Editorial, Opinion

Quebec’s racist health care system needs reform

On Sept. 28, Joyce Echaquan, an Atikamekw woman and mother of seven, livestreamed the moments before her death at Joliette Hospital. The widely-shared video shows hospital staff making racist comments towards Echaquan, and sparked outrage across the country. The horrific situation highlights the deep flaws inherent in the Canadian health care system, which, despite being “universal,” remains inaccessible to Indigenous people, often going even further to actively harm and kill them. McGill, as Canada’s top-ranked medical school, is actively complicit in this. Quebec and McGill must overhaul medical care distribution and professional practice in the province to provide better care, agency, and opportunities to Indigenous communities.

In July 2020, premier Francois Legault doubled down on his position that systematic racism does not exist in Quebec and that the majority of Quebecers are not racist. Time and time again, however, both of these statements have proven to be unequivocally false. Published in 2019, the final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls included an almost two hundred page supplementary report dedicated to Quebec. The document includes a section on the province’s inadequate health and social services, and condemns Quebec’s failure to address these issues.

Indigenous people in Quebec tend to have traumatizing experiences with the health care system that range from inadequate to deadly outcomes. This is due to factors such as a lack of services in remote areas, racist encounters with non-Indigenous health care workers, and a lack of Indigenous health care providers who possess the cultural understanding necessary for adequate treatment, especially when it comes to mental health services. Those who cannot access a particular service within their area must travel to city centres, placing the onus on Indigenous people living in remote areas to go out of their way to access care. This leads to disastrous health outcomes; for example, tuberculosis rates among Inuit are 300 times higher than in non-Indigenous Canadians. When accounting for these discrepancies, it is impossible to ignore the systemic racism that lies at the heart of this province. 

As a leader in medical training, research, and provision, McGill is also responsible for this anti-Indigenous institutionalized racism. A Mi’kmaq woman named Kimberly Gloade died only two years ago after being turned away at the McGill University Health Centre because she did not have a health card, illustrating yet another structural factor limiting access to health care for Indigenous people in Quebec. If one is denied care at the first point of contact due to this kind of systemic problem, they will be far less likely to see treatment in the future.  

As a response to these inequities and ongoing calls to action from activists, medical schools have taken steps to place a greater emphasis on Indigenous health care and healing, leading to the creation of new courses and programs in recent years. McGill’s Department of Family Medicine recently introduced an Inuit health module that seeks to incorporate Inuit understandings of health as holistic, with spirituality as a vital component. The module is not mandatory, however, and will only be offered within Family Medicine for the time being. While this kind of education is crucial, an even greater emphasis must be placed on outreach and support for Indigenous students to increase the number of Indigenous health care professionals in Quebec. In 2016, less than one per cent of specialists and general practitioners in all of Canada identified as “Aboriginal.” Governments and educational institutions must provide Indigenous people with the agency to administer care within their own communities. This starts with financial and academic support for Indigenous youth.

While Quebec and McGill must act, only so much reform is possible within a colonial state that continues to commit genocide against Indigenous Peoples. The federal and provincial governments have repeatedly proven that they have no tangible regard for Indigenous life and are committed to power and profit above all else. As a result, non-Indigenous and particularly white McGill students should provide financial support when they can to Indigenous activists and uplift land back movements while working to unlearn their own internal colonial and eurocentric biases. Students must also support programs that increase access to education for Indigenous students and continue to listen to the needs of Indigenous students on campus. If systemic racism did not exist in Quebec, what happened to Joyce Echequan would not have happened. It is time to finally face these issues rather than continuing to deny them. 

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  1. All nursing training courses, Vocational, college and university schools, and nursing professional orders in Quebec and beyond need to address the issue of racial bias and the denial of safe professional care based on the patient’s race ‘head on’. Nurses’ education and training is supposed to include the philosophy and unspoken oath that a critical part of a nurse’s role, is to BE AN ADVOCATE FOR THE PATIENT. This advocacy role includes professional, non-judgemental care, based on the needs of the patient – REGARDLESS OF RACE, CREED OR COLOUR – Ie: Maslow’s Hierarchy of needs and Virginia Henderson’s Need Theory. This is basic nursing training. Racist nursing education programs, hospitals and nursing departments need to be evaluated by out of province professional bodies, the sources of racism based toxicity identified, and a plan with clear steps, measures and timelines put in place within the next year. Nursing licensing bodies need to take action by monitoring and penalizing racist behaviour within their membership. The need for this is urgent. Lives are in jeopardy.

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