Events

Parts Known & Unknown: Exploring the Borders of Truth, Reconciliation and Redress

Every Child Matters


Parts Known & Unknown:  Exploring the Borders of Truth, Reconciliation and Redress

W. Kamau Bell joined Anthony Bourdain in Kenya in what was to be the final season of the CNN series, Parts Unknown. Kamau has roots in Kenya and this was his first time travelling to the motherlands of his people, and he stated something that I thought was interesting. He said something like, “coming to Kenya, you know, it’s nice to have a diasporic-kind-of-connection, even though I did not come from Kenya, but I have roots in Kenya, and even if that frame that the connection was built through was colonialism.”

It made me think about what it would be like for someone like myself to travel to the ancestral homes of my people. Well, this is my home. Certainly, more than it is your home, and in this era of truth and reconciliation, it is now both my home as much as it is your home. I come from no other place in the world than from right here, diitiidʔaaʔtx̣ – Ditidaht, we are the Nuuchahnulth and the seas for miles of shoreline and all of the land on the western side of our Vancouver Island home, from Point No Point in the south to Brooks Peninsula in the north, is Nuuchahnulth territory, our haahuulthii.

In the conclusion of that episode with W. Kamau Bell in Parts Unknown, Tony narrates an epilogue, “Who gets to tell the stories? This is a question asked often. The answer in this case, for better or for worse, is I do, at least this time out. I do my best, I look, I listen, but in the end, I know it’s my story. Not Kamau’s, not Kenya’s, or Kenyans’. Those stories are yet to be heard.”

It’s important for colonial settlers, and for new settlers, to Canada to consider who you are and where you come from, and what it means to live in British Columbia, and to think about your own frame of reference as being truly Canadian, even if that frame that the connection was built through was colonialism. The context, the narrative, the history, the good or bad of it, the story of what it means to be Canadian is apart and a part of your individual and shared story as a British Columbian, as a Canadian, as an unwelcomed or welcomed colonial settler, and as a new settler. The stories that have yet to be heard, and are now starting in some ways to be told, is our story, my story, of what it means to be diitiidʔaaʔtx̣, to be Nuuchahnulth, to be First Nations, to be Indigenous, and to also be Canadian in this country and in this province.

The National Day for Truth and Reconciliation is a unique opportunity to bridge the divide of our individual and collective stories, our distinct and shared experiences, and our united effort to right and write a new history chaptered with the stories of a sincere determination to tell the truths of the past, to reaffirm and renew our commitments to reconcile all things oppressive, racist and insufferable, and to create an honest and just redress for all Indigenous – First Nations, Inuit, Métis – peoples. It would be momentous to proclaim someday that we all come from a country in which the frame that the connection was built through was equality, acceptance and compassion.

It’s fair to ask, “What will you do between October 1st, 2022 and September 29th, 2023, to recognize your part in this history, this story, and what will you actively do to shift the narrative?” We’re at an urgent time in our country’s history to thoughtfully and actively explore all parts known and unknown in our ongoing journey to come to terms with each other and with our past, and with the present day. I look forward to the work ahead this year, and I’ll look forward to us hearing each other’s stories next year and in the many years to come.

With Respect,

Derek Thompson – Thlaapkiituup
Indigenous Initiatives Advisor, Office of Respectful Environments, Equity, Diversity & Inclusion


Continue Learning

“The time to make things happen is now. The time to seek out our individual and shared power is now.”

Read the Message from the Indigenous Initiatives Advisor, Derek Thompson – Thlaapkiituuphere

Discover REDI’s Indigenous-Specific Resources here

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New Year, New You: REDI’s New Year Book List

New Year, New You: REDI's New Year Book List

Explore a compilation of books that have deeply inspired the REDI team in their work. Immersing yourself in the stories, lived experiences, and perspectives of individuals from various historically marginalized groups can foster empathy, understanding, and even aid in mitigating bias in your teaching and clinical practice.


