Moving Past the Headlines: Are You Ready to Take on Canada’s Colonial Problems?
When my mother was in residential school in the late 1930s, she became gravely ill with pneumonia. As her condition worsened, she was transferred from the infirmary at the Lebret Indian Industrial Residential School to the Fort Qu’Appelle Indian hospital 7 kilometres away. No one notified my grandmother, who was at home with her two younger children on our reserve in File Hills, even as my mother reached the point of receiving the last rites. Nevertheless, my grandmother felt compelled to get on a train and go to Lebret to check on my mother. Upon arriving at the school, she learned of my mom’s transfer, but her request for transportation to get to the hospital was denied. She eventually found help from a priest in the nearby village, and my grandmother was able to make her way to Fort Qu’Appelle to be at her 9-year-old daughter’s bedside.
I am fortunate that my mother survived to tell the tale of this, and many other sickening experiences she had during her 12 years in residential school. 215 children at the Kamloops Residential School are among countless others that did not. As First Nations people subject to state control through the Indian Act, three generations of my family had all aspects of their life regulated. They were moved onto our reserve and required written permission to leave its boundaries. When the federal government decided to implement a social experiment in our community to help accelerate assimilation, my great grandfathers were trained to work the land, although they were not permitted to sell or consume the commodities without approval by the Indian Agent. Illness had devastated the population in our community, and there weren’t enough men to carry out the government’s farming experiment. Their solution was to forcibly relocate individuals from other reserves and place them into arranged marriages. And, of course, all children had to attend residential school where they were punished if they did not conform to the Eurocentric standards.
It is mind boggling to me that I am of the first generation in my family since the passing of the Indian Act who had the privilege of being raised at home year-round. That I think of this as a privilege speaks to the deep and persistent impact colonization has had on people like me. And despite being spared the direct trauma of attending residential school, the legacy of my
predecessors’ collective experience reverberates through my life. Being robbed of my connections to my culture, language, and land has often left me with a general sense of unease. I don’t quite fit in the non-Indigenous world, and for decades I had internalized the colonial ideas about indigeneity being inferior and shameful.
In the journey to reclaim my identity as a Plains Cree/Algonquin woman (with a sprinkling of British and French in the mix), it’s become increasingly important to me that my energy be directed at transforming the systems that continue to oppress Indigenous peoples. The way I’m choosing to do that is through my work to implement anti- racism in professional health education. Anti- racism education is not just about understanding racism; it includes a commitment to challenge the structures that result in certain groups in society being oppressed because of their racial identity. When I started down this path over 12 years ago, non-Indigenous colleagues did not want to discuss racism as an integral part of Indigenous health curricula, instead insisting that I focus on “the beautiful parts” of my culture and not dwell so much on the negative. But Indigenous people don’t have the privilege of escaping racism. It has been with us as we move through the world, rearing its head at every turn in both overt and subtle ways, since the beginning of colonization.
As a health educator, I am grateful that there appears to be a shift in consciousness in this country that is permitting Indigenous experiences of racism to be acknowledged in a greater way. But I want to be clear that this has come at a great cost to Indigenous people. Over 6500 Indigenous people recounted their trauma during the Truth and Reconciliation Commission hearings that ultimately led to the publication of 94 Calls to Action, including one specifically instructing medical and nursing schools to integrate mandatory anti-racism in their Indigenous health curricula. The National Inquiry into Missing and Murdered Indigenous Women and Girls heard the painful testimonies of over 1500 family members, survivors, experts, and knowledge keepers. More recently, evidence presented in the Joyce Echaquan inquiry (As Joyce Echaquan coroner’s inquiry closes, community marches in her memory. https://montreal. ctvnews.ca/as-joyce-echaquan-coroner-s-inquiry-clos- es-community-marches-in-her-memory-1.5452739) in Quebec illustrates the lethal consequences that can result when Indigenous people seek health care in systems where racism goes unchecked. Ms. Echaquan, a 37-year-old Atikamekw woman, died shortly after she livestreamed her experience of being subjected to racist comments from multiple healthcare staff while her health needs were neglected. This is a situation that those of us who reside in Winnipeg know all too well from our own high-profile inquest into the death of Brian Sinclair, an Indigenous man who presented to the downtown Winnipeg ER for treatment of a bladder infection and catheter change. (Ignored to death: Brian Sinclair’s death caused by racism, inquest inadequate, group says. CBC News. https://www.cbc.ca/news/canada/manitoba/winnipeg- brian-sinclair-report-1.4295996) He was found dead in the waiting room, having not been seen during his 34 hour wait despite the efforts of other visitors to alert the staff to his declining condition. And the latest tipping point has been the discovery of the remains of 215 children at the site of the Kamloops residential school. While I appreciate that more of my fellow Canadians are moved to take action as a result of these stories of Indigenous suffering, I remain frustrated that it has taken such extreme efforts for our voices to be heard.
