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      Canada and Anti-Indigenous Racism in Healthcare

      By Tamara Hansen

      Over the last year, during the Covid-19 pandemic, there have been numerous stories in Canada's mainstream media about anti-Indigenous racism across many jurisdictions: from policing, to children in care, to access to clean drinking water to the justice system. Still, some of the most infuriating stories of discrimination have come from the healthcare sector.

      While healthcare is quite literally meant to be about people’s health and wellness, under capitalism it is a for-profit scheme, even in countries like Canada with a public (or nationalized) system. Just as the country of Canada was born from colonialism, the removal of Indigenous people from their lands, and the attempted erasure of their cultures and languages, there are colonial roots to Canada’s healthcare system.

      To better understand this, we can look specifically at the province of British Columbia, where two health crises – the overdose crisis and the Covid-19 pandemic – have further exposed systemic racism within the provincial healthcare system. Dr. Mary Ellen Turpel-Lafond, a member of the Muskeg Lake Cree Nation and former judge, was appointed by the B.C. Ministry of Health to carry out a review of anti-Indigenous racism in the provincial healthcare system. Turpel-Lafond's highly critical report was issued in November 2020 under the title, "In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care." On February 4, 2021, the same review released some important supplemental evidence in “the data report.”

      In every talk or interview, Turpel-Lafond starts discussions about this review with a trigger warning, as the contents may trigger unpleasant feelings, memories, or even post-traumatic stress in people who have had their health and lives endangered during their experiences with the B.C. healthcare system. This is an important reminder that while to some (mostly non-Indigenous people) the review’s first-hand stories will be angering and perhaps shocking, to others, these stories are a recounting of direct violence and trauma inflicted on their community, friends, and family. As human-loving people, we have a responsibility to listen, learn and join the fight for change.

      First-hand accounts of anti-Indigenous racism in B.C. healthcare

      The review collected hundreds of first-hand reports from those surveyed during the process. Here are five accounts that were published in the report:

      >> First, the review highlights the words of a non-Indigenous man whose family gets better treatment when he accompanies them to appointments instead of his partner, a First Nations woman. He says, “After the third time, we gave up and I just started taking the kids to every appointment because I am a white male and got better service. Sad, but reality."

      >> Second, "A First Nations woman in her 50s, living in Vancouver’s Downtown Eastside, told the Review about her recent experience when, after going to the hospital for a COVID-19 assessment, she was mistakenly assessed as suicidal and temporarily detained under the Mental Health Act.

      The woman, who has recently been working as an advocate for Indigenous women in her neighbourhood, has become terrified of going to the Emergency Department to seek care because of past traumatic experiences in more than one hospital. She told the Review that the only time she has been able to get respectful treatment and not be assumed to be drunk or high or subject to racism was when she had a non-Indigenous friend accompany her as an advocate and support person.

      >> Third, "An Indigenous physician offered the Review some personal observations about the racism they have experienced on the job:

      • I have been asked to look after my “drunk relatives” in the ER or have had Indigenous patients reassigned to me on the wards [who were considered difficult patients] when I was a resident.

      • As a resident, I was often required to advocate for Indigenous patients who were scared and frightened due to mistreatment while they were in the hospital. [...]

      • My own family members have left without receiving care because they were told they were just “drug-seeking.”

      >> Fourth,
      "A non-Indigenous woman, employed in food services at a hospital told the Review about her experiences with racism in the health care workplace. She says a fellow employee went on a “rant” about Indigenous people, “and when I informed them that my partner was Native, they doubled down and declared that Native people and their partners (i.e., me) should be ‘sterilized, so they don’t have eight kids on welfare.’”

      The woman emailed her supervisor and recalls being told: “We can’t control peoples’ opinions, sweetie.” She says the employee who made the comments to her received no correction or reprimand. The woman knows she is not the only employee who has complained about racism in her workplace.

      >> Fifth, an Indigenous health director, gave their perspective for the report, explaining, "As First Nations people, we have a vivid memory of pandemics, and this collective fear sets us apart from others. Now, our people are avoiding going to the Emergency Room because they are afraid of racism. And because of COVID, they can’t bring anyone with them to speak on their behalf."

      Anti-Indigenous racism impacting the health and wellness

      The first-hand accounts are not just stories to shock or anger, they have real impacts on Indigenous people’s willingness to access healthcare and thus on their health outcomes. For example, the "In Plain Sight” report found that:

      ▪ “Indigenous people in B.C. don't have access to family doctors and other primary-care services, and instead, end up in the emergency room dealing with health crises.” (CBC)

      ▪ “Indigenous patients are 75 percent more likely to visit the ER than anyone else in B.C.” (CBC)

      ▪ “Overall, Indigenous people in B.C. have a higher rate of chronic conditions, worse outcomes for babies and children and have been disproportionately affected by both the COVID-19 pandemic and the overdose crisis. The death rate for Indigenous women from overdoses in 2020 was almost twice as high as that of non-Indigenous women.” (CBC)