We Are the Change We Seek: Leading Indigenous Health in British Columbia

Thank you for joining us virtually on January 14th, 2026, from 12:00 – 3:00 PM (PT), for an Indigenous Speakers Series session featuring Indigenous Vice Presidents from Fraser Health, Island Health, and the Provincial Health Services Authority. In this session, they shared how Indigenous leadership is transforming health systems across B.C.—advancing Cultural Safety, Humility, and Truth and Reconciliation. If you missed the session, watch the recording to learn more about how Indigenous voices at the executive level are reshaping policy, addressing racism and discrimination, and creating lasting change for First Nations, Inuit, and Métis peoples across the province.


Topic | We Are the Change We Seek: Leading Indigenous Health in British Columbia

Date: Wednesday, January 14th, 2026

Time: 12:00 PM – 3:00 PM (PT)

Live Stream & Recording | Register to receive the webcast link or access to the recording after the event.

All REDI events are open to the public unless otherwise noted.


Speaker Bio

Amanda Laboucane,

Amanda Laboucane,
Interim Vice President, Indigenous Health and Cultural Safety, Fraser Health
,
Citizen of the Métis Nation

Amanda LaBoucane is a Métis citizen and mother of two strong Métis–Ojibwe daughters. Born and raised on Coast Salish lands, she has lived and worked in Indigenous communities in both rural and urban settings.

The importance of preserving cultural teachings and traditions in all aspects of daily life inspires Amanda’s commitment to embedding Indigenous cultural safety and humility into health care. Her work focuses on transforming the health-care system to address Indigenous-specific racism through strength, determination, political acumen, kindness, and heart.

Amanda joined Fraser Health in 2017 and currently serves as the organization’s Interim Vice President of Indigenous Health. Her leadership within the Indigenous Health portfolio unites an exceptional team delivering clinical services and advancing Indigenous cultural safety programming and education across the health authority.

She holds a Master of Public Health from Simon Fraser University and a Bachelor of Science from the University of the Fraser Valley. Amanda is completing her Master of Business Administration at Simon Fraser University and is a past member of the Canadian College of Health Leaders.


Dawn Thomas - Aa ap waa iik,

Dawn Thomas – Aa ap waa iik,
Vice President, Indigenous Health and Rural & Remote, Island Health,
Member of the Snuneymuxw First Nation

Dawn Thomas is a proud member of the Snuneymuxw First Nation on Vancouver Island. Her traditional Nuu-chah-nulth name is Aa ap waa iik, which loosely translates to “The one who says the right words about chiefly business.”

Dawn joined Island Health in June 2020 and is responsible for enabling and facilitating system transformation and service delivery improvements that enhance the wellness, health, and care provided to all Indigenous peoples across the Island Health service area, including First Nations, Métis, Inuit, and non-status Indigenous peoples—both on and off reserve. She is also instrumental in leading the organization’s cultural humility journey, supporting continuous growth, and fostering cultural safety at all levels.

In 2021, Dawn was seconded to the Ministry of Health as the Interim Associate Deputy Minister (ADM) of Indigenous Health and Reconciliation. She was the first Indigenous woman to hold this senior role within the provincial government and played a key role in introducing the In Plain Sight report and its recommendations into the ministry’s work. Her leadership in the province’s and the B.C. health system’s initial response to In Plain Sight, the relationships she developed during this time, and the Indigenous-led and informed practices she brings back to Island Health continue to guide and advance efforts to address Indigenous-specific racism.

As Vice President, Dawn engages with a wide range of senior internal and external partners to foster effective partnerships and create the conditions for culturally safe service delivery. She leads the organization’s approach to culturally informed governance and decision-making, partnering with Indigenous communities to develop and implement progressive, relevant, and culturally safe policies and practices for both patients and Indigenous staff.

Dawn brings more than 20 years of experience working with Indigenous children, families, communities, and leadership to Island Health. She previously held senior leadership positions with the B.C. government at the Ministry of Children and Family Development and the Office of the Representative for Children and Youth, where she served as Deputy Representative.

She holds a Master of Arts in Dispute Resolution and a Bachelor of Arts in Child and Youth Care, both from the University of Victoria.


Joe Gallagher - k’ʷunəmɛn,

Joe Gallagher – k’ʷunəmɛn,
Vice President, Indigenous Health and Cultural Safety, Provincial Health Services Authority
,
Member of the Tla’amin First Nation

Joe Gallagher guides the further development and evolution of PHSA’s Indigenous Health and Cultural Safety Strategy, leads the delivery of cultural safety and humility education, and supports PHSA’s Indigenous Health and Human Resources Plan.

