Quebec’s Indigenous sensitivity training falls short, say health care workers

As the second anniversary of Joyce Echaquan’s death approaches this week, Indigenous health professionals say the measures taken by the Quebec government to combat racism and discrimination in medical facilities have been inadequate.

Echaquan, a 37-year-old Atikamekw mother of seven, died at a hospital in Joliette, Que., in 2020 after filming herself being subjected to offensive comments from staff.

The Quebec Ministry of Health and Human Services (MSSS) developed mandatory training for all of its healthcare workers after a coroner’s report found racism and discrimination had contributed to her death.

However, Glenda Sandy, a Naskapi Cree nurse from Kawawachikamach, Que., says the training does little to combat racism, prejudice, or harmful misconceptions in the province’s health care system.

“It does more harm than good,” Sandy said of the workout.

Originally designed for public officials, the 90-minute online Aboriginal Realities Awareness training course was made available by the MSSS in June 2021 with the aim of “improving access and continuity to culturally safe and relevant services for First Nations and Inuit.”

CBC News received access to the training from the MSSS. The first module, History and Settlement, focuses on creation stories, the fur trade, treaties, assimilation policies, Indian law, and boarding schools.

It also addresses the Bering Strait theory — which recent studies have cast into doubt — that migration to North America occurred when humans crossed a land bridge from Asia thousands of years ago.

“It honestly felt like a high school history class,” said Sandy, who works as a nurse counselor in the Public Health Division of the Nunavik Regional Board of Health and Social Services.

She described the content as chilling and superficial, noting how few indigenous perspectives and voices were included compared to Québécois professors.

“I timed it and it was less than two minutes for the creation story and more than five for a non-Indigenous archaeologist talking about the migration of humans thousands and thousands of years ago,” Sandy said.

“Having non-Indigenous experts tell our story undermines Indigenous people and continues to put them on an inferior level.”

The second module focuses on vocabulary and toponymy best practices and includes a video montage of testimonies on how to improve relationships with indigenous peoples.

It also contains factual errors in a section on how to say hello and thank you in Quebec’s 11 indigenous languages. The training incorrectly states that “migwech” means “thank you” in Inuktitut. It also uses outdated terminology like “Malecite” and “Micmac”.

lack of cultural security

dr Darlene Kitty, a Cree family doctor from Chisasibi, Que., said she was disappointed with the way the training was being conducted.

She wrote a letter to the board of directors of McGill University Health Center expressing concern at the lack of reference to calls to action by the Truth and Reconciliation Commission, the Viens Commission and the national inquiry into missing and murdered Indigenous women brought girls.

“I think they have good intentions, but you can’t learn everything about tribal peoples in one module,” Kitty said.

“It needs to be an ongoing journey and more interactive. It’s not just about listening to videos and seeing a few slides.”

She said two major aspects are missing from the training: cultural safety and cultural humility – principles that go beyond awareness, sensitivity and competence by incorporating a culture’s political, social and historical contexts.

Cultural humility is a self-reflective process in a relationship between an indigenous patient and a professional, she said.

The Viens Commission, which looked at public service treatment of First Nations and Inuit people in Quebec, called on health and social service network organizations to work with Indigenous Peoples to develop services and programs based on cultural protection principles.

It is also enshrined in Joyce’s Principle, a document prepared by the Council of the Atikamekw Nation and the Atikamekw Council of Manawan, which aims to ensure indigenous peoples’ equal access to health and social services without discrimination.

The training doesn’t mention Echaquan at all.

58 percent of employees have completed training

As of September 21, 183,844 healthcare workers have completed the training, representing approximately 58 percent of the network.

During a provincial election debate organized by the Assembly of First Nations Quebec Labrador (AFNQL) last week, outgoing CAQ Minister for Indigenous Affairs Ian Lafrenière expressed pride in the “good progress” his party has made on education.

“We didn’t wait, we didn’t sit on our hands. We made several changes on the ground to the cultural safety guide that was written with First Nations,” he said.

The MSSS, in an emailed statement sent to CBC News and Radio-Canada, said the training was the result of more than two years of work and was developed with the participation of “several prominent members of Indigenous communities, university researchers and certain officials.”

“Their work was submitted to an interdepartmental working committee responsible for verifying the accuracy and completeness of the information, and then to an Indigenous Advisory Committee,” said Marie-Hélène Émond of MSSS Media Relations.

‘Check a box’

dr Samir Shaheen-Hussain, a doctor from Montreal, wrote the book Struggle for a Hand to Hold: Confronting Medical Colonialism Against Indigenous Children in Canada.

He questions the relevance and effectiveness of training without acknowledging the history of colonialism that produced the inequalities and injustices in healthcare.

“There’s huge, long-standing generations of historical baggage, medical colonialism, that we bring with us as people who work in healthcare that needs to be undone,” Shaheen-Hussain said.

Internal schools, for example, he said, are discussed in the training, but it omits how medical institutions, scientists and healthcare providers played a role in the system.

Education needs to address that history, he said, and be specific to the healthcare context.

“The danger is basically ticking a box,” Shaheen-Hussain said.

“It’s actually going to be detrimental because people are going to come out of this training, which is government sponsored, thinking that the knowledge that’s being imparted is the truth with a capital ‘T’.”

As for Sandy, she hopes the training will be revised to include indigenous peoples who will share their perspectives and experiences in the healthcare system.

“I am a nurse. I know how to navigate this system and that doesn’t relieve me of being afraid,” she said.

“When I enter a hospital, I am afraid. You’re not sure if you’re being heard or being listened to.”