To Reconcile, the Truth about Indigenous Health Care needs to be acknowledged
Nicholas Keller (2nd Year)
Major in Sociology, Minor in Health Sciences
Systemic Racism
The Truth and Reconciliation Commission (TRC) was launched in 2008. The commission was established based on the purpose of documenting the lasting history of Indian Residential Schools (“Advancing reconciliation”, n.d.). In 2015, the TRC released their multi-volume report, which included the 94 Calls to Action. These calls address what Canadian society, from the government, societal, and individual level, need to do in order for steps toward reconciliation to happen between Indigenous peoples and non-Indigenous peoples (Government of Canada; Crown-Indigenous Relations and Northern Affairs Canada, 2022).
In May 2021, the first set of child burials were discovered at the former Kamloops Indian Residential school. Despite the claims of genocide by Indigenous advocates and survivors for many years, only now are these claims partially seen as evidence-based and valid by Canadian society (Kennedy, 2022).
How about claims of injustice within healthcare settings by Indigenous peoples? Canadian society continues to need hard proof from Indigenous peoples in order to be somewhat heard. An example is Joyce Echaquan, a 37-year-old Indigenous woman who died in a Quebec hospital on September 28, 2020 after staff ignored her pleas for help and denigrated her, issuing racist insult after insult. Echaquan recorded and live streamed what became, tragically, her final encounter with the Quebec healthcare system.
Echaquan was a mother to seven children. The location of her death was at the Centre hospitalier de Lanaudière. The nursing staff denied Echaquan her rights as a member of Canadian society to appropriate and respectful care. They assumed that Echaquan was suffering from drug addiction withdrawal. Despite Echaquan’s complaints of heart palpitations, she was given sedatives and no further tests. The cause of Echaquan’s death was excess fluid in her lungs, from a biomedical perspective. From a social perspective, Echaquan suffered from the neglect of health care and systemic racism, being provided limited and negative support from the staff (Nerestant, 2021). If she had not captured the racist remarks by healthcare workers towards her, would Canadian society uphold her experience as valid?
Call to Action 18 states the following:
- We call upon the federal government, in consultation with Aboriginal peoples, to establish measurable goals to identify and close the gaps in health outcomes, call upon the federal government to appoint, in between Aboriginal and non-Aboriginal communities, and to publish annual progress reports and assess long- term trends. Such efforts would focus on indicators such as: infant mortality, maternal health, suicide, mental health, addictions, life expectancy, birth rates, infant and child health issues, chronic diseases, illness and injury incidence, and the availability of appropriate health services (“Truth and reconciliation”, 2015).
In order for reconciliation to progress in Canadian healthcare, exposure and admittance of truth from the Canadian government is important. This includes the acknowledgement of colonial and genocidal practices embedded within healthcare settings.
The negative healthcare environment that many Indigenous peoples find themselves navigating represent a continuity of colonial practices. Even a brief survey of the academic literature provides evidence of this. An academic article written by Erin Clarke reveals the purposeful policy that forced sterilization onto Indigenous women in Canada (Clarke, 2021). The eugenics movement in the 1900s was based on racial and disability thoughts on breeding. Specifically, a process of limiting certain people from breeding if they had unfavorable racial qualities and disabilities. Throughout 1923 to 1978, over 3,000 Indigenous women were forcefully sterilized through tubal ligation and hysterectomy. It is important to acknowledge that these numbers are likely to be under representative, given that other statistical data related to colonial practices, such as Indian Residential School child mortality rate were underrepresented (Torkaman, 2022). These historical eugenic policies have been investigated in contemporary healthcare settings. “Recent investigations reveal sterilization procedures continue to be pushed onto Indigenous women using coercive and manipulative tactics” (Clarke, 2021,p. 144).
A study by Boyer and Bartlett included the research method of interviewing Aboriginal women on their healthcare related experiences. The majority of women interviewed “felt victimized within the healthcare system and faced discrimination that included “racism from cold responses, racial questioning and refusal of care” (Boyer & Bartlett, 2017, p. 8).
