France grants citizenship to 12,000 Covid frontline workers

Quicker than Canada (as of this week, only about 4,300 have applied out of 20,000 slots):

France has granted citizenship to more than 12,000 frontline workers whose jobs put them at risk during the Covid pandemic under a special fast-track scheme.

As well as speeding up the application process, which normally takes up to two years, the government also cut the residency requirement from five years to two.

“Frontline workers responded to the call of the nation, so it is right that the nation takes a step towards them,” said the citizenship minister, Marlène Schiappa. “The country pulled through thanks to them.

“I welcome our new compatriots to French nationality and thank them in the name of the republic. The country also thanks them.”

In September 2020, the interior ministry invited those who had “actively contributed” to fighting the Covid health crisis to apply for fast-track naturalisation. On Thursday, Schiappa said 16,381 had applied and 12,012 applications were approved.

Among them were health professionals, security and cleaning staff, those who looked after essential workers’ children, home help workers and refuse collectors, the minister announced.

John Spacey, a Briton, was one of those given fast-track nationality as a foreigner who had “proved their commitment to the republic” in the eyes of the ministry.

Spacey lives in the Creuse region in central France and works for an organisation that provides domestic care for elderly people. “It genuinely feels like a great honour to be offered citizenship,” he told the Local earlier this year.

“France has been very good to me since my arrival and has given me opportunities I could never have dreamed of before stepping off the Eurostar in 2016 – a home of my own, a wonderful relationship, a 20-year-old Peugeot 106, a 40-year-old Mobilette, the most satisfying job in the world and a very bright future.

“Soon, I’ll be able to vote, will regain my freedom of movement and will finally feel fully European once more, finally feel fully integrated into the nation I’ve already come to love like my own.”

Spacey said he also received a one-off bonus payment from the state “as a kind of merci for services rendered during the crisis … something for which I was very grateful and that I’d not expected, given I’d been paid for my work anyway”.

He added: “Then came another, far more unexpected, thank you – the chance to apply for French nationality six months earlier than would have been possible under the normal rules and to have the process fast-tracked. All for doing a job I love.”

In April 2020, French hospital staff and nursing home workers were awarded tax-free bonuses of between €1,000 and €1,500 as part of the government thank you for their work during the Covid-19 crisis.

In August 2020, France’s 320,000 home-care workers were given Covid-19 bonuses of up to €1,000.

Source: France grants citizenship to 12,000 Covid frontline workers

The Black Mortality Gap, and a Document Written in 1910

Important history:

Black Americans die at higher rates than white Americans at nearly every age.

In 2019, the most recent year with available mortality data, there were about 62,000 such earlier deaths — or one out of every five African American deaths.

The age group most affected by the inequality was infants. Black babies were more than twice as likely as white babies to die before their first birthday.

The overall mortality disparity has existed for centuries. Racism drives some of the key social determinants of health, like lower levels of income and generational wealth; less access to healthy food, water and public spaces; environmental damage; overpolicing and disproportionate incarceration; and the stresses of prolonged discrimination.

But the health care system also plays a part in this disparity.

Research shows Black Americans receive less and lower-quality care for conditions like cancer, heart problems, pneumonia, pain management, prenatal and maternal health, and overall preventive health. During the pandemic, this racial longevity gap seemed to grow again after narrowing in recent years.

Some clues to why health care is failing African Americans can be found in a document written over 100 years ago: the Flexner Report.

In the early 1900s, the U.S. medical field was in disarray. Churning students through short academic terms with inadequate clinical facilities, medical schools were flooding the field with unqualified doctors — and pocketing the tuition fees. Dangerous quacks and con artists flourished.

Physicians led by the American Medical Association (A.M.A.) were pushing for reform. Abraham Flexner, an educator, was chosen to perform a nationwide survey of the state of medical schools.

He did not like what he saw.

Published in 1910, the Flexner Report blasted the unregulated state of medical education, urging professional standards to produce a force of “fewer and better doctors.”

Flexner recommended raising students’ pre-medical entry requirements and academic terms. Medical schools should partner with hospitals, invest more in faculty and facilities, and adopt Northern city training models. States should bolster regulation. Specialties should expand. Medicine should be based on science.

