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Dr. Janet Smylie is a Tier 1 Canada Research Chair in Indigenous Health at the University of Toronto. Diane Smylie is a consultant and specialist in addressing anti-Indigenous racism in health organizations. Dr. Lisa Richardson is strategic lead in Indigenous health at the University of Toronto’s Faculty of Medicine and Women’s College Hospital.

Over recent years we have seen an alarming increase in media reports of striking events of negligence and anti-Indigenous racism in Canadian hospitals. The emerging pattern is one of public outrage and a linked public policy debate in which Indigenous leaders advocate for tangible systemic change while non-Indigenous hospital and governmental leaders resist the premise or don’t see that anti-Indigenous racism in Canadian hospitals is common, pervasive and systemic.

For example, during the inquest into the death of Brian Sinclair, a 45-year-old First Nations man who died from treatable causes after waiting 34 hours in a Winnipeg emergency department, Dr. Thambirajah Balachandra, the province’s chief medical examiner, stated: “Even if Snow White had gone there, she would have got the same treatment under the same circumstances.”

While most incidents of anti-Indigenous racism in hospitals go unreported, at times evidence and public outrage are sufficient to result in public investigations or inquests with subsequent recommendations. Sadly, the latter are commonly diluted and only partially implemented. Efforts are typically superficial and performative, involving, for example, ineffective “cultural sensitivity” trainings.

Like most readers, we didn’t get a chance to know Joyce Echaquan, the 37-year-old mother and member of the Atikemekw Nation of Manawan. What we do know is that she went to the hospital in Joliette, Que., to get medical assistance for stomach pain and that in her most vulnerable and critically ill moments, she had the resilience to record a video of racist abuse from health-care professionals who were supposed to be caring for her. We understand that this wasn’t the first time she had experienced racism at this hospital while seeking medical care.

Finally, we know that her family, friends and community leaders are calling for concrete systemic change while Quebec Premier François Legault clings to his position that systemic anti-Indigenous racism in the province’s public services is not an issue.

Interconnections between the personal and systemic are intrinsic to many Indigenous worldviews. A few weeks ago, when advising on how to deal with systemic racism in Toronto hospitals, an elder shared the teaching “when one of us is hurt, we are all hurt.” Conversely, “when one of us is cared for, we are all cared for.”

Such thinking is not unique to Indigenous peoples. An Indigenous physician colleague recently reminded us that even the “bad apple” metaphor (commonly applied to non-systems-level approaches to addressing racism) has a second part that links individual to systemic rot. “The bad apple spoils the barrel.”

While it’s important to identify individual practitioners who engage in behaviours that are racist, it is more important to hold health-care institutions accountable so they are compelled to make critical changes. We already have numerous public reports citing evidence-based knowledge of what needs to happen to produce tangible change.

To eradicate anti-Indigenous discrimination in hospitals, we need to recognize and fight it the same way we do infection. We need leaders who label it as a preventable and life-threatening organizational challenge, and who promote cross-system extermination, ongoing vigilance and prevention. We need action, including co-ordinated systems-level responses that hold individuals and institutions accountable.

Key elements include trust relationships between Indigenous and allied leaders that form a foundation for Indigenous self-determination in health-care settings; clearly articulated and measurable goals developed in partnership with Indigenous community leaders and tracked through regular audits and public reports; creation of safe pathways so staff and patients can report incidents of racism with confidence that their disclosures will feed into positive change; recruitment and support of Indigenous staff; and anti-Indigenous racism education for all non-Indigenous staff.

It appears we are at a crossroads nationally with respect to whether or not we will walk our talk regarding accessible health care for all. What may appear to be the easier path involves denial, defensiveness, and maintenance of the status quo – but comes at the cost of further dishonouring Joyce Echaquan and her dying wish for assistance.

The more challenging path toward addressing anti-Indigenous racism requires the humility and courage to acknowledge the pervasive and systemic nature of this problem and to share the continuous hard work of both personal and systems change. The harms and linked continuing traumatization of Indigenous peoples has to stop. We urge leaders to address the anti-Indigenous racism occurring under your watch. We further urge all Canadians to hold health-care leaders and institutions accountable, and insist on justice for Joyce.

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