The Interdisciplinarian

For my last two posts as an columnist for HPHR, the articles that follow are a summary of my discussion with Nick Bauer (he/him), a young academic and activist from Canada, who works mainly in the field of sexual and reproductive health and rights (SRHR). Nick is a member of the organisation Medical Herstory (https://medicalherstory.com/), and in August 2021 he organised an event hosting several Indigenous leaders, healers, and storytellers, who kindly shared their perspectives on Indigenous gender and health equity in Canada (find the recording at: https://youtu.be/wzxP7ZD_fRU). Impacted by this event’s content, I reached out to Nick about using the HPHR platform to amplify key messages from the discussion.

The columns presented here introduce Nick and his work (Part 1), and then delve into an in-depth discussion about Indigenous Health in Canada (Parts 1 & 2). We also discuss what can and needs to be done for systemic and meaningful change to Canadian healthcare, with the aim of making sure that everyone is treated justly by the healthcare system, and that better health for all in Canada becomes a reality (Part 2).

Content warning: In these articles, topics pertaining to SRHR are explored. Further, several cases of extreme injustice committed against Indigenous peoples in Canada are mentioned. Though details are not given gratuitously, we did feel it important to be factful about the discrimination and abuses Indigenous peoples in Canada have faced, so as to sensitise on the topic and make absolutely clear how such mistreatment has, and continues to, occur. Some readers may find the examples given tragic and disturbing – in short, because they are. Please take the time to decide if you wish to engage with this content or not, and read with care if you think you might be affected by the text.

A note on our own reflections about the process of creating this piece of writing: Nick and I are both white-presenting individuals who have thus directly benefited from white privilege as well as ingrained structures of power that continue to systematically oppress Indigenous people. It is not at all our intention here to present ourselves as experts or as people who have personally suffered anti-Indigenous discrimination. However, we do feel shocked and outraged about the treatment of Indigenous peoples in Canada, and have sought to educate ourselves about the injustices that Indigenous individuals and communities face to this day. We have tried our utmost here to create a sensitive and informed piece of text, which we hope can be a useful source of information about Indigenous Health in Canada, as well as promote discussion and ideally positive actions in response to it – which we ourselves are also trying to take, including through the organisations with which we are involved. 

Section 2 Continued: Indigenous Health in Canada

S: Can you give some background or examples of how some Indigenous peoples might view health and wellbeing?

N: Yes, although I will note that Indigenous peoples are diverse and may hold various differing worldviews – there is not one pan-Indigenous view of health. In this discussion,  I will draw on the specific perspectives that were shared by the Anishinaabe elder, Anzoked (https://www.aanmitaagzi.net/about/founding-members/perry-mcleod-shabogesic/) at the Medical Herstory ‘Decolonising Medicine’ event. In sharing his teachings, Anzoked spoke of the role of the mother and the importance of interconnectedness in Indigenous health. Historically, many Indigenous communities have recognized egalitarian roles for both men and women, as well as even gender-diverse and two-spirited people. Anzoked explained that medicine is often viewed as originating from the mother, which links back to the deep-rooted centrality of women in Indigenous society. He shared his perspective that colonialism has eroded the deeply respected and regarded position of women, and that ‘Western’ allopathic medicine has become distanced from the mother. He also shared that it is a critical aspect of the view of many Indigenous people that health is holistic, and thus involves the emotional, physical, mental, and spiritual aspects of a person’s being. Therefore, diseases aren’t approached in isolation, but with the aim to support a person in healing wholly. 

S: This is fascinating to hear for many reasons, one of them is that it brings to mind precisely a critique of a lot of ‘Western’ medicine – that it doesn’t treat people holistically, but rather focuses on diseases, often leaving the patient behind in some way. To listen to Anzoked is to remember that health and healthcare can be viewed and provided differently; that there are other valid and possibly more helpful ways of engaging with people’s health and wellbeing.

Nevertheless, my understanding is that in many countries, including Canada and the USA, Indigenous people have worse health experiences and outcomes than non-Indigenous people. Can you elaborate on this problem? 

