position in real-time and the ways in which our presence can affect the community and our interactions within it. We will carry these lessons forward into the patient care aspects of our undergraduate medical training to better understand the experiences and perspectives of the patients we meet in our community.  

Throughout the program, we learned of the broad structural inequities that permeate the medical field. These inequities, often perpetuated unconsciously, are rooted in historical, socio-economic, and political realities of the past. On all three of our practicums, we were able to witness first-hand how some of these structural biases came to be, and how they continue to pervade the healthcare sector to this day. For example, in Ghana we had the opportunity to visit the Slave Dungeons of the Gold-Coast. On this trip, we learned of the macro-scale consequences of the trans-Atlantic slave trade, including persistent health inequities in affected groups as well as improvements in medicine as a direct result of the atrocities that occurred during this time including the transmission of communicable diseases and the pathophysiology and management of severe malnutrition. For an example closer to home, we learned of the pernicious stereotypes that are foisted on Indigenous peoples in Canada, and how our government was instrumental in creating and promulgating these stereotypes throughout our country’s history. These negative stereotypes persist until today and can often dictate how interpersonal interactions occur in our emergency rooms and hospitals. It is important for us as future healthcare practitioners to recognize our own personal biases, as well as work to dismantle those that pervade our institutions.  

This program has built a strong foundation for our personal and professional growth, and we are so grateful to have this training early on in our careers as it will inform our future practice in medicine and has empowered us by building our knowledge and skillset for social accountability and advocacy. As future physicians, we must continue to improve our cultural humility and work with the communities we serve to better represent them in our future practices.  

By: Cassie Jones
President – Gender Engagement in Medicine

This past spring the SMSS has been making changes to improve students’ groups within the College of Medicine. There was a heavy focus placed on combining student groups with aligning values. The hope with the new changes is to encourage collaboration amongst groups to come together with a larger task force to facilitate events and experiences for medical students. What was formerly Gender Engagement in Medicine, QHealth and Association of Womens Surgeons have all been amalgamated into a new group under one mission statement. The new group will now be named Gender Representation in Medicine (GRM) with a mission to provide the medical student body with an intersectional and unbiased perspective to human health with an emphasis on promoting and understanding the ways that gender, sexuality, and sexual orientation can contribute to inequities for both physicians and patients. Through a strong emphasis on education and advocacy we will build a community of medical students keenly aware of these issues with the tools they need to be change makers. [GRM] aims to support and facilitate initiatives working towards a culture of inclusivity in medicine and medical education.

Events classically held by the individual groups will be continued such as the mentorship program for female identifying medical students with women surgeons to gain valuable insight into the gendered experience within surgery. GRM will continue sexual health awareness week formally led by Gender Engagement in Medicine with highlights such as Sexual Health Trivia Night and the Sexual History Taking lunch talk classically facilitated by Dr. Clark. GRM is excited to be involved in pride festivities in the month of June including the parades in both Saskatoon and Regina.

Looking to the future Gender Representation in Medicine would like to expand on what has been done in the past. In the fall members of GEM had the opportunity to speak with political leaders at the legislature building to advocate for increased abortion access within our province. With a larger task force and new roles GRM hopes to continue to advocate for gender issues within our province. New events and missions’ medical students can look forward to this year include the distribution of gender pins to be displayed on ID badges as well as introducing new lunch talks such as ‘Parents in Medicine” and the return of the Trans Health Panel where students have the opportunity to hear the perspectives and experiences from members of the Trans Community.

Gender Representation in Medicine hopes to expand their presence to social media in the fall term to expand their reach for educational content surrounding prevalent gender issues. The group is excited for all the new changes and potential for new and exciting initiatives this year.

By: Lindsay Balezantis
Class of 2025, College of Medicine
President – Indigenous, Rural, and Remote Health Group

The Indigenous, Rural, and Remote Health Group (IRRHG) is a student organized group from the College of Medicine. We consist of passionate members who are motivated to spread awareness and advocate for changes to the barriers faced by people who live in rural and remote Saskatchewan. We are also dedicated to taking steps towards reconciliation and creating a peer-led space where Indigenous voices can be listened to and elevated to the greater community.

