This article has been adapted from an interview in the Canadian Society of Physician Leaders’ Leading the Way podcast series.* In episode 29, recorded on 30 Jan. 2021 and aired on 4 Feb. 2021, Dr. Johny Van Aerde (executive medical director of CSPL) spoke with Dr. Alika Lafontaine about his personal leadership journey and his views on advancing equity, diversity, and inclusiveness.
Dr. Lafontaine is an anesthesiologist in Grand Prairie, Alberta, and an acknowledged advocate for improving Indigenous health care. He is of Cree, Anishinaabe, Métis, and Pacific Islander heritage. Dr. Lafontaine is president elect of the Canadian Medical Association, the recipient of various advocacy awards, and a member of the board of several nonprofit organizations.
Your leadership journey has been accelerated and diverse. How would you describe it?
Leadership, from my own experience, is a mix of opportunities. I knew early on in my leadership journey that I had specific individuals who looked at me differently than I looked at myself. I never thought that I’d be in a leadership position. I never thought that I’d have all the leadership experiences I’ve had over the last two decades. Individuals like Dr. Tom Dignan, who was a family physician and champion for Indigenous health, who passed away [in January 2021], was one of the people who saw the way that I looked at things and decided for whatever reason that he was going to give me the opportunity to enter into some of these spaces that he carved out through his own advocacy and work. Top
I think when you look at leaders, some of us have been on the path our entire lives to eventually get there, and others of us were placed in the path by other people. My accelerated and diverse journey has really been eclectic: opportunity after opportunity that’s come up because of others’ work. As a result, I’ve had the great blessing of walking this path, learning the things that I’ve learned, living these different experiences. It’s brought me to a place in leadership where I think I’ve realized that my job is to create that space for others.
At the beginning of leadership, you really look at it as an advocate, instead of as a leader. I think you want to fill the space with your lived experience, your pain, your priorities. But as you walk down the path, and you start to realize the way that change actually works, you recognize that there comes a point where you can’t fill it with yourself anymore. You’ve got to bring other people into it. I think that’s what Tom felt when he first brought me into this. And that’s how I feel now, which just brings everything full circle. It’s kind of a nice bookend to my relationship with him. Top
The picture you portray of going from advocacy to leadership ties in with a question that I’ve been thinking about. For political advocacy, primarily for your work on Indigenous health, do you fear being pigeonholed as an advocate in this area, because of your heritage and this type of work?
I think if the spaces that you lead in are only filled with yourself, then it’s inevitable that eventually you’re going to get pigeonholed because there’s only so much lived experience that you can pour into that space. If you start to see it as a way of bringing other people into those spaces, amplifying their voices, making sure that they feel like they’re heard, and then teaching them how to navigate and lead them along so they can avoid some of the bumps and pitfalls that you went through as part of your own leadership journey, [that’s leadership]. There’s a lateralization of leadership experience that occurs. Top
I don’t see myself any more as exclusively within the realm of Indigenous health. At the beginning, I thought that a lot of the things that happen in Indigenous health were unique to Indigenous health systems, but they were really a magnification of problems that everyone was going through. If you go through trust and communication issues with your care team or if you have problems with continuity of care and fragmentation, they’re just magnified within the Indigenous health context. Understanding that and reframing my role — not filling the space with myself, but with the lived experience, pain and priorities of other persons working in other areas — has been a wonderful journey to now bring other people with other expertise and lived experience into this space. It broadens your mind to what you can achieve. I don’t feel pigeonholed any more, but that’s really because of the other people I’ve connected to on this path. Top
COVID-19 has exposed many cracks in our health care system and in society in general. With regard to equity, diversity, and inclusion (EDI), do you think we’re going to make real progress this time?
The interesting part about EDI from an historical context is that we often think that we’re the first ones who went through this problem. We obviously know that we’re not, but we think we’re the first ones to gather people together, create a common narrative, or say that this can’t continue. Top
If you look at racialization, for example, there have been several cycles even the last five years where we’ve had crises that have broken out in, say, Northern Ontario with the suicide pact. There was the mental health crisis in northern Saskatchewan; in northern Manitoba, there are problems with access to care. There are more and more stories that are coming out about persons who live in these systems and have unequal power and lack of equity, diversity, and inclusion, who are having really negative health outcomes.
If we can find a way to link today with yesterday and bring in those experiences and those learnings, I think we really do have a chance to create a new sort of story. Social media has changed the way that we communicate. You can go on Facebook, you can have something go viral, you can get on Twitter and share your story, something that’s shared thousands of times. Getting these stories out is really how we trigger change. Looking back, in the [Truth and Reconciliation Commission] when we talked about truth and reconciliation, I wish we had said, “truth before reconciliation.” It’s getting the truth out of what’s happening right now in the system in a way that keeps the integrity of the experience, not worrying so much about the palatability of the pain that we’re sharing, but saying the honest truth.
People are harmed because of inequities. Voices are excluded because of a lack of diversity and a lack of inclusion. That’s wrong, not just from a moral standpoint. It’s also wrong from the point of good system design. If you don’t have people sharing what’s actually going on with them, how are you ever going to make the right choices when it comes to how the system should evolve? And so we have these new opportunities, new ways of sharing these ways of establishing truth, where we really create a firm foundation of lived experience that has integrity, that’s linked with reality, and that we’re not trying to make more palatable. Top
Our challenge is then creating that environment where people feel like change can happen. The real power of the status quo is keeping us in this space, where we feel that no matter what we do, we actually can’t change our future. And I’m really heartened by conversations I have with colleagues, especially new colleagues who have just finished residency and medical students, that there’s this hope there. I think that as a medical profession, we really need to feed that until it becomes a norm.
I’m fascinated with your reasoning, because I recognize the four steps of compassionate leadership: awareness (becoming aware that there is a problem); coordination (the facts and stories that need to be told); closely linked is empathy (feeling what other people are going through); and action (doing something about it).
One of the things that we’re taught in Indigenous philosophy and worldview is that all truth takes us to the same place. I do believe that those four steps are very similar, if not the same, as what I just shared in Indigenous health. Things are magnified if you take those four steps and then you take them beyond and imagine if they became even bigger, where they almost swallowed up the system. I think that that’s how we need to amplify and magnify those four steps in areas that traditionally have been intractable and use them to unwind what we’re really doing. I think in all of this is we’re humanizing each other in the process of achieving system change. Intuitively, I think we all feel like that’s a message that belongs to us and that’s a part of us.