It’s the summer before medical school and I have the most incredible job. I have been hired to hike and map out the trails of Nova Scotia so that the information can be uploaded onto a computer database for everyone to access from anywhere. It’s 1995, and I still don’t know how this is going to be possible. I do not have much experience with the internet, and I haven’t even heard of the World Wide Web. But I do not really care about the logistics because I am sold on the fact that someone is going to pay me to explore, hike and camp for the summer. My fellow summer students and I are paired up, given our marching orders, and we set off all around Canada’s Ocean Playground.
One night, towards the end of our summer, my co-worker and I find ourselves on the southeast coast of beautiful Cape Breton Island. Another pair of co-workers are in the area as well, and we plan to meet up that evening and share a campsite out on the Mira River that evening.
We get to our campsite and start to set up. I do not want to eat the other’s cooking, so I volunteer to make dinner. They agree, and after pitching the tents, they take on the job of building a campfire. The first guy has a go. He arranges the logs in a tee-pee formation and put some gathered kindling underneath. Then he sets it aflame. Because it rained the night before, the kindling is a bit wet and does not catch. So, the next guy offers to help. He gets some paper, puts it on the kindling and lights it. Once again, it does not catch. Then the next guy makes another suggestion. They continue to go back and forth, trying to get the fire alight. Nothing they do gets the fire going. Then they give up. They sit around the pit and accept that because all three have tried everything, the fire simply cannot be lit. We were going to be sitting around in the dark without a campfire because they believe it cannot be done.
I for one did not want to sit in the dark. So as supper is stewing, I take a turn at building the fire. From where I am standing, I can see that there is too much soot in the pit and that it is wet. (I did try to tell them this, but it fell on deaf ears). I clear out as much as I can and put the kindling and paper back into the pit. The fire catches but does not last. Then I remember that my colleague has packed lighter fluid in the trunk. I grab it and douse a little bit on to the wood. Then I step back, light a match and throw it onto the logs. Poof! It goes up in flames AND the wood finally catches. We have a campfire!
I look over at the guys and smile. They respond with grim faces.
Supper was ready, so I dish out their supper and we sit around the campfire eating. They are completely silent. They do not say a word to me, and do not even a thank me cooking them dinner! I get irritated.
After a while of sitting in uncomfortable silence, I ask “What’s was wrong guys? Don’t you like the food?” Me so ethnic.
They continue to give me the silent treatment. Then my partner speaks up and says “We are mad that you lit the fire. Lighting a campfire is a guy thing”
I am in shock. A GUY thing? My jaw drops. I had no idea I have made such a large cultural faux pas, and it is not my intention to hurt anyone’s feelings.
So I apologize. Then I say:
“Wait – you all accepted that it couldn’t be done after all three of you had a try. But it could be done, just not by doing it the way you were doing it. You guys just needed to see it from a different perspective. From where I was standing, I could see that the soot needed to be cleaned out, and it wasn’t letting enough oxygen get to the fire.
Obviously, the wood was wet too. But we had lighter fluid, and there’s no law against using it. If using a little bit of lighter fluid could help start the fire, then why not?”
Silence and avoidance.
“Look, I didn’t mean to hurt your feelings. I just wanted to have a campfire because this is our last night out. Honestly, you guys built most of it, I just added my two cents worth.”
I had unknowingly insulted them. But once I explain my perspective, they come around. In the end, they agree that everyone’s contribution was important in getting the job done. We enjoy the rest of the night, out on the Mira, telling stories over the bonfire as it blazes to our delight.
This story reminds of the issues we face in healthcare today. We cannot solve the problems by looking at them from the same perspective we have used in the past. It simply causes us to overlook the root causes of many systemic issues. This is partly because we mostly research and practice from one perspective, while we treat a diverse population, with many variable factors affecting their wellbeing.
I remember hearing Dr. Shawn Whatley, then the President of the Ontario Medical Association, address the OMA’s Women’s Physician Day meeting. In apparent awe, he said we “are discussing important issues that he and general council had not even considered.” Precisely, Dr, Whatley. If we do not create spaces to have discussions with those traditionally not represented at the levels of medical leadership, we will no doubt miss out on many key issues and strategies that are important to leading change and improving healthcare delivery.
To include those voices, we need to actively invite diverse perspectives to the table. Many people may not have had the ability or the comfort level to be at the table, especially if they have previously been excluded, silenced, or shamed due their identity, ideas, perspectives or traditional roles. We must also make it safe for them to speak and be heard. They are not starting with the same privilege that many at the table have been afforded. So many have also had to put up with the race-based traumatic stress as they train and practice medicine. After dealing with this type of stress daily, there is often little energy or will left to dedicate more time to solving the problems.
It may seem uncomfortable at to try new ways of doing things, especially if we are only used to the Eurocentric methods of governance and problem-solving that we have been taught through our colonized education systems. However, if we can see that our processes have proven to be exclusive and ineffective, then perhaps we can understand why we need to approach our problem from a different angle. Einstein is often credited for saying “Insanity is doing the same thing over and over and expecting different results.” Perhaps it is not the issues of equity, diversity and inclusion that are unsolvable, rather we cannot solve these issues using the same method or thinking that we have used in the past.
I commend the Canadian Medical Association (CMA) for proposing a new procedure to increase under-represented voices in medical leadership. This is a key step to improve healthcare delivery. I am heartbroken that so many of my colleagues did not have the perspective to see why these changes were so important. They may not be perfect, but at least we could apply the methodology of quality improvement. The CMA proposed a plan that could have been tested and studied. If it worked, we could continue to implement the change, and if not, we could learn from what didn’t work and develop a new method. After all, continuous improvement is how we evolve. We ALL know medical culture needs to evolve.
If we do not make change now, we will continue to be a group of blind men just looking at the same part of the elephant and agreeing with each other, because we are so ignorantly unaware that rest of the elephant exists. We will be missing the forest because we are only examining one tree, ignorant that the forest is made up of many different types of trees. We will not have all the pieces of the puzzle so we will not be able to solve it. We will end up sitting around in the cold and dark, when we could be enjoying the light of the fire and the warmth of each other’s company. I refuse to sit in the dark, when siting in the light is so much more enjoyable.
This blog post was inspired by a recent blog by Dr. Shawn Whatley on attempts at Equity, Diversity and Inclusion. It was also inspired by recent events at the Canadian Medical Associations AGM, where a motion to adopt a new method to increase representation in CMA leadership was voted down.
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