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”.

Understandings of Colonization on Indigenous Health

For the Canadians reading this, The Ashes is a series of five, five-day cricket matches between Australia and England played roughly every two years. Like hockey to Canadians, cricket is something most Aussies do not take lightly and the thought of missing even one game due to the time zone differences made me feel pretty anxious. The google search came back with some disheartening news… I would be away for 4 of the 5 games in the series and they wouldn’t start until 10pm Canadian time. Crushed and defeated, I tried my best to put on a brave face and conjure up a plan to solve the issue at hand. The solution was a surprisingly easy one. What followed were some late bedtimes and early starts in order to satisfy my cricketing needs.  Despite being exhausted some mornings, the excitement of training to be a doctor in another country and learning so much about an entirely new culture made getting out of bed an easy decision.

My first of many lessons in Canada took place over breakfast on day one of placement with Beth (fellow JCU student). Jet-lagged but filled of excitement and curiosity, we bombarded Val Arnault (UoS Medicine, Aboriginal Coordinator) and Bob Badger (UoS, Cultural Coordinator) with questions, transforming our breakfast into a spontaneous lecture on the indigenous history of Canada. We were immediately blown away by the parallels when compared to Australia’s history and it was something that continued to fascinate us over our month spent in Canada.

It’s a very similar story really… colonialism almost destroying an indigenous population through stripping them of their land, culture and family with no consideration for the repercussions. The aftermath involves unfathomable rates of diabetes, obesity and mental illnesses in indigenous communities, incomparable to the rest of the population. The parallels continue, with both populations having near identical alarming incarceration rates – in Australia, the 3% of the population who identify as Aboriginal or Torres Strait Islanders make up 27% of those in prison compared to Canada’s indigenous people making up 4% of the population and 25% of its prison population. Being able to witness the living standards on reserves through assisting Nurses with home visits while on placement was also a real eye opener to how similar living conditions are to those I’ve witnessed in indigenous communities in Australia (such as in Woorabinda).

These populations have come to have such similar circumstances following a series of near identical events inflicted upon them by their respective governments, including having children forcibly removed from their families. Over 150,000 Canadian aboriginal children were placed in residential schools between the late 19^th and early 20^th century. Residential schools were designed by the Canadian government with the purpose of removing children from the influence of their own culture and assimilating them into the dominant Canadian culture. I was lucky enough to sit in on a lecture during a “Making the Links” class from a man whose mother had endured the turmoil of the residential school system. He discussed the effects that the system had on her years later and how it impacted his own upbringing with her lacking any traditional template of how to be a “parent”. Rather than reading it out of a textbook, the opportunity to hear a story first-hand had a significant impact on me in recognising how events that occurred almost 100 years ago still continue to have an effect today.

Throughout a similar time period to Canada’s residential schools, Australia’s “stolen generation” saw roughly 11,000 Australian aboriginal children removed from their families to be placed with non-Indigenous families or in missions. Given the years of psychological, physical and sexual abuse; dire living conditions and rejection of indigenous culture that occurred in these institutions and residential schools, there’s no wonder why problems continue to prevail years later.

All in all, I was continually reminded each day throughout my placement how similar Australia and Canada’s indigenous populations’ really are despite being situated on the other side of the world. The experiences I had throughout my month in Saskatchewan are something I know I’ll treasure looking back on and I’d be more than happy to miss the cricket a hundred times over to do it all again!

Dr. Josh Lawson (Faculty, Canadian Centre for Health and Safety in Agriculture) describes how a Division of Social Accountability Global Health Travel Award helped him research Childhood Asthma in Poland.

 This past spring your research into childhood asthma brought you to Poland. Why Poland?

My original involvement with this research and education program started about 7-8 years ago. The project lead, Jan Zejda, completed a post-doc in Saskatoon at the Centre for Agricultural Medicine (now CCHSA) in 1989-91. Following this work, he went back to Poland and built an incredible career based on both clinical and academic work. In the 2000s, he started the Department of Epidemiology at the Medical University of Silesia. As part of this he wanted to establish a strong research program and use CCHSA as a bit of a model. In about 2008-9 he was bringing together colleagues from Belarus and Ukraine to investigate childhood asthma in the region. In order to build research capacity and aid in the investigation, he went back to CCHSA to ask for some support. Dr. Donna Rennie and I were invited to participate in the research program as advisors so we visited Poland to meet the team and see what we could do to help.