So often in my anti-racism work within health education, the situations that gain attention are the acts of egregious, interpersonal racism directed at Indigenous students, staff, or patients. And these incidents absolutely need to be addressed. But if you are interested in making profound and lasting change, I invite you to tune into the smaller, quieter forms of racism that are present in all aspects of our society. Racism has an uncanny ability to hide in plain sight, remaining unseen and unacknowledged by those who are not targeted. For Indigenous people, these forms of racism are not invisible, and the impacts are very real. Racial battle fatigue is a term that has been used to describe the chronic state of stress many racialized people experience from having to navigate these everyday forms of racism.
Subtle Forms of Racism
To assist in bringing the more subtle forms of racism out of the shadows, I’ll highlight three types that, in my experience, seem to be particularly challenging for my non-Indigenous colleagues to recognize when they first enter anti-racism work: racial microaggressions, systemic racism, and epistemic racism.
As a person who has experienced countless microaggressions, I can attest to how difficult these are to deal with. These are the casual and subtle remarks, actions, body language, or questions that can be painful because they reinforce race-based stereotypes or biases. Even though I am very familiar with the concept, I still find myself blind sided and asking myself, “what just happened?” And when you push back, there are the typical responses by the perpetrator to say they were only joking, I’m being too sensitive, or they didn’t mean any harm.
This brings us to an important concept that you need to understand in racism: the intention-impact gap. Racism tends to be thought of as intentional acts directed at individuals based on their racial identity. We now understand racism as not requiring intention. The colleague who was asking me to focus on my culture’s beauty was, I believe, trying to be supportive. How it impacted me was a complete invalidation of the lived experiences of my people under colonization. Had she approached it differently, perhaps asking why I was choosing to focus on racism instead of my culture, I could have entered into a dialogue to share my knowledge on this topic instead of being directive of how I should approach my work. I still feel the impact of her well-intentioned words seven years later and how it made it difficult for me to continue discussing racism in that meeting.
It is useful to keep the intention-impact gap in mind when considering the role of systemic forms of racism in our country. In the early days of colonization, legislation like the Indian Act and the related policies and processes that flowed from it did have a clear intention to assimilate Indigenous people and strip them of their land, culture, spirituality, agency, and language. In contemporary times, systems and institutions may not intend
to exclude or create barriers to participation for Indigenous peoples, but this is all too often the result. Systemic or institutional racism refers to the policies, practices, and behaviours that are part of the social, cultural, or administrative elements of an organization that create or maintain positions of disadvantage for racialized individuals. (University of Manitoba. “Disruption of all Forms of Racism.” Rady Faculty of Health Sciences Policy. https://umanitoba.ca/faculties/health_sciences/media/ Disruption-of-all-Forms-of-Racism_Policy-approved- August-25-2020.pdf.)
For example, my colleagues in admissions are examining the ways that standardized tests and processes may be systematically disadvantaging Indigenous applicants and how these could be changed to be more equitable.
Epistemic racism occurs when the knowledge system of one group is positioned as superior to the knowledge system of another racial group. (Glossary. Addressing Racism. (2020, July 7). https:// engage.gov.bc.ca/addressingracism/glossary/) This is at the heart of colonization that has entrenched Eurocentric/Western knowledge as the gold standard and rendering Indigenous knowledges as alternative, inferior, or even invalid. To illustrate, I will ask you to tune into your reaction to the following statement:
For my PhD dissertation, knowledge emerging from dreams, visions, ceremony, and teachings will be considered as valid and meaningful as the data I gather from interviews.