Joe is Coast Salish from the Tla’amin First Nation and has made extraordinary contributions to B.C.’s health-care system over the course of his career. He was the founding Chief Executive Officer of the First Nations Health Authority—the first and only health authority of its kind in Canada—and served as CEO from 2009 to 2019. Prior to this role, Joe held senior leadership positions in several governmental and First Nations organizations, working in areas such as health care, community development, economic development, and intergovernmental affairs.

A recipient of the King Charles III Coronation Medal, Joe holds an Honorary Doctor of Laws (LLD) from the University of Victoria and has provided executive-level consulting support to B.C. health regulatory colleges and other institutions as they work to address Indigenous-specific racism and advance cultural safety and humility in health-care settings. He also co-authored Now You Know Me: Seeing the Unhidden Truth in Settler Colonialism, received a Leadership in Quality Award from Health Quality BC, and most recently was honoured with the Trail Blazer Award from Native Education College.



Description 

Written by Derek K Thompson – Čaabať Bookwilla | Suhiltun
, Director, Indigenous Engagement

Opening the door to Indigenous peoples’ participation in leading health systems transformation is an expression of the commitment to truth and reconciliation. Health systems that develop and implement policy based on the active participation of First Nations, Inuit, and Métis peoples can be expected to ensure an enduring legacy of transformative change. Guided by this work, it is with great anticipation and promise that health systems begin to fundamentally shift the paradigms that perpetuate racism and discrimination against Indigenous peoples toward standards that uphold Truth and Reconciliation for all Canadians.

Stepping into and leading this important work are the dynamic and experienced individuals appointed to their respective roles as Vice Presidents. They are integral members of the senior executive teams in Fraser Health, Island Health, and the Provincial Health Services Authority. We are honoured and excited to welcome Joe Gallagher, Amanda Laboucane, and Dawn Thomas to the Indigenous Speakers Series.

This work addresses policy related to racism and discrimination against Indigenous peoples in British Columbia and defines an approach that emphasizes the importance of Cultural Safety and Humility. The work ahead will guide how health systems can adapt to better respond to First Nations, Inuit, and Métis peoples. Indigenous peoples are vital to British Columbia, and how BC relates to them defines its sense of justice, purpose, and redress. There is urgency at all levels within health systems to open the door to Indigenous participation in advancing reconciliation through Cultural Safety and Humility.

The creation of senior executive roles within regional and provincial health authorities offers the potential for transformative change within health systems in both the short and long term. Comprehensive Indigenous leadership is essential for policy changes that address racism and discrimination and enhance Cultural Safety and Humility as legitimate standards. First Nations, Inuit, and Métis peoples can be expected to welcome changes that clearly define Cultural Safety and foster confidence in the practice of Humility. This approach must extend beyond transformative change within health systems to have a far-reaching impact on all Canadians and other systems.


Moderator

Derek K Thompson – Čaabať Bookwilla | Suhiltun
, Director, Indigenous Engagement

Derek K Thompson – Čaabať Bookwilla | Suhiltun, Director, Indigenous Engagement


What Will I Learn?

You will learn about the overall work of Indigenous health in Fraser Health, Island Health, and the Provincial Health Services Authority.


Derek K Thompson – Čaabať Bookwilla | Suhiltun
, Director, Indigenous Engagement

Continue Learning

“The time to make things happen is now. The time to seek out our individual and shared power is now.”

Discover more about REDI’s Indigenous Speakers Series here

Find REDI’s Indigenous-Specific Resources here

REDI Digest Guides: Inclusive Professionalism in Practice

REDI Moments That Matter: Faculty & Staff Recruitment

Moving from Harm to Healing (part II): A Practical and Relational Lens on Harm and Conflict

This It Starts With Us session builds on Moving From Harm to Healing (Part I) and focuses on concrete, applied ways to use relational and restorative approaches to address harm and conflict across clinical, lab, classroom, and workplace settings.