How did immersing yourself in a new culture have an impact on your research?

It has been a learning experience that has allowed me to watch and learn how asthma is thought of and approached and to see similarities with what was happening in Canada several years ago. In addition, it has allowed me to have a much larger understanding of the political, economic and clinical factors that affect asthma. It has become clear that differences in asthma prevalence and morbidity go beyond environmental reasons. We have learned a lot and brought some of the ideas and things we have learned home to investigate in a Canadian setting. Traveling and interacting with these other scientists help shape our ideas and stimulate research questions or direction.

What was it like to learn and work with your Polish Colleagues?

It has been an outstanding experience. We have been able to develop strong professional ties but have also become close friends. We keep in communication often about potential research and providing assistance but also advice personally. This has occurred with several colleagues from within our international network. In my career, the thing that has helped me most is having incredible mentors. Watching and working with my colleagues in a region where there is a lot of political difference and seeing how this is negotiated has been very educational. It has also allowed me to see the problems that occur in countries with little research capacity or funding. It has also allowed me to see some of the similarities and how good science knows no borders.

What were some of the most striking things you took away from that experience?

Specific to the research program, I was amazed at the amount of potential asthma under-diagnosis and some of the reasons why, which were partly based on traditional labeling practices within the region as well as some political or system reasons. Learning about these issues has influenced some of the research we have conducted in Saskatchewan as we look at reasons other than environmental to explain geographic differences in asthma prevalence.  From a more personal perspective, it was very interesting to see some of the differences in culture and lifestyle, especially from an academic perspective and the differences in the expectations, system, and ability to conduct research.

Why should people either students, residents, faculty or staff consider applying for a Global Health Travel Award?

I believe that experience is the key to learning and development whether it is personal or career focused. This includes working with people from different regions and perspectives. The international experience can open your eyes through experiences that you would not be able to have at home. Whether the program is research, education, clinical, etc., at minimum the participant will walk away with an adjusted or new perspective. These experiences may also alter a person’s career path or focus. While the person completing the travel will be able to learn and develop, hopefully most of these experiences allow that person to have a positive impact on the group or community in which they are working as well.

The Spring Global Health Travel Award Deadline is March 15^th, 2018!

Come to our First Annual Global Health Networking Event on March 7th 2018.
EVERYONE IS WELCOME!

For more information and to apply visit:
Global Health Travel Awards 2018

The winter in Australia’s north is mild, to say the least. If the temperature drops below 20 degrees, North Queenslanders like me shiver, pulling out the one long sleeve t-shirt we own from the depths of our closets, before braving the biting cold weather. We immediately regret this decision when the temperature spikes back to 27 degrees by midday, and a few weeks like this pretty much comprises the extent of our winter.

So when I learned I’d be undertaking a four week community placement in Saskatchewan, along with my fellow medical student Keane, I really had no idea what I was in for. It was certainly cold – a welcoming minus 24 degrees on the day of our arrival in Saskatoon. However, what I quickly learned was that the weather was far from the most extraordinary thing about this wonderful country.

The highlight of my placement was the people – Canada certainly lives up to its stereotype of being the friendliest country in the world. From the kind man who helped a confused Keane and me locate a supermarket, to the wonderful staff of the university who helped make our trip comfortable and interesting, we were constantly amazed by how genuinely friendly everyone in this country seems to be. One day we were in a bakery (enjoying some delicious Canadian donuts, which I could easily write a separate blog post about) and a man happened to hear our accents. He then sat down with us for half an hour and told us of his Australian travel adventures, before inviting us out to have a cup of coffee with him again. Moments like these made us feel truly welcome and at home, despite home being on the other side of the planet.

Amongst the most welcoming of all were Indigenous Canadians, who taught us about their culture and kindly allowed us to share in their experiences and traditions. We were invited to participate in various smudge ceremonies, feasts and even on one occasion a sweat ceremony. The sweat was an experience that particularly resonated with Keane and I – not only was it spiritually healing and insightful, but Canada suddenly became both the coldest and the hottest place either of us had ever been.