What was your reaction? As a person who has spent decades training and working in the Western academic system, I have had to actively ‘decolonize’ my mind before I could fully embrace centering my research in an Indigenous worldview and truly hold the knowledge I derive from dreams and ceremony at the same level as data derived through Western methodologies.
What Can We Do?
Bringing these forms of racism out of the shadows is a critical first step, but what can you do to create health care systems that are truly safe for Indigenous people? It can be difficult to know where to start, but my advice is always to consider what can be changed in your personal sphere of influence. From there, the opportunities to challenge ongoing colonial oppression are endless. It is not possible or appropriate for me – or any Indigenous person – to provide you with list of what you need to do. Part of becoming active in anti-racism as a non-Indigenous person is doing this work yourself. What I can offer as an anti- racist educator are some principles and ideas for self-reflection that may help you in getting started on this journey.
Look in the Mirror Everyday
Are you aware of the biases or stereotypes you have concerning Indigenous people? Allow me to share some of the common ones I encounter routinely in my work:
- Indigenous women have too many kids;
- Indigenous people get everything paid for and they don’t pay taxes;
- Indigenous students have an easier time getting into medical/dental school;
- Indigenous patients are:
- Never on time for appointments/no-shows;
- Indigenous people should just “get over” colonization/residential school – all our families went through tough times;
- Indigenous people have knowledge that can fix our environmental problems.
Did the last one surprise you? Stereotypes are not always overtly negative. I do believe my people possess deep and important knowledge that I am continually learning, and that there are important lessons that can benefit our world in these teaching. However, problems arise when Indigenous knowledge is fetishized, romanticized, co-opted, or otherwise taken out of its context. This can start as a well-intentioned effort, but we all need to be self-reflective about the intention- impact gap. If what you are doing is experienced as hurtful to Indigenous people, good intentions become irrelevant.
Reflect on your Privilege
When asking people to reflect on their privilege for perhaps the first time, I find it interesting that I often hear the many ways they do not have privilege. I can understand the temptation to do this. Privilege has some strong connotations in our language. I have a few non-Indigenous people in my circle who have struggled financially for most of their lives and chafe at the thought of describing themselves as being ‘privileged’. Yet, the very fact that a person is subjected to discrimination based on their personal characteristics, differentiates them from others who have not been subjected to the same discrimination. That is the experience of privilege, even if we are not privileged in every way. When we find ourselves on the outside of any of privileged category, we experience varying degrees of disadvantage and restricted opportunities that are not connected to what we have earned.
Privilege, in short, is something you cannot change because it is embedded in how our society is structured. Equipped with this understanding, you can mobilize your privilege to become an anti- racism warrior in ways that I cannot. For example, if you are a white male physician or dentist, you have entrée to a sphere of influence where I, as an Indigenous woman who is not a health professional, would probably struggle to have my message effectively heard. When you start talking about anti-Indigenous racism, your peers will pay attention; don’t let that opportunity go to waste. (To learn more, I recommend reading University of Toronto scholar Stephanie Nixon’s (2019) coin model to help identify the way that we may or may not have privilege. See: Nixon, S. A. (2019). The coin model of privilege and critical allyship: Implications for health. BMC Public Health, 19(1). https://doi.org/10.1186/ s12889-019-7884-9)
Do your Homework
Do you know the history of the Indigenous people in your territory? What are the historic and contemporary traumas they have been forced to survive? What languages do they speak? Maybe you don’t know where to find this information. Resist the urge to ask the Indigenous people in your life to explain this to you. Instead, start with your local public or university library. Many have librarians who oversee their Indigenous collections and can help direct you to find these resources.Local Indigenous groups often hold events and festivals that are open to the public and can be a great entry point for understanding regional history and issues. Online webinars, such as the Indigenous Cultural Safety Collaborative Learning Series (https://www.icscollaborative.com/) are also highly accessible resources.
Get Comfortable with Discomfort
Change is uncomfortable, as is challenging the ideologies and systems that perpetuate colonialism and discrimination. For many people, grappling with the concepts of racism and privilege is often accompanied by intense reactions, from guilt to anger and defensiveness. I think it is important for non-Indigenous people to understand why they might feel this way, but also to not expect Indigenous to help them process these reactions.
