This week the coroner's inquest into the September 2020 death of Joyce Echaquan heard from hospital staff about the treatment she received at the Quebec hospital where she died.
One of the arguments presented to explain staff cruelty and Echaquan's poor medical care was that the hospital was short staffed and lacked resources, and that staff was overwhelmed, overworked and stressed. This line of argument sounds especially compelling in a context of myriad additional pressures on health-care staff as a result of the COVID-19 pandemic.
Yet this line of argument is not new. As members of the Brian Sinclair Working Group -- which works to understand how systemic racism impacts Indigenous people in health-care institutions and beyond -- we heard this same logic in explaining Sinclair's 2008 preventable death in a Winnipeg emergency room. We did not buy it then and we do not buy it now.
Pressures on staff do not produce prejudice: it is there all along. Our research has shown again and again that differential treatment based on prejudice is pervasive throughout all health-care settings regardless of the resources at hand. Professional associations and unions are vitally important voices for standards of care; and yet fail to penalize the racism of their members and make health care safer for Indigenous people.
Likewise, institutions use extreme forms of solidarity ("omerta") and decoys like "overwork" to distract the public when Indigenous people die of unsafe treatment in their care. In the case of Sinclair we learned that obstructed sightlines, long wait times and a faulty triage system were responsible for staff ignoring a 46-year-old Anishinaabe man while he became sicker and sicker in plain sight, as every other ER patient was treated or left voluntarily.
Thanks to the pressure of Coroner Kamel who rejected the statements of some staff that prejudice simply didn't exist at Joliette hospital, witnesses eventually gave evidence during the inquest that stereotypes about Indigenous people circulated at the hospital: specifically that Atikamekw patients used drugs and alcohol and took advantage of the health-care system.
We know from our research that assumptions like these in hospital settings lead staff to treat Indigenous patients differently than other patients, including under-treating or over-treating Indigenous patients and classifying them as not deserving of care. Indeed, Joyce's family members testified about multiple instances where Manawan community members reported complaints related to differential care, well before and since the death of Joyce Echaquan. This is not the inevitable outcome of busy hospitals and overworked staff: rather, we need to confront prejudice, and hold those whose care is informed by prejudice accountable.
Next week, we will be hearing from the hospital's administrators, who will, we hope, shed light on what was done with the multiple complaints of poor care made by Atikamekw patients. There should be evidence and witnesses who can answer honestly about how the hospital has responded to the prejudice Indigenous people experience -- and what they are willing to do to ensure all of their staff can make the necessary cultural change so all patients receive the care they deserve.
Joyce Echaquan's experience of overt racism cannot be attributed to an isolated incident involving the behaviour of "two bad apples." Nor can it be acceptable that staff are too busy to meet their professional obligations.
There is a bigger picture. Where individuals are not held accountable and complaints are repeatedly ignored, people will continue to die untimely deaths in hospitals. Expectantly, it would be good if the upcoming testimony explains Echaquan's cause of death and also explores how the hospital can adopt anti-racist policies and practices.
Hospital administrators are the witnesses who should be able to explain the possibilities for change that will truly prevent similar circumstances to the one that Echaquan experienced.
Recommendations coming out of this Inquest must lead to cultural change within our system and its staff and not simply argue for increasing staff or personnel. Any efforts to reduce workload or increase staff must include ensuring staff are providing fair and equitable health-care services to all patients -- and combat the known racism that has been unaddressed for too long.
Mary Jane Logan McCallum is an assistant professor in the history department at the University of Winnipeg.
Christa Big Canoe is legal advocacy director at Aboriginal Legal Services.
Josée Lavoie is a professor with the Department of Community Health Sciences, College of Medicine at the University of Manitoba.
The authors are experts with the Sinclair Working Group.
Image credit: Ante Samarzija/Unsplash
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