Travelling north, we were amazed by the frozen lakes and the Northern Lights, and I fell in love with looking at snowflakes. We were lucky enough to enjoy some moose meat in Ile a La Crosse, freshly caught by a local elder, and I saw the winter landscape from above as a travelled in a light plane to the Indigenous reserve of Patuanak. We learned to skin a muskrat, light a fire in the snow and that sometimes it’s okay to drive a truck across ice. The North was one of the most beautiful places I’ve ever seen, and I enjoyed being part of a small community with such tight-knit residents, even if only for a short time.

Our placement, and particularly our time in the North, also taught us about the historical mistreatment and ongoing hardships of Indigenous Canadians. Acknowledging these, as well as the steps being taken towards reconciliation, became an important focus of our placement. Listening to the stories of people affected by a history of marginalisation and discrimination, as well as their hopes for the future, highlighted the important role that health professionals play moving forward. I learned that health means different things to different people, and for many includes spirituality and community at its forefront, so integrating this into medical care is essential. This is a lesson that will be very applicable for me at home, where our Indigenous people share many parallels to those of Canada.

I feel so privileged to have had the opportunity to explore a part of the world so different to my own. Placement overseas really highlights that regardless of geographical distance, we face similar issues and challenges and have a lot we can learn from one another. Now I’ve left Canada, and as I sit here at home, sweating in the Australian summer, I find myself missing seeing the snow pile up outside my window and I know that some day I’ll be back.

By Erin Wolfson, Community Engagement Specialist, Division of Social Accountability, College of Medicine, University of Saskatchewan  

This post is taken from “The Law Sourcery” blog which was posted on October 19th 2017. Click here to see the original post.

The College of Medicine was delighted to be a part of the Second Annual Saskatchewan Access to Justice Week! On October 18^th, 2017 at noon in the College of Law, we had the pleasure of co-coordinating the lecture, Expanding Engagement: Creating Connections Between Delivery of Justice and Health Service, delivered by Michelle Leering, Executive Director of the Community Advocacy and Legal Centre in Belleville, Ontario. Michelle spoke about the promise of justice and health partnerships, and the vital role justice and health partnerships have to play in increasing access to justice in Saskatchewan. As Michelle described, justice and health partnerships have emerged as a holistic and proactive approach to address intersecting health and justice issues, the social determinants of health and health disparities in communities. While such partnerships are commonly seen in the United States and Australia, justice and health partnerships are only just beginning to appear in Canada, with one excellent example being the Rural Justice and Health Partnerships Project founded by Michelle in Ontario.

The lecture helped to continue the dialogue that began at the College of Law’s Dean’s Forum on Access to Justice and Dispute Resolution in March of this year. On March 1^st, 2017, the College of Law hosted their Fifth Annual Dean’s Forum on Access to Justice and Dispute Resolution. Again, the College of Medicine participated as one of the topics centered on expanding engagement between justice and health services here in Saskatchewan. Three common themes arose during the meeting: (i) the focus of all collaborations should be benefits to patients or clients; (ii) more research must be done regarding all connections between health and justice and the types of collaborations best able to serve patients and clients; and (iii) the interdisciplinary education of students and active professionals should be prioritized. The group also identified key goals/principles and options for steps moving forward, which can be viewed here.

We hope to continue the collaboration between the College of Medicine and the College of Law with events in the future and would like to extend a special thanks to the 60 + people in attendance from both justice and health sectors – faculty, practitioners, students and administrators. We look forward to what we might see in terms of future interdisciplinary and interprofessional collaborations here in Saskatchewan. We hope this is just the beginning and look forward to many more conversations to come.

This lecture was made possible by the Office of the Vice-President Research Visiting Lecture Fund at the University of Saskatchewan, with support from CREATE Justice, and the Division of Social Accountability, College of Medicine.

What is social accountability, and how does it translate into the activities of the College of Medicine?
Written by Lisa Yeo, Division of Social Accountability Strategist, U of S

The Division of Social Accountability, CoM was established in 2011 to promote and support the college’s social accountability promise – a promise to direct its Clinical, Advocacy, Research and Education (CARE Model) activities towards the priority health needs of the communities we serve. We see this promise reflected in the 2017-2022 College of Medicine Strategic Plan and mission statement of our college. It’s a promise to address community health needs, but it’s also much more than that.