Foremost, IRRHG values highlighting the work of the incredible community organizations already working in the field. We have had representatives from the All Nations Healing Hospital in Fort Qu’Appelle, and Wellness Wheel Centre in Regina give guest speaker presentations to our college. These events raised awareness for programs available to those seeking culturally safe, holistic, and comprehensive care. We believe it is crucial for physicians entering the field of medicine to be aware of the variety of ways healthcare can be delivered and the community resources available to the patients they serve.

Our group helps to highlight the diverse job opportunities available for those working in rural and remote regions of Saskatchewan. We aim to provide resources for our peers who may be considering a career in these areas. We connect students with a variety of physicians working in rural and remote areas through lunch talks. We teamed up with the Artificial Intelligence in Medicine Group to give students a tour of the remote presence laboratory we have right here at the U of S. This tour and demonstration gave our colleagues a first-hand look at the incredible technology on our campus that can assist health care practitioners in delivering care in a unique and innovative way.

This fall, we organized a fundraiser for Indigenous Awareness Week, to raise money for the Saskatoon Survivors Circle. This is a group dedicated to providing opportunities and supporting those who have survived residential school. We also distributed infographics on social media to help highlight Indigenous culture and history, and the importance of reconciliation.

We collaborated with the Exercise is Medicine student group and were fortunate to welcome Tarrant Crosschild, who a Niitsitapi man from Kainai in Alberta, to share his riveting and heart-wrenching life story to Usask students. Through powerful storytelling, he exclaimed how his personal history and culture, as well as his passion for long-distance running helped him navigate his struggle with addiction. He also exclaimed the admirable work he does today, bringing employment opportunities to people living in rural and remote areas and underserved communities, as well as sharing his love for running throughout the country by organizing running clinics and races. We were honored to have one of Saskatoon’s best community engagement and reconciliation advocates speak for us.

This year upcoming spring, we are looking forward to doing research into the current state of rural healthcare in Saskatchewan and advocating to our MLAs. Saskatchewan has a strong and tight knit community, and we believe we can work together to ensure that every resident has equitable access to healthcare across the province.

For more information find the IRRHG on instagram @Wicihowin or email lindsay.balezantis@usask.ca

In honour of pride month, the Division of Social Accountability has connected with medical students Colten Molnar and Jovana Miladinovic to highlight the great work of the student groups: qHealth and Gender Equity in Medicine (GEM). Colten and Jovana provided answers to our following questions:

Q: How do qHealth and GEM focus their energy?

A: The Queer Health Interest Group (qHealth) is focused on providing opportunities for queer and ally medical students to engage in advocacy and education regarding 2SLGBTQ+ health topics. It supports and facilitates initiatives to work towards a culture of inclusivity in medicine and medical education. The landscape of advocacy is changing rapidly, and a dedicated queer health interest group is necessary to advance such advocacy work at local and national levels. We wanted a space where members of the 2SLGBTQ+ community and allies have a chance to work together to make medicine a safer and more inclusive space for our colleagues and patients.

The Gender Engagement in Medicine student group – or GEM for short – is committed to providing the medical student body with an intersectional perspective on human health. Our goal is to promote an understanding of the ways in which gender and sexuality can contribute to health inequities, and also to educate and guide medical students so that they are well-equipped to establish future practices that are safe and inclusive of all patients.

Q: What are some initiatives related to 2SLGBTQIA+ health that your groups have been involved with this year?

A: This year qHealth worked with the Provost’s Advisory Committee on Gender and Sexual Diversity to present to interested students a workshop entitled ‘Positive Spaces’. This experience gave medical learners the opportunity to develop their understanding of what a positive space is and to develop strategies for implementing these principles in clinical medicine. This workshop was relevant to learners at all levels of medical school, from pre-clerks practicing inclusive language with SPs to soon-to-be residents looking for skills specific to their patient populations of interest. qHealth was also able to secure funding for pronoun pins for CoM learners in years 1-3.

Furthermore, qHealth continues to be involved with letters of advocacy geared towards developing pronoun best practices in clinical settings and increasing visibility of providers that commit to practicing inclusivity towards 2SLGBTQIA+ people.

GEM held its annual Trans Health Panel on the Trans Day of Visibility. We invited healthcare professionals with experience working with this patient population – including a family doctor, psychiatrist, and pharmacist – as well as folks with lived experience to speak on this panel. They provided us with valuable insights regarding the health needs of trans and gender nonconforming patients, systemic barriers to accessing care, and strategies to foster safe spaces in healthcare.

Q: What were some of the takeaways from the Trans Health Panel this year?

