Canadian First Nations' Discrimination

"We see once again disparities across the board that put Indigenous peoples on the wrong side of the coin -- and we have to start to answer why."

"I think if we're to study this in further detail, I would predict that we would find racism as one of the crux points in terms of where the journey of an Indigenous person in Canada is different than a non-Indigenous person."

"But those are challenges in a high-income country that pretty much stamps the words, 'universal health care' onto our currency."

Dr.Nadine Caron, first female First Nations general surgeon in Canada

"If we have better data, that will show us what is working and what isn't working."

"It shouldn't matter if you live in Ottawa or Shamattawa, your access to quality of care should be the same."

Dr.Jason McVicar, Metis anesthesiologist, The Ottawa Hospital

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Indigenous communities in Canada are well known  to suffer greater health issues than do other Canadians. A situation reflective of social-economic factors more than anything, accounted for largely by income, education,  housing, employment and food security. A recently published paper attributes these factors to 'vestiges' of colonialism and disastrous government policy, and this may be largely correct, though there are undoubtedly other factors at play. Not the least of which is Indigenous peoples' continued embrace of the past and their cultural preference for living in isolated communities on traditional tribal land.

In those communities employment is scarce, private property is not part of the reservations system, wholly funded by the federal government through the Department of Indian Affairs, now titled Indigenous and North Affairs Canada. Housing on reserve land is substandard and crowded. People who have no personal investment in the homes they occupy will not care for them and everything uncared for has a tendency to fall apart. Potable water is always an issue in Northern and isolated communities. The most basic ingredients for good health outcomes missing.

Indigenous peoples in Canada have not been well served by their leaders; many reservation band councils are corrupt and fail to share equally among all who live on reserves the benefits that should accrue to all through annual reserve funding through universal general tax-funded allocations, while other reservations are led by responsible, innovative councils who conduct band affairs fairly and equitably with a view to being self-sufficient and productive.

When health issues arise, both physical and mental, it would be of immense value to have expert health professionals available near at hand, but in remote communities this is obviously not possible. Clinics can have a role, but they can only be as efficient and useful as the medical staff that would agree to be posted in those communities. Isolation does not make for happy hunting grounds. Many who live on reserves live in extreme poverty, violence is common, alcohol and drug addiction and a high rate of suicide is as well.

A study was published in the Canadian Medical Association Journal out of research conducted in Ottawa, which found that Indigenous patients had a 30 percent higher death rate following surgery than non-Indigenous patients. That Indigenous patients are likelier to die following an operation than are other Canadians, and less likely to be able to schedule the surgery that they require for heart conditions, failing organ transplants, or joint replacement.

 

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Post-operative complications such as pneumonia are more common with Indigenous patients, according to the CMAJ study which was based on a systemic review of 28 previously-published studies which also found that Indigenous people had lower rates of life-saving surgeries like kidney transplants, heart operations and C-sections, along with significantly lower rates of knee and  hip replacement surgeries. "There's real data here showing real differences in outcomes for Indigenous populations", Dr.Donna May Kimmaliardjuk, the first Inuk heart surgeon in Canada, pointed out.

The study authors feel that statistical evidence of systemic racism First Nations, Metis and Inuit medical patients have complained of in Canada, proves their complaints correct. According to the study it is past time for a comprehensive national plan to be developed with the goal of improving surgical care for Indigenous people. As well, such a plan would include a commitment to collect better health-care data on the Indigenous experience. 

 

There are complications that non-Indigenous patients don't face: For surgery, those living on reserves must be flown out to large city centers for hospital care. Being a long way absent from home and the emotional support of family members, having to be temporarily housed in a city for post-surgical follow-up care until complete recovery has been established is disorienting and emotionally upsetting for people, not liable to hasten recovery.

The goal of the study was to synthesize all available data on surgical access and outcomes for Indigenous people, which saw researchers identify 28 studies involving 2.9 million patients, roughly ten percent of whom were Indigenous, allowing them to compare surgical experiences of Indigenous people with those of other Canadians. Some 20 of the studies were used to compare rates of surgery and wait times between Indigenous and non-Indigenous patients.

 

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Two of those studies found kidney transplant recipients for Indigenous patients seeing them experience wait times over three to seven months lengthier than their non-Indigenous counterparts. Four other studies found Caesarian delivery rates to be three to five percent lower among Indigenous women. (Since Caesarian deliveries have latterly transitioned from a medical necessity procedure to a convenience procedure in many cases despite certain dangers associated with the procedure, that can only be seen as a plus.)

Higher rates of amputation was seen among Indigenous patients in three studies on diabetic patients. Which could conceivably be traced to less self-monitoring and adjustment of daily insulin doses against blood-glucose level tests, linked perhaps to poorly diabetes-educated exposures, or simply personal neglect on the part of the person with diabetes, resulting in severe nerve damage ultimately requiring amputation.

Hip and knee replacement surgeries saw Indigenous patients about half the rate of non-Indigenous patients in other studies. Both urban and geographically isolated Indigenous populations experienced less effective surgical care than other Canadians, the researchers found, despite Indigenous people suffering a greater disease burden; living in poverty, lack of adequate education and employment opportunities, crowded living conditions, which should logically trigger an alert.

Quality surgical care requires screening and diagnosis, along with access to hospitals and followup appointments, representing a challenge when Canada's Indigenous population is culturally diverse and widely distributed, with great numbers living in remote Northern communities, the study noted. Needless to say, poverty, lack of education and remunerative employment, along with good housing conditions, afflicts many low-income and unemployed Canadians who are non-Indigenous. Their condition leaves them as well vulnerable to neglect and privation.

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