Source: The Black Mortality Gap, and a Document Written in 1910

Why doctors want Canada to collect better data on Black maternal health

Need this for many groups:

A growing body of data about the heightened risks faced by Black women in the U.K. and U.S. during pregnancy has highlighted the failings of Canada’s colour-blind approach to health care, according to Black health professionals and patients.

Black women in the U.K. and U.S. are four times more likely to die in pregnancy or childbirth than white women, according to official data. A recent U.K. study published in The Lancet found that Black women’s risk of miscarriage is 40 per cent higher than white women’s. In Canada, that level of demographic tracking isn’t available.

“For our country, we don’t have that data. So it’s difficult to know exactly what we’re dealing with,” said Dr. Modupe Tunde-Byass, a Toronto obstetrician-gynecologist, and president of Black Physicians of Canada. “We can only extrapolate from other countries.”

Source: Why doctors want Canada to collect better data on Black maternal health

Report from Alberta Anti-Racism Advisory Council takes aim at justice system, education and health-care layoffs

Of note. Bit odd weighing in on healthcare outsourcing but legitimate to note the disproportionate  impact falls on women and visible minorities:

Mandatory anti-racism training for the province’s police, prosecutors and judges and more content addressing systemic racism in the K-12 curriculum are among recommendations proposed by the Alberta Anti-Racism Advisory Council in its long-awaited report.

Released Friday, it calls for an in-depth education on the impact of hate incidents for all Justice Ministry staff, and to see K-12 students learn about the historical roots of racism and its impact on the present-day.

Source: Report from Anti-Racism Advisory Council takes aim at justice system, education and health-care layoffs

The Pandemic Imperiled Non-English Speakers In A Hospital

Of note, both the findings and the measures the hospital took to address the problem:

In March, just weeks into the COVID-19 pandemic, the incident command center at Brigham and Women’s Hospital in Boston was scrambling to understand this deadly new disease. It appeared to be killing more black and brown patients than whites. For Latino patients, there was an additional warning sign — language.

Patients who didn’t speak much, if any, English had a 35% greater chance of death.

Clinicians who couldn’t communicate clearly with patients in the hospital’s COVID units noticed it was affecting outcomes.

“We had an inkling that language was going to be an issue early on,” says Dr. Karthik Sivashankar, the Brigham’s then medical director for quality, safety and equity. “We were getting safety reports saying language is a problem.”

Sivashankar dove into the records, isolating and layering the unique characteristics of each of the patients who died: their race, age, gender and whether they spoke English.

“That’s where we started to really discover some deeper, previously invisible inequities,” he says.

Inequities that weren’t about race alone.

Hospitals across the country are reporting higher hospitalizations and deaths for Black and Latino patients as compared to whites. Black and brown patients may be more susceptible because they are more likely to have a chronic illness that increases the risk of serious COVID. But when the Brigham team compared Black and brown patients to white patients with similar chronic illnesses, they found no difference in the risk of death from COVID.

But a difference did emerge for Latino patients who don’t speak English.

That sobering realization helped them home in on a specific health disparity, think about some possible solutions, and begin a commitment to change.

“That’s the future,” says Sivashankar.

Identifying the mortality risk is just the first step

But first, the Brigham had to unravel this latest example of a life threatening health disparity. It started outside the hospital, in lower-income communities within and just outside Boston, where the coronavirus spread quickly among many native Spanish speakers who live in close quarters with jobs they can’t do from home.

Some avoided coming to the hospital until they were very sick, because they didn’t trust the care in big hospitals or feared detection by immigration authorities. Nevertheless, just weeks into the pandemic, COVID patients who spoke little English began surging into Boston hospitals, including Brigham and Women’s.

” We were frankly not fully prepared for that surge,” says Sivashanker. “We have really amazing interpreter services, but they were starting to get overwhelmed.”

“In the beginning, we didn’t know how to act, we were panicking,” says Ana Maria Rios-Velez, a Spanish-language interpreter at the Brigham.

Rios-Velez remembers searching for words to translate this new disease and experience for patients. When called to a COVID patient’s room, interpreters were confused about whether they could go in, and how close they should get to a patient. Some interpreters say they felt disposable in the early days of the pandemic, when they weren’t given adequate personal protective equipment.