A: We spent a lot of time discussing barriers that transgender and gender non-conforming people face in accessing care. The relative lack of family doctors in the province makes accessing primary care challenging for all patients, and patients from marginalized communities are disproportionately affected by this barrier. It is difficult to find a family doctor at all, let alone one who is affirming, knowledgeable, and well-equipped to support trans patients. Our curriculum doesn’t adequately prepare us to deal with the unique health needs of various underserved groups, including trans folks–healthcare providers must engage in their own learning to be able to provide safe, evidence-based care. Many physicians lack knowledge or experience working with this patient population, so they tend to refer their trans patients to providers with a special interest in queer health. Unfortunately, in Saskatchewan, these healthcare providers are few and far between, and their waitlists are long. As such, trans and gender non-conforming patients face a bottleneck when it comes to being able to see a doctor who can provide them with appropriate healthcare.

Access to certain gender-affirming surgeries is impeded by outdated provincial requirements. In Saskatchewan, a psychiatrist must be one of two healthcare professionals who provide patients with a referral letter for bottom surgery, which is performed in Montreal. This is not in line with (dated, soon-to-be-updated!) guidelines from The World Professional Association for Transgender Health, which only specify the need for a “qualified mental health professional” to be involved. This requirement further exacerbates trans patients’ difficulties in accessing gender-affirming care, especially given our shortage of psychiatrists. Additionally, while the surgery itself is covered, the costs of travel and accommodation aren’t, nor are the costs associated with bringing a support person. Once again, this contributes to health inequity by placing affirming care further out of reach, especially for patients at the intersection of multiple oppressions.

Q: In the spirit of pride, what can we all do going forward to truly make a difference for 2SLGBTQIA+ patients?

A: If you’ve made it to this point in the blog you are already off to a great start! Through our collective experiences as queer students, patients, and allies, we feel that the single change that anyone can make with the biggest impact is to begin educating themselves.

We challenge you to explore the resources available through the USask Library Guide at https://libguides.usask.ca/c.php?g=706788&p=5030005 and to begin conversations with colleagues about how you can contribute to the betterment of care for 2SLGBTQIA+ patients.

If you are a medical student, please consider joining us in a weekly summer book club run by the Canadian Queer Medical Students Association to spend some time discussing 2SLGBTQ+ health and the ways in which current systems can be reimagined to be more effective, safe, and joyful. The book club runs on Thursdays in June and July – you can find more details here https://twitter.com/CQMSA_National/status/1527420113091280919?s=20&t=EmWnGrYNWcwjU4Nli0GeXg

Lastly, join GEM, QHealth, and the 2SLGBTQIA+ Mentorship group in Saskatoon as we walk in this year’s pride parade on June 18th! Last year GEM was able to participate virtually https://youtu.be/Duiy5KCpLlw?t=6097 and this year we look forward to walking together with our CoM family as a tangible representation of our commitment to bettering care for our 2SLGBTQIA+ patients. For more info on the parade please reach out to us at qHealthSK@gmail.com.

For the month of May 2022, medical students from the SHIRP student group were our guest bloggers. Students Ryan Krochak, Anthony Kanz, Baljit Pandher, Sarah Valentine, Adrian Teare, Lauren Ritchie, Erin White and Adam Wandzura share with us the importance of harm reduction in Saskatchewan and the specific health advocacy efforts of SHIRP. You can find more about SHIRP  on Facebook (USask Students for Harm Reduction and Informed Policy), Instagram (@SHRIP_Sk), or by email (SHRIP.USask@gmail.com ).

Why is Harm Reduction Necessary in Saskatchewan?

The term harm reduction encompasses a range of health and social services that are rooted in respect and dignity. These services aim to minimize the negative consequences associated with substance use through non-judgemental and non-coercive methods. Harm reduction strategies offer an opportunity to keep people alive, provide support, and encourage positive change. Some examples of harm reduction include safe consumption sites, needle exchange programs, and drug testing strips.

