PERSONAL
10/22/2020 14:37 EDT

Health Care Has A Problem. As Doctors, It's On Us To Be Part Of The Solution Too.

The circumstances of Joyce Echaquan's death say as much about the state of health care as society at large.

I am a doctor. 

I grew up without ever seeing a single Indigenous person in my daily life. I did not see their arts, rarely heard their music or language, I did not play with their children. Yet, I knew there was an “us” that looked like me, and a “them” hanging somewhere in old-fashioned images of longhouses, teepees and feathers. Like many, I watched dozens of news reports on “problems of Aboriginals” (when it wasn’t the “Aboriginal problem”). My sister was born during the Oka Crisis, I paid attention to grown-ups’ conversations, saw the cartoons and listened to Kashtin.

I am a doctor. In fact, I am now the family doctor of 550 people who live in the Atikamekw community of Manawan. I had the chance and privilege to train here with them.

On September 28, patients from the community sent me messages, and then the videos. The horror. The horror that we all now know. Like many, I am deeply shaken by the tragic death of Joyce Echaquan. People are crying out – and rightly so – that racism is built into the health-care system, pointing to the inaction of governments, looking for those to blame and shame. 

WATCH: Coroner launches inquiry into the death of Joyce Echaquan. Story continues below.

But I can’t escape the idea, as the saying goes, that when you point your finger, there are still three of them pointing back at you. Yes, there is systemic racism, but there is also internalized racism built over a lifetime. A racism that is not unique to Quebec — it is the history of the entire country.

Since Joyce Echaquan’s death, I have been remembering dozens of conversations with patients and families at the Manawan dispensary who begged me – who negotiated – not to be “sent down” to the hospital in Joliette, Que., for fear of the care, of the reception, of not being understood, of not being heard, of being denigrated. To live with racism, again. 

And I always reassured, explained. Sometimes, I would simply say that I had no choice. But so many other times, I would offer a justification: “Probably a misunderstanding, the nurse meant this, the doctor must have meant that, don’t you think the attendant was simply overwhelmed?” 

In short, I was giving them my version, my narrative, of what their story was. I told them that I know the people in Joliette, that they are my colleagues, that they are good, and that they would take care of them. I think no less of them today.

But I am shaken. I am shaken because I feel like someone who didn’t believe the victims. Because racism, before it becomes a system, is made up of little links that become stronger than the sum of their parts. I am shaken because racism, whether individual or systemic, is perpetuated by someone I know, and that person looks like me. And it all started a long time ago.

Eric Thomas/AFP via Getty Images
Protesters gather during a demonstration in central Montreal on October 3, 2020, to demand action for the death of Joyce Echaquan.

An anecdote: I gave a course for a few years where I tackled the notion of “implicit biases,” those inclinations of the unconscious to prefer, favour or neglect that are absorbed from the environment in which one grows up. Everyone has implicit biases. So, here I am, presenting 200 medical students with clinical vignettes to prove it.

“Indigenous man, 42 years old, confused, neglected hygiene, vomit on his clothes. Your diagnoses?” 

Answers pour in: “Alcoholism; he drank too much; addiction; drug addict.” Variations on a theme. Then I move on to the next slide which presents the multiple diagnostic hypotheses that might explain an altered state of consciousness with vomiting.

Silence. Discomfort. Everyone understands. Everyone understands that the patient’s diagnosis was conferred by a stereotype. Stereotypes kill, and are perpetuated in isolation from and ignorance about the First Peoples, of their cultures, of their version of historical facts, of their humour, of their knowledge.

It is the whole system that needs to be improved, a system that will never be stronger than its weakest link.

We have to admit that the “health-care workers factory” is not exactly otherness-friendly. Indeed, the training of health professionals remains essentially hospital-centered, and it is important to understand that few people come to the emergency room with a smile on their face. The environment is hostile, for the caregivers, patients and trainees. Moreover, for many professionals (in training or certified), the care environment will be their only point of contact with First Nations, Métis and Inuit. This is not normal. But that is how the system feeds itself.

I can’t get away from the idea that without the video, no one would have really believed the victim’s version of what happened. And it’s uncomfortable for me to admit it, as someone who likes to see myself as an ally, but without the video, I doubt I would have behaved any differently than I usually do. I would have reassured, explained. These are my colleagues. I know them well. They are good and they take care. I think no less of them today. 

But I am shaken. It’s not a misunderstanding. On the contrary, we all heard the health-care workers’ words in the video. It is the whole system that needs to be improved, a system that will never be stronger than its weakest link.

I am the family doctor of 550 patients who live in the Atikamekw community of Manawan. I want to tell them today: I believe you and I am so sorry. Justice for Joyce, and safety for the community. The path to reconciliation has never seemed so long. It is time to stop dragging our feet.

Pascale Breault, M.D. CCMF

Family physician at the Groupe de médecine familiale universitaire du Nord de Lanaudière, Centre de santé Masko-Siwin & Centre de pédiatrie sociale Mihawoso

Hospitalist at the Centre hospitalier régional de Lanaudière (Joliette)

Chargée d’enseignement clinique, Département de médecine familiale et de médecine d’urgence de l’Université Laval

Kindly translated from the original version in French with the help of Christopher Fletcher, Professor, Département de médecine sociale et préventive, Université Laval.

A version of this article was originally published on Facebook on Oct. 5, 2020. It includes the names of 257 people who have signed in support of the author’s statement.

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