When she had PPE, Rios-Velez says she still struggled to gain a patient’s trust from behind a mask, face shield and gown. For safety, many interpreters were urged to work from home. But speaking to patients over the phone created new problems.

“It was extremely difficult, extremely difficult,” she says. “The patients were having breathing issues. They were coughing. Their voices were muffled.”

And Rios-Velez couldn’t look her patients in the eye to put them at ease and try to build a connection.

“It’s not only the voice, sometimes I need to see the lips, if smiling,” she says. “I want them to see the compassion in me.”

Adding interpreters and telemedicine tech

The Brigham responded by adding more interpreters and buying more iPads so that remote workers could see patients. The hospital purchased amplifiers to raise the volume of the patient’s voice above the beeps and machines humming in an ICU. The Mass General Brigham network is piloting the use of interpreters available via video in primary care offices. A study found lower use of telemedicine visits by Spanish-speaking patients as compared to white patients during the pandemic.

The Brigham’s goal is that every patient who needs an interpreter will get one. Sivashankar says that happens now for most patients who make the request. The bigger challenge, he says, is including an interpreter in the care of patients who may need the help but don’t ask for it.

In the midst of the first surge, interpreters also became translators for the hospital’s website, information kiosks, COVID safety signs and brochures.

“It was really tough. I got sick and had to take a week off,” saysYilu Ma, the Brigham’s director of interpreter services.

Mass General Brigham is now expanding a centralized translation service for the entire hospital network.

Seeing the inequities within the hospital workforce

Brigham and Women’s analytics team uncovered other disparities. Lower-paid employees were getting COVID more often than nurses and doctors. Sivashankar says there were dozens of small group meetings with medical assistants, transport workers, security staff and those in environmental services where he shared the higher positive test rates and encouraged everyone to get tested.

“We let them know they wouldn’t lose their jobs,” if they had to miss work, Sivashankar says. And he, along with managers, told these employees “that we realize you’re risking your life just like any other doctor of nurse is, every single day you come to work.”

Some employees complained of favoritism in the distribution of PPE, which the hospital investigated. To make sure all employees were receiving timely updates as pandemic guidance changed, the Brigham started translating all coronavirus messages into Spanish and other languages, and sending them via text, which people who are on the move all day are more likely to read. The Mass General Brigham system offered hardship grants of up to $1,000 for employees with added financial pressures, such as additional child care costs.

Angelina German, a hospital housekeeper with limited English, says she appreciates getting updates via text in Spanish, as well as in-person COVID briefings from her bosses.

“Now they’re more aware of us all,” German says through an interpreter, “making sure people are taking care of themselves. ”

Moving beyond the hospital walls to address disparities

The hospital also set up testing sites in some Boston neighborhoods with high coronavirus infection rates, including neighborhoods where many employees live and were getting infected. At least one of those sites now offers COVID vaccinations.

“No one has to be scheduled, you don’t need insurance, you just walk up and we can test you,” explained Dr. Christin Price during a visit to one of the testing sites last fall. It was located in the parking lot of Brookside Community Health Center, in Boston’s Jamaica Plain neighborhood.

Nancy Santiago left the testing site carrying a free 10-pound bag of fruits and vegetables, which she’ll share with her mother. Santiago said she’s grateful for the help.

“I had to leave my job because of [lack of] daycare, and it’s been pretty tough,” she said, “but you know, we gotta keep staying strong and hopefully this is over sooner rather than later.”

The Brigham recently opened a similar indoor operation at the Strand Theater in Dorchester. Everyone who comes for a coronavirus test is asked if they have enough to eat, if they can afford their medications, whether they need housing assistance and if they’re registered to vote.

The bags of free food, and the referrals to social support, are evidence of a debate playing out about the role hospitals will play, outside their walls, to curb health disparities rooted in racism.

“Poverty and social determinants of health needs are not going away any time soon, and so if there’s a way to continue to serve the communities, I think that would be tremendous,” says Price, who helped organize the Brigham’s community testing program.

Mass General Brigham leaders say they’ll take what they’ve learned dissecting disparities during the COVID-19 pandemic, and expand the remedies across the hospital network.