In recent years, overdose fatalities have dramatically increased in Saskatchewan. The primary drugs driving the overdose crisis in Saskatchewan are opioids and methamphetamines.^1,2 Notably, fentanyl has heavily permeated the drug supply within Canada. With Fentanyl being 30-50x more potent than heroin, even very small variabilities of fentanyl in a sample of drugs can have lethal effects.³ According to the most recent report released by the Saskatchewan Coroners Service, there were 446 suspected overdose deaths in 2021, representing a 39% increase from 2020 and a 390% increase from the 2010-2015 average.⁴ It should be noted that there have been zero overdose fatalities at safe consumption sites within the province.⁵

As this overdose crisis continues to grow, clinicians in all medical care disciplines are increasingly confronted with the infectious complications of substance use. Currently, Saskatchewan has the highest rate of HIV and second highest rate of Hepatitis C in Canada.^6,7 The Saskatchewan Ministry of Health has identified that injection drug use (IDU) is the primary driving force behind the province’s HIV and Hep C epidemics.^6,8 It is estimated that 67% of new HIV diagnoses and 52-61% of new Hep C infections in Saskatchewan are transmitted via IDU.

The Start of SHRIP

Harm reduction is a topic close to the hearts of many students in the College of Medicine. Yet, when the members of the class of 2024, who are passionate about this topic, began their search for student interest groups to join, there was nothing to be found. A small group of then-first-year students – Anthony Kanz, Baljit Pandher, Sarah Valentine, Adrian Teare, and Lauren Ritchie – gathered around a kitchen table and expressed their desire to do something to address the situation. From these humble beginnings, Students for Harm Reduction and Informed Policy (SHRIP) was born. They set out with a mission to advocate for patient-centered approaches toward substance use with a focus on providing education and creating conversation about harm reduction, drug policy, and community advocacy.

Since SHRIP’s inception, our group has made every effort to advocate for underserved populations, and provide awareness and education on the benefits of harm reduction. With a very grassroots approach, we sought to collaborate with community members and organizations whenever possible to develop a network of experts around us who we could learn from and support as they worked toward making meaningful change. We have learned so much from those who have been working tirelessly on the front lines serving people who use substances and feel honoured to be included in this community of support.

Our group’s origin story is very much one of not having a concrete plan, but instead having the unbridled passion of our group members (plus the extraordinary good fortune of being welcomed in by the experts in this community) led us to a variety of wonderful endeavours and learning experiences.

The main goals of SHRIP are to advocate for evidence-based harm reduction policies, to collaborate and support community-based organizations, and provide education on harm reduction principles.

The Current State of SHRIP

Today, the main goals of SHRIP remain unchanged, though the size of the group and the scope of our operations have greatly evolved. SHRIP has become the largest SMSS ratified student group and to best utilize our large team and maximize engagement, we are split into four separate task forces.

The Community Engagement task force is responsible for developing relationships with local organizations and community members. We aspire to learn about our community-based organizations and determine the best ways to support them – whether that is through volunteering, fundraising, or collecting donations of physical goods such as winter clothing, diapers, or food.

The Events task force is responsible for raising awareness of harm reduction principles amongst our colleagues both in the College of Medicine and in other professional health colleges at USask. For example, our events taskforce has planned harm reduction trivia nights, naloxone kit distribution and training, and educational talks such as trauma-informed care, substance use amongst physicians, and psychedelics in medicine.

The Policy task force is responsible for advocating for evidence-based harm reduction in Saskatchewan and beyond. We aspire to use our platform to raise community awareness, create dialogue, and make change. Prior to the 2022-23 Government of Saskatchewan budget release, SHRIP had the opportunity to be honoured guests of the official opposition and attend question period at the Saskatchewan legislature. We were very fortunate that the Minister of Health and the Minister of Mental Health and Addictions offered to meet and discuss why safe consumption sites are necessary in Saskatchewan. In response to the Government of Saskatchewan’s decision not to publicly fund safe consumption sites, SHRIP penned an open letter that highlighted the humanitarian and economic benefits of safe consumption sites. Our open letter received support from many professional health organizations such as the Canadian Medical Association, Saskatchewan Medical Association, Saskatchewan Union of Nurses, Saskatchewan Association of Social Workers, and many others.

The Social Media task force is responsible for educating the broader community on the importance of harm reduction, sharing the work of other local harm reduction advocates and community-based organizations, and highlighting the great work that people in our student group are doing. Notably, our social media team organizes and shares a weekly “Lit Blitz” in which one of our group members critically analyzes peer-reviewed literature and summarizes the information so that it is more accessible for the public. Topics have ranged from examining the link between housing and harm reduction to how nutrition and food security are essential components of harm reduction.