The reality of continued colonial practices are clear in these and other innumerable examples. Perhaps what is most important to acknowledge is the complexity and pervasiveness of these practices. Such practices cannot be stopped suddenly, because they are rooted in dominant ways of thinking and acting, and they are ingrained in institutional norms. From forced sterilizations and other acts wherein a healthcare worker purposely sabotages an Indigenous person’s health through authoritarian action, to subtle or not so subtle expressions of conscious and unconscious bias, the colonial logic in healthcare practices takes grip and reproduces itself in instances of mistreatment, but also in the normality of discrimination faced by Indigenous peoples in Canadian healthcare.
Trust
Trust is an aspect that is critical for improving Indigenous healthcare in Canada. Trust is a process that will not happen overnight. It will take a long time and many experiences of non-discriminatory, fair treatment and practices. This is inevitable given the long time period of colonial practices embedded within Canadian social structures, including but not limited to healthcare settings. I regard trust as connected to truth, specifically healthcare settings acknowledging the truth of colonial practices that have negatively impacted Indigenous peoples. In addition, after acknowledging the truth, healthcare settings can collaborate with Indigenous peoples on working towards decolonizing these socially embedded colonial attitudes and practices.
To conclude, as I continue my advocacy work for Indigenous peoples, including Indigenous healthcare, I am hopeful that sustainable solutions can be implemented in healthcare settings to improve Indigenous women’s encounters, and Indigenous peoples’ health seeking and outcomes overall in healthcare settings. Possible solutions may include providing Indigenous women priority within hospitals for childbirth, or funding and resourcing safe, Indigenous traditional birthing practices at home for Indigenous women, if that is their preference and in towards decolonizing health services. Another solution, which aligns with call to action 23(i), is incorporating more Indigenous peoples into existing healthcare settings. This is not to say that non-Indigenous doctors are not capable of performing childbirth procedures, but having more Indigenous peoples within healthcare may allow for more Indigenous perspectives to be heard. For example, Indigenous healthcare workers may provide guidance on creating a safe space for Indigenous patients in healthcare settings. To reduce negative bias towards Indigenous peoples within healthcare workers, sensitivity training and cultural awareness teachings can provide opportunities for decolonizing workers’ mindset and approaches to healthcare practices. In order for positive change to be made for Indigenous health, the Canadian healthcare system base and construct needs to be rebuilt through collaboration with Indigenous peoples. To decolonize a social institution such as the healthcare system, it requires to make a change to a system that “works well.”
Bibliography
Advancing reconciliation overview of canada’s truth and reconciliation ... (n.d.). Retrieved March 18, 2023, from https://www.albertaschoolcouncils.ca/public/download/documents/57308
Boyer, Y., & Bartlett, J. (2017, July 22). External Review: Tubal ligation in the Saskatoon Health ... - researchgate. Saskatoon health region . https://www.researchgate.net/publication/318987435_External_Review_Tubal_Ligation_in_the_Saskatoon_Health_Region_The_Lived_Experience_of_Aboriginal_Women
Clarke. (2021). Indigenous Women and the Risk of Reproductive Healthcare: Forced Sterilization, Genocide, and Contemporary Population Control. Journal of Human Rights and Social Work, 6(2), 144–147. https://doi.org/10.1007/s41134-020-00139-9
Government of Canada; Crown-Indigenous Relations and Northern Affairs Canada. (2022, September 29). Truth and reconciliation commission of Canada. Government of Canada; Crown-Indigenous Relations and Northern Affairs Canada. https://www.rcaanc-cirnac.gc.ca/eng/1450124405592/1529106060525
Kennedy, D. (2022, May 30). 'biggest fake news story in Canada': Kamloops mass grave debunked by academics. New York Post. https://nypost.com/2022/05/27/kamloops-mass-grave-debunked-biggest-fake-news-in-canada/
Nerestant, A. (2021, October 2). Racism, prejudice contributed to Joyce Echaquan's death in hospital, Quebec Coroner's inquiry concludes | CBC News. CBCnews. https://www.cbc.ca/news/canada/montreal/joyce-echaquan-systemic-racism-quebec-government-1.6196038
Torkaman, A. (2022, December 13). Enough is enough: The ongoing forced and coerced sterilization of indigenous women in Canada. MIR. https://www.mironline.ca/enough-is-enough-the-ongoing-forced-and-coerced-sterilization-of-indigenous-women-in-canada/
Truth and reconciliation commission of canada: Calls to action - gov. (2015). Province of British Columbia- Gov.bc.ca. https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf
Photo by Guillaume Jaillet on Unsplash