“Many of the issues that were identified during the COVID equity response are unfortunately pretty universal issues that we need to address, if we’re going to be an anti-racist organization and one that promotes equity strongly as one of our core strategies,” says Tom Sequist, chief of patient experience and equity for Mass General Brigham.

The Brigham’s work on health disparities comes, in part, out of a collaboration with the Institute for Healthcare Improvement (IHI), and included a focus on gathering, analyzing and tracking data.

“There’s a lot of defensive routines into which we slip as clinicians, that the data can help cut through and reveal that there are some biases in your own practice,” explains IHI President and CEO Dr. Kedar Mate.

“If we don’t name and start to talk about racism and how we intend to dismantle it or undo it,” Mate adds, “we’ll continue to place Band-Aids on the problem and not actually tackle the underlying causes.”

But has the Brigham’s work lowered the risk of death from COVID for Spanish-speaking patients? The hospital hasn’t updated the analysis yet, and even when it does, determining whether (or how) the interventions worked will be hard to prove, Sivashankar says.

“It’s never going to be as simple as ‘We just didn’t give them enough iPads or translators and that was the only problem,’ and now that we’ve given that, we’ve shown that the mortality difference has gone away,” said Sivashankar.

But Sivashankar says more interpreters, iPads, and better messaging to non-English speaking employees, plus all the other steps the Brigham has taken during COVID have improved both the patient and employee experience. That, he says, counts as a success, while work on the next layer of discrimination continues.

Source: The Pandemic Imperiled Non-English Speakers In A Hospital

Nili Kaplan-Myrth: Vaccination nation – or, a word with the prime minister

From our family doctor:
As a family doctor, I never dreamed I’d speak to the prime minister about a life and death issue for Canadians. But this afternoon (Thursday), joined by my RN colleague Amie Varley, I am moderating a panel of health-care workers and community advocates across the country. We’ve been called “front-line heroes” throughout the COVID-19 pandemic, but our voices are often excluded from decision-making tables. I put together this panel to have a national conversation about COVID-19 vaccination strategies. Many of the issues that keep me up at night are similar to the issues that keep my colleagues, patients, friends and family awake.
What it is that we are all worrying about? Geographic disparities. My friend is a doctor in Kenora. She told me that in a 700-km corridor, from Winnipeg to Thunder Bay, none of the doctors and nurses in intensive care units (ICUs) and emergency departments, staff in LTC, health workers in any setting – has received the vaccine. She told me how fragile their hospital is in a remote area, where their entire system could collapse if anyone on their team gets sick.
We’re worried about systemic inequalities in our health-care system. First Nations, Inuit and Metis patients, and racialized Canadians, occupy a disproportionate number of the beds in our ICUs, and make up a disproportionate number of deaths from COVID-19. People who live in poverty, or are homeless, are far less likely to access the vaccine than affluent people are. Registration for vaccination may be entirely online, reliant on individuals to act as if they are buying tickets to a rock concert. How will my patients who are in their 80s, or my patients who do not own computers, who have already struggled to book COVID-19 tests, ensure that they get their shots?
There are so many issues of equity and diversity. In the process of putting together our panel, I was approached by people who wanted to know if we would talk about the vulnerability of seniors who live in the community, people with disabilities, caregivers outside of institutional settings. I spoke with people who were concerned we’d forget about Canadians who live or work in shelters, in jails. I was also approached by women’s health experts, discussing the need for national standards to support pregnant and lactating women as recipients of the COVID-19 vaccine.
I couldn’t include every advocate or every subject in our conversation with the prime minister, let alone every province and territory. How does one cover issues of racism, ableism, ageism, sexism, language barriers, socioeconomic barriers, discrimination faced by LGBTQ patients, and all the ways in which our health care fundamentally disadvantages members of our society, all in a one-hour conversation about access to COVID-19 vaccine across the country?
I also wanted to address the idea that we are “in this together,” when in fact we tend to work in silos. Our panel brings us together: Nurses, doctors, midwives, pharmacists, personal support workers, health policy researchers, patient advocates, essential caregivers. We end the panel by talking about how we can collaborate to get the COVID-19 vaccine into the arms of Canadians.
While I am still pinching myself, amazed that this is possible – I’ve told my children to speak up for what matters, but who’d have thought I’d speak directly to the prime minister? – our panel is an example of the diverse voices that should be at every decision-making table. This is only the beginning of a collaborative conversation that I hope will continue.
Dr. Nili Kaplan-Myrth, MD, CCFP, PhD, is a family doctor and anthropologist who writes about health policy and politics. She also co-hosts the podcast

