Tag: health care

A brief history of medical racism in Canada

How the healthcare sector has repeatedly failed Indigenous people

Content warning: This story contains some elements of racism and abuse, which some readers may find disturbing

Though the topic of anti-Indigenous racism in Canada has regained some public attention since the beginning of the Black Lives Matter protests this summer, nothing has served as a more vivid reminder of this reality than the recent death of Joyce Echaquan and Georges-Hervé Awashish.

Hospitalized for stomach pains, Echaquan, an Atikamekw woman livestreamed the abuse she experienced by the medical staff whose care she was under, as she screamed for help and pleaded that she was being given too much morphine. She passed later that evening, after spending two days in the hospital, leaving her husband with the care of their seven children. Awashish, an Atikamekw man from Obedjiwan, did not receive the same spotlight from the public, but his treatment was just as poor. The circumstances of his passing are still being investigated.

As protesters decried the deeply entrenched problem of racism in the medical industry, specifically when it comes to the care of First Nations peoples, Premier François Legault’s reaction and apology sparked controversy when he didn’t directly address the systemic nature of racism in our province, with many recalling his denial of it over the summer.

We know this is false. And the fact that Legault used to be our province’s Minister of Health makes this belief all the more alarming.

Articles revealing the absurd statistics about racial bias in our medical system are not scarce. A 2017 report confirmed a five-to-seven year gap between the life expectancies of Indigenous and non-Indigenous people, as well as an infant mortality rate 1.5 times higher for Indigenous populations. These numbers barely touch the surface of the issue; among these communities, studies have recorded higher rates of HIV/AIDS, diabetes, tuberculosis, depression and anxiety, substance abuse, and deaths from accidental or preventable conditions.

Studies about the disenfranchisement of Indigenous people in the medical industry point to disproportionately inaccessible and underfunded services, deficient education and data collection systems, and failure to consider cultural barriers as the main culprits.

But the government isn’t the only authoritative body to have failed Indigenous people; so have medical practitioners themselves. Other than the victims of doctors and nurses’ individual discrimination, who have turned into statistics and archived stories in the public’s eyes, genetics-based medical research has also often proven to uphold or be rooted in racial biases.

In 1962, geneticist James V. Neel formulated what he called the “thrifty gene hypothesis” — a supposed genetic explanation for Indigenous people’s higher tendency to be affected by diabetes and obesity.

In 2020, this hypothesis still has yet to be confirmed, and many experts have flagged it as a lazy excuse to shrug off responsibility for the type II diabetes epidemic currently plaguing First Nations communities.

The emphasis on genetics has repeatedly served this purpose. During the H1N1 pandemic, researchers were quick to suspect a correlation between the exponential rates at which the virus spread in Indigenous communities as a genetic predisposition. This meant relieving some of society’s accountability for the long-standing socio-economic circumstances that have led to higher chances of transmission and greater risk for medical complications — circumstances which have re-emerged in the age of COVID-19.

And let’s not forget the healthcare workers who took the practice of eugenics into their own hands for decades and performed forced, irreversible sterilization procedures on over a thousand Indigenous women. Shielded from legal repercussions by proclaiming these women were “mentally defective,” overly promiscuous, or alcoholics, practitioners were allowed to continue these operations until 2018, as far as we know.

The indictments of these practices as a form of genocide can hardly be called controversial. And those who choose to fool themselves into thinking that we aren’t a racist province are those who will continue to vote for a leadership whose agenda purposely excludes Indigenous rights and issues. I wonder how Premier Legault has managed to convince himself that these blatant acts of racism aren’t systemic. Crying ignorance to these issues is unacceptable; in 2020, it’s become irresponsible not to know.

 

Feature graphic by @the.beta.lab

Categories
Student Life

Steps towards trans-affirmative health care

Graphic by Mackenzie Lad

Concordia and McGill groups address the need for LGBTQ+ patient-physician allyship

Universal health care is a core value and a major source of pride amongst Canadians. Canada’s medical institutions are expected to meet the needs of a diverse population, yet the conversation around understanding and delivering quality care to meet trans-specific health needs is full of holes, if not entirely absent.

At the end of February, a panel of experts convened at McGill to discuss the ways public health systems perpetuate outdated practices and institutionalized discrimination against LGBTQ+ people. Healthy McGill and the Nursing Peer Mentorship Program facilitated this safe space and invited audience members to bring the potentially offensive, random, or menial questions they might otherwise be afraid to ask about queer and trans health.

Simple things like asking a patient’s pronouns and prefacing potentially sensitive questions can make a huge and lasting difference, said Wong. The willingness of health care workers to learn and use LGBTQ+ friendly language signifies allyship, which is crucial in building the trust needed to give and receive quality care.