The definition of social accountability came out of the World Health Organization in 1995 and states that social accountability is “the obligation [of medical schools] to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public.” But what does that really mean and how does it translate into the activities of the CoM? What values and philosophy are we upholding by being socially accountable?

For us, social accountability is about health equity. It’s about access to quality healthcare for all people and it’s about meeting the unique needs of underserved populations. It’s about engaging with and being responsive to the issues our communities face and recognizing that we—as a College of Medicine, as current and future clinicians, researchers, health educators and administrators—are but one part of the complex condition that is health. Improving health is tantamount to working together in partnership with policy makers, health care organizations, health professionals and communities to create a sustainable and equitable health care system. It’s about humbly acknowledging the limitations of our clinical work, and appreciating that major and pervasive factors that contribute to the wellness and ill-health of Canadians  often lie far beyond the walls of the hospital or the clinic.

Translated into our world of medical education, social accountability is about ensuring that our graduates are adequately prepared to respond to the diverse and ever-changing health needs of the population. It is producing a physician workforce that is diverse in dimensions such as ethnicity and religion, gender and sexual orientation, geographic origin, socioeconomic status, etc., by attracting an applicant base (both student and faculty) that is more representative of the Canadian population. Medical schools demonstrate their social accountability through a commitment to producing the right mix of professionals (i.e., specialists and generalists) and ensuring their graduates go on to practice in areas where they are needed most.

Social accountability means the content and context of the learning environment reflects the diversity of geographic, socioeconomic and cultural practice settings. It’s about supporting and promoting community-engaged teaching and learning that is of mutual benefit to partnering organizations, students and the university. It emphasizes a philosophy that values health promotion, disease prevention (“thinking upstream”) and cultural safety as key components of medical care. It’s preparing graduates to work in multidisciplinary, inter-professional teams that can work together to tackle all the determinants of health—including the social determinants—to reduce health inequities. It emphasizes our role in instilling a culture of health advocacy where physicians are accountable to society and recognize their duty to improve the health and well-being of their patients, their communities and the broader populations they serve. It’s about preparing future physicians to be leaders who engage in the evolution of the health care system and contribute to sustainability through health system reform.

In the world of research, social accountability translates into investigation inspired by and responsive to the needs of the community, especially the needs of our underserved communities; it is about supporting and promoting high-quality community-engaged research related to expressed needs. It is often research that is collaborative, participatory and action-focused from the onset, with the research agenda, questions, methodology and knowledge translation components being developed in partnership with key stakeholders. In socially accountable research, mechanisms are put into ensure direct community impact: investigators take initiative to develop and implement interventions in collaboration with the community. It is research that emphasizes population health and has a role in identifying and anticipating the health status and health care needs of the community.  It is basic biomedical research that creates new understanding of the biological pathways to the determinants of health and applied clinical research that evaluates the safety and efficacy of drugs, treatments and procedures and contributes to the quality of care provided. It is health services research that evaluates new delivery models and their impact from the level of individual patients to the health system.

And at the structural level of our college, social accountability is partnership and engagement: engagement with our community, health system and health provider partners. It’s a genuine commitment to meaningfully engage in a manner that is mutually beneficial with recognition of the local and regional community as primary stakeholders. In redefining who is “expert,” we strengthen the CoM’s reputation for engaging in respectful and trusting partnerships. Partnership in designing, implementing and evaluating our education, research and service programs to meet the priority health needs of the communities we serve is key. Partnering with health regions and health organizations to helps to ensure graduates are properly deployed, supported and retained where they are most needed. Partnerships for social accountability is understanding the integrity of relationships and working from a collaborative leadership perspective that will have the best possible impact on socially marginalized and medically underserved people and communities.

We recognize that it can be difficult to wrap one’s head around the concept of social accountability and that it is often at the application stage, where theory is translated into practice, that things become a little clearer. The four-part series of papers Practising Social Accountability outlines how clinicians can actualize social accountability in their practice, from the micro to the macro levels.  The division will be releasing a series of resources outlining how social accountability may be actualised through curriculum, admissions, research, etc. in the coming months. Stay tuned!