Doctor's goal to improve Aboriginal health care

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Dr. Vince Tookenay is a pivotal part of the growing crop of Canadian Aboriginal physicians and medical students.

In 1980 he left Health Care Concepts International in Minnesota to become director of Indian and Inuit health policy for Health and Welfare Canada. That year there were reportedly just six Canadian Aboriginal physicians working in North America.

Today there are at least 60 physicians and 30 medical students of Aboriginal ancestry. Dr. Tookenay doesn't take credit for that, but he will continue to draw attention to these numbers while working to facilitate better health and health care for Canadian Aboriginals.

And work he does. The Ottawa-area physician is on loan to the Canadian Medical Association as part of an executive exchange program with Health Canada. He's also in his second two-year term as president of the Native Physicians' Association in Canada.

A day's drive from the nation's capital you'll find Heron Bay Reserve, on the shore of Lake Superior, where Tookenay was born and grew up in nearby Schreiber. It was an unlikely launching pad for a medical career.

"When you grow up in a town where you're one of the few Native families, a very average student, and probably in the lower echelons of community hierarchy, you don't go around saying you're going to be a doctor some day. You'd get laughed out of everything," said the Ojibway physician.

"But knowing you had something you wanted to achieve, that came very early in life."

In 1974 he graduated from the University of Minnesota. Twenty-one years later he lives in a small town just outside Ottawa, is married, the father of four boys, and is kept busy with work and what he describes as an "administrative" role with the Native Physicians' Association. It is a private, apolitical volunteer organization that developed out of a 1990 meeting of five Aboriginal physicians at Dr. Clare Brant's farm on Tyandanaga Reserve.

Today, Dr. Tookenay and fellow Aboriginal physicians lecture at the 10 Canadian universities that house health science and medical facilities. The most popular lecture sites are the Universities of Alberta, British Columbia, Manitoba and Montreal. The latter is the alma mater for 29-year-old Stanley Vollant, the Baie Comeau, Quebec physician who is Canada's first francophone Aboriginal surgeon.

"In general, there's a lot of excitement about Aboriginal health. It's a drama," said Dr. Tookenay with mixed feelings. "An example was the W5 program the other night that looked at Pikangikum Reserve and the possible effect religion on the (high) suicide rate. It provided valuable information on external community influence, but it was sensational in the sense of being superficial."

Clearly concerns about the status of Aboriginal health and health care require addressing in Canada. Take the Canadian Medical Association, whose 1993 submission

to the Royal Commission on Aboriginal people stated: "Although there have been some significant improvements in the health of Aboriginal peoples over the last few decades, particularly in infectious diseases and infant mortality, their overall health status falls well below that of others living in Canada."

Women's health

As CMA consultant on Aboriginal health, Tookenay is part of the organization's preparation for a forthcoming Aboriginal Women's Health Workshop. The workshop will examine, from a woman's perspective, such mental and physical components of health as suicide and addictions. Also under the microscope will be the social, economic and physical factors affecting mental health.

The conference is of particular importance in reviewing national statistics which show violence-related injuries are 30-40 times higher among Indian women than non-Indian women in rural or urban areas. For Indian males, the figure is17-fold. Meanwhile, the CMA has begun a four-year $100,000 bursary program for Aboriginal medical students and may develop an on-line Aboriginal documentation centre.

As far as ookenay is concerned, the NPAC also has a key role to play in facilitating improved Aboriginal health care, by acting as a community resource and as a bridge between the government, professionals and Aboriginal community.

Technically, NPAC only represents its membership, but has 1-1.2 million potential clients, including 500,000 status Indians as well as off-reserve Indians, Metis and Inuit.

A key to their improved health status is providing them with more autonomy, insists Tookenay. If there were greater autonomy and assurance of on-going funding, he argues that individuals could be more responsible to community needs while assuming more leadership.

"The government of the day is pressing forward for a transfer of responsibility to the Aboriginal people in areas of education, health, policing and justice," said Tookenay.

"However, Aboriginal people are unsure if they're being taken down a garden path, and they're even more skeptical about where they might end up."

Western, traditional medicine

Wherever the road leads, questions remain about the possible co-existence of western and traditional (Indian) medicine. Let each Aboriginal community decide for itself, suggested Tookenay.

"It is understood that traditional medicine needs a belief in the system. To expect the traditional systems to make the transition to the dominant society is a quantum leap that may never be achieved.

"I think it's given that a lot of people will continue to bring their own medicine to help them during periods of illness.

Tookenay added that communities have to determine who's genuine and who isn't.

"There's a fine line between the Elders, the spiritual and traditional medicine, and I don't claim to know anything except that I'm aware of it."

Meanwhile, he continues to strive for increasing awareness and more long-range answers to Aboriginal health care concerns.

The Native Physicians Association in Canada is located at 116 Albert, Suite 703, Ottawa, Ont. Tel: (613) 237-7900 Fax: (613) 237-7355.