Racism in Health Care Services in La Ronge

The following is a selection from an article CBC Saskatchewan published in March 2022 on racism in healthcare, and contextualizes some of the current healthcare challenges Northern Communities are facing:  

“Racism within the health-care system has prevented First Nations people from seeking and receiving proper care, according to Dr. Veronica McKinney, director of northern medical services at the University of Saskatchewan college of medicine.

‘We know there's huge disparities between the health care of Indigenous peoples and the general population of Saskatchewan,’ McKinney said. McKinney said the province lacks data on how widespread issues of racism are. She said there are many reasons why First Nations people haven't filed formal complaints when encountering racism in the system. People don't know who to contact or their complaints can get bounced around between sectors, often creating more harm or shame, she said. 

‘[People are] asked to repeat their stories over and over and over again. When you think about it for these things to happen it's usually at the most vulnerable times of their lives — and it's usually something that's traumatizing for them,’ she said.

‘It's a very sort of disconnected system that really doesn't allow that patient's voice to be heard in a way that I think it should.’

She said First Nations people living in remote communities or ‘on the rez’ won't complain because they fear it will lead to repercussions for a family member who works at facility or will need to seek care themselves. She said people are afraid of driving away providers because recruitment to remote areas is difficult.  This leads people who have been harmed to stay silent. McKinney said this means little change within the system and a lot of distrust among First Nations people.

‘When they do require health care, they're only going up at the last minute when it's often a very desperate situation. Maybe there's a misdiagnosis of cancer and it's too late to really treat.’

Nothing is more alienating for patients who are vulnerable and needing care than experiencing discrimination, said Caroline Tait, a professor at the University of Saskatchewan who works with the Indigenous Peoples' Health Research Centre. For years she's conducted community-based research with First Nations and Métis communities. 

‘Feeling that people don't want you there, they don't like you.… There's lots of emotional, psychological fallout from that for people," Tait said. "They will avoid seeking treatments that they need.’

She said patients with chronic conditions have recurring treatments that they can't avoid, so they often won't report mistreatment because they fear punishment for being a ‘difficult patient’[…]

"It's very easy for people's experiences and their negative experiences with the health-care system to be dismissed."[i]

Historical Context

In an interview with Verna Richards via the Gabriel Dumont Institute, a La Ronge resident in the 1950s and 1960s, she communicated that the provided Indian Health Service doctor was both racist and conducted medical procedures without the use of contemporary medicine at the time, such as anesthetic.[ii] This abysmal care alienated the First Nations and Métis residents of La Ronge from their only community doctor, effectively removing access to healthcare.  

Mary-Ellen Kelm’s work details the policies, lack of ethics, and zero accountability structures inherent to the Indian Health Service. An insufficient policy and accountability structure in the Indian Health Service were two of the major issues causing service failures that affected Indigenous communities. The Department of Indian Affairs did not engage in an effort to recruit any Indian Health Service doctors in Northern Saskatchewan, opting to accept any doctor who applied. Kelm writes:

"In 1902, [the DIA] implemented a system of salaries that was intended to reduce medical costs. Doctors received the same payment whether they visited reserves once a year or as often as was necessary. If they rendered more services than could be paid for by their salaries, then they could submit accounts for further reimbursement. Extra remuneration, however, was seldom granted."[iii]

Doctors who served in the Indian Health Service were not supervised nor expected to report procedures to ensure the provision of ethical, appropriate care. An issue arose where doctors neglected their Indigenous patients in favour of white patients, who paid directly out of pocket. The financial incentive to visit the reserve as little as possible to maximize personal profit jeopardized health in Indigenous communities. Indian Health Services was used as a means of legitimizing colonial relations and paternalism within Canada:

"…aid given across cultures, where one society is seen as bearing knowledge vital to the ignorant other, buttresses notions of racial superiority and furthers the sense that relationships of dependency are natural and requisite. In this way, provision of medical services and the discourses surrounding it have aided in ideological formulations that are needed for the continuation of internal colonialism in this country. Non-Native medicine, then, also functioned as a legitimizer of colonial relations."[iv]