Source: Nili Kaplan-Myrth: Vaccination nation – or, a word with the prime minister

Before COVID-19, inequity in healthcare was, in effect, a pandemic for Black communities. Here are five issues that need to be addressed

Of note. Good list of issues:

Toronto has a new, $6.8-million plan to fight the disproportionate impact of COVID-19 on the Black community. But the roots of health inequity were taking hold long before the pandemic started.

“These are conversations we have been having. We’ve been advocating, we’ve been speaking about it,” said Lydia-Joi Marshall, president of the Black Health Alliance. “This is not a new crisis for the Black community …. This is just highlighting the inequities that have been happening all along.”

Marshall, who has worked in healthcare research for more than 15 years and was a speaker at this month’s TEDxToronto: Uncharted, spoke with the Star to explain five long-standing issues that have made the healthcare system unequal for the Black community. Many of these still need to be addressed.

It’s not biology, it’s racism: As a geneticist, Marshall said she does not believe in race as a biological construct. “Race is not the determinant of health. Racism is,” she said.

“We often hear all these higher rates of illness in Black people — Black people have higher hypertension and diabetes,” and we can see that and think there must be a “very specific biological reason,” Marshall said. But, really, it’s more to do with systemic barriers that make these illnesses more likely, such as disproportionate stress and lack of access to nutritious food. “What are the other social determinants?” she said.

For instance, a 2019 study by FoodShare and the University of Toronto showed that Black Canadians are twice as likely as white Canadians to be food insecure. Without access to affordable, healthy food, health problems can fester.

“This idea that it is biological, we have to come away from that, because it allows people to dismiss the systemic and institutionalized racism of why we’re seeing such different rates.”

Microaggressions take a toll on physical health: Dealing with small, daily instances of racism can overtime lead to poorer health outcomes. “It takes a toll on our health,” Marshall said.

A study conducted by Harvard University and NPR in 2017 found that people who reported high numbers of daily indignities, such as receiving poor service in a restaurant or being treated with less courtesy than others, also ranked high in developing heart disease, or, in the case of pregnant women, ranked high in giving birth to babies of a lower weight.

“This stress, whether it is daily stress or overt … can result in illness,” Marshall said.

Mental health and wellness has a ripple effect: Marshall notes that mental health can affect other branches of health, and yet have so far not received as much attention.

Much of Marshall’s research relates to other clinical and chronic illnesses, but rates of under-diagnosed or misdiagnosed mental illness in the Black community, have “shocked” her, when she has looked at them.

Black respondents ranked the lowest in a December 2020 mental health surveyconducted by Morneau Shepell.

Barriers to mental healthcare for the Black community must be reduced, and a better understanding at the point of diagnosis developed, so the rates of under- and misdiagnosis are addressed.

Bias affects quality of care: Marshall recalls a time when her aunt called Telehealth to assess her symptoms when she was feeling ill. The questions went: “Are you healthy? Does your skin look pink?” Marshall said.

“I had to explain to her that this is just the ingrained bias — that here in Canada, the normal is not us.”

Apart from small instances such as this, the phenomenon also manifests in textbooks that are used in medical schools, hospital visits and is a hardship shared by Indigenous communities.

Mistrust of the system lingers: As concerns about hesitancy around taking the vaccine get more attention in public policy, it’s worth really considering the questions Black communities have and the source of their concerns, Marshall says.

Mistreatment has been both on a large scale historically — as with the Tuskegee study in the U.S. and nutrition experiments in the Indigenous community in Canada — but also on a smaller scale in the form of personal trips to the hospital.

Many are “asking valid questions, because of a historical pattern of the system not catering to our needs,” she said.

“Why would we trust a system that has not been built for us?”

This approach can inform the way Canada addresses vaccine concerns in the Black community.