      Furthermore, prior to the "In Plain Sight” review beginning its research, there was an assumption that problems would be worse in rural/remote areas of B.C. However, Turpel-Lafond explains, “When we did the review and looked at it, we found it is not a rural/remote problem, but in fact, it is a problem everywhere in British Columbia. […] Indigenous women, in particular, are quite disproportionally affected even in our best teaching/high quality specialty hospitals, like Women’s hospital. We have Indigenous women leaving against medical advice at 11 times greater rate than other residents." (the Quality Forum 2021)

      The "In Plain Sight” review has been summarized in a graphic. The review graphic establishes that Indigenous people's problems at the point of care start with racist stereotypes. This includes the racist stereotypes that Indigenous patients are: “Less “worthy,” drinkers/alcoholics, drug-seeking, bad parents, “frequent flyers,” non-compliant, less capable, get “stuff for free,” and generally misogynist views of Indigenous women.” These stereotypes lead to discrimination when Indigenous patients seek care, including: “Abusive interactions, denial of service, ignoring and shunning, inappropriate pain management, medical mistakes, and disdain for cultural healing.”

      Each of these factors contributes to poor health outcomes for Indigenous patients, including higher suicide rates, higher stress, reduced life expectancy, increased rates of chronic disease, and higher infant mortality. This of course is an infringement on their human rights as well as Indigenous specific rights recently encoded into B.C. law through the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). The "In Plain Sight” review graphic indicates that the foundation of this cycle is colonialism, segregation, racism, and discrimination.

      The “In Plain Sight” review ends with 24 recommendations based on the information exposed by the survey. These recommendations involve setting up new Indigenous leadership positions in hospitals and the ministry of health, as well as better training, awareness building within healthcare settings, etc. These recommendations should be implemented but will not be sufficient actually to end anti-Indigenous racism in B.C. healthcare. Reforming the broken capitalist health care system is not enough. It needs to be dismantled to expose and dig up the colonial and racist roots of the system; then rebuilt from scratch putting people’s health and wellbeing ahead of profits.

      Not just a B.C. problem, not just an anti-Indigenous problem

      While this report focuses on the province of British Columbia, its findings clearly apply to all health jurisdictions in Canada, which need to work to dismantle capitalist anti-Indigenous racism actively. On January 27-28, 2021, Canada's federal government held a national dialogue on anti-Indigenous racism in healthcare with provincial, territorial, and Indigenous representatives. However, this government meeting was not a benevolent gesture – instead, it was organized in reaction to community fury and protest following the death of Joyce Echaquan. Echaquan, a 37-year-old Atikamekw mother of seven, died on September 28, 2020, in a Quebec hospital. Prior to her death, Echaquan used Facebook live to broadcast racist and discriminatory comments made to her by hospital workers. In the video, nurses can be heard saying, “She’s good at having sex, more than anything else,” and ask, “Are you done acting stupid? Are you done?” Among other hateful comments. These remarks are clearly based on the same racist stereotypes that were identified in the B.C. review.

      Anti-Indigenous racism is not the only racism plaguing Canada’s healthcare system, many racialized people face racist stereotypes, which lead to discrimination and barriers to accessing care. In many racialized communities this leads to poorer health outcomes than for white patients. Meanwhile, racism is also only one barrier to care, many people with disabilities are stuck with huge and unpayable medical bills despite Canada’s so-called ‘universal’ system, many of their therapies, assistive devices, and medications are not covered. The same goes for trans folks on hormones and some aspects of gender confirmation surgeries such as vocal feminization or reduction of Adam’s apple, which are not covered. It should also be mentioned that this universal healthcare system is a capitalist and colonial based system, and it is only partially extended to non-residents and migrant workers, which is completely unjust and must be dismantled.

      How do we confront and change systemic issues within healthcare?

      The base of the healthcare system in Canada continues to be many private companies and corporations vying for contracts and business. People across Canada must pay out of pocket for dental care, eye care, so-called “elective surgeries,” medicines, physiotherapy, counselling, psychology, and even parking at many hospitals. While some workers have coverage from workplace insurance plans, in many cases, there are yearly maximums, and for many, there is no coverage. Many of the services that are not covered are medically necessary: glasses, hearing aids, hormone treatments, dental work, counsellors, and psychologists, etc. For many, these are medical requirements to get out of bed in the morning and go about your regular day.

      Within all of this, we also have to recognize the stress and pressure placed on the shoulders of healthcare workers. Every year funding for the public system is under threat of being cut, and healthcare workers are asked to do more with less resources. This is not to excuse racism and discrimination from healthcare workers towards patients, but to acknowledge that the problem is built into the whole system and something that a few reforms will not fix.

      Each of these issues reminds us that healthcare in Canada is not an unbiased science and care system for the betterment of human health and wellbeing. This whole system needs to be dismantled and reimagined with human beings and their health and wellness as the priority. The system should prioritize preventing illness, providing discrimination-free access to all, and ensuring all medicines and therapies are available free of charge. We need a free healthcare for all system. This is the healthcare system that working and oppressed people in Canada deserve, but it is not something that we will be given to us, it is something we will have to fight for together.

      Follow Tamara on Twitter: @THans01

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