Indigenous people in Canada experience widespread disparities in health outcomes. I have found that undergraduate students come to recognize this through discussions about the incidence, morbidity, and mortality of various chronic illnesses. Students have also explored how chronic illness statistics can be reflective of the structural discrimination and racism that shapes health care policies and practices. In class discussions, we have considered the ways in which health disparities between Indigenous and non-Indigenous people are rooted in Canada’s colonial history. In the fall of 2020, I invited students to attend several academic talks on the history of health and colonialism. On October 30, 2020, the Department of History at the University of Lethbridge held a lecture by zoom as part of its Driedger Lecture Series. The lecture was delivered by guest speaker Mary Jane Logan McCallum, a Professor of History and Canada Research Chair in Indigenous People, History and Archives at the University of Winnipeg. McCallum’s talk was called Structures of Indifference: An Indigenous Life and Death in a Canadian City and was based on a book by the same title that McCallum co-wrote with historian Adele Perry.
Structures of Indifference focuses on the life and death of Brian Sinclair, an Anishinaabe man, who died in 2008 from an easily treatable infection after spending thirty-four hours in the emergency waiting room at the Health Sciences Centre in Winnipeg. Hospital staff ignored and dismissed him, assuming he was homeless or intoxicated, and failed to provide him with necessary medical care. Following his death, an inquest found that no single person was to blame and that the situation could have happened to anyone. Instead of focusing on racism and discrimination, the inquest linked Sinclair’s death primarily “to multiple failures in the policies and procedures of processing patients in the ER” (McCallum & Perry, 2018, p. 132). In Structures of Indifference, McCallum and Perry challenge the findings of the inquest by placing Sinclair’s life and death in historical context and exposing the structures of indifference that undermine and devalue Indigenous lives. Historical methodology is one tool that nursing students can use to explore broader issues of racism and systemic discrimination in healthcare, as well as foster discussions about ways to promote health equity. What follows is Emily’s critical reflection on Mary Jane Logan McCallum’s talk on October 30, 2020.
Emily Peacock:
Nursing students are continually reminded of the caring and benevolent nature of the nursing profession. If that is so, then why do Indigenous people suffer neglect from healthcare providers time and time again? In a transformative lecture, Dr. Mary Jane Logan McCallum discussed the prevalence of racism in Canada’s health care system by talking about Brian Sinclair’s death. McCallum began by reviewing the history of colonialism in Winnipeg. Even though Winnipeg’s Health Sciences Centre was established on Indigenous land through Indigenous displacement, Indigenous people were denied access to quality health care. For much of the twentieth century, Indigenous people in Manitoba received medical care in segregated hospitals that were often understaffed and under resourced. Indigenous people wanted access to modern healthcare facilities and were interested in adapting and combining various forms of medicine to best support their communities. Despite this, they were met with significant resistance by a health care system created to benefit predominantly white settler Canadians.
Fast forward to 2008, when Brian Sinclair wheeled himself into the Emergency Department of the Health Sciences Centre where he was seeking care for a treatable bladder infection. During his time in the Emergency Department, health care providers ignored and neglected Sinclair. On multiple occasions, members of the public alerted health care providers to Sinclair’s deteriorating condition, but health care professionals dismissed these concerns by suggesting that he was likely homeless or intoxicated. Ultimately, it was their indifference that led to Sinclair’s death only thirty-four hours later. This indifference, as McCallum and Perry (2018) point out in their book, and the related neglect, continue to influence the provision of healthcare. Their book has not lost any of its relevance, as in September 2020, we witnessed how nurses taunted 37-year-old Atikamekw woman Joyce Echaquan, who captured the nurses’ failed actions and abuse on her phone as she died. While the Quebec premier condemned the actions of these nurses, two of whom were subsequently fired, he was also quick to assure the public that this situation was a ‘one-off’ and not an issue of racism. Yet, Indigenous lives, like Brian Sinclair and Joyce Echaquan, continue to be lost. In addition, individualizing the nurses’ actions also avoids any consideration about how these might be indications of larger health care system failures. This begs the question: How can this possibly not be an issue of systemic racism?
McCallum, M. J., & Perry, A. (2018). Structures of indifference: An Indigenous life and death in a Canadian city. University of Manitoba Press.
Lydia Wytenbroek is an Assistant Professor at UBC School of Nursing. She is a historian of twentieth-century health care, with a particular interest in the history of nursing.
Emily Peacock graduated from the University of Victoria with a BSc in Psychology. She has spent the previous four summers working for the B.C. Wildfire Service and is currently a nursing student at the University of British Columbia.
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