Indigenous health professionals describe from the inside the systemic racism revealed in the Echaquan inquest

Open this photo in gallery:

Atikamekw outreach worker Barbara Flamand felt like a police officer at Joliette hospital, walking the hallways like a beat cop in a hostile neighbourhood, trying to serve and protect Indigenous patients who felt insecure in what should be society’s safest setting.

Innu physician Dr. Stanley Vollant described systemic racism in the health system so insidious he found himself looking down on Indigenous patients as bias seeped into his mind. He described the realization he was turning into “an apple” – a derogatory term for an Indigenous person perceived to have become acculturated into white ways of thinking.

“Most people are not raging, overt racists, but the way we are educated, the culture behind that education, all of our society’s processes are tainted with racism,” Dr. Vollant said in an interview. “I only spoke Innu until I was 6. I was raised in the bush by my grandparents. I’m very proud to be Innu. But after years in the education and health system, there I was, having some of those same reflexes.”

Ms. Flamand and Dr. Vollant testified at the recently completed inquiry into the death of Joyce Echaquan. Among 59 witnesses, they were the only two who were Indigenous health care workers. They had a critical insider view of how their people are treated in Canada’s most important public service. During the inquest and afterward, they described running into systemic brick walls that created a hostile and sometimes deadly environment for Indigenous people.

An Atikamekw mother of seven, Ms. Echaquan died at the Joliette, Que., regional hospital Sept. 28, 2020. The inquest heard the 37-year-old woman was the victim of overt racism and more subtle bias which delayed her care for treatable pulmonary oedema, or fluid on the lungs, that turned fatal.

Quebec coroner finishes Joyce Echaquan inquest

After Ms. Echaquan broadcast a Facebook Live video that day of medical workers bombarding her with racist abuse, her alarmed family called Ms. Flamand and asked her to check on Ms. Echaquan.

Ms. Flamand knew Ms. Echaquan and had worked at the 350-bed hospital for two years. She should have been an integral part of Ms. Echaquan’s emergency care team. Instead, what happened next was emblematic of how the outreach worker and Indigenous people were treated at the hospital.

“I went to the emergency room and the person in charge didn’t recognize me and wouldn’t let me in, so when someone left through a staff door I grabbed it and snuck in,” Ms. Flamand said.

Once inside emergency, Ms. Flamand couldn’t find a nurse. A secretary was alone and wouldn’t tell her where to find Ms. Echaquan and sent her to a waiting room. “I could tell something was wrong so I paced around the hallway, shaking,” Ms. Flamand recounted.

Once Ms. Echaquan was dead, hospital staff decided she could be useful. A doctor on duty asked her to inform the family of the death, which she refused. She then was asked to organize their transport to the hospital so they would find out. “I was in a state of shock,” Ms. Flamand said.

This treatment wasn’t new, said Ms. Flamand, who recalled how she was given shared office space with maintenance and technical staff at the other end of the hospital. “I tried to get an ID card, they wouldn’t give me one. When I was with patients they would tell me visiting hours are over,” she said. “I’d tell them ‘I work here.’ They really didn’t want me there.”

Ms. Flamand said she would just loiter in busy parts of the hospital such as the emergency room trying to spot Atikamekw patients.

Dr. Jacques Ramsey, a physician-coroner who assisted coroner Géhane Kamel at the inquest, said Ms. Flamand was as insecure as the patients she was trying to protect. “They never gave you the tools for the job,” he said.

Ms. Flamand’s brief career as the hospital outreach worker started with a long period of deliberation, training and patience.

Around 2000, Ms. Flamand assisted a friend through her end-of-life care. They spoke of her friend’s sister, who was the Atikamekw outreach worker at the Joliette hospital. The friend told her she would be perfect for the job.

She was also driven by her mother, Véronique Ottawa Flamand, who had told her about losing a baby at the Joliette hospital and how the experience left her with deep feelings of insecurity and distrust about care at the hospital.

Ms. Flamand worked for more than a decade at the community health centre in the Atikamekw community of Manawan. In 2019, the outreach dream job at the Joliette hospital came open and she was hired. “It was always what I wanted to do,” Ms. Flamand said.

Nearly two years at a frustrating job turned into a nightmare on the day Ms. Echaquan died. She resigned in February and has yet to go back to another job at the Manawan clinic. “I’m still in shock and I cry just thinking about it,” she said in the days after her testimony.

The stories of Ms. Flamand and Ms. Echaquan are familiar to Dr. Vollant, 56, and Quebec’s first Indigenous surgeon. He’s participated in a number of inquiries, hearings and commissions into Indigenous health care. He’s walked across Quebec a couple times over, more than 6,000 kilometres, to raise awareness for Indigenous health.

Now, as one of Canada’s senior Indigenous doctors, others across the country seek his counsel. “I hear the same problems we’re facing across the country,” he said this week outside Montreal’s Notre-Dame hospital, during a break after performing bowel surgery.

“I hear from medical students and professionals in Saskatchewan, Alberta and Manitoba being bullied in their work and training. This is not just a Quebec problem.”

Dr. Vollant sees a direct line between Ms. Echaquan’s poor treatment and the long legacy of Indian Residential Schools which was highlighted again recently with the discovery of 215 unmarked child graves in Kamloops, B.C.

“The line is the unfair, unequal, and disrespectful treatment of Indigenous people in systems of care,” Dr. Vollant said. “Residential schools, tuberculosis sanitoriums, hospitals, they’re all institutions rife with systemic racism that traumatize Indigenous people who can’t escape and can’t protect themselves. This is just the more modern version.”

Dr. Vollant has a list of things that need to improve, long memorized from the many times he’s pleaded for action. Deeper education to promote cultural understanding is vital, he said, along with zero tolerance for racist language. He called for a simplified and streamlined complaint process to overcome cultural barriers to speaking out. Every piece of the health care system needs to be “decolonized,” he said – reformulated with Indigenous reality and security in mind.

“Every person who works in a hospital or medical clinic down to the person pushing a broom needs to be made sensitive to this issue,” Dr. Vollant said. “When we walk in the hallway we can feel when someone looks at us and says, ‘Oh there’s an Indian.’ We can see it in the eyes.

“The insecurity starts in the hallway.”

Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.