White Coat Black Art

'It's the hardest conversation we can have': Confronting racism in health care

The San'yas Indigenous Cultural Safety Training program uses blunt talk to confront racial bias in Canadian health care, with the goal of making care safer and more accessible for Indigenous patients.

Confronting the bias in health care against Indigenous patients

6 years ago
Duration 1:24
The San'yas Indigenous Cultural Safety Training program was created by the Provincial Health Services Authority’s (PHSA) Indigenous Health program to improve cultural safety for Indigenous people cared for by non-Indigenous health care professionals

Updated Nov. 13, 2020

In October, the Quebec government launched an inquiry into the death of 37-year-old Joyce Echaquan. Echaquan was an Atikamekw woman who live streamed her final moments in a hospital in Joliette, Que., where she was subjected to a barrage of verbal abuse from staff before she died.

A nurse and an orderly at the hospital have since been fired, and investigations by the local health authority are underway.

After Echaquan's death, some listeners recalled our show in 2016 about cultural safety training which teaches health-care workers to understand and respect the history and experience of Indigenous peoples in order to provide appropriate care.

Here is the original story.

Originally published on Dec. 17, 2016

When you get sick and call an ambulance or you make your way to the local ER, the assumption is you're heading to a safe place.

They'll greet you, treat you and heal you.

But it's not something all Canadians can take for granted. 

"The hospital is probably very safe for you, a middle-aged, affluent white man," Cheryl Ward tells White Coat, Black Art host Dr. Brian Goldman.

Ward is the B.C. provincial lead for the San'yas Indigenous Cultural Safety Program, which is designed to "increase Aboriginal-specific knowledge, enhance individual self-awareness and strengthen skills for any professional working directly or indirectly with Indigenous people."

Ward says she knows the course is needed because her own family has experienced racism in Canada's health-care system. 

"I can tell you horror stories.... My own mother experienced overt racism, violence and was treated like she wasn't a human being,"  says Ward, who is Indigenous, and is also the interim director for Indigenous health in B.C.'s Provincial Health Services Authority.

On the day her mother died, Ward didn't make it to the hospital in time to say goodbye. But when her family arrived with plans to carry out traditional rituals, they found her room cleaned out and her belongings packed away.

Left to right: Chelsey Branch, Cheryl Ward, Rain Daniels and Laurie Harding of the San'yas Indigenous Cultural Safety Training course team.

"My auntie said the nurses had come in and said they wanted to make sure they could look at everything that was taken out of the room before we left," says Ward. "So the implication was, we were a bunch of thieves, that instead of grieving and doing our own protocols, we'd be concerned about stealing what ... gloves, Kleenex? It was the moment our mother passed away, and I'll never forget that as long as I live."

The most common stereotype associated with Indigenous patients is that they are alcoholics, says course facilitator Rain Daniels. But it's "far from the only one." 

"I simply don't care about my health. I might lie to you so I can get drugs. I don't feel pain, so if I am asking for medication for my pain, I might be lying." Daniels says listing off biases she and other Indigenous people face.

Ward says that Canadians haven't been "ready" to confront their own racism, but the ongoing discussion around residential schools and the release of the Truth and Reconciliation Report in 2015 have opened some doors.

She says Canadians like to believe that Indigenous people are treated as "full members of society," even when evidence suggests otherwise.

 "What happens when we are faced with reports and data and statistics that show us that Indigenous people have a different reality in Canada. What do we do about it?

It's the hardest conversation we can have as Canadians.-  Cheryl Ward, on the need for Canadians to confront their own racism toward Indigenous people


What the San'yas ICS training does  is confronts those biases head on. 

One of the first things participants are asked to do is identify themselves, using language such as "I'm a white settler." 

And that, admits Ward, can be uncomfortable.

"A complaint went right up to the top because this doctor was being asked to identify as a white man, and he didn't like that. So he used his white privilege to create a lot of problems for us."

The real aim of the program, she says, is to make people aware. 

"No health-care worker got up in the morning and says, 'Gee, I think I'll discriminate against an Indigenous family today'.... That never happens. We have to understand the context for this." she says. ​

Since 2008 more than 35,000 people have taken the training, which has been exported to Ontario and will soon be taught in Manitoba.

Dr. Marcia Anderson is one of the people working to bring the course to that province.

Dr. Marcia Anderson spoke to White Coat, Black Art from the Winnipeg studio, with her daughter Myla.

She was a guest on White Coat, Black Art when we broadcast a program called First Nations, Second Class Care.

At that time, she spoke about her experiences as an Indigenous physician and the racism her own father experienced in the health-care system.

Anderson is hopeful this training will help her health-care colleagues confront racism when they see it. 

"In the  WRHA (Winnipeg Regional Health Authority), it is considered more acceptable to say something racist than to challenge someone on saying something racist," she says. 

"I did a talk about a year ago for a family physician education day in Manitoba ... And on the evaluation, one of my physician colleagues had written something like, 'Well, clearly residential schools worked, because you're educated now.'" 

She had no recourse to confront him. 

These types of conversations wouldn't even even be happening five years ago. It has taken generations of Indigenous people in the health-care system to get to the point where we can have them now.- Dr. Marcia Anderson

"There's no way to respond to the person or enter into a dialogue. The real advantage of the online facilitated course is there's an opportunity ... to openly discuss biases they have." 

She says while the health-care system has far to go, she's had some difficult, but rewarding conversations with co-workers in recent months about their own biases. 






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