Source: Before COVID-19, inequity in healthcare was, in effect, a pandemic for Black communities. Here are five issues that need to be addressed

Knock down anti-Black racism in medicine, two powerhouse advocates tell health-care sector in new CMAJ article

More on process-type recommendations to identify approaches to address issues, many of which reflect social determinants of health:

When rapper John River went to a hospital emergency room in 2017 with shortness of breath and severe headaches, he was treated like he was faking his symptoms to get drugs. When he turned to social media for help, well-wishers told him how he and his family acted and dressed at the hospital would impact the kind of care he would receive. No hoodies, for instance. His mother tried to button a dress shirt on to him as he lay unconscious on a stretcher. He was eventually diagnosed with a spontaneous cerebrospinal fluid leak from a prior procedure.

For years, Black people have shared, with data scientists, governments, academics, journalists and each other, terrifying stories of not being believed in hospitals, of receiving substandard care, of feeling like they were left to die.

In this COVID-era, race-aggregated data showing Black people disproportionately impacted by the virus has rightly raised awareness and alarm over the impact of racism across systems leading to that outcome.

“The field of medicine can no longer deny or overlook the existence of systemic anti-Black racism in Canada and how it affects the health of Black people and communities,” write OmiSoore Dryden of Dalhousie University and Onye Nnorom from the University of Toronto. 

In a Canadian Medical Association Journal article released Monday, the two powerhouse experts in the field of anti-Black racism in medicine say the health-care system needs to focus on — and redress — not only the reasons that send Black Canadians to hospitals but how they’re treated when they get there. 

Despite protests against anti-Black racism this summer, despite the UN expressing concern in 2017 of the plight of Black Canadians, “the impression that we got is that many Canadian physicians did not think that anti-Black racism is a problem in Canada,” Nnorom told the Star. And that “most physicians do not have an understanding of how racism operates as a system such that some groups are disproportionately disadvantaged.” 

With this article, Dryden said, the authors aimed to “tell practitioners and clinicians that your patients are not just bodies in front of you. They come with experiences. One of the experiences your Black patients come with is anti-Black racism.” 

Dryden is the James R. Johnston (JRJ) Chair in Black Canadian Studies at Dalhousie University’s faculty of medicine. Nnorom is trained as a public health physician and a family physician and has published several articles in medicine.

About a year ago, they set up Canada’s Black Health Education Collaborative by bringing together a group of scholars of Critical Race Theory from across Canada and working on creating curriculum around how anti-Black racism affects health outcomes in medical schools.

The many manifestations of racism in society — being passed over for a job or a promotion, being treated with suspicion in public spaces, being denied homes to rent, being unduly disciplined in school — all boil down to one unspoken assumption: that the person in question is not credible because they are not innocent. An assumption we like to give the innocuous label of “implicit” bias, even though its consequences can be tragically explicit. 

“This article and the conversations many of us have been having is identifying that racism is not an anomaly, it’s an everyday experience,” Dryden said. 

When Black people go to the hospital in pain, they are profiled as drug seeking, she said. Or the assumption is they don’t feel pain at the same level. Or if they are given medication that they’re not compliant and won’t follow guidelines. 

In her many public talks to health and medical professionals, Dryden tells them, “If you have a patient that doesn’t return, instead of thinking they’re not compliant, you might want to start with, ‘Did something racist happen and how do I find out?’

Although modern science conclusively busts the myth that race has biological origins, medical stereotypes rely on the belief that Black people are a different genetic species of humans. 

“Yes, the human genome has been mapped,” Nnorom said. “Yes, we know a person’s postal code has more impact on their health than their genetic code but it is difficult to completely remove that type of thinking. The history of medicine and these genetic biological associations with race dates back centuries.” 

The first program of medical education began in Montreal about 20 years before the end of slavery in Canada, Dryden said. “So it began at a time when Black and Indigenous are enslaved and that becomes the continuing flavour of education in Canada.”

If studies show how African-Americans have higher rates of diabetes or hypertension, the medical approach is there’s something wrong with their genetics or their culture or their practices that needs to be fixed. 

“The way we’ve been traditionally taught in medicine is to pathologize the marginalized group.” Nnorom said. “We’ve been taught to assume there is something wrong with the group that has been marginalized as opposed to thinking there was something wrong with society to create the conditions in which those communities find themselves.