For many of the future health care providers in the room, it was their first opportunity to address health care in an LGBTQ+ context with experts working in the field. For others, it was a chance to gain a better understanding of the barriers trans people face when seeking health care in Montreal and beyond.

In A (Not So) Short Introduction to LGBTQIA2S+ Language, bioethicist and trans activist Florence Ashley defines transgender, often shortened to “trans” as, “a person whose gender identity differs from the gender they were assigned at birth.” They point out, “being trans is independent of one’s choice to take hormones or undergo surgeries.” It is not a sexual orientation, nor is it premised on anatomical criteria.

“For health care providers there’s often the confusion between sex (assigned at birth) and gender,” said panelist Kimberly Wong, a youth sexual health educator at AIDS Community Care Montreal. “When we’re talking about sex, we’re really talking about anatomy. Gender is really a self-feeling kind of thing.”

Health care providers often conflate the two, resulting in the frustrating experience of being repeatedly misgendered, interrogated about one’s transition, or forced to bear the burden of educating the physician about transgender realities in general. A strained patient-physician relationship can inhibit one’s willingness to disclose pertinent medical information, or lead to broad assumptions premised on misinformation. “As soon as you start assuming, things go wrong really quickly. So many people end up with substandard care,” said Ashley.

Simple things like asking a patient’s pronouns and prefacing potentially sensitive questions can make a huge and lasting difference, said Wong. The willingness of health care workers to learn and use LGBTQ+ friendly language signifies allyship, which is crucial in building the trust needed to give and receive quality care.

The process of unlearning outdated terms and practices written into medical literature is still in its early stages, and in the meantime trans people have had to seek out resources and services elsewhere. “Trans people are often very good advocates for themselves because they have to be,” said Eve Finley, an equity facilitator at McGill. “That often translates into these very interesting networks of knowledge sharing that happen online and in person.”

The Centre for Gender Advocacy (CGA), based out of Concordia, is one such network for trans people in Montreal. “A lot of people reach out to us or to other trans organizations and we provide them with such important information,” said D.T., trans advocate and public educator at the CGA. “The role of the center is to provide guidance and resources to people, whether Concordia students or not.”

“Change comes from people advocating for their rights to exist,” said  D.T. “That advocacy creates the pressure that cannot be repressed, and it leads to change in policy.”

In collaboration with Concordia Health Services, the CGA reached out to experts in trans health care and organized the opportunity for health services staff to receive training in trans-affirmative care. Concordia is the only university in Quebec to have done so, said D.T, “and they also use the latest approaches to transitioning, namely the informed consent model, where we accompany the person (throughout the process) and validate and affirm their decisions regarding their own body and self.”

Despite the progress made at Concordia, the public system in Montreal is still rife with hostile spaces and ill-informed doctors unable or unwilling to provide trans-competent care. “Outside Concordia, it’s hit or miss.” said D.T. “If you don’t know who the trans-friendly doctors are, you might end up in the wrong place with someone who will not help you affirm your gender and would rather discourage you from being who you are, which is sad in 2019.” To help avoid these pitfalls, the CGA provides an interactive map of health care providers who have denied services to patients on the basis of their trans identities.

“It’s really difficult to find non-judgemental health providers,” said Wong. “There are so many situations where people will not talk to their doctors or seek care because they fear judgement.” When they do, the reported medical problems are often minimized, dismissed, or blamed on unrelated factors. D.T. called it “trans broken arm syndrome,” which refers to the tendency of health care professionals to blame medical problems that someone might have on their trans status. “It still happens a lot, and many trans people choose not to go to the hospital,” said D.T.

The syndrome is not an isolated phenomena, and it’s one with significant repercussions. A 2012 study of trans people’s medical experiences in Ontario found that over half of respondents had negative experiences in clinical settings, and 21 per cent opted not to seek emergency care due to fear of being mistreated. The Twitter hashtag #transhealthfail is an online repository for first-person accounts of such encounters, offering a glimpse at incidents ranging from careless misgendering to outright denials of service from health care providers.

With so few capable physicians in the Montreal area, even those who do manage to seek them out end up waiting weeks or months for an appointment. “We know from research and from people’s personal experiences [that] that time between discovering, affirming to yourself that you are trans and starting transitioning is the time when people go through the most distress,” added D.T. “The longer they wait, the longer they experience dysphoria.”

While the gains made at Concordia signify positive change, D.T said there is still a long way to go to reach a trans-affirmative standard of care in Montreal and beyond. “We know very well that the trans health care field evolves very quickly. There are new needs, new approaches, and so the trainings [Concordia Health Services] did should be ongoing.”

