One-size-fits-all care not an Indigenous solution
Biennial health meeting examines community-led ways to address failings
As a pediatrician with extensive experience working with marginalized groups, Anna Banerji believed herself more than equipped to advocate for her Inuk son when he began to display signs of deep depression.
She recalls taking him to hospital and pleading with mental health experts for help, but says her concerns were dismissed. Less than two weeks later, in September 2018, Nathan killed himself.
Banerji acknowledges many factors led to her son’s death, but believes the health-care system failed to recognize specific racial, social and cultural aspects that contributed to his suicide.
It’s a blind spot she ascribes broadly to mainstream health care, and had been one of the reasons she founded the biennial Indigenous Health Conference in 2014.
The fourth edition launches Thursday as a three-day digital gathering focused on youth mental health and will be dedicated to Nathan.
Banerji says Indigenous-led solutions are key as the pandemic exacerbates mental health struggles, and especially as fresh accounts of racism in health care this year bring repeated calls for change.
“We see this all across Canada — Joyce Echaquan recorded it so we have documentation of her dying while they’re calling her names,” said Banerji, referencing the hospital death in September of an Atikamekw woman from Manawan in central Quebec.
“Joyce is one example, but there are so many examples that don’t get documented and that’s why it’s really important that we document that because Joyce’s story or my son’s story are not unique.”
Speakers include Nunavut singer Susan Aglukark, who will discuss child sexual abuse and its links to colonization, and Michèle Audette, commissioner of the National Inquiry into Missing and Murdered Indigenous Women and Girls, who will talk about systemic discrimination.
Of course, youth will take centre stage.
Youth panel moderator Joshua Stribbell, program co-ordinator of the Ottawa-based service provider Tungasuvvingat Inuit, says he’s impressed with the topics younger participants plan to raise: a comparison of Indigenous and colonial approaches to mental health and a look at intergenerational determinants of health and resilience.
“What I love about them coming up with those two learning objectives is it’s youth refusing … to just talk about (being) youth,” says the 30-year-old Stribbell, based in Toronto and a friend of Nathan’s.
“Because no Indigenous youth is just Indigenous youth; they’re part of a community and that community has intergenerational things that are continuing to happen and are always happening (and) they understand that they (are not) alone, that they heal together as a community.”
There is no shortage of troubling incidents to fuel discussion.
While the spread of COVID-19 has highlighted and deepened racial disparities in health care and social supports, it’s also revealed the benefits of Indigenous-led public health measures that resulted in far fewer infections in many communities, Toronto doctors Allison Crawford and Lisa Richardson argued in an article for the CMAJ in September.
“At its foundation, Indigenous public health must be self-determined: adapted for the needs of specific nations and grounded in local Indigenous language, culture and ways of knowing; developed, implemented and led by Indigenous Peoples,” they write.
Such instances are rare. Earlier this week, former Saskatchewan judge Mary Ellen TurpelLafond released a damning report detailing widespread systemic racism in British Columbia’s health-care system, including extensive profiling of patients based on stereotypes about addictions.
Banerji believes much the same can be said of health-care systems across the country and “that’s exactly why we do this conference.”
“We need to address some of those issues and try to educate people on the fact that this is real and it impacts people’s lives, and can result in high rates of morbidity and mortality,” says Banerji, an associate professor at the University of Toronto’s Temerty Faculty of Medicine.
In the case of her son, Banerji laments that experts appeared to discount the possible impact of tumultuous events in his young life.
Nathan left Baffin Island as a baby when Banerji was asked by an adoptions official she knew through her work in the Arctic to adopt him and raise him in Toronto.
Keen to keep Nathan connected to his culture and relatives in Clyde River, Banerji (who is of South Asian descent) brought him back several times to visit his parents, siblings and grandparents. He was very proud of his culture, but Banerji says he grew disillusioned as he became aware of fractures in his birth family, and social and economic problems in the community.
As he approached his teen years, she says Nathan was shattered by news of his 14year-old brother’s death by suicide.
She says these experiences all likely played a role in Nathan’s mental health and should have been given more weight. “It’s not overt discrimination, it’s a lack of information. It’s the omission where they just didn’t understand intergenerational trauma that contributed to his death,” says Banerji.
Malcolm Ranta, executive director of the Ilisaqsivik Society, says an Inuit-focused approach makes an incredible difference in the health outcomes of the Baffin communities he serves.
The Clyde River non-profit created a counsellor training program about 13 years ago to offer support in Inuktitut from locals who could better understand local issues. He says the program was accredited three years ago and he now hears regularly from residents thankful they can get help in Inuktitut from someone who better understands their pain.
“We want Inuit to be part of the systems that impact their lives. Because we know there’s going to be better health outcomes.”
Demand is “huge” he says, pointing to 26 crisis response calls in 2019. In February, he says Ilisaqsivik is launching a 28-day addiction treatment camp that will allow residents to avoid having to go south, such as to Toronto or Calgary, for care.
Banerji says these are the solutions that can help address gaps in care across the country. Even as a physician and university professor, she says she still could not find adequate help for her son.
“The system failed even me with an Indigenous child,” says Banerji.
“I can imagine how the system continues to fail Indigenous people that may not be in that position, or may not be as wellresourced or may not be in a position of power as someone like me.”