No one-size-fits-all solution to anti-Indigenous racism in Canadian healthcare system: doctor

By Camille Bains


Bernice Thorassie couldn’t help but speak out for a patient in the emergency room of a northern Manitoba hospital after being treated there herself and noticing staff attitudes that smack of anti-indigenous racism.

Thorassie, who helps patients navigate the health care system for the nonprofit advocacy group Manitoba Keewatinowi Okimakanak, said the cutting tone of a lone worker was too much to bear as she watched a man who clearly needed help languishing in the waiting room.

“What I saw there, I couldn’t believe,” she said of her recent experience about a month ago. “I intervened. When I finished my treatment, I told them this is who I am, this is what I do.

Ongoing racism against many Indigenous patients has bred a deep distrust of the health care system, often preventing people from getting to a hospital or clinic in Thompson, Manitoba, a major health care hub in the area,” said Thorassie, a member of the Sayisi Dene First Nation.

Discussions of systemic racism intensified in First Nations communities after the 2020 death of Joyce Echaquan, an Atikamekw woman who, before her death in a Quebec hospital, posted a Facebook live stream of staff making derogatory comments.

Although the problem is widespread across Canada, some provinces are partnering with Indigenous groups to provide anti-racism training.

This week, ahead of the National Day for Truth and Reconciliation on Friday, Manitoba Health Minister Audrey Gordon joined health officials and Indigenous leaders in Thompson to sign a statement acknowledging a high number of incidents of racism and that transformative change must be led by First Nations. .

The three groups involved are the Manitoba Keewatinowi Okimakanak, which in Cree means Northern Manitoba Chiefs, a health organization called Keewatinohk Inniniw Minoayawin Inc., which means Northern People’s Wellness, and the Northern Regional Health Authority.

Dr. Barry Lavallee, CEO of Keewatinohk Inniniw Minoayawin Inc., or KIM, said the group aims to take over service delivery in the region, based on a successful agreement with the provincial and federal governments. The new governance structure would be similar to the First Nations Health Authority in British Columbia.

Physicians and other health care providers will be required to undergo mandatory training to “confront their own biases,” Lavallee said of planned changes to the health care system in northern Manitoba, where patients are transported from other regions without hospitals and clinics.

He said it was time to focus on the impact of racism, instead of providing “cultural sensitivity training”, which avoids a major problem in the healthcare system.

“We want our communities to interview doctors and other providers and decide whether those providers can come into the communities to serve them as they wish. The current imbalance and asymmetry in the system is that it’s the white system that decides which doctors go to (communities),” he said.

“We are beginning to understand how we are going to hire Aboriginal birth attendants and facilitate better care and facilitate a process for the Northern Regional Health Authority to understand the depth of its biases, which is hurting people trying to access the services. .”

First Nations people have poorer health outcomes because they often don’t get the care they need in a system that, for example, stereotypes them as forgetful when they miss appointments in environments where they feel unwelcome and neglected, he said.

The high number of uninvestigated cases of racism in the region has been a concern for years, said Lavallee, a family physician and former assistant professor at the University of Manitoba, where he specialized in developing Indigenous programs in undergraduate medicine.

He said $4.6 million in federal funding for the reporting work was requested before Echaquan’s experience gained national attention. A Quebec coroner later said his death from pulmonary edema linked to a rare heart condition involved “undeniable” systemic racism and the failings of the healthcare system.

Echaquan’s story and its tragic ending are far from an isolated incident.

Lavallee recently reviewed the case of a 42-year-old Indigenous man with osteomyelitis, or a bone infection, in his left foot and said he could only conclude that racism was at the heart of how the he case was handled in Thompson and Winnipeg. The patient’s family requested the examination after his condition deteriorated rapidly and they feared he might have his foot amputated unnecessarily, the doctor added.

“They imprisoned him, they put him in a mental institute and refused to listen to him for three years that he had a problem with his foot. So this young man went from an income of $4,000 per month as a high-level machine operator on welfare because he could no longer work, Lavallee said.

“In three years, this man’s life has been destroyed. About three or four months ago, they were trying to force him to amputate his left foot.

The patient recently received six weeks of antibiotics in Winnipeg to clear the infection, allowing him to walk, Lavallee said.

Jurisdictions across the country are trying to develop their own strategies to address the challenges rooted in so-called medical colonialism.

In British Columbia, a former judge was appointed two years ago to investigate allegations of racism in emergency rooms where staff allegedly played games to try to guess Indigenous patients’ blood alcohol levels.

An update last year to Mary Ellen Turpel-Lafond’s initial report in December 2020 found that 84% of the survey’s 2,780 Indigenous respondents said they experienced discrimination in health care and that those who don’t have not received primary and preventive care often end up needing secondary treatment.

British Columbia has created an Indigenous Health and Reconciliation Division within the Ministry of Health to try to ensure the availability of culturally appropriate care through “system-wide reforms”, a said the ministry in a written statement.

He said that over the next few months the province plans to release the first progress report outlining the work of a group of First Nations, Métis and health officials in implementing the changes, but he declined to provide details.

“We recognize that we cannot move quickly enough to respond to historic and ongoing Indigenous-specific racism. Deep systems transformation takes time, dedication and ongoing work to ensure cultural humility is embedded and Indigenous-specific racism is eradicated.

Dr. Alika Lafontaine, the first Indigenous president of the Canadian Medical Association, said members of her own family had faced racism, including one who sought treatment for abdominal pain before calling her for help. tips.

“It became clear to me that it was probably a misdiagnosis,”

Lafontaine said, adding that he advised the person in Saskatchewan to get reassessed.

“They were very, very worried about what would happen if they disputed the assessment,” Lafontaine said, adding that he arranged for a colleague to follow up and the patient ended up having a emergency surgery the same evening, without which he would probably have suffered a great deal of pain. harm.

Patients, family members and healthcare providers who report racism face a “very heavy burden” as the focus can be on imposing punitive consequences on those who caused the harm, instead of looking for long-term solutions, said Fontaine, an anesthesiologist. in Grande Prairie, Alberta.

Fontaine, who was to mark the National Day for Truth and Reconciliation with an online conference on racism in health care organized by the Canadian Health Coalition, said strategies in some parts of Canada are making a difference because that they were led by indigenous peoples with the support of local communities.

“I think as we reflect on the National Day for Truth and Reconciliation, we have an opportunity to realize that there is hope out there,” he said of the work being done. to implement changes in various regions.

“I think we really want as a country to have that example that we can spread across the country. But the truth is that things that work in Manitoba, Ontario, Alberta, British Columbia or wherever, work in those areas because they engage local people.

This report from The Canadian Press was first published on September 30, 2022.

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