A belief in universal health care is a belief in offering accessible care to meet the unique health needs of all Canadians, and trans-affirmative care is no exception. Of all the things that can be done to improve the quality of services for trans people on a local level, D.T. said it starts with education and advocacy. “Change comes from people advocating for their rights to exist. That advocacy creates the pressure that cannot be repressed, and it leads to change in policy.”

Feature graphic by Mackenzie Lad

Article updated on Jan. 31. 2024 – One of the sources of this article has come forth and requested to be anonymous.

Categories
Arts

So what’s up, docs?

A scene from Håvard Bustnes’ Health Factory.
A scene from Håvard Bustnes’ Health Factory.

The 1980s may be remembered for Madonna, Tom Petty and Phil Collins—or are those the the Superbowl halftime shows of the past decade?—but it was also a turning point for the perception of government in both the United States and Britain. As the great (sarcasm) Ronald Reagan said, “government is not the solution to our problem; government is the problem.”
This ushered in a new paradigm of absolute and obsequious commitment to the market. America was built on competition, it was said, and its improvement was dependent on unfettered capitalism.
The market is a brilliant tool and an important facet of good democracies. But the overzealous commitment to wholesale privatization is deeply flawed. Competition amongst retailers and car makers forces innovation because these industries are based on consumer desires, and providing excellent products is a powerful incentive. These tenets are absent in other fields, the most obvious of which is health care, an industry based on need and trust.
The idea that government-run health care is a bloated bureaucratic mess comes from this era (which also brought us shoulder pads, big hair and Sixteen Candles), and it was the decade in which Britain and Norway partially privatized their health care systems, exemplified by Margaret Thatcher’s famous “hospital of my own choosing” speech.
Håvard Bustnes’ Health Factory documents the effects of this pseudo-privatization,where government funds create a faux market. In Norway, the state pays hospitals by the procedure; birthing a baby, for example, nets a Norwegian hospital 18,000 kroner. But should a slow-paced birth require a vacuum, the hospital pockets an additional 10,000 kroner. Needless to say, the threshold between “normal” and “requiring expedition” starts to wane fairly fast.
According to nurses in Norway, hospitals go as far as to chastise employees for an abundance of “normal births” in a given month.
A prominent Norwegian doctor sums up this state of affairs deftly: paying by the procedure incentivizes quantifiable items, shifting focus away from improving health. A hospital would rather treat 10 easy patients as opposed to five difficult ones, since the former has a better ratio of time to value. It also discourages the human side of health care. What value is there in holding someone’s hand who is in deep crisis, he asks, and how long do you hold on before it becomes unprofitable?
The obvious ethical issue of ranking patients by profitability aside, a hospital market isn’t feasible because healthy markets require informed consumers. Consumers chose VHS over Betamax because they could easily deduce the former’s cost-benefit superiority. This choice eventually drove Betamax out of existence (to the dismay of many picture-quality purists). But making this kind of decision about your health care provider requires knowledge of a much more esoteric nature. And, as is argued in the film, consumers don’t necessarily want choice when it comes to which hospital to go to; they just want good care. Competition, it seems, is not the golden goose the Iron Lady made it out to be.
Obviously, public health care has its own major flaws; Canadians know this well. The Big Wait addresses one of these: the inability of international medical graduates to practice medicine in Canada. IMGs, be they from Kenya or Serbia or India, arrive in Canada hoping to benefit from the country’s need for doctors. Owing to their degree and, for most, their experience, they can skip medical school but must pass the same licensing exams as new Canadian graduates. Then they must go through our residency program before becoming certified doctors, but this step represents a major bottleneck. All Canadian medical school graduates are guaranteed a residency; IMGs must fight for a handful of these positions. If they don’t snag one, they must wait an entire year before reapplying. Many languish in stopgap jobs for years before finally setting foot inside a Canadian hospital.
This logjam is driving many of these would-be doctors southwards, because the American private system is better equipped to offer a wealth of residency positions. For communities like Midland, Ont., where family doctors are rare and the walk-in clinic recently closed, the idea that trained doctors are being turned away is justly frustrating. Wait times are a national problem and more doctors are needed. Turning away potential fast-track doctors seems ludicrous.
The question, however, is whose warts are worse? Is inefficiency a worthy price to pay for a system incapable of prioritizing anything but need? Or is expediency something to covet above the risk of monetizing patients, which in itself may not be endemic to privatization?After these two films, you can at least say you’re informed enough to make an intelligent decision and, hopefully, have a healthy discussion. Just don’t pay by the word.

Health Factory and The Big Wait are showing on Feb. 20 at 7 p.m. in H-110. Visit www.cinemapolitica.org for more details.

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