N: First, the problem needs to be considered in its historical context. Colonisation was, put bluntly, nation-building by killing and subordinating Indigenous people and stealing their land. History is full of explicit attempts by settlers, and later by the de facto Canadian and American governments, to commit genocide against Indigenous people (Stote, 2015). In this context, it’s no surprise that colonialism has had a lasting impact on health today. 

Since I work in SRHR, many of the cases I am most familiar with pertain to this area. For example, the coercive or forced sterilisation of Indigenous people is being increasingly documented and is obviously extremely detrimental and unjust. Boyer and Bartlett’s ‘Tubal Ligation in the Saskatoon Health Region’ discusses the physical and psychological impacts on Indigenous women of undergoing coercive and/or forced tubal ligation (Boyer & Bartlett, 2017). Amongst other effects, sterilisation strips these people of their reproductive ability and their rights to bodily autonomy. It’s a horrific and genocidal reality that cannot be understated. Unfortunately, it does not only belong to the Saskatoon region. Recent reports from 2021 have come out suggesting that elsewhere in Canada, Indigenous girls as young as nine-years-old have had intrauterine devices forcibly implanted, among other reports (Basu, 2021). 

It’s unsurprising that in addition to stripping these people of their bodily autonomy, such injustices further destroy Indigenous people’s trust in healthcare. If people then – understandably – don’t trust healthcare, they are likely to experience worse health outcomes over a lifetime, especially for preventable issues. Furthermore, when people have come forward about these atrocities, it’s been reported – for example, in the Boyer and Bartlett review – that they have not been believed, or that they have been ignored by healthcare providers. In some cases, healthcare providers have even sought to justify abuses, including by stating that sterilisation was somehow ‘beneficial’ for the people who underwent it. This deflection by healthcare providers can be understood by the ‘DARVO’ concept, which stands for ‘deny, attack, and reverse the victim and offender’ (Harsey & Freyd, 2020). This serves to take away accountability from healthcare providers and place blame on the victims, feeding into a vicious cycle that worsens medical mistrust and the later health outcomes of Indigenous people. 

Dr. Veronica McKinney, the Northern Medical Services Director for Saskatchewan (https://medicine.usask.ca/profiles/family-medicine/nms/veronica-mckinney.php), also talked about accessibility challenges at the event. She described a two-tiered healthcare system in Canada, wherein healthcare on First Nation Reservations is facilitated by the underfunded federal system, unlike the provincial systems that all other Canadians utilise. Thus, healthcare access and quality are not equal for all. As a further example, high-risk pregnancies of Indigenous people are of particular concern. Many face limited maternity services where they live, and have to travel long distances to receive care. This means that people can be removed from their communities for days, weeks or even months, leaving them isolated during a vulnerable time and limiting opportunities for culturally affirmative births (Smylie and Phillips-Beck, 2019).

There are many other profound and long-standing inequities concerning health, and I cannot do them all justice here. However, I’d like to mention a few more issues that threaten Indigenous health to this day. These include: suicides crises in northern Indigenous communities (Eggertson, 2017); food and clean water insecurity (Ford et al., 2019); the effect of adverse childhood events on lifelong health outcomes (Bradford, 2020); the intersectional experiences of 2SLGBTQ+ healthcare patients (Kia et al., 2020); the legacy of ‘Indian hospitals’ and scientific racism (Joseph, 2017); lasting intergenerational trauma (Adams and Clarmont, 2016); disproportionate disease burdens of HIV/AIDS (Giliauskas and Gogolishvili, 2019); as well as the ongoing overdose crisis (Lavalley et al., 2018). These problems do not exist in a bubble, and many of them are impacted by social, economic and political factors which constitute the structural oppression that Indigenous communities have faced in Canada (and elsewhere) for centuries now. 

S: Is anything being done in Canada to respond to these realities?

