A Doctor’s Practice

The most compelling memoirs are those that get beyond an individual’s life to tell larger stories, training beams of light on a time, place, or society that readers otherwise can’t see. Such is the case with Gretchen Roedde’s Deep Water Dream, a look at Canada’s evolving relationship with Indigenous peoples through one physician’s eyes. Roedde writes of her career in remote northern Ontario, drawing on memories from the 1970s, ’80s, and ’90s. These decades were critical in the transition between a colonial past and a future that strives for reconciliation and new relationships. In the early 1970s, for example, Indigenous leaders rejected the infamous 1969 White Paper, put forward by prime minister Pierre Trudeau and minister of Indian Affairs and Northern Development Jean Chrétien, which would have eliminated “Indian status” and voided treaties. Things haven’t been the same since. Roedde’s memories illustrate how for young people on the ground, hippie-like engagement supplanted the missionary zeal that had marked the colonial past.

Gretchen Roedde grew up on the Toronto Islands and attended medical school at McMaster University, in Hamilton. During her admissions interview, in 1974, she announced her plans to go north and work with First Nations. “The panel laughed,” she recalls. Four years later, armed with a medical degree, she left for an isolated island in Lake Temagami with her equally idealistic husband, a researcher eager to work on land claims.

Roedde reflects on the big picture of her profession over the last forty years. “Many of the efforts to provide health care to Indigenous Peoples have been colonial and destructive of culture,” she writes. “And yet it is the strengths of community and tradition that have proved the most promising in helping to build First Nations, Inuit and Métis identities and close the gaps in health status with non-Indigenous people in Canada.”

Her stories supply nuanced context that rarely registers in southern reporting. The arrival of mental health professionals in an isolated community beset by a rash of suicides, for example, shows why nuance is essential. Despite the best intentions of the health care providers, and of the faraway government that dispatched them, they experienced a serious disconnect in cultural understanding:

It was the time of the spring goose hunt. The whole community — everyone, all ages, even the dogs — set out at night for the annual traditional celebration. In the morning, the surprised crisis workers wondered where everyone had gone. Out on the goose hunt, in the midst of a community’s grief, there were chuckles about how the health workers were faring alone in the community.

Though she does not name the community, the story illuminates a larger national saga and the divide that deserves more and more attention today.

Roedde has worked hard to bridge that divide. When travelling throughout the North, she has opted to stay in First Nations homes rather than nursing stations and other “white” accommodations. She describes how her many hosts have ­welcomed her to births, deaths, and funerals, and how they have built deep, lasting friendships.

For a time in the mid-1980s, Roedde went global, teaching at the Liverpool School of Tropical Medicine, in the U.K., and fighting HIV/AIDS in Africa, a period she recounts in her 2012 book, A Doctor’s Quest: The Struggle for Mother-­and-Child Health around the Globe. But her career has largely taken her from one First Nations community to another: Temagami, Sioux Lookout, and Moosonee, where she spent a season helping local health workers and elders develop a Cree-­English medical dictionary “to help to explain symptoms and illnesses” to Indigenous patients.

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The story of northern health care delivery has evolved slowly, and there have been setbacks along the way (consider the prime minister’s recent apology for twentieth-­century tuberculosis policies among Inuit communities). But, as this book shows, dramatic things are finally happening.

When Roedde entered medical school, her teachers were mostly “staff men,” who complemented their white coats and stethoscopes with “stern frowns.” While McMaster had “a reputation for innovative learning,” she recalls, “many of our professors were old school and enjoyed ridiculing the students.” And although women were almost 50 percent of the class, “these more traditional physicians weren’t sure what to make of us.”

Forty-­five years later, Roedde herself is preparing the next generation of doctors as an assistant professor at the Northern Ontario School of Medicine, a pan-­northern institution with campuses at Laurentian University, in Sudbury, and Lakehead University, in Thunder Bay. Accredited less than twenty years ago, NOSM trains physicians for the type of hard-to-fill posting Roedde eagerly sought when she started out. One of its innovative strategies: every first-year student spends a month living on a remote reserve — not to learn medicine, but to understand a culture. Roedde mentors many of these students, the vast majority of whom are from the North and plan to stay there.

Another absorbing part of Deep Water Dream describes childbirth from a cultural and medical point of view. When Roedde first went north, she had an opportunity to learn from Indigenous women with deep knowledge about birthing practices. She gained valuable lessons, even as the mainstream system failed to recognize the important role of midwives, instead transporting pregnant women to obstetrics wards sometimes hundreds of kilometres away. But Roedde stuck around long enough to see that wheel turn.

Today, there is an uptick in the numbers of midwives and a growing appreciation of them. In the book’s final chapter, Roedde describes the birthing room she has set up in her own home, in Haileybury, with the help of local midwives. There they mainly serve Amish women who have settled in the area and disdain hospital births.

Ultimately, Roedde’s book offers an important perspective. Reconciliation — very much a part of public discourse today — is not always easy to actualize. It is possible that, beyond sweeping gestures of the state or society at large, it comes through one small action at a time. Deep Water Dreams is the story of a culturally and psychologically adventurous white doctor who engages in daily activities with her Indigenous neighbours, colleagues, and patients, developing rewarding relationships and mutual understanding on the path toward positive change.