“The process (of learning), you’d almost have consider it an unlearning.”

To address racism, the authors say health-care professionals should acknowledge its existence first. “We can do this by listening to the voices of Black Canadians, patients and health care professionals who have been grappling with anti-Black racism for generations, and by engaging with the many communities that have made recommendations for meaningful change to address the problem,” they write.

What would listening look like? 

“That’s a very good question,” said Nnorom, because while organizations might engage in consultations with focus groups in different communities, “what ends up coming out of that is not what the community has recommended. That is not true listening.”

Hospital leaders, administrators and academics would have to take up hard, uncomfortable work of “actually looking at recommendations by Black communities, to hold town halls start, to have Black community members at the board — and not just with one person because that would be tokenism.” 

Said Dryden: “There’s always an excuse for why something isn’t anti-Black racism as opposed to sitting with it for a moment (and thinking) ‘If this is racism what should I be doing differently?’ And nobody asks themselves that question. That’s the thing we want them to ask themselves.” 

This article is intended as a building block in that journey towards change, Nnorom said. 

“So that we can see a Black patient can come into a hospital and be treated with dignity, where their pain is recognized and they receive respect and empathy and not be treated worse because of the colour of their skin.”


Groundbreaking investigation shows ‘pervasive racism’ against Indigenous people in B.C. health-care system

Of note:

Racism against Indigenous people is pervasive in British Columbia’s health-care system, concludes an investigation that is being touted as the first complete review of racism in a Canadian medical system.

It’s racism that is hurting the health of Indigenous people and leaving them more harshly affected by health crises in the province, including the opioid crisis and the COVID-19 pandemic, finds the newly released report.

“What it looks like are abusive interactions at the point of care; verbal and physical abuse; denial of service,” Mary Ellen Turpel-Lafond, a well-known Indigenous lawyer and former B.C. advocate for children and youth, who led the investigation at the request of the provincial government, said Monday.

“We have a major problem with Indigenous-specific racism and prejudice in B.C. health care.”

Turpel-Lafond said her team’s recommendations could provide a blueprint for the rest of the country for rooting out racism and discrimination.

The B.C. probe was initiated in June, after B.C. Health Minister Adrian Dix said he found out about allegations that health-care workers in an emergency room had played a game in which they guessed the blood-alcohol level of largely Indigenous patients before they received treatment.

Métis Nation British Columbia told CBC that health-care staff called the game “The Price Is Right.”

Turpel-Lafond said the investigation did not find evidence of an organized “Price is Right” game, but that it unearthed an even more insidious picture of a system rife with racism and prejudice, that is making the B.C. health-care system an unsafe place for Indigenous people to seek care.

The report, called In Plain Sight, is based on input from 9,000 people, including Indigenous people and health-care workers.

Turpel-Lafond said a second report, a data-analysis of Indigenous-specific health outcomes, will be released in the next month.

The report’s 24 recommendations deal with implementing systems and cultural expectations to root our implicit and explicit racism in B.C.’s health-care system, including the creation of a B.C. Indigenous officer of health and an associate deputy minister of Indigenous health at the provincial government.

Dix on Monday offered an “unequivocal” apology for the findings of racism in the report, and vowed to implement recommendations immediately, including by introducing new Indigenous health liaisons in each of the province’s health authorities.

Indigenous leaders were quick to express their support for the recommendations, saying they were especially urgent in view of the ongoing pandemic.

“There is no time to wait; the current COVID-19 pandemic necessitates constant engagement by First Nations with the health care system, and we categorically demand a safe health care system for our people at this time and going forward,” reads a portion of a statement by the First Nations Leadership Council.

The treatment of a Quebec woman in hospital earlier this year also served to highlight the barriers Indigenous people face to getting care.

Joyce Echaquan, an Atikamekw mother of seven, died soon after she filmed herself from her hospital bed in late September while she was in clear distress and pleading for help. Toward the end of the video, which was streamed live, two female hospital staff enter her room and are heard making degrading comments, including calling her stupid and saying she’d be better off dead.

The video has created widespread indignation, several inquiries and a lawsuit from Echaquan’s family against the hospital where she died in Joliette, Que.

