First Nations Healthcare: Discrimination, Progress, and Resilience

Bigstone Health Center, Alberta

Marion Crowe is a citizen of Piapot First Nation and the Chief Executive Officer of the First Nations Health Managers Association (FNHMA).  

Imagine if a pandemic had swept the earth, and the only people who could save you were also known for discriminating against you. 

Ginew Wellness Center in Manitoba

When a system is strained, it often snaps at the point of existing fractures. As we move past the one-year anniversary of the pandemic, cracks in Canada’s healthcare system related to First Nations healthcare have become even more painfully evident. There is hope, but the failings of healthcare as it relates to First Nations have become increasingly concerning. 

Is there doubt our existing healthcare system harbours anti-Indigenous sentiment? Hard ‘no’!  Heartbreaking individual cases are well documented and alive.  Consider the now well-known death of Joyce Echaquan, who, last fall arrived at a hospital in Quebec requiring medical treatment. Instead of care,  Echaquan was insulted by those from whom she needed help. She was called “stupid” and told she would be “better off dead”. Tragically, Echaquan did die. And, while media exploded with shock at the cruel acts caught on camera, others in the First Nations community were dismayed but not surprised. Unfortunately, her experience is not new, nor one of a kind. Her experience encountering racism in the healthcare system has been shared by many others in our community.  

Indigenous people continue to feel excluded from their own healthcare system. With no power to make decisions on how healthcare is delivered, with low representation in the field, with a lack of cultural competency from those who provide services, is it any surprise?  

We have: Joyce’s Principle; Jordan’s Principle; the Truth and Reconciliation Commission of Canada, Calls to Action (specifically 18 to 24); Anti-Indigenous Racism movements; In Plain Sight, Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care Addressing Racism Review December 2020 Data Report (Nearly 85% of Indigenous participants indicated they had faced discrimination in the healthcare system); and numerous other reports that show a failing system. Discrimination in healthcare seems to be a simple fact of life for many Indigenous people.  

But progress is being made, and we are working together with Canada to make things better. The lack of infrastructure, funding and capacity in First Nations communities is no secret; in that context, the government of Canada aimed to provide those communities some of the country’s first COVID vaccine doses. The federal government, in their fall budget, also put aside $15.6-million for new Indigenous health legislation related to fighting anti-Indigenous racism in the healthcare sector. If delivered and developed as hoped, the legislation will support bringing control back to First Nations people over the delivery and development of our own health services. How this approach rolls out will be an important metric in measuring just how serious Canada is about reconciliation.  

We have thousands of battles to fight. Infrastructure countrywide needs to be improved; systemic racism rooted out; cultural competency & humility spread to service providers; resources and power put back in the hands of First Nations. But just as hard times bring to light the weak spots in our healthcare system, they also underscore just how strong First Nations communities are. We do more with less. The First Nations state of healthcare is one of resilience against heavy odds. We fill in gaps by acting as a community. We draw strength and knowledge from our beliefs, traditions and inherent knowledge to lift those in our community who need help the most. At our best, we work together as a community, weaving western and traditional practices and medicine into treatment. Our blended approach is one of respect, stories, dance, and consistency in culture that provides a mental and spiritual backbone against anxiety in uncertain times.  

 As we move to healthcare delivery by us and for us, there are heartwarming stories that are too precious not to share.  Nations are weaving western PPE care packs with cedar, sweetgrass and sage medicines to double the protection.  Nations have developed helplines for the biggest epidemic of our time in the fight against suicide, overdoses and racism.  We have seen a huge resurgence of our practices, languages and ways of healing.  There is hope. That is what we want our next seven generations to know.   

At FNHMA, we have numerous activities underway to support First Nations health.  We continue to grow new health leaders while supporting and strengthening existing health leaders who will take over our own health systems through the FNHMA certification and training programs that we offer.  FNHMA also started a Virtual Town Hall to keep people connected and informed on Covid -19. Now, over 150 Indigenous radio stations, not to mention multiple websites and social media, brings credible, relevant and timely information from trusted sources and experts. These are encouraging first steps, but only first steps, to what is needed in developing an inclusive healthcare infrastructure for First Nations. There is much to be done, and the marathon to improve our healthcare system continues.   

We lift you all, especially those working tirelessly on the front lines, ensuring the safety and protection of our nations.  We thank you and stand united in all the work that you do.