As a Health Leadership Academy National Health Fellow provocateur, Dr. Amy Montour discusses her path to become a doctor, how she bridges Indigenous and Western medicine, and the importance of broadening perspectives by understanding Indigenous ways of knowing.
Amy is the Co-Lead, Division of Indigenous Medicine at Brant Community Healthcare System and Haudenosaunee physician at Six Nations of the Grand River Territory. She has a unique medical practice which spans multiple sectors as a clinician, administrator, educator, and advocate to challenge individuals and organizations to reimagine current healthcare processes and systems using a wholistic lens.
Amy works with health and social systems, community organizations, academia, and individuals to share an approach to healthcare that is rooted in respect, relationships, and reciprocity. She brings a Two-Eyed Seeing perspective to all aspects of her work, which incorporates Indigenous and Western concepts of health and healing to influence the design and delivery of healthcare.
Her current clinical practice includes providing adult medicine and palliative care services in hospital and home care settings while providing support to Indigenous people who are accessing the health care system. As an administrator her innovative work within the Brant Community Healthcare System led to the development and implementation of the Division of Indigenous Medicine incorporating Indigenous physicians and a patient navigator into the hospital system with a focus on improving the Indigenous patient experience.
Can you tell us about your experience and career path?
I have a very different experience and career path than most people in medicine. I actually dropped out of high school at the age of 15. I was married and had three children by the age of 25. Unfortunately, I ended up being single, and as most First Nations people who live on reserve, I didn’t have a lot of material resources. But I had a lot of spiritual resources in the fact that I had such great family and community support.
Even when times are tough, you get through because you’re working as a collective. So, at the age of 25 I decided that I would return to school because I wanted a better future for my children. I ended up going to a very small Polytechnic Institute on Six Nations. I did a first year, sort of a Grade 13 year, to get me ready for university. And then I applied to nursing at McMaster. That decision was based on need. I have nurses in my family, but I had never seen myself as a nurse. I needed a career path that would allow me to look after my children in a short timeframe and nursing looked good for that.
Once I got into nursing, I realized that my gifts actually lied in the area of health care. I was reintroduced to an old friend who turned out to be an excellent mentor. Pat Mandy helped guide me through my nursing undergraduate degree and as I was coming up to the end of my degree my mentors around me said you need to do a master’s. So, I worked clinically, did a master’s, and as I was coming to the end of my master’s, again, I had a professor reach out and say, I think you should apply to medicine. I tell this story frequently because it’s important. I thanked her politely, I hung up the phone and I laughed, because I had never known a doctor who was a high school dropout, and a single mom, and all of the things that I had been through in my life and I literally couldn’t see the possibility – until I called my mother who didn’t laugh and all she said was, ‘well, why not?’ I only applied to McMaster because I have three children and I needed to be with my family and community. It was my only option really – and I got in.
I was so overwhelmed in a world that first of all contains very little Indigenous people and there was no frame of reference for me, because there are not many Indigenous physicians. And the ones that do exist are so busy that it’s hard to get close to them to get an idea of what their experiences are like. I went into medicine completely blind to what I was going into. I had children at home to look after and I’m going through this medical program, and I thought, okay I’ve just got to put my nose to the grindstone and get through this and then I’ll be out of here, and I’ll do family medicine.
I ended up getting into a family medicine clinic in my home community. However, the system was still very non-Indigenous. Trying to be an Indigenous physician who walks down both pathways – the Western science pathway and Indigenous ways of knowing pathway – it felt like every day was incongruent. I was going through the motions and doing what I should do, according to guidelines, but not feeling like I was providing the care that people needed. So, I ended up leaving family medicine and clinically started to work as a hospitalist and I’ve been in palliative care since I became a physician.
I continue to do palliative care, because in that realm, I could be the doctor that I needed to be. I could bring forward Indigenous ways of knowing as a doctor and my Western science, and take time, but again, I don’t look like any other doctor because to walk that pathway, to actually use Two-Eyed Seeing, there’s no model of care that accommodates that, understands that, or remunerates that appropriately.
So, you have to make a choice as an Indigenous person most of the time to forego some of the things that you may need for the greater good of the people because that’s who Indigenous people are. It’s never just about ourselves – it’s about the greater good of our people and seven generations forward.
I have held many titles over the course of the last year. I’ve spent time in the cancer system as an Indigenous lead. I’ve spent time with the province as a palliative care lead. I have been a chief hospitalist all the while also being a professor and a teacher. My job probably doesn’t look like any other physician’s because you’re working in a system of rules that don’t fit but you have to conform to those rules to maintain your license.
My whole job is looking at the system, finding where it doesn’t fit, and then trying to apply a Two-Eyed Seeing problem-solving approach to that problem. It’s difficult because oftentimes the problems that you’re solving are also problems that are personally impacting you. But again, if you go back to Indigenous ways of knowing, it is the role of Indigenous people to care for each other and our communities.
I think what makes me different, and what makes using Two-Eyed Seeing different as a physician, administrator, and educator, is that you have to be willing to be courageous. You have to be willing to be brave and stand all by yourself and you have to be a problem solver all the time.
Can you tell us a little bit about your role in the National Health Fellows Program?
I’ve been invited to be a provocateur, which I really enjoy. In a nonprofessional way I often say that I’m a jack of all trades and a disruptor. One of my good friends uses the term ‘innovative disruption’.
