Author’s Note: Colonialism on Turtle Island, known today as North America, began with the arrival of European explorers and settlers. This period marked a profound transformation for the Indigenous Peoples of the land, who had long thrived in diverse cultures and societies across the continent. The new European presence brought about significant disruptions, including, but not limited to, land theft, cultural assimilation, genocide, and economic exploitation. Colonists imposed their political structures, disregarding traditional Indigenous governance systems, and enacted policies that led to the displacement and marginalization of First Nations, Métis, and Inuit communities. This colonial legacy and continued colonialist practices have led to lasting effects on the sociopolitical and economic landscape of Canada, creating ongoing challenges and shaping the contemporary relationship between Indigenous Peoples and the State. If you would like to learn about the survivor-led protocol for mending settler-Indigenous relations in Canada, please see the Truth and Reconciliation Commission of Canada’s Calls to Action.
Beginning in 2021, 30 September is the National Day for Truth and Reconciliation in Canada. We are sharing an insightful discussion with Jaris Swidrovich, one of the many unique and diverse voices in pain research. Jaris – who is Two-Spirit and of Saulteaux and Ukrainian descent – integrates their intersectionality with their professional work, focusing on improving healthcare delivery to Indigenous communities. As a pharmacist and assistant professor at the University of Toronto, Canada, Jaris aims to bridge gaps in healthcare access and ensure that all patients receive respectful and effective care. Jaris is known for their contributions to pharmacy education and their advocacy for Indigenous health and wellness. As an educator, Jaris is dedicated to training the next generation of pharmacists with an emphasis on cultural competency and social accountability. Their research interests include HIV, chronic pain, Indigenous health, pharmacy practice, and health equity.
Editor’s note: Following their keynote lecture at the International Symposium on Pediatric Pain 2023, Jaris spoke with PRF-ISPP Correspondent Annemarie Dedek (University of Waterloo, Ontario, Canada), which was a conversation made possible by generous contributions from Solutions for Kids in Pain (SKIP) and the Centre for Pediatric Pain Research (CPPR). IASP is committed to promoting open dialogue and critical thinking about pain research and management while maintaining a commitment to inclusivity and respect for diverse perspectives.
Can you tell me about the path that led you to pharmacy?
My path to pharmacy was chaotic and unexpected. I was first registered at the University of Saskatchewan to become a drama teacher for high school students. As a high school theater kid, I was friends with lots of folks older than me, and many of them had gone down the education path. After finding out from them that I would have to move out of Saskatoon – my home at the time – to get a job, I dropped all of that.
Then, I registered in biochemistry, physics, and all the prerequisites that you needed to apply to medicine. I did two years of arts and science to prepare for that med school application. I didn’t believe in myself, and I didn’t want to face the embarrassment of not getting in and having to tell people, so I didn’t apply. What I did do is stumble upon pharmacy. One of my classmates sitting behind me in biochemistry asked, “Oh, Jaris, did you get your pharmacy application in? It’s due on Friday, right?” When I said no, he replied, “Oh, I thought you were applying to pharmacy.” I didn’t even know it was a program offered by the University of Saskatchewan! The option never crossed my mind; no one in my family, at least at the time, was a health professional. My grandparents weren’t even on any medications; it didn’t impact me at all. When I looked at it online and saw that I had all the prerequisites, and it was only a $75 application, I just put in my application. I ended up getting in that first try, and was like, “Oh, that’s cool. Okay, well, at least I have something,” that kind of thing. But I still felt like that was probably not going to be what I do.
I went through the first year of the program and felt like, “I don’t know if this is that great.” We were learning “not-really-pharmacy” things at the time and I wasn’t a fan of the way the curriculum was going. But I wanted to try to get something out of it, so I put myself out there and volunteered with the Canadian Association of Pharmacy Students and Interns (CAPSI) and became our local representative. Moving into my second year, I became the CAPSI Junior Rep. for Saskatchewan and after that, I became the CAPSI national president-elect.
I really wanted to be part of something, but what I was learning in the classroom was not matching up with the things that we were advocating for on CAPSI, and I just thought to myself, I don’t know if this is right for me. After my second year of pharmacy school, I decided I was going to apply to medicine.
So in the summer after my third year of pharmacy school, when that whole cycle was done, I got in to medicine at the University of Saskatchewan. I had to make a decision: I had one year left of pharmacy to be a pharmacist, that fourth year was only three months in the classroom, and then the rest of it was practicum. I’m thinking to myself, “Well, that would be a pretty sweet summer job, and my future patients would love the fact that I have a pharmacy degree and an MD!” So I asked for a one-year deferral for medicine and they gave it to me so I could finish pharmacy.