Harm reduction saves lives. Our group and the organizations/individuals we have been fortunate enough to work alongside know this to be true, and it remains our mission to spread this message as widely as possible. We are incredibly excited for another year of peer education on harm reduction, supporting community-based organizations, and advocating for evidence-based policy change. If you are interested in keeping up with our operations and initiatives, you can connect with us on Facebook (USask Students for Harm Reduction and Informed Policy), Instagram (@SHRIP_Sk), or by email (SHRIP.USask@gmail.com ).

References:

1. Saskatchewan Coroners Service. Confirmed and Suspected Drug Toxicity Deaths (2010 – 2015) [Internet]. Government of Saskatchewan. [cited 2022 Mar 20]. Available from: https://publications.saskatchewan.ca/#/products/116473
2. Martell C. Meth takes up 10x larger share of addiction treatment in Sask. than five years ago. CBC News [Internet]. 2019 May 8 [cited 2022 Mar 26]; Available from: https://www.cbc.ca/news/canada/saskatchewan/sask-meth-10x-increase-in-treatment-share-1.5127570
3. Government of Canada. Fentanyl [Internet]. Government of Canada. Available from: https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs/fentanyl.html
4. Di Donato N. “It’s right across the board’: Sask. reports record number of overdose deaths in 2021 [Internet]. CTV News. 2022 [cited 2022 Mar 26]. Available from: https://saskatoon.ctvnews.ca/it-s-right-across-the-board-sask-reports-record-number-of-overdose-deaths-in-2021-1.573800 0
5. Simmonds E-M. PHR executive director responds after safe consumption services denied by provincial funding [Internet]. Global News. 2022 [cited 2022 Mar 26]. Available from: https://globalnews.ca/news/8708461/phr-executive-director-safe-consumption-services-provincial-funding/
6. Saskatchewan.ca. HIV & AIDS in Saskatchewan (2019). Government of Saskatchewan;
7. Public Health Agency of Canada. Hepatitis C in Canada: 2019 surveillance data [Internet]. Government of Canada. [cited 2022 Mar 26]. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hepatitis-c-2019-surveillance-data.html
8. Hepatitis C in Saskatchewan (2017). Government of Saskatchewan; 2017. Available from: Saskatchewan.ca

Dear College of Medicine community,

I hope that you are hanging in there at the end of this harsh Winter.

On January 23rd, a woman named Kimberly Squirrell froze to death on the streets of Saskatoon, only 3 days after being released from the Pine Grove correctional centre. Added to the grief of losing a loved and valuable member of our community, I have been outraged reading comments that continue to blame Indigenous women for the violence they suffer. Comments that continue to attribute poverty and marginalization to lack of “work ethic” or the “right morals”. Comments that judge Indigenous women for their “bad choices” by people who have never encountered discrimination, barriers, harmful stereotypes. Racism determines not only the quality of life and health for Indigenous people in our province, but also the quality of care that one will receive. Racism will determine if you are perceived as a citizen deserving of rights, protection, and care, or someone who is disposable. The death of Kimberly Squirrell is unacceptable and outrageous because it was preventable. Because it shows how little our systems value the lives of Indigenous women. Racism is a health crisis, and it is no longer acceptable.

The DSA is one of the actors trying to push for transformation and real change in the College of Medicine, but not the only ones. I want to honor and acknowledge the efforts of our Black, Indigenous and people of color faculty, staff and students who everyday overcome the racism of the University to be leaders, advocates, and mentors. If you are striving to be an ally too, we invite you to engage with the many anti-racism initiatives happening across the CoM including our upcoming webinar in the Health and Equity Series: Making Systems Accountable “Patterns of White Dominance in Health Care” by Sharissa Hankte (RN).

Health and Racism News:

Social SharingFederal, provincial officials discuss ways to counter anti-Indigenous racism in health care

Federal, provincial officials discuss ways to counter anti-Indigenous racism in health care

Sask.’s decision to end widely criticized practice of birth alerts doesn’t go far enough: experts

Indigenous People lack access to health care because of systemic racism report says

Workers tasked with tackling anti-Indigenous racism say they faced scapegoating and ‘backlash’ at Island Health

Haisla family sues doctors, hospitals, health authority in B.C.

Tackle lack of basic health care for Indigenous peoples, then worry about racism, Nunavut’s MP says

Opinion pieces:

Canadian complacency is the killer of collective change

Racism in province continues to show through inaction

When will we all start giving a damn about Indigenous lives?