N: Yes, although many critics have continually reported that it is not enough. For example, the Canadian government has established the Truth and Reconciliation Commission, following the atrocious history of residential schools in Canada (Mosby & Millions, 2021). Canadian Senator Yvonne Boyer, whose paper I have mentioned, is working to confront the past and present condition of coerced sterilisation (Boyer & Bartlett, 2017). But then you look elsewhere, and you realise that more than 100 First Nations communities across the country still lack clean water, and that despite Trudeau’s promises, the government in 2020 missed its own five-year targets to resolve this situation (Cecco, 2021). It’s frankly inexcusable that these communities have gone decades without clean water, but it’s the reality that the government expects us to accept. 

Finally, by-Indigenous for-Indigenous organisations are leading the charge on confronting health equity issues (examples and links to their organisations are provided at the end of this article). However, these efforts face underfunding, oppressive systems resistant to change, and enduring racism and discrimination. We only need to think of Joyce Echaquan to gain some insight into the depth of the challenges faced, and how far we still have to go. Ms Echaquan was a young Atikamekw woman who was racially abused by the nurses supposed to care for her in hospital, leading to her preventable death. This happened only a year ago, and the coroner found that racism played a part in her death (BBC, 2021). The nurses were fired, but they have not been convicted with any crime (Banerjee, 2021). Furthermore, the government of Quebec has refused to acknowledge the role played by systemic racism towards Ms. Echaquan’s death.  So yes, there are efforts to improve the situation, but there are still horrific injustices occurring, with very limited accountability, and we shouldn’t forget or ignore them. 

S: Do you have any ideas of what needs to be done next? 

N: I will first speak to what must be done by current and future healthcare providers, as this was an active theme throughout the event. We have established that colonisation has lasting impacts on the health of Indigenous people. Further, the inequalities it creates are kept alive in the present by unchecked racism, stereotyping, implicit bias, and discrimination. Healthcare professionals hmust educate themselves on these topics, and on how health inequities lead to real, highly deleterious health outcomes for Indigenous peoples. Dr. Karen Stote, an assistant professor of Women and Gender studies (https://www.wlu.ca/academics/faculties/faculty-of-arts/faculty-profiles/karen-stote/index.html), and who was a speaker at Medical Herstory’s event, said that until coerced sterilisation is explicitly criminalised, women will continue to be at risk. Further, she added, that until healthcare professionals hold each other accountable, and are held accountable themselves by the system, nothing will change. 

We need to break away from this idea that ‘Western’ medicine is inherently good or neutral, because there is evidence that this is not the case. Rather, ‘Western’ medicine has a history of being imposed on Indigenous people, often against their will, and of upholding the power structures central to colonialism. We need instead to support Indigenous people in constituting their own modes of healing and wellness (possibly including both traditional and ‘Western’ approaches), and medical professionals must seek to build back trust with Indigenous peoples. However, this is obviously very difficult when abuse and mistreatment continue. We really need to work towards building a culture in healthcare – amongst healthcare professionals, and integrated into the system at large itself – that calls out and addresses racist and anti-Indigenous behaviour and practises, and makes sure that perpetrators are held accountable and that justice for victims is sought. 

Secondly, outside of the realm of healthcare, I would like to raise some more general points. The speakers of the event established that we must support and provide reparations to those who have experienced sterilisation, racism, residential schools, and/or medical mistreatment. The lasting physiological and psychological impacts, amongst others, of these harmful and unjust practises must be acknowledged and addressed. Further, we also need to pursue environmental justice for Indigenous peoples. This includes guaranteeing access to healthy lands and waters to live on, and ensuring the secure availability of affordable food and clean drinking water. Food insecurity is a very real problem for many Indigenous communities, and Indigenous peoples across North America unacceptably go without clean drinking water. We need to recognise the interconnectedness of environmental justice with other issues, and, as Dr Stote described it, we must connect violence against the land to violence against Indigenous bodies. We must respect Indigenous land, and all the people who live on it. 

