An Indigenous woman wakes up in a hospital far from her rural community in 2018 and again in 2019, dry heaving after both of her surgeries.
She thinks she could be allergic to the sedative, but the nurse assumes she is going through withdrawal, despite the fact she hadn’t been drinking before either surgery. “You people drink too much,” the nurse says, and moves the woman to a bed where she doesn’t get further care for three days.
A health-care worker witnesses an Indigenous patient go untreated for days against medical advice. The patient eventually had a stroke that could have been prevented.
An Elder described how her teeth were forcibly and improperly removed when she was at a residential school. Her mother was held for nearly two decades in the Nanaimo Indian Hospital.
The woman now avoids the hospital and the dentist out of fear, and is assumed to be drug-seeking when she seeks care for lifelong tooth infections. “We don’t give drugs,” the staff say.
And she describes how, while still a teen, a urologist performed a rough examination, and said “Come on, you know you native women like it rough,” when she cried out in pain.
A first-of-its-kind report into anti-Indigenous racism in B.C. health care has found these and hundreds more horrific stories of racism against Indigenous peoples seeking care.
Racism is “widespread and insidious” in every corner of the health system, according to the report, titled “In Plain Sight.”
After surveying and interviewing almost 9,000 patients and health-care workers about decades and generations of their experiences, the investigation found that 84 per cent of Indigenous patients had experienced racism in health care. More than 50 per cent of Indigenous health care workers reported experiencing racism on the job, mostly from their own colleagues.
The disturbing findings led investigator Mary Ellen Turpel-Lafond to call today for drastic changes in the beliefs, behaviours and structures of health care in the province and new accountability measures.
A startling 13 per cent of surveyed health-care workers of all races also made racist comments in their responses to the survey itself. Turpel-Lafond said that showed the degree of racism in the system and health-care workers’ comfort in expressing it.
The report noted racist acts not only harm a patient’s dignity but also reduce the quality of care of Indigenous patients and increase their likelihood of chronic illness, poor health outcomes and self-harm.
“At the point of care, there is direct prejudice and racism touching all points of care and impact Indigenous people in B.C.,” said the former provincial representative for children and youth, who is a member of the Muskeg Lake Cree Nation.
“Any Indigenous person could face it because it is pervasive and entrenched in the system.”
The independent probe was commissioned by Health Minister Adrian Dix in June after allegations of racist games in emergency rooms, alleging health-care workers were guessing the blood alcohol contents of Indigenous patients in the style of “The Price Is Right.”
Turpel-Lafond said her investigation “found no evidence of an organized game as originally depicted,” but its results were much more alarming.
Harmful stereotypes that Indigenous people drink alcohol in excess, are drug-seeking, less worthy, poor parents, get things for free, or that Indigenous women are sexually promiscuous or involved in the sex trade permeated the comments from patients and health-care workers alike.
Those surveyed reported experiencing and witnessing everything from outright denial of care to physical or emotional abuse to medical mistakes because concerns were not heard or respected.
“Often these kinds of stereotypes lead to poor care and services,” said Turpel-Lafond. “These actions begin a cycle of poorer outcomes.”
The investigation’s analysis of patient data on 185,000 Indigenous people found they go to emergency rooms at nearly twice the rate of non-Indigenous peoples, due to poor access to primary care services or because they avoid care due to past traumatic experiences.
Hospitalization rates are three times higher for Indigenous peoples with preventable conditions and Indigenous women are 11 times more likely to leave the hospital against medical advice than non-Indigenous patients due to mistreatment and concerns for their safety.
Sexism and misogyny directed at Indigenous women and Two-Spirit people means they are more severely impacted by racism in health care and half as likely to feel safe in health-care settings as Indigenous men. They are more likely to be in poor health, the report found.
The impacts of the current pandemic and overdose crises in B.C. disproportionately harm Indigenous women, Turpel-Lafond said.
Turpel-Lafond said the rampant problems stem from a lack of accountability and respect and protection for patients and health-care workers who blow the whistle on racism.
She wants to see commitments to improving access to care and increasing Indigenous-led services that include cultural healing and traditional practices.
And the responsibility to bring change must rest on the health-care sector and government, not Indigenous peoples.
“Racism isn’t an Indigenous person’s problem,” said Turpel-Lafond.
In her 24 recommendations, Turpel-Lafond says changing systems, beliefs and behaviours is required to address these problems.
She wants to see whistleblower protection legislation extended to health-care workers, and new senior positions in government working specifically on anti-racism in health care. Anti-racism policies should be required in all colleges, regulatory bodies and post-secondary training institutions for health-care providers and leaders, she said.
Dix offered an apology to all Indigenous people who experienced racism when seeking care and vowed to formulate a cross-government plan to implement the recommendations rooted “in anti-racism and cultural humility.”
“My apology today is an acknowledgement of the pain that Indigenous people have borne from racism,” he said today. “Racism will have no place here.”
The province has already directed each health authority to hire five new Indigenous health liaisons and has seconded Dawn Thomas, a member of the Snuneymuxw First Nation and a vice-president of Island Health, to serve as associate deputy minister of Indigenous health in Dix’s portfolio.
Turpel-Lafond thanked the people who came forward to tell their stories and urged Indigenous peoples to seek care for themselves and support one another in light of the disturbing report.
“It’s up to Indigenous people whether they can accept that apology today,” she said. “And today is a very important beginning, so I do feel comfort in that.”