Join us virtually on Monday, March 30, 2026, from 12:00 PM – 1:30 PM (PT), for a session with Catherine Bargen, co-founder of Just Outcomes Canada and a recognized leader in restorative and relational conflict transformation. Moving beyond the “why” of restorative practice, this session provides both principles and examples to guide everyday situations. Participants will be introduced to frameworks for addressing conflict and harm, and for centring relationships by promoting belonging, accountability, and repair.

Moving from Harm to Healing (part II): A Practical and Relational Lens on Harm and Conflict


Topic | Moving from Harm to Healing (part II): A Practical and Relational Lens on Harm and Conflict

Date: Monday, March 30, 2026

Time: 12:00 PM – 1:30 PM (PT)

Live Stream & Recording | Register to receive the webcast link or access to the recording after the event.

All REDI events are open to the public unless otherwise noted.


Speaker Bio

Catherine Bargen, M.A. (She/her)

Catherine Bargen, MA (She/her),
Co-founder, Just Outcomes Canada

Catherine Bargen is a co-founder of Just Outcomes Canada and a recognized leader in designing programs that help organizations and communities respond to harm and conflict in ways that promote healing, accountability, and stronger relationships. With more than 25 years of experience, she has worked with governments, healthcare organizations, educational institutions, Indigenous Nations, victim services, anti-violence groups, and religious communities to implement practical approaches to transforming conflict. Her work has taken her around the world, including Switzerland, Israel/Palestine, and Colombia, where she has supported organizations in implementing processes that centre understanding, collective problem-solving, repairing relationships, and preventing future harm. Catherine holds a Master’s degree in Conflict Transformation from the Center for Justice and Peacebuilding in Virginia, USA, and in 2019, she was honoured with British Columbia’s Community Safety and Crime Prevention Award.


Description 


This It Starts With Us session builds on Moving From Harm to Healing (Part I) and focuses on concrete, applied ways to use relational and restorative approaches to address harm and conflict across clinical, lab, classroom, and workplace settings.

This session will feature Catherine Bargen, co-founder of Just Outcomes Canada and a recognized leader in restorative and relational conflict transformation. Moving beyond the “why” of restorative practice, this session provides both principles and examples to guide everyday situations. Participants will be introduced to frameworks for addressing conflict and harm, and for centring relationships by promoting belonging, accountability, and repair.



What will you learn?

  • How a restorative approach can provide a reliable, values-based compass when making decisions about how to address conflict and harm at both the individual and systemic levels
  • Common misconceptions about restorative approaches (including deflecting accountability or “losing” authority or power), and how this framework can instead uphold accountability, relationships, and care across systems
  • How restorative approaches are being adopted within healthcare settings
  • How these approaches are relevant across roles, responsibilities, and power dynamics
  • How to foster a proactive, relational culture that supports connection, belonging, and repair

Why this matters

Where there are relationships, conflict and harm are inevitable. Often, people experience harm in isolation, without safe ways to speak up or repair relationships, which can lead to shame, defensiveness, fear of retaliation, and backlash. Over time, this creates a reactive culture that manages incidents rather than strengthening connection.

Relational and restorative approaches shift this dynamic by centring shared values and supporting accountability and repair. By focusing on dignity and relationships, these approaches reduce division, strengthen feedback cultures, and create more connected and resilient learning, clinical, and workplace environments.


Research Voices from the Field with Cheryl Holmes

Research Voices from the Field with Cheryl Holmes

Research Voices from the Field is a new feature that showcases cutting-edge research that breaks barriers and promotes inclusion in medicine. Each edition spotlights a research publication and includes insights directly from the authors—revealing their motivations, the significance of their findings, and why the research matters for healthcare professionals everywhere.

In this edition, Cheryl Holmes, Associate Dean of Undergraduate Medical Education and Clinical Professor of Critical Care in the Department of Medicine reflects on why she co-authored “Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Educationa must-read for leaders and educators seeking to embed disability justice into medical education.


Cheryl L. Holmes

In this edition, Cheryl Holmes, Associate Dean of Undergraduate Medical Education and Clinical Professor of Critical Care in the Department of Medicine reflects on why she co-authored “Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education”— a must-read for leaders and educators seeking to embed disability justice into medical education.