So, I think my role is to help people to see through two eyes. And it doesn’t have to just be the Indigenous lens. When I think about my colleagues from the Middle East, they have their own lenses, and their own cultures, and their own perspectives on health and health systems. And there’s value and there’s worth in that.
Can you share a little bit more about the perspective of Two-Eyed Seeing?
It’s a Mi’kmaw teaching so it comes from our East Coast relations. It’s so simple and so easy to apply in so many situations in that you take the best of your knowledge system – the one that you grew up with and that you know about – and you look for the best of the other knowledge system. If we think about visual seeing, monocular vision only gives you a limited perspective, binocular vision gives you a wider perspective.
It’s that concept that you apply to every situation. If I look at this from a Western perspective, take for instance, in a busy clinic we want efficiency, we want people to get the services they need, but we want to service as many people as we can. So oftentimes we number people, and from my Western eye, coming through medicine, I didn’t have a problem with that. I just kept thinking, okay, that’s efficiency, we’re going to get people through. Until I met an Indigenous patient who said, ‘I will never go. Do not send me back to that clinic ever again, I will not go back there. They numbered me.’ I was looking at the situation with monocular vision, but when I took the blinds off my other eye and used my Indigenous ways of knowing it made perfect sense. Here was a residential school survivor that had his name taken away from him and he was numbered. It’s not a fault of anybody, it wasn’t a purposeful thing to hurt anybody, but it is a consequence of a system that has been built not for Indigenous people, but despite them.
Why do you think the perspective of Two-Eyed Seeing has been so impactful on this NHF cohort?
Indigenous knowledge is ancient. It’s based on thousands of years of observation. It’s not completely dissimilar to Western science. We have a way of gathering knowledge and retaining knowledge and passing along knowledge that looks different than Western science. But I think colonization and part of the goal of colonization was to erase Indigenous ways of knowing. So even Indigenous people have lost a lot of Indigenous ways of knowing.
We’re now reclaiming back; we’re recognizing the value of that. And I think that teachings like this are not unique to just Indigenous people from Canada. What I like to say to people is that everybody’s Indigenous from somewhere. Find out who you are, where are your roots, who are your people, and what they experienced. I think it’s a tool that is easy to understand. I think it’s something that is easy to apply to any issues that you come up with, whether it’s big or small and it just helps you to understand why the whole picture is not being seen.
It’s not assigning blame to anybody; it is not even identifying the problem. It’s just allowing you to see with a bigger perspective what is actually happening and the experiences of the people that we’re serving. When you’re educated and you’re moving into a career, you know a lot about that field of study. But you couldn’t possibly know how to also be a veterinarian, but you can come to learn how that veterinarian experiences the same event by building relationships, and the relationship has to come with the Two-Eyed Seeing. It’s harder, it’s the action – it’s more than just seeing it, now you have to enact this piece of it.
Even in relationships you need to use Two-Eyed Seeing. If you think about simple relationships, like the one you have with say your mother, you can have a conversation with your mother, and she may say something to you, and it may feel hurtful. She didn’t mean it to be that way. And you as the child may not address it with her because you feel that power imbalance. Like I’m not supposed to speak back to my mother and then it grows, and it becomes a problem. And eventually the relationship starts to sever.
The very same thing has happened with Indigenous people and non-Indigenous people – it’s a problem of relationship. We’re all people, we’re all humans, we all have knowledge and skills and benefits that we bring to the table. We’ve just lost the ability to see the worth of others around us. Two-Eyed Seeing allows us to start seeing the worth of everyone at the table and allows us to have a bigger perspective on the problem.
Why is it so important to have specific systems and rules in place that help Indigenous people access our current healthcare system?
We have a nation that was built on colonization principles, and systems that were built on those principles that either Indigenous people should assimilate, or they won’t be here. Every system in our country was built on those principles. It’s not my fault, it’s not your fault. That was the systems that were built. They’re large, complex, unwieldly systems – they can’t just be reset.
We’re now in a situation where we have these complex systems that will take time to either dismantle or adapt to the new realities of equity, diversity, and inclusion. So, in that gap period, we still have Indigenous people who are accessing services who have memory of colonization and all that has happened to change their whole community. They’re walking into a system that doesn’t exactly hear them or see them all of the time, and at times has abused them. So, for Indigenous people who are relational, if you are all alone, and you have no relationship with the people around you, it’s anxiety provoking.
If you have Indigenous people in that organization who can reach out and be a friendly face, just knowing that you’re not alone makes a huge difference.
It’s a twofold process, it’s one to actually provide that comfort and support, and comfort and support for the community, and to be a role model for generations that are coming up. But also, there’s a term that’s used by many Indigenous people: Existence is resistance – if you see us, if you hear us, then maybe we can start to work on that relationship together.
So, I think it’s important that we share our knowledge bases because Western science is limited in its knowledge, Indigenous ways of knowing are constantly evolving and has limits to its knowledge. But if we put them together and you carry the best out of both of them, not only will we make a great healthcare environment for Indigenous people, but it will actually be great for everybody.
What do you hope the National Health Fellows participants will take back to their communities and back to their work from your sessions?
I think the hardest thing for established professionals to do is to have a fundamental shift in how they perceive their work and the system that they’re working in. I really hope that in some small way, my participation in this cohort of National Health Fellows is to do just that – to help them to open up both eyes and to see the problems and the solutions with a fuller perspective.
Part two of our conversation with Amy Montour will cover how hospitals and healthcare systems can help improve the patient experience, and lessons learned from her career, including advice she would provide to her younger self, her definition of leadership and what she wants her legacy to be.