During the late 1800s and early 1900s, tuberculosis was sweeping across the Canadian Prairies, resulting in many deaths. Periodic but severe famines were also documented in several communities. During this period of time, theories of social Darwinism and racial evolution informed the perspective of many health professionals and policy makers in Ottawa, impacting how they treated Indigenous people who had contracted tuberculosis. In the 1930s, sanatorium directors and government medical personnel warned of the threat of "Indian tuberculosis" spreading to white communities. Indigenous people were characterized as being negligent towards their own health. In Saskatchewan, as in other prairie provinces, provincial sanatoria and community hospitals often refused to take Indigenous patients. For example, the Fort Qu'Appelle Sanatorium reserved its more than 300 beds for white patients, although at a time the administration opened up 40 beds for Indigenous people in order to repay debts to the Federal government. Further north in Prince Albert, the sanatorium provided a few beds for Indigenous people who were deemed deserving of care by the Indian Agents or local physicians. In this case, it was social rather than medical criteria that determined which Indigenous people would be admitted to the sanatorium: young residential school students who came from families demonstrating progress and assimilation. This led to the development of segregated health care, and the construction of "Indian hospitals" such as the Fort Qu'Appelle Indian Hospital in 1936. At the time, Dr. Ferguson, director of the Fort Qu'Appelle Sanatorium, began conducting an experimental trial of the controversial BCG vaccine on Indigenous children (see BCG Lubeck disaster). His trial was funded by Indian Affairs and the National Research Council. Ferguson had began his investigation into TB in 1927 at the nearby File Hills school. Surrounded by poverty-ridden Treaty 4 reserves, Ferguson had a readily available source of subjects to test the vaccine. Ferguson's twelve-year study was an apparent success. However, his research revealed that 77 of the 609 children in the study, more than 12%, died before their first birthday, but only four of these were tuberculosis deaths. The rest of the child deaths were caused by other diseases such as pneumonia and gastroenteritis. The most likely cause of these diseases was poverty, an issue not addressed by the BCG vaccine, nor by the provincial and federal governments. Finally, historical research has demonstrated that residential schools played a significant role in the spread of tuberculosis, as sanitation was poor, ventilation in most schools was substandard, and infected children were not properly quarantined, often sleeping in the same rooms as the other children, increasing the risk of cross-infection. According to the final report of the TRC, tuberculosis accounted for just under 50% of counted deaths in residential schools. In addition to the residential school system, several government policies contributed to undermining the health conditions of Indigenous people. For example, in periods of starvation, rations were withheld from bands in an effort to force them to abandon their lands. Aid that was promised by the government when making the treaties was slow to come, if it came at all. Restrictions on Indigenous farmers made it difficult for them to sell their produce of borrow money to invest in farming technology. Reserve housing was also poor and crowded, sanitation was inadequate and access to clean water was limited. Under these conditions, TB flourished on reserves and within Indigenous communities.
Within the context of a tuberculosis crisis, health officials were granted the authority to forcibly remove sick people from their communities and place them in sanatoriums. For one, the act of being removed from the community is described by many as a traumatic experience. Traditional healing practices were not allowed in sanatoriums, and English was the spoken language. Thus, many Indigenous patients remember being confused and feeling lost. Loss of language and culture occurred heavily, and this had long-lasting consequences. Many patients became disconnected from their home communities, losing the ability to speak their mother-tongue. As many patients were institutionalized for extended periods of time, families were torn apart. Some of the children of former patients describe how social services apprehended them and separated them once their mother was institutionalized. The impacts of being away from their home community also had social consequences for returning patients. Some described their skin becoming white because they spent so much time inside, causing them to be ridiculed once they returned to their home communities. In this sense, exclusion for Indigenous TB patients was twofold: exclusion of cultural healing practices within the treatment of TB, and internal exclusion within their communities, where their community labelled them as "others" once they returned from the sanatorium. Other lasting impacts of the sanatorium experience include: a reluctance to seek western medical types of help, the belief that contemporary treatment options have not improved and a general fear of healthcare. The fact that English was the only language used in sanatoriums also has long-lasting impacts. According to a report published by United Nations Permanent Forum on Indigenous Issues, "the enforcement of Aboriginal individuals into English-only speaking institutions was linked to serious mental harm, social dislocation, psychological, cognitive, linguistic and educational harm, and particularly through this, also economic, social and political marginalization." Furthermore, a disconnect from one's culture has been linked to higher rates of suicide, violence, depression and addictive behaviors. In addition, the segregation of Indigenous patients and the characterization of Indigenous communities as thoroughly infected and primitive only served to reinforce the superiority of white settlers, justifying their isolation on reserves and cultural repression. Indian hospitals and sanatoriums can be located within a larger context of colonial racial exclusion and segregation.
Tuberculosis Crisis and the BCG Vaccine Trial