Read Cheryl Holmes‘ bio

Cheryl Holmes, MD FRCPC MHPE (she, her/s)

Dr. Cheryl Holmes is Associate Dean, Undergraduate Medical Education at the University of British Columbia (UBC) and Clinical Professor and former Head of the UBC Department of Medicine’s Division of Critical Care.  Dr. Holmes is committed to fostering respectful, compassionate, and health-promoting environments in academic medicine—where excellence is strengthened by equity, decolonization, diversity, inclusion, accessibility, belonging, and social justice.  Her scholarly interests include supporting learner wellbeing, creating inclusive and accessible learning environments, and advancing the social accountability of medical schools.

My journey began with a question about our technical standards that brought to my attention that I didn’t actually know what technical standards were. As I investigated, it became clear to me that the widely adopted traditional “organic” technical standards were not neutral descriptions of competence—they had, whether intentionally or not, been used to exclude people with disabilities from medical training. What were assumed to be objective expectations were, in fact, grounded in deeply ableist ideas about who is deemed “fit” to become a physician. This realization was profoundly unsettling, and it compelled me not only to undertake a project at UBC to re-envision technical standards but also to confront how little I had previously questioned the structures and assumptions I had inherited.

As I began discussing this project with colleagues, it became clear that other institutions were also interested in re-examining their technical standards, leading to the formation of a national coalition. Working alongside disabled colleagues, scholars, learners, and patient partners to re-envision these standards, I found myself reflecting on the hidden curriculum of my own specialty—critical care. At the time I was trained, the implicit message was clear: be tireless, be invulnerable, be more-than-human. I had absorbed this culture and, without realizing it, had carried those expectations into my assumptions about what all learners must be able to do.

It has been humbling to recognize the ways in which my own beliefs aligned with the very ideas that had marginalized disabled learners in our system. Listening to the experiences of colleagues who had navigated these barriers has been profoundly transformative. Their insights changed not only how I understood ableism in medicine, but also how I understood my role as a leader, an educator, and a human.

The functional Core Competencies we ultimately developed reflect a collective effort grounded in disability affirmation, universal design, and justice. But the deeper impact for me was personal: learning that disability inclusion requires ongoing unlearning—of old norms, old assumptions, and old definitions of ability—and the humility to grow because of what others so generously teach us.


Key Take-Home Messages

  • Traditional technical standards were shaped by ableist norms rather than true measures of competence.
  • Canada has adopted new functional Core Competencies, shifting from “organic” requirements to inclusive, outcome-focused expectations that support accommodations and assistive technologies.
  • disability-affirming, transparent, and inclusive process—centered on disabled physicians, learners, and scholars—guided the creation of these competencies.
  • Medical schools have legal duties to reduce barriers, provide accommodations unless undue hardship is proven, and ensure accessible admissions and learning environments.
  • This national shift advances social accountability, promotes universal design, and strengthens the diversity and well-being of the future physician workforce.


Core Competencies for Students Entering Medical School: Reaching Pan-Canadian Consensus for Inclusive and Accessible Medical Education

Authors: Cheryl L HolmesLaura Yvonne BulkNaomi LearLynn AshdownQuinten K ClarkeLaura FarrellRachel GiddingsLisa GravesJulia Ersilia HanesGeorge KimMichael QuonSaleem RazackFrancesco A RizzutiGinger RuddyAlex ScottErene StergiopoulosLee TonerLaura Nimmon

Abstract

A socially accountable physician workforce must include disabled learners and providers. However, current Canadian Technical Standards (TS) for medical school admissions create barriers to their inclusion. These standards overlook advances in assistive technology, universal design, evolving inclusion practices, and legal protections. Replacing the TS required consensus, but traditional methods of achieving consensus on disability inclusion risk reinforcing ableism in medical education. To address challenges with existing TS, the Association of Faculties of Medicine of Canada (AFMC) formed the “Re-envisioning TS Working Group,” using a novel consensus approach grounded in disability inclusion and critical disability discourse. Guided by transparency, accessibility, and respect for disability as diversity, the group prioritized engagement with disabled physicians, educators, scholars, and learners. The WG followed 5 stages: (1) identifying key concepts and reviewing literature on TS reform and ableism; (2) examining relevant legislation and case law; (3) drafting functional Core Competencies; (4) consulting partners across the medical education continuum; and (5) presenting outcomes to the AFMC Board, highlighting a commitment to disability inclusion in undergraduate medical education. The AFMC Board unanimously endorsed the “Report on Re-Envisioning Technical Standards,” including the “Desired Outcomes” and the “Core Competencies for Entering Medical Students.” The AFMC’s adoption of functional Core Competencies is a significant step toward inclusion and support for learners with disabilities in Canadian medical education. Medical schools should adopt these competencies, combat ableism, and invest in universal design to promote access. Accommodation support should extend from admission through postgraduate training to independent practice. Finally, efforts to foster an inclusive culture and contribute to a healthy, diverse physician workforce must be evaluated as part of medical schools’ social accountability mandate.


