Indigenous Canadians are avoiding going to the doctor or seeking urgent care in hospitals, says the president of The Indigenous Physicians Association. The COVID-19 pandemic has had an impact, but there’s also another equally invisible and potentially deadly factor: racism.
“People are fearing that they will be treated in a racist manner, or not receive the standard of care that a non-Indigenous person would,” Dr. Cornelia (Nel) Wieman, told Dr. Brian Goldman, host of White Coat, Black Art.
The death of Joyce Echaquan was a wake-up call to the kind of inequity that Indigenous people face as patients in the health-care system, says Wieman, who is also a psychiatrist and Acting Deputy Chief Medical Officer.at the First Nations Health Authority in Vancouver
In September, Echaquan, an Atikamekw mother of seven, died in a hospital in Joliette, Que., after live streaming some of the painful last moments of her life on Facebook.
The video captured Echaquan screaming in distress, along with the voices of staff members hurling racial insults at her.
After the video was circulated widely, thousands of people attended protests in Montreal and Quebec City demanding “Justice for Joyce.”
A public coroner’s inquest is investigating the circumstances of Echaquan ‘s death. In Wieman’s home province of British Columbia, another inquiry is underway to determine the range and extent of anti-Indigenous racism in B.C.’s health-care system.
Wieman spoke with Goldman, about the Indigenous community’s fear of the health-care system, and her own experiences as an Indigenous doctor and health-care leader.
Here is part of their conversation.
Are Indigenous people saying they’re afraid to go to the hospital because of what might happen to them or how they might be treated?
I can absolutely confirm that. That’s what people are saying.
And, in fact, it’s in some ways only been complicated by the COVID-19 pandemic. And then on top of that, people are fearing that they will be treated in a racist manner, or not receive the standard of care that a non-Indigenous person would.
I have to say, as an emergency physician for many decades, this is like a punch in the gut. This really bothers me a lot. And I don’t know if we are as bothered by this in medical culture as we should be. I want to ask you what you think about that.
I agree with you, Brian. I think we’re at a point in history where Canada is really reckoning with this issue.
Here in British Columbia, we are currently having a provincial inquiry into anti-Indigenous racism in the health-care system.
The whole inquiry was precipitated by reports of a blood alcohol guessing game that was taking place amongst the health-care staff in an emergency room.
We need to focus on being patient-centred, and respecting all patients no matter what background they have, including being Indigenous.– Dr. Nel Wieman
We really are looking forward to hearing the results of that provincial inquiry because I think we are going to be hearing about thousands of episodes that involve racism against First Nations patients.
We all go into medicine, I think, most of us because we want to help people and we want to be helpful. But somewhere along the way, people seem to have lost that perspective that we need to focus on being patient-centred, and respecting all patients no matter what background they have, including being Indigenous.
When we’ve spoken to other Indigenous physicians, they’ve said they face direct incidents of racism when they were in school. Was that something that happened to you?
Oh, for sure. I’m a survivor of the Sixties Scoop so my first experience with being treated in a racist manner probably started in kindergarten and continued all the way through my educational journey, including medical school and residency — not just from supervisors or peers, but sometimes even from patients themselves.
I used to work in emergency psychiatry and there were a few occasions where I had patients actually refuse to see me because I was visibly identified as a First Nations person. But you have to be a professional at all times. So, it was humiliating, and it hurt to be honest.
What’s your sense as to why these incidents are still happening?
Most people wouldn’t think of themselves as racist. I mean, that’s a pretty charged word even to start with. But I think that there’s a lot of negative stereotypes that we have about Indigenous people. There’s a lot of implicit biases that we hold that we might not necessarily be conscious of.
The other issue that comes into play is that very few First Nations patients come forward to make complaints when they have been treated poorly.
There are a number of reasons for that. We are a very rural and remote province in some ways. So in many cases, if you were treated badly by your primary care provider, that may be the only person that you have access to for health care.
The other aspect is that they feel that they won’t be believed, partly because of the power imbalance between a physician and a patient. That’s where the idea of cultural safety comes into play.
Cultural safety and humility is all about understanding and acknowledging the power imbalances and acknowledging yourself humbly as a learner when it comes to another person’s experience.
We are now five years out from the 2015 report by the Truth and Reconciliation Commission, which issued calls for action related to systemic racism in the health-care system. Has that helped to have the TRC put that in writing in regards to health care?
Yes, I do believe so. In my role at First Nations Health Authority and as president of the Indigenous Physicians Association, I see that the major national medical associations we work with all try to include the TRC calls to action in their frameworks for anti-racism. Just before I moved to British Columbia three years ago when I was in a meeting at an academic institution … one of those leaders said, “Do we have to use the ‘R’ word?” They couldn’t even say the word “racism.” And three years on from that, now we’re talking about racism. So that is great. I think we’re getting there. I think we’re starting that journey to get there together.
Q&A has been edited for length and clarity.