Source: Groundbreaking investigation shows ‘pervasive racism’ against Indigenous people in B.C. health-care system

Philpott: A call to end #racism in Canada’s health care systems

Of note the emphasis on practical initiatives:

I wish I could say with certainty that the death of 37-year-old Joyce Echaquan will be a wake-up call for health systems in Canada. It should be. But history gives us no confidence to make such a claim. Joyce Echaquan is not the first person to die as a direct or indirect result of racism in Canadian health care systems. Tragically she won’t be the last. But her death comes at a point in our history where Canadians may be more attuned to the dangers of systemic racism than we were, for example, when 45-year-old Brian Sinclair died in a Winnipeg hospital in 2008.

We must seize this moment in history and act to prevent more senseless deaths. There is no better place to start than with changing the way we train health professionals. A 2019 international consensus statement on Indigenous health equity notes that “Medical education institutions must acknowledge their historical and contemporary role in the colonial project and engage in an institutional decolonization process.”

Here at Queen’s University, our principal, Patrick Deane, has not shied away from declaring that racism and other forms of oppression, including colonialism, “deeply affect our institution, as they do the systems and formations of our society at large.” Such a categorical admission of institutional racism from the leader of a prominent post-secondary institution is not something we heard a decade ago. The open admission that an organization like ours is plagued with structural injustices, which permit some to be privileged and others to be harmed, is an essential step on our journey to changing those deep-rooted patterns of injustice. That kind of openness leads me to think that we are at a point in time when we can more effectively take on racism and colonialism in health care; in hopes that Joyce Echaquan’s death will not be in vain.

There is no single intervention that leads to the reduction or the elimination of racism and colonialism in health systems or in the training of health professionals. We need comprehensive and collaborative cultural transformation. We don’t need more studies; we need action on a suite of reforms. Steps have been laid out in multiple reports including the Calls to Action of the Truth and Reconciliation Commission and the Calls for Justice from the Inquiry on Missing and Murdered Indigenous Women and Girls. The Association of Medical Faculties of Canada tabled its own commitment last year entitled a Joint Commitment to Action on Indigenous Health.

As dean of the Faculty of Health Sciences at Queen’s, I’m determined to work with my colleagues to breathe life into those reports. We have hired new staff including an elder-in-residence to provide ceremonial and cultural supports. Last week we opened an Office of Equity, Diversity, and Inclusion and we now have over 150 volunteers from students, staff, and faculty participating in a Dean’s Action Table on Equity, Diversity, and Inclusion.

We have an obligation to expand the Indigenous health workforce by increasing the number of First Nations, Inuit and Métis students in medicine, nursing and rehabilitation therapy. Indigenous Peoples must see themselves reflected in the health professionals who treat them. We must continue to identify structural biases in our admissions processes and make amendments, accordingly, including diversifying the membership of admissions committees and introducing cultural safety training for their members.

We’ve already changed the focus of the Queen’s Accelerated Route to Medical School to enable 10 students who identify as Indigenous or Black to begin a pathway to medical education that addresses some of the well-known systemic barriers to access. We know this means we’ll need a broad community of support for growing numbers of Indigenous and Black students on campus and in our health professions programs, but we’ve already taken steps to enable that, by hiring mentors such as Wendy Phillips, elder-in-residence and former MP Celina Caesar-Chavannes, senior advisor on equity, diversity and inclusion.

Just as important as the diversity of our student body is what we teach our students. Our curricula must include Indigenous perspectives of history and culture. It should include concepts of power, privilege and conflict resolution. This work is underway. We have professional development courses in cultural safety, anti-racism and anti-oppression. We have started to diversify our workforce, recognizing the importance of having staff and faculty from under-represented groups in leadership positions and on decision-making bodies.

We also need tools to help us identify personal, institutional and systemic forms of racism. As we use these tools, there will be an obligation to act on what we learn, with cycles of self-reflection and informed action. Increasingly, we must learn safe and effective ways to speak up when we recognize bias, harassment, and micro-aggressions.

Speaking up is the minimum response. Our collective goal is to change the entrenched patterns of injustice in our health systems. In some cases, it’s a matter of life or death.

Source: A call to end racism in Canada’s health care systems