Further, we must also support the tireless work of For-Indigenous, By-Indigenous initiatives, amplifying the voices of those within the community fighting for a more equitable future. We the voters need to hold local and national governments accountable, and push for policy changes on all levels that will lead to justice for Indigenous peoples, as they have always deserved. 

And finally, rounding off with medicine, we desperately need to address current accessibility challenges, addressing shortages of healthcare professionals in Indigenous communities and emphasising the importance of culturally affirmative practises. For rural communities where access remains a challenge, we need to investigate options, possibly telemedicine, to make sure that everyone can reach suitable care on an appropriate time scale. 

S: Do you have any recommendations for further resources that our listeners can turn to, in order to educate themselves further on Indigenous Health in Canada, or to help them with beginning to act in other concrete ways?

N: Yes, and as a starting point I would recommend reading the stories of Joyce Echaquan, Jordan Anderson, and Brian Sinclair in detail.

For more in-depth reports, please see the following:

• The review paper “Tubal Ligation in the Saskatoon Health Region: The Lived Experience of Aboriginal Women” by Dr. Yvonne Boyer, Dr. Judith Bartlett. Link: https://www.saskatoonhealthregion.ca/DocumentsInternal/Tubal_Ligation_intheSaskatoonHealthRegion_the_Lived_Experience_of_Aboriginal_Women_BoyerandBartlett_July_22_2017.pdf 
• The book “An Act of Genocide: Colonialism and the Sterilization of Aboriginal Women” by Dr. Karen Stote. Information about the book here: https://cup.columbia.edu/book/an-act-of-genocide/9781552667323 
• Listening to the stories that are told by Indigenous people themselves, in your or other communities, and supporting For Indigenous, By Indigenous initiatives in any way that you can. 

You can also hear directly from the Indigenous speakers mentioned throughout these articles by watching the Decolonising Medicine event, which has been recorded and uploaded to Medical Herstory’s YouTube channel, and can be found at the following link: https://youtu.be/wzxP7ZD_fRU.

Section 3: Conclusions

S: To round off, I’d like to ask you a few ‘quick-fire’ questions.

The first is: do you have a personal mantra or inspiration that guides you in what you do? It can be an idea, a person… 

N: Yes, I have a ‘motto’. It is “the wound may not have been your fault, but healing is your responsibility.” All of us, especially those with the power and privilege to do so, must be held accountable for confronting and shifting the systems of power that continue to oppress people. We are all responsible for healing ourselves and this world. 

S: What does the future hold for Nick? What are your upcoming plans in health and beyond? 

N: I am currently in the process of applying to medical school. My goal is to one day become a Queer-inclusive, culturally affirming, and trauma-informed Obstetrician and Gynaecologist. I would ultimately like to balance clinical practice with biomedical research and a career in public health, which ties into the work I do today. 

S: Finally, is there anything else you’d like to add for our listeners before we round off today? 

N: I’d like to end by speaking to the power of storytelling as a humanising vehicle to understand and empathise with people. To the listeners, I encourage you to simply listen to people’s stories, especially those of Indigenous people. Meet them where they are at; believe their past and their pain; and listen attentively to their hopes for the future. I believe that the compassion and emotion brought forward by storytelling are a powerful tool for effecting change, and ultimately help us to see that the gaps we imagine there are between us and other people are much narrower than we might first think.

For-Indigenous, By-Indigenous organisations: 

True North Aid, the Moon Time sisters – an organisation helping Indigenous peoples in Northern communities access menstrual products. 

https://truenorthaid.ca/moon-time-sisters/

Native Wellness Institute – an institute seeking to promote the well-being of Native people through programs and trainings that embrace the teachings and traditions of Indigenous ancestors.

https://www.nativewellness.com/

Legacy of Hope Foundation – an organisation with the mandate to educate and create awareness and understanding about the Residential School System, including its intergenerational impacts.

https://legacyofhope.ca/

A further article detailing some Indigenous-led healthcare partnerships in Canada:

https://www.cmaj.ca/content/192/9/E208.short

References