Written by Emma Rodriguez
Edited by Bhromor Rahman
In September 2020, Joyce Echaquan, mother of 7 from the Atikamekw Nation in southwestern Quebec, went to a Joliette hospital to be treated for stomach pains. Instead of receiving proper care, hospital staff berated her; calling her stupid, saying she was good only for sex, and would be better off dead. As her pain worsened, she began to livestream on Facebook, recording as healthcare workers gave her morphine, to which she was allergic. As a result of such mistreatment, she tragically passed away, sparking protests and renewing calls from Indigenous leaders to confront Canada’s systemic racism, specifically in the medical system.
Despite the horrifying nature of the incident, this death is not an isolated one. In fact, the tragedy is symbolic of the discrimination towards the Indigenous in Canada; countless cases of ignorance, negligence, and prejudice expose the horrifying reality of the Canadian medical system for Indigenous peoples. In spite of all research and anecdotes exposing this mistreatment, healthcare workers and administrators often deny the prevalence of the barriers Indigenous peoples face to receive adequate healthcare. Even the Quebec Premier, François Legault, rejects that systemic racism is prevalent in the province, stating: “What happened to Ms. Echaquan is totally unacceptable… This does not mean that Quebec is racist.” By examining Canada’s mistreatment of Indigenous peoples in the healthcare system, prevalent today as it has been for centuries, it’s sad to see that Natives have become nothing more than a talking point for politicians, only relevant when it suits the ruling class’ interest. However, no one in power really cares about them. What you are about to read is the outcome of that neglect and what can be done to stop the carnage.
History of racism in Healthcare
Systemic racism in the healthcare system is rooted in Canada’s colonial history. The colonialism present at many levels of the healthcare system inherently undermines Indigenous healthcare by reinforcing western views on medicine and discrediting holistic Indigenous medical practices. According to the Federal Health Minister, Patty Hajdu, the Canadian healthcare system was built on racism: “The system is not broken. It was created this way. And the people in the system are incentivized to stay the same.”
When settlers encountered the First Nations, they were exposed to new diseases with which they had never been in contact with, like smallpox. These diseases led to large scale epidemics in the communities, decimating the population with an estimated mortality rate ranging from 50% to 90%. Along with many deaths, communities also faced the loss of some of their traditions, as the illnesses discredited traditional healing methods that were ineffective to new sicknesses. Taking advantage of the weakened nations, the colonial governments and the Church sought to colonize and convert Indigenous peoples. They imposed restrictions on the communities, repressing their spirituality, autonomy, their traditional education and healthcare practices. With the introduction of the paternalistic Indian Act in 1867, many traditional healing practices were outlawed and some First Nations people were sent to prison for practicing traditional medicine. In 1920, an amendment to the act made residential schools mandatory for all Indigenous children. At these schools, the Canadian government and Christian Churches used education as a weapon of choice for assimilation. Conditions were so horrible that mortality rates reached 60% in some schools due to malnutrition and the spread of disease. Furthermore, at some schools in the 1940s and 1950s, highly unethical nutritional experiments were conducted: children were denied proper nutrition, leading some to become anemic, affecting development and possibly leading to death. To control other factors, researchers even stopped some participants’ dental care to observe its impacts. Simultaneously, Canada expanded its network of “Indian Hospitals”, racially segregated hospitals designed to further undermine traditional healing practices and replace them with biomedicine. Invasive and unnecessary procedures were often performed because hospital workers saw Indigenous peoples as inferior to the white Canadian and unfit to treat their illnesses at home. Abuse was rampant at the hospitals, with unconsenting medical researchers using Indigneous peoples as subjects. In its quest to seize even more power, the Federal government forced Indigenous peoples to stay in those slaughterhouses by passing an amendment in 1953 which made it a crime for Indigenous people to refuse to see a doctor, to refuse to go to a hospital, and to leave a hospital before discharge. Do not let euphemisms fool you; this is state-sanctioned human experimentation.
These medical colonial policies are not all in the distant past. Until as recently as 2014, children from regions of Northern Quebec, typically Indigenous, were not allowed a caregiver when they were taken to hospitals in the South. This traumatizing experience reminded Indigenous communities of the history of having their children forcibly removed and never coming back.
Clearly, these many harmful programs have led not only to the ever present generational trauma in Indigenous communities, but also to Indigenous mistrust towards the medical system. Despite the many reconciliation attempts from the government, this mistrust continues today and remains a major driver of health inequities. Many elders delay seeing healthcare professionals until they are seriously ill as they fear they will be forced into long-term care facilities for sick Indigenous people, not unlike residential schooling policies. Furthermore, people who experience racism often underutilize healthcare services and underreport their symptoms expecting discrimination and mistreatment. Also, new research has found an increase of disease caused by allostatic load; instances of racism and scorn against minorities affecting their ability to cope with stress which may lead to a decline in biological functions.
Along with the traumatic history, Indigenous peoples must also deal with the complicated challenge of receiving medical care despite the lack of clear authority on Indigenous healthcare. While the Federal Government assumes control over most of the delivery of healthcare, the lack of clear regulations makes it unclear which responsibilities fall onto the Federal or Provincial Government, leading to a “patchwork” of different legislations delegating the responsibilities.
Moreover, social determinants of health (social and economic factors affecting wellness) also disadvantages Indigenous peoples. For example, Indigenous mortality rate on reserves is up to three times higher than the Canadian national average, while Indigenous life expectancy is 15 years shorter, and incidence of diseases, like diabetes is up to four times higher than non-Indidenous peoples. These discrepancies can be explained by not only the inequality in healthcare, but also other factors, such as poverty and a lack of access to adequate housing or healthy foods.
Improving Canada’s healthcare system begins by acknowledging its flaws. If we continue to ignore the medical system’s systemic racism and its consequences, countless more lives will be lost. Therefore, after recognizing the barriers Indigenous people face to receive adequate health services, we may then work on breaking those down to ensure equal healthcare for all. By educating healthcare professionals on Indigenous cultures and histories, they can begin to understand their patients, what they’ve been through, and how that awareness instructs them to care for others without judgement.
One method is cultural safety, developed by Māori nurse, Irihapeti Ramsden. By developing equal partnerships between health professionals and Indigenous communities, power imbalances can be reversed to give communities proper care in accordance with their norms and values. This can include having more Indigenous healthcare workers, implementing proper training to instruct current healthcare providers on respectful treatments, and providing interpreters and coordinators for Indigenous patients. Including traditional Indigenous medicines with western practices and allowing the community to have a say in decisions regarding healthcare can also reduce Indigenous peoples’ obstacles to healthcare. Finally, having elders in hospital settings who are adept in understanding and working within Indigenous perspectives would provide patients not only with comfort, but also understanding. Recent evidence suggests that when Indigenous-led healthcare services partner with hospitals, Indigenous people’s mental, spiritual and physical health improve, as does their access to care and their adherence to their treatment plans.
Purvirnituq hospital, a northern remote maternity ward and birth center, implemented a midwifery program, where prenatal, birth, and postnatal services would be performed by Inuit midwives with both medical and traditional training. Since the program began, evacuations, cesarean deliveries, and inductions have greatly reduced, and postnatal mortality is equal to the Canadian average, which is lower than other Indigenous populations.
However, improving health services is not enough. As previously mentioned, social determinants of health also gravely impact Indigenous wellness. Therefore, we must also address social determinants on a broad scale, from access to healthy food and clean water to proper housing and equal job opportunities.
Though Indigenous health has improved in recent decades, the battle for equality is far from over; we must address both systemic racism toward Indigenous people in the healthcare system and better the broader social determinants of health to ensure adequate health care for all.