Amplify Indigenous Voices
We are living in a time of unprecedented access to Indigenous peoples’ expressions of their lived experiences. Articles, books, films, videos, creative works are one mouse click away. As you travel the path of your anti-racism journey, share these with the people in your sphere who may not be as familiar with hearing about Indigenous experiences. Challenge those around you to consider an issue from the perspective of Indigenous people. Our voices are out there; find ways to hear them.
Intergenerational, or historic, trauma is a type of trauma that compounds over time and is transmitted across generations, resulting in persistent physical, psychological, and economic disparities. Many Indigenous patients are grappling with multiple traumas as they seek care. Integrating a trauma-informed approach to clinical practice is something that health care practitioners can do to make health care safer for Indigenous patients. The Manitoba Trauma Information and Resource Centre has developed a comprehensive toolkit to assist programs to develop a trauma-informed approach for Indigenous clients. (Manitoba Trauma Information and Education Centre. Trauma Informed: The Trauma Toolkit. https://trauma- informed.ca/wp-content/uploads/2013/10/Trauma- informed_Toolkit.pdf)
Learn from your Mistakes and Move Forward
I can guarantee you will make a misstep. Maybe you will say or do something that makes an Indigenous person feel less safe. Or you will fail to speak or act to interrupt racism. Either way, take it as another opportunity for self-reflection and figure out how you can do better the next time around. And if an Indigenous person has let you know that what you did or didn’t do made them feel unsafe, don’t get caught up in defending your intentions. Mind the intention-impact gap, acknowledge how it was received, and make the needed change.
Reduce the Barriers in your Professional Practice
Do Indigenous people feel safe and comfortable seeking care in your practice? Would you know if they didn’t? Consider the ways you could address the aspects of your clinic that aren’t meeting the needs of Indigenous patients. Perhaps you could invest in cultural safety/anti-racism or trauma- informed care training for your staff, or actively recruit Indigenous staff when hiring.
Ask your Alma Mater what they are Doing to Promote Indigenous Student Success
We know that Indigenous people are underrepresented among the health professions. Our medical and dental schools are well-positioned to help change this situation. Is there anything you can do to help your school increase the number of Indigenous graduates? Has the school adopted an anti-racism policy or a strategy for implementing the TRC Calls to Action? Find out what you can do to support their efforts.
Think about what Reconciliation Really Means
In defining reconciliation, the Truth and Reconciliation Commission emphasized the importance of being aware and acknowledging the harms inflicted in the past, but also the need to atone for the underlying causes and take action to change behaviour. (Honouring the Truth, Reconciling for the Future Summary of the Final Report of the Truth and Reconciliation Commission of Canada, The Truth and Reconciliation Commission of Canada, 2015, p. 6)
Forging a truly reconciled relationship between Indigenous and non-Indigenous peoples in Canada cannot stop at apologies and removing the symbols of problematic historical figures. We all need to actively engage in disrupting the systems and discourses that oppress Indigenous peoples.
Share what you Learn
Part of being actively engaged in anti-racism involves not only sharing your knowledge about colonization, but also using your own journey as a teaching opportunity. Some of the most effective teaching I’ve witnessed at our medical school has occurred when my non-Indigenous colleagues discuss how they were at first unaware of their privilege or held stereotypes about Indigenous people, and how they continue to be self-reflective and engaging in life-long learning about addressing colonial harms.
Remember that Healing Takes Time and Energy
With every new headline, Indigenous people must individually and collectively deal with the deep wounds that have been inflicted upon us, our loved ones, and our communities because of colonization. As I write this, we are less than two weeks from the painful Kamloops discovery. My fellow Indigenous friends and family continue with their anti-racism work, but with the added burden of processing this latest event and what it means for our people. These can be particularly challenging times, and I always appreciate when the allies in my life recognize and acknowledge this.
Don’t Wait for the Next Headline (and there will be one) to be Inspired
For Indigenous people, persistent racism in health care can quickly become a life-or-death situation. We need you to take action now.