Have you’ve published or come across valuable research on the praxis of REDI in medicine? Share it today.

We especially welcome submissions of research articles that explore equity, diversity, inclusion, justice, decolonization, Indigenization, or trauma-informed practices in medicine and healthcare.

Accessibility & Disability Inclusion Resources

The ABCs of Compassionate Support

Research Voices from the Field with Faizal Haji

Research Voices from the Field with Faizal Haji

Research Voices from the Field is a new feature that showcases cutting-edge research that breaks barriers and promotes inclusion in medicine. Each edition spotlights a research publication and includes insights directly from the authors—revealing their motivations, the significance of their findings, and why the research matters for healthcare professionals everywhere.

In this edition, Faizal Haji, a pediatric neurosurgeon at the BC Children’s Hospital, Scholar at the Centre for Health Education Scholarship (CHES), and Assistant Professor in the Department of Surgery, reflects on why he co-authored “Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships” with colleagues in the Branch for Global Surgical Care  — a piece relevant to anyone interested in decolonization and global health equity.


 Faizal Haji

In this edition, Faizal Haji, a pediatric neurosurgeon at the BC Children’s Hospital, Scholar at the Centre for Health Education Scholarship (CHES), and Assistant Professor in the Department of Surgery, reflects on why he co-authored “Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships” with colleagues in the Branch for Global Surgical Care  — a piece relevant to anyone interested in decolonization and global health equity.

Read Faizal Haji‘s bio

Faizal Haji, MD, PhD, FRCSC

Dr. Faizal Haji is a pediatric neurosurgeon at the BC Children’s Hospital and an Assistant Professor in the Department of Surgery at the University of British Columbia. Dr. Haji is also co-lead for the Surgical Education Research Interest Group, Graduate Program Advisor for the Masters and Certificate Program in Global Surgical Care, and Associate Director of the Global Surgery Lab within the Department of Surgery at UBC.

Dr. Haji completed undergraduate studies followed by medical training at McMaster University. After graduating from medical school in 2008, he completed his neurosurgical residency at Western University in London, Ontario, Canada. During residency, Dr. Haji obtained a PhD from the Institute of Medical Science at the University of Toronto, alongside completing research fellowships at the Ronald R. Wilson Centre for Research in Education at UHN and the Learning Institute at the Hospital for Sick Children. His dissertation focused on the effect of fidelity, complexity and cognitive load on learning and transfer of procedural skills for novices engaged in simulation-based education. Upon completing neurosurgical residency and becoming a fellow of the Royal College of Physicians and Surgeons of Canada in 2018, Dr. Haji completed a postgraduate fellowship in pediatric neurological surgery at the Children’s Hospital of Alabama and the University of Alabama at Birmingham (UAB), where his research focused on capacity development for postgraduate surgical training in resource-limited settings. After training, Dr. Haji spent two years as a pediatric and adult neurosurgeon at the Kingston Health Sciences Centre and Medical Education Scholar at Queen’s University. Dr. Haji’s academic interest is in health professions education, with his program of research focusing on three areas: (i) surgical education, including clinical reasoning, the integration of basic and clinical sciences in surgical training, and entrustment; (ii) the globalization of health professions education, including its implications for international medical graduates (IMGs) and learners, educational policy (e.g. related to admissions, certification, and accreditation), international collaborations, and the migration of pedagogical and assessment approaches (e.g, CBME); and (iii) optimizing the design of simulation-based education for medical and surgical skills training with particular focus on cognitive load and learner engagement.

