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The death of an Atikamekw woman in a Joliette hospital September 28 has led to renewed discussions about systemic racism that Indigenous patients face in the healthcare system.

Joyce Echaquan was a 37-year-old mother of seven from the community of Manawan, 250 km north of Montreal, who had travelled to Joliette to seek medical treatment for stomach pain. However, during her stay she became concerned about her treatment and began filming her interactions with hospital staff.

Broadcast on Facebook Live, her videos captured her distress and pleas for help while hospital staff in her room made insulting and derogatory comments – calling her “stupid’, saying she was “only good for sex” and would be “better off dead.”

Echaquan died hours later as her videos rapidly spread online, leading to widespread condemnation.

Two healthcare workers involved in her care have since been fired. The local health authority promised to implement measures that would prevent similar events.

During a press conference at the Lanaudière Native Friendship Centre October 2, Echaquan’s spouse, Carol Dubé, announced that the family is pursuing a series of complaints – with the Quebec government, the Quebec Order of Nurses