Joyce Echaquan, a 37-year-old Atikamekw mother of seven, tragically died in hospital while nurses attending to her uttered racist remarks and Echaquan shared a live video on Facebook. Her death has called attention to a health-care system that Indigenous medical workers say has been failing to serve Indigenous people for years.
Cheryllee Bourgeois is a Métis “exemption midwife” with Seventh Generation Midwives Toronto. She said that when speaking with friends and colleagues about Echaquan’s death, people would share that they had similar experiences.
“I can’t tell you since I first heard about it on Tuesday, how many people have said, ‘Yeah, my family actually had an incident like that X number of years ago,’ or, you know, ‘last year when my dad died.’ ”
Exemption midwives are regulated through a community process instead of through the College of Midwives of Ontario, which allows them to broaden their scope of care for Indigenous women. For example, they are able to perform STI tests and Pap tests on women who are not pregnant, while midwives can usually only perform on women who are pregnant.
“It provides a different way than in the usual health-care system,” Bourgeois said. It makes a difference for women knowing that their practitioner is “also Indigenous, and also (has) understandings and teachings that go along with how you care for yourself.”
At the same time, Bourgeois recognizes the privilege to be able to provide or have access to someone like an exemption midwife, which only exists in Ontario and Quebec, and says change is needed beyond that.
“A transformative health-care system really has to be the full system,” Bourgeois said. “So often, when you go into these spaces, you’re treated as not human enough. And then what ends up happening is you see the outcomes of that dehumanization, in situations like the one that happened with Joyce. But Joyce’s situation is not uncommon.”
Another recent example is Brian Sinclair, an Ojibwa man, who in 2008 died in a Winnipeg emergency room, where he waited for 34 hours and was not seen by hospital staff who assumed he was intoxicated, or homeless, or had been previously discharged.
The inquest found that he died of a treatable bladder infection and had a referral letter from a physician in his pocket. Some academics and physicians say his cause of death was racism.
The history of colonization in this country is fraught with appalling health experiences for Indigenous people, from smallpox brought early on by settlers, to the spread of tuberculosis and other illnesses in residential schools.
In a press conference, Quebec Premier François Legault said he was shocked at the racism Echaquan endured, but he refused to acknowledge that Indigenous people experience systemic racism in Quebec institutions.
For Dr. Lisa Richardson, a mixed Anishinaabe physician who is the strategic lead in Indigenous health for Women’s College Hospital and U of T, the existence of systemic racism in health care is a truth with several reports to back it up, but a truth that people seem afraid to acknowledge. “We will not have reconciliation, until we have truth,” she says.
Dr. Suzanne Shoush, a Black and Indigenous physician and Indigenous health lead at U of T’s department of family and community medicine, agrees that Echaquan’s death should not be seen as a “two rotten eggs” situation. “All of this treatment is not unique to Joyce,” she said. “I want it to be seen as systemic and structural.”
Medicine runs on algorithms and stereotypes, Dr. Shoush said. Doctors look for patterns and symptoms to determine what looks like appendicitis or what looks like a stomachache. But when racist stereotypes are in the mix, the result can be deadly in the form of misdiagnosis, overlooked symptoms or failure to treat.
“If you’re not culturally competent you, you can kill people,” she said.
If care and history are taken into account, the experience for Indigenous people can be different. Dr. Shoush remembers a patient of hers who was a residential school survivor and asked to be taken to the hospital to get help for substance abuse. During the patient’s intake, it was discovered that she had scabies, and she was isolated in a room.
“To walk into an institution that is not Indigenous, not seeing any Indigenous faces, immediately be told, oh, you’re dirty, get into this room, stripped (of) your clothes” and belongings, Dr. Shoush said. “It was such a triggering reminder of residential school that she fled.”
A small but powerful detail could come about in what is hanging on the walls. For example, Dr. Shoush said that over the years, as LGBTQI people’s difficulty accessing fair health care was recognized, clinics have begun posting positive signage.
“We are telling people from the LGBTQ community, we see you, we care about you, you are important, we will not discriminate, we will make an active effort to not discriminate,” she said.
“If an Indigenous person walks into a room, what do they have in the physical environment to show that they’re that this is a place for Indigenous people where they are welcomed and will be treated with dignity?”
Bourgeois said that all health-care providers need to understand that they have to be mindful of their approach when caring for a patient who has a mistrust of the system, even for herself as a Métis midwife. “I still am a health-care provider, that could be a potential harm to somebody. So, it’s important to remember that, for all health-care providers, that you need to keep that humility in terms of the care you’re providing.”
She also said similar challenges exist for Black communities, other racialized people and people who are vulnerable to being targeted by systems.
“We can hold individuals responsible for their individual behaviour, and we should,” Bourgeois said. “But unless you look at the systems that are holding them up and change those, it’s going to continue.”