Sen. Murray Sinclair urges Canadians to reckon with systemic racism

Warm regards,

Manuela Valle-Castro, PhD (she/her, they/them)
Director, Division of Social Accountability
College of Medicine
University of Saskatchewan

I acknowledge that I live and work on Treaty 6, the traditional territories of the Nêhiyawak, Nahkawe, Dakota, Lakota, Dene and Homeland of the Metis peoples.

By: Carlyn Seguin – Global Health Manager – Division of Social Accountability

Making the links is a unique certificate program for undergraduate medical students at the University of Saskatchewan, which is operated by the Division of Social Accountability and the Department of Community Health and Epidemiology. which MTL exposes the students to health issues in the context of an urban underserved community in Saskatoon or Regina, rural/remote and Indigenous communities in Saskatchewan and international communities globally.

The overall goal of this certificate program is to “improve the health of the community through socially accountable universities and professionals”. This program introduces students to complex and diverse settings and offers students opportunities to hone and apply the skills they have learned which are required under the CanMEDS framework to be a competent physician.

Summer practicums located in partner communities after the first and second year of the program are foundational opportunities to have practical experiences. The updated learning objectives are:

1. Identify principles of and compare approaches to community advocacy
2. Apply basic principles of leadership and collaboration in implementing community advocacy initiatives
3. Apply the principles of patience, humility, and partnership  in working with peers and within community
4. Describe challenges faced by organizations providing care and services during the COVID-19 pandemic and ongoing responses
5. Apply theoretical classroom learning on health inequities within resource constrained settings
6. Explain historical influences on contemporary health inequities / issues
7. Analyze how power and oppression operate interpersonally and structurally and locate themselves in such dynamics

With the challenges of engaging with communities for practicum experiences during COVID, we needed to pivot how students and their practicums hosts interacted. We expanded our net to include organizations whose mandate is focused on advocacy in health and health equity, with the ability for virtual engagement, we were able to partner with several new organizations! This included the Decent work and Health Network, the Peoples Health Network and the Saskatoon Interagency Response to COVID-19. This was in addition to 3 of our continued Indigenous community partners throughout Saskatchewan.

We shifted the content expectations of the program to better support the priorities of our partners and the practicum activities and outcomes were directed by the community/organization. Based on student reflections and evaluations of their 6-week summer practicums, this shift, paired with updated course materials was conducive to achieving the course objectives! We will be continuing to evaluate learning outcomes as well as those of the communities in the coming months to better integrate the learnings into future program planning, content and engagement strategies.

Stay tuned as we continue to report and share our learnings!

By: Jessica Froelich, 2nd Year Medical Student

This summer, myself and some colleagues made the long drive north to Dillon, Sask. as part of the College of Medicine’s Making the Links. The program prepares students for work in underserved communities and involves course-based learning, volunteering at an inner-city health clinic, and practicums in rural Indigenous communities and abroad.

Dillon is situated on Treaty 10 and the reserve territory of Buffalo River Dene Nation. Every Wednesday one or two doctors from Île-à-la-Crosse fly in to Dillon to provide patient care. They allowed us to shadow them in clinic so we could learn some of the delights and challenges of being a rural generalist.

After successfully completing my Year 1 OSCE, it was exciting to practice some new skills in a clinical setting. I was grateful for every chance to look in a new patient’s throat or listen to their heart beat. The doctors do their best to ensure people can get much of the care they need in Dillon or surrounding areas, by adapting to the needs of the community and focusing their skills on what is needed most. However, many residents must journey more than 5 hours to Saskatoon to receive the care or procedures they need. Though my learning time in the clinic was a good refresher in the knowledge I had been immersed in throughout the past year, it was the community endeavours that really helped me begin to understand what health and healing looked like in a community such as Dillon. Here, a lot of healing happens outside the white walls of the health clinic.

As student visitors, we were warmly embraced by many community members: our host family Martha, Warren, and their two teenage daughters, James a community elder, and the staff and nurses at the Buffalo River Health Centre. I presented on various health topics to the school children and hosted community events for them to attend. I went duck egg hunting, quadding along the river, participated in Treaty Days, met with Chief and Council, played bingo, fished, cut up a moose, and attended some sweats. I ate all of the bannock, fried fish, and moose stew that my belly could hold. Martha even taught me how to make her special bannock recipe.