Together with over 70 students and faculty from around the world who are members of the Global Surgery Lab at UBC, we conducted this study to provide guidelines for the development of ethical and sustainable global surgery partnerships (GSPs). Global Surgery has grown substantially since the publication of the 2015 Lancet Commission, which demonstrated that over two-thirds of the world’s population lack access to safe and affordable surgical and anesthetic care, the majority of whom live in the poorest and most resource-limited regions of the globe. The associated World Health Assembly Declarations 68.15 and 76.2 recognize access to safe, timely, and affordable surgical care as a critical component of Universal Health Coverage, and the integration of emergency, obstetric, and anesthetic care is essential to building resilient health systems.

In response to this unmet need, historically surgical care providers engaged in short-term “missions” to provide care in resource-constrained (often international) settings. Unfortunately, these activities are rooted in a colonial framework, where surgical providers from high-resource settings engage in short-term missions to provide surgical care to populations without adequate consideration of the ethics and sustainability of such work, particularly with respect to local culture, needs, and context. More recently, efforts to scale up surgical care in resource-constrained settings have focused on reciprocal, bidirectional partnerships between institutions and teams in High-Income Countries (HICs) and Low- and Low-Middle-Income Countries (LICs/LMICs) that centre around education and training, capacity development, and health systems strengthening. In an ongoing effort to decolonize Global Surgery, our lab engaged in this study in hopes of initiating a conversation around what ethical, sustainable GSPs look like.

Using a modified Delphi technique, we recruited 50 global surgery experts from 34 countries representing all six WHO regions to iteratively establish consensus around the definitions and evaluation metrics for six “pillars” of sustainable GSPs: Stakeholder Engagement, Multidisciplinary Collaboration, Context-Relevant Education and Training, Bilateral Authorship, Multisource Funding, and Outcome Measurement. The associated 47-item checklist achieved full consensus among the expert panel over three rounds of the Delphi process and can serve as a self-auditing tool and benchmark to ensure accountability for those funding and engaging in GSPs. Importantly, this work also furthered an important conversation among panelists, within our lab, and in the literature about knowledge-sharing, co-creation, and decolonization by working in solidarity with, and uplifting, local and Indigenous providers, knowledge, and healthcare practices around the world.

In an ongoing effort to further this work, we are actively involved in pilot testing and iteratively revising this framework with Global Surgery groups engaged in GSPs within Canada and around the world.


Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships

Authors: Catherine J BindaJayd AdamsRachel LivergantSheila LamKapilan PanchendraboseShahrzad JoharifardFaizal HajiEmilie Joos 

Abstract

Objective: The aim of this study was to use expert consensus to build a concrete and realistic framework and checklist to evaluate sustainability in global surgery partnerships (GSPs).

Background: Partnerships between high-resourced and low-resourced settings are often created to address the burden of unmet surgical need. Reflecting on the negative, unintended consequences of asymmetrical partnerships, global surgery community members have proposed frameworks and best practices to promote sustainable engagement between partners, though these frameworks lack consensus. This project proposes a cohesive, consensus-driven framework with accompanying evaluation metrics to guide sustainability in GSPs.

Methods: A modified Delphi technique with purposive sampling was used to build consensus on the definitions and associated evaluation metrics of previously proposed pillars (Stakeholder Engagement, Multidisciplinary Collaboration, Context-Relevant Education and Training, Bilateral Authorship, Multisource Funding, Outcome Measurement) of sustainable GSPs.

Results: Fifty global surgery experts from 34 countries with a median of 9.5 years of experience in the field of global surgery participated in 3 Delphi rounds. Consensus was achieved on the identity, definitions, and a 47-item checklist for the evaluation of the 6 pillars of sustainability in GSPs. In all, 29% of items achieved consensus in the first round, whereas 100% achieved consensus in the second and third rounds.

Conclusions: We present the first framework for building sustainable GSPs using the input of experts from all World Health Organization regions. We hope this tool will help the global surgery community to find noncolonial solutions to addressing the gap in access to quality surgical care in low-resource settings.


Have you’ve published or come across valuable research on the praxis of REDI in medicine? Share it today.

We especially welcome submissions of research articles that explore equity, diversity, inclusion, justice, decolonization, Indigenization, or trauma-informed practices in medicine and healthcare.