I started writing this article the week after the Kamloops discovery. I’m finishing it on the day that the discovery unmarked graves of 751 Indigenous adults and children at the Marievel school in Saskatchewan, a mere 100 km from the school my mother attended, was announced. Six years after the work of the Truth and Reconciliation Commission wrapped up, we are still in the process of confronting the painful truths of what happened on these lands. Healing these deep wounds is going to take a long time, especially when they keep being reopened with every new, horrific event. But I remain hopeful by remembering the collective strength of Indigenous people. We have survived myriad colonial assaults that sought to eliminate us, and we are still here. I look forward to a day, perhaps not in my lifetime, that our energy does not have to be spent on survival. With your help, we can get there faster.
Cultural Safety in Practice
Cultural safety is term that emerged in New Zealand as a response to the unsafe encounters Maori patients reported in the health care system. While the definition continues to evolve, the foundation of cultural safety is understanding that power differentials exist in the health care system, and therefore requires the practitioner to continually reflect on the power dynamics in clinical relationships and strive to mitigate this inequity. Some ways that this can be incorporated in practice are:
- Building trust with Indigenous patients;
- Communicating respect for Indigenous patients’ beliefs and values;
- Ensure that Indigenous patients are a partner in decision making;
- Be mindful of the socioeconomic and historical circumstances that impact Indigenous patients’ lives, especially how these can make it difficult to engage in health promoting behaviours and activities.
Cultural safety is an outcome that can only be evaluated by those who receive the service. By engaging in ongoing self-reflective and trauma-informedpractice, health care professionals can creates a space where Indigenous patients feel safe and empowered in the patient-provider relationship.
- Indigenous Writes: A Guide to First Nations, Métis & Inuit Issues in Canada
This is an accessible introduction to historic and contemporary Indigenous issues from author Chelsea Vowel. I would also suggest checking out her blog, âpihtawikosiasân (https://apihtawikosisan.com).
- 500 Years of Indigenous Experiences in Canada: The Blanket Exercise Video: If you have the opportunity post-pandemic to take part in a Blanket Exercise workshop, I would encourage you to sign up. Developed by Kairos Canada, this exercise is a hands-on experience designed to introduce participants to key events in the colonization of Canada. While this video cannot replicate the in-person workshop and discussion, I have found it to be a useful teaching resource (https://vimeo. com/223496039).
- Truth and Reconciliation Commission of Canada: Calls to Action: The TRC provided us with 94 specific calls to action that serve as a roadmap for next steps in addressing the historic and contemporary colonial harms inflicted upon Indigenous peoples. Calls 18 to 24 specifically relate to health, but I would argue that all 94 are connected to the wellbeing of Indigenous peoples. (http://trc.ca/assets/pdf/Calls_to_ Action_English2.pdf).
- Clearing the Plains: Disease, Politics of Starvation, and the Loss of Indigenous Life James Daschuk’s book lays bare the brutal colonial history of Western Canada. Books such as this offer a critical alternative to the history that most of us were taught in high school that did not represent the experiences of Indigenous nations.
- Surviving Canada: Indigenous Peoples Celebrate 150 Years of Betrayal: This is a powerful collection from Indigenous academics, artists, and activists reflecting on the realities of being Indigenous in Canada.
- National Collaborating Centre for Indigenous Health (NCCIH): Based at the University of Northern BC, the NCCIH website houses a wealth of resources concerning Indigenous health issues. A good place to start is with their collection of fact sheets on a wide range of topics, from the social determinants of health to traditional healing practices (https://www.nccih.ca/34/ Publication.nccih?type=0).
- 21 Things You May Not Know About the Indian Act: Helping Canadians Make Reconciliation with Indigenous Peoples a Reality Understanding the role that the Indian Act plays in the lives of Indigenous peoples is an essential part of reconciliation. Bob Joseph’s book is a great place to start if you are not familiar with this legislation.
- Structures of Indifference: An Indigenous Life and Death in a Canadian City: Although this is written about the Brian Sinclair case in Winnipeg, historians Mary Jane Logan McCallum and Adele Perry explain how colonial racism becomes entrenched in systems in a way that can be applied to the broader Canadian health care system.
- Unsettling the Settler Within: Indian Residential Schools, Truth Telling, and Reconciliation in Canada: Paulette Regan’s book offers some guidelines for non-Indigenous Canadians to engage in the process of decolonization, starting with the disruption their own assumptions about Canada’s relationship with Indigenous peoples.