Thus far, many of my greatest learning experiences in medicine have not been in the classroom or the clinic, but from participating in community. Early morning coffee with Martha and late-night bonfires with James led to discussions about what health and healing meant to them.  “Our community doesn’t have time to heal before there is another tragedy. We can’t start healing because there is always something else that happens too soon after,” Martha once told me. Dillon is a community that has faced a lot of colonial trauma and ignoring that would not do justice to the growth and resilience of these people. “Every house here has a story like that,” she said. The resiliency and love within this community is the basis for healing from historical and ongoing trauma which has drastically impacted the health of these residents.

My time in Dillon had me reflecting on social accountability in medicine more than any lecture or course-based material ever had. I had begun to develop meaningful relationships and feel a sense of solidarity with this community. To practice medicine in a community such as Dillon, understanding what was important to them and where healing came from is as important as any other clinical skill. It means not only learning to understand what is most important to the patients you are seeing, but what their everyday lives encompass and what is integral to their very being. I have no doubt that the lessons I have learned here will be treasured throughout my career in medicine. I understand the importance of knowing the community one is working within and that healing and medicine come at many times and in many forms.

University of Saskatchewan – Making the Links

Cultural Immersion Exchange Program

November – December 2018

Written By: Maddy Brown

Unlike my travelling companion Mac, my knowledge of English literature is fairly limited, and moulded by the great philosophers and authors studied in my Year 12 English class.

However, when reflecting on my month long rural medical placement throughout Saskatchewan, my favourite Year 12 philosopher, Alain de Botton, once again, pulled through with the goods. In his text Art of Travel, de Botton suggested that, “journeys are the midwives of thought…” Indeed, my experiences in Saskatchewan gave birth to new insights into the multitude of factors that contribute to the health status of Canada’s Indigenous people, whilst challenging my understanding of healthcare in my own country.

Throughout our two weeks in Saskatoon, Mac and I were warmly welcomed by the University of Saskatchewan community. Under the guidance of Carlyn, Val and Cal, we were offered insights into the cultural and spiritual beliefs of Canada’s First Nations and Metis People, as well as the emotional, physical, mental and spiritual trauma that continues to influence the inequalities experienced by these people, even to this day. Whilst it is hard to pinpoint a single highlight of our time in Saskatoon, my thanks go out to Bob Badger and his family at the Kawacatoose Reserve. The Badger family humbly welcomed Mac and I into their home to participate in a traditional Sweatlodge Ceremony and feast – an experience I will never forget. Bob’s willingness to share his knowledge and wisdom is a testament to the resilience of his people, and the strength of culture in overcoming enormous adversity.

Our opportunities to learn were countless in Saskatoon. Some of the most valuable experiences included those at the SWITCH Clinic and Station 20 West, both of which humanised the social determinants of health. I was humbled by the generosity of all of those who welcomed Mac and I into their workplaces. For me, their attitudes towards their work, and those they are working with, was just as inspiring as the actual work itself, and one of the greatest lessons I took from my Saskatchewan experience was the power of their empathy and humility.

On our great journey through Saskatchewan, Mac and I were privileged to experience the diversity of rural medicine in a number of settings, many of which I had never previously experienced. In Fort Qu’apelle, the All Nations’ Healing Hospital provided an exempla model of the fusion of western and traditional medicine in the management of renal dialysis – a major health issue amongst Indigenous communities of both Canada and Australia. The Needle Exchange program delivered out of Access Place in Prince Albert modelled the role of harm reduction strategies in community health and infectious disease control, whilst the centre itself emphasised the importance of opportunistic care in helping society’s most vulnerable members.

One of the highlights of my Saskatchewan adventure was the ten days spent in the northern village of Ile-A-La-Crosse. Amongst ice fishing, cross country skiing, sledding, ice hockey and northern light chasing, we were privy to some inspirational rural medicine, driven by the team of doctors at Ile-A-La-Crosse hospital. Here, we saw the medical staff live and breathe their community; a huge investment that bred a deep respect and rapport amongst those they were serving,. Their dedication to ensure the best outcomes for their patients, despite enormous geographical isolation and support, was inspiring.