Indigenous peoples have and continue to practice their own medicines; Western medicine did not replace Indigenous medicines and ways of knowing. Arguably, there has been a great deal of damage caused by the imposition of Western medicine on Indigenous peoples. The disruption and demonization of Indigenous medicines, replaced with Western approaches contributes to health disparities and other systemic factors (cultural loss, dislocation, poverty etc.). Not only are the treatments not necessarily culturally relevant, but western practitioner’s biases towards Indigenous patients evidently create disparities in care.     

La Ronge resident Verna Richards (interviewed by Murray Dobbin, c. 1976) remembers that the resident doctor was outspokenly racist. Richards described that he would handle Indigenous residents in an unnecessarily rough manner. The maltreatment by the resident doctor alienated First Nations residents in La Ronge from health services, as he was the only Indian Health Doctor available in the region.

Verna: “...the doctor, the Indian health doctor that used to come up, he was such a racist pig, at that time. Well, the people called him the butcher, because he used to come up and pull teeth and that too, and he wouldn't even freeze your mouth - he'd just yank them out. There was one fellow that worked in the fish plant steady. He was quite, you know, sort of religious, and so he never drank. And he had cut himself with a knife at the fish plant when he was working and they flew him down to P.A. and he went to this doctor. And he sewed it up without freezing it and all the time he's getting after this guy. He says, "Yeah, you were probably out fighting and drunk. That's why you got cut." And he was very hurt when he came back that anyone would accuse him of being drunk and fighting because, you know, no way he would do that, because he was quite religious. And different things like this, this doctor used to do. So they would have to be half dead before they would go the doctor, because this was the only doctor that they had to go to.”

Murray: “So they knew what kind of treatment they would get?”

Verna: “And they knew. The girls, I used to get after them about, you know, looking after their teeth. And they said no way. In fact one girl, she had a cavity, she used to put Ambroid [a type of adhesive glue – one of the first synthetic cements] in the cavity and it used to burn the root, rather than go to the doctor and have it pulled it. She used to have toothache, and that is what she said she used to do. And I said, ‘My God, doesn't that hurt?’ ‘Well, just for a minute,’ she said. ‘But,’ she said, ‘I'm not going to that butcher.’”[v] 

Verna also recalled that after the implementation of Medicare, community members continued being referred only to Doctor Green (the Indian Health Service Doctor).[vi]

Verna: “… after I moved to P.A. You see, the native people still thought, after this was disbanded, that they still had to go to this doctor. And they didn't, they could go to any doctor they wanted to.”

Murray: “With Medicare?”

Verna: “Yeah [….] But still a lot of them used to come. And also he figured he could still get all the natives...”

Murray: “As patients?”

Verna: “As patients. And at one time he refused to go and see a baby that Berry [Richards] had brought down from the north, until Berry threatened him. And then finally he went to see the baby. You know, things like that. And in fact some of the native people now had a note, Dr. Jurdus had given this native person a note when he went to the hospital, and that was thrown in the garbage and Green was called.”

Murray: “Really?”

Verna: “Well, even the hospital staff was still referring all natives to this one doctor.”

Murray: “So Jurdus would give them a note saying that this person is suppose to see me, and they would just throw it in the garbage?”

 Verna: “Yeah, and then it would just go in the garbage and they'd call Green.”

Murray: “Did he treat white people that way, too?”

Verna: “No. Just native people. I guess he was just a racist.”[vii]

This section demonstrates the challenges that La Ronge and its associated LLRIB communities have experienced in acquiring healthcare which is fair, free of discrimination, culturally relevant, and kind. It demonstrates a century of negative experiences with healthcare, and how these systemic problems (underfunding, informal policies, disregard for patients and a lack of accountability, etc.) influence systemic factors for First Nations and Métis people.