Re: Truth before reconciliation; humility before truth

Kudos to both the BCMJ and Dr Greggain for this heartfelt and inspiring President’s Comment [BCMJ 2023;65:240-241]. Imagine if all in our profession acted in accordance with the principles outlined in this piece.

As for Dr Greggain, hearing reports of finding remains of Indigenous children on the grounds of the Kamloops residential school was gut-wrenching for me. I worked in Kamloops for 15 years at the Urban Aboriginal Health Centre. Many of my patients had attended that school. I recall utter exhaustion at the end of one clinic day and the realization as I looked over our patient list with our clinic MOA that 18 of the day’s patients were seen for medical issues related to posttraumatic stress disorder.

I want to submit that two additional Calls to Action from the Truth and Reconciliation Commission of Canada (#33 and #34) are also health related, even though they are captured under the “Justice” category, and should be included with the Calls to Action that Dr Greggain drew our attention to [Box].

Calls #33 and #34 mean we as health care providers need to identify, diagnose, and appropriately support people with fetal alcohol spectrum disorder (FASD) and their families. We need to become FASD aware. When we diagnose people with FASD we can also learn about their family and their environment and can then recognize and advance opportunities for prevention. Prevention will require increased mental health and social support for birth mothers. Based on an estimate of 2400 federal jail inmates and 2400 provincial jail inmates, BC has approximately 4800 inmates; between 24% and 28% have FASD.[1] That is 1300 individuals. I have diagnosed about 14 incarcerated individuals with FASD in the last few years. Our clinic—currently the only clinic in BC that diagnoses adults with FASD—receives no sustainable funding from either the federal or provincial governments. More governmental support is required to meaningfully respond to Calls to Action #33 and #34. FASD is not a niche issue; FASD is diagnosed in 28% of foster and adopted youth referred to a children’s mental health centre, 9% of children in special education programs, and 25% of children in foster care.[1]
—Rod Densmore, MD
Medical Assessor, Adult FASD Clinic, Independent Living Vernon

BOX. Truth and Reconciliation Commission of Canada Calls to Action #33 and #34.
www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf [10].

Truth and Reconciliation Commission of Canada Calls to Action #33 and #34

(italics added by Dr Densmore)

33. We call upon the federal, provincial, and territorial governments to recognize as a high priority the need to address and prevent Fetal Alcohol Spectrum Disorder (FASD), and to develop, in collaboration with Aboriginal people, FASD preventive programs that can be delivered in a culturally appropriate manner.

34. We call upon the governments of Canada, the provinces, and territories to undertake reforms to the criminal justice system to better address the needs of offenders with Fetal Alcohol Spectrum Disorder (FASD), including:

i. Providing increased community resources and powers for courts to ensure that FASD is properly diagnosed, and that appropriate community supports are in place for those with FASD.

ii. Enacting statutory exemptions from mandatory minimum sentences of imprisonment for offenders affected by FASD.

iii. Providing community, correctional, and parole resources to maximize the ability of people with FASD to live in the community.

iv. Adopting appropriate evaluation mechanisms to measure the effectiveness of such programs and ensure community safety.

This letter was submitted in response to “Truth before reconciliation; humility before truth [11].” [11]

[12]

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License [12].

References

1. Popova S, Lange S, Shield K, et al. Prevalence of fetal alcohol spectrum disorder among special subpopulations: A systematic review and meta-analysis. Addiction 2019;114:1150-1172.