My journey through Saskatchewan was life changing in the way in which in re-birthed my perspective of rural medicine. However, the lessons I learnt and the connections I made are an attribution to those who so humbly shared their knowledge, expertise, experiences and homes with both Mac and myself. My thanks goes to Carlyn, Val and Cal at the University of Saskatchewan for the time and generosity they invested in organising this wonderful experiences. Thank you also to the much respected Dr Tom Smith-Windsor for his generosity in hosting Mac and I, and sharing his passion for rural medicine. Thank you also to Sharon Favel and the entire Ile-A-La-Crosse community, including Darcey and Reid McGonigle for making the very cold Ile-A-La-Crosse such a warm and welcoming place.

Hosting Mozambican Medical Students in Saskatoon

On Sept 10^th 2018, Sara Cassambai and Victor Muansinar arrived in Saskatoon after a long, two day journey from Mozambique to spend a month in Saskatoon to learn about the Canadian health care system through a medical observership. Several physicians graciously supervised the students to observe practice in labour and delivery, pediatrics (emergency, inpatient and outpatients), surgery, respiratory services, general practice and the REACH Refugee Health clinic.  Sara and Victor also were able to volunteer their time at the SWITCH clinic and the Saskatoon Food Bank, and were able to tour the Wanuskewin Heritage site with first year medical students.  Our medical students Nick, Kristina and Gabi  generously provided their time as “buddies” to Sara and Victor to show them around Saskatoon, go out for supper and bring them to a few of their classes. A special thanks to Dr. Ron Siemens for hosting these students in his home.

The observership was funded by the Division of Social Accountability to provide a reciprocal exchange opportunity to pay forward the opportunity available to U of S students hosted each year in Mozambique as part of the Making the Links –Certificate in Global Health Certificate.

Sara and Victor left a lasting impression with their big smiles, gentle demeanor, humble appreciation and openness to learn and experience all they could while here. Sara and Victor are due to graduate from the medical degree program at Lúrio University in 2019.

Below are Victor and Sara’s responses to questions about their experience in Saskatoon:

What was your first impression of Saskatoon?

“The biggest highlight of our exchange was the people – Canada certainly makes the stereotype of being the friendliest country in the world. When we landed soon on the way to the residence where we would be hosted, the first thing I learned was Saskatoon is called “the land of living skies.” Today I have a new concept and I am proud to call “Saskatoon the land of good people”.

What have you liked best?

“We lack words to describe what we like most, because it was an exchange with expectations exceeded. Working on community services in Saskatoon bank food and on the SWITCH showed us a different view, college teaches the art of healing but in community service we learned the most beautiful art of life, the love for the next. The SWITCH is a very interesting program [where] we saw students with high social status learn from the lower social class and vice versa. During the four weeks we gained enough knowledge and important things that we could describe each of them in a separate blog. But we will talk about the 3 essential important things though they all were: Community clinic and REACH; Wanuskewin heritage park and [our] accommodation”.

What was the hardest adjustment?

“The climate in Mozambique is tropical and a summer with maximum temperatures of 37 to 41^oCelsius degrees, with very cold water and the lighter shirts of our closets we faced the heat suffocated, without notion of the summer that awaited us on the other side of the pearl of the world. To adjust to a summer [in Saskatoon] with temperatures that varied between -3 to 7^OC, it was quite difficult. From the cold summer the wise nature showed us in our most difficult setting one of the most wonderful days for us when it snowed for two days, [it] was a very beautiful experience because it was the first time we saw it snowing”.

What was your favorite experience here?

“Our favorite experience was to meet people who even with the language barrier were always willing to pass on knowledge about medical practice and we have no words to express our greatest gratitude”.

“We wondered how much a SWITCH program would be important in our province and convey our greater experience of this exchange to other students in order to help the neediest. Working on SWITCH was the most favorite experience for us, “a man does not change the world but can make the difference” this was the concept we learned in SWITCH”.

What are the biggest differences between the health care system in Canada and the health care system in Mozambique?

“The Canada Health System shares similarities with the Mozambican System because they are divided from primary health care to quaternary care. The major difference lies in the fact that the Canadian systems are built around the principle of equity in which all citizens receive the necessary medical and hospital services (universality) and are treated in the same way (equity) and also by investing more in primary health care, which is not the case in Mozambique where the investments are centered at the quaternary level. We feel honored and privileged to have the opportunity to explore the other side of the world quite different from Mozambique”.

Our greatest gratitude goes to everyone who made this exchange possible. Words are missing to describe our appreciation of gratitude”.