I went through all the steps of fourth year in pharmacy, culminating in my fourth and final rotation in Regina General Hospital. It was there that I thought, “Wow, this is really cool!” It was lots of what I pictured myself doing as a physician, working in a hospital as a pharmacy student: Ordering and interpreting blood tests, meeting with patients and families, and even some aspects of counseling and collaborating with the other health professionals. I had this false assumption that physicians and nurses also do what pharmacists do, but pharmacists, that was their only job. I was wrong! People were coming to me with questions that I had answers to, and I ended up falling in love with the profession.
I didn’t have a post-graduation plan after pharmacy school now that I found my passion for pharmacy, but after speaking to a professor at the University of Saskatchewan, I got a research-related position in the College of Pharmacy and Nutrition. I did some consulting and I worked casually in a community pharmacy setting at Costco®. I also worked in a hospital setting that year after graduating, and that was when I decided to further my education in the field with a PharmD. At the time, it was only offered at the University of Toronto and University of British Columbia. Each program took approximately eight students every year, and I got into Toronto!
After my PharmD, I went back to Saskatoon and worked as a clinical coordinator at St. Paul’s Hospital. My clinical work was mostly in HIV, and after two years there, I moved to the faculty, was a lecturer for three years, and an assistant professor in a tenure-stream for three years. Now, I’ve been at the University of Toronto for three years!
You’ve mentioned that you didn’t seek out the pain field, that it sought you out. Can you tell me a little bit more about that story?
That started with my sister who developed an indescribable level of pain. I’m talking screaming in pain.
Pain is different for every person, and for her, it wasn’t [something] she could [just] struggle through. I’m talking screaming in pain to the point where she rarely even had a voice left because of the screaming. In fact, even if she still did have a voice, speaking hurt her too much because of what was going on in her jaw as a result of atypical trigeminal neuralgia. There was just a lot happening. It was an awful, horrible time for my whole family. We all withdrew from society because of her pain.
Trying to navigate her pain and being a pharmacist, I had to learn a lot more about how to help my sister. I was looking at things like drug interactions and, if she’s trying “drug X” or something like gabapentin, how long should she try it to understand if it will work or not work? What’s an adequate trial length? So I had to teach myself more about pain than I would have learned in the general curriculum of pharmacy. Then, randomly, the Canadian Pain Task Force asked, “Would you join us?”
Getting involved with the Canadian Pain Task Force, along with everything that was going on with my sister … those two things together were so special and close to me. My sister is the closest person to me, next to my Mom, who’s no longer around, so watching her live through that was the worst part of my life at the time. Then, I was a part of that Canadian Pain Task Force, which had such an important mandate with so many wonderful collaborators. I thought, “This is needed,” and, “I can actually wear multiple hats here!” The task force eventually published an Action Plan for Pain in Canada, which outlined guidelines for the federal government for the prevention, diagnosis, and management of chronic pain.
How do you view your role, given your unique intersectionality?
I have started seeing myself as an emulsifier. A common emulsifier that everybody knows is soap. If your hands are full of grease, or you have a greasy pot that you need to clean and you just run it under water, it’s not going to come clean, right? Those two substances, the water and oil, just don’t come together. You can have them in a pot together, but they still act separately. So I perceive Western knowledge systems and Indigenous knowledge systems as those two separate liquids.
Sure, they can exist together in the same space, but they don’t actually mesh that well. You could put an Indigenous healer into a primary care clinic, but it doesn’t mean that everything’s just going to work out nicely. So me – a person who is both Ukrainian and Saulteaux First Nations, a two-spirit person with the masculinity and femininity within me – I even credit being a middle child – I’m always in the middle. I’m always a mediator and I bring people and systems together when they may not otherwise be brought together. So I use a pharmacy term of “emulsifier” to refer to myself as one that brings together Western and Indigenous knowledge systems in ways that they can work together.
Sometimes, non-Indigenous folks in pharmacy might have an appreciation for things but feel lost on how to integrate. Then, Indigenous folks – who aren’t pharmacists – don’t know the world of pharmacy. I’ve got both of those pieces, so I can bring them together in some pretty unique ways. One very practical example is Indigenous folks who practice smudging but also want to take prescription medications, which is lots of people. There’s a misunderstanding that Indigenous folks don’t use Western meds. That’s totally false. One suggestion I’ve given is to open all their pill vials or take out their blister pack or whatever vessel their weekly dose comes in, and smudge over it. Some people might smudge every day, so I tell them to smudge over their medicines, over whatever it is that they’re using, and bring them together in that way. Do your prayer, ask the Creator that those medicines and medications will do what they’re supposed to do, and that they don’t do what they’re not supposed to do, that there are no harmful interactions, and we can embrace both ideas that way.
I know where the pharmacists might be and how they’re receiving what I’m sharing, and then I know where the Indigenous folks would be, what the women are thinking and what men are thinking, that kind of thing. So I can adapt my words and approach to make sure that people are hearing what they need to hear.
Annemarie Dedek is an assistant professor in the School of Pharmacy at the University of Waterloo, based out of Kitchener, Ontario. You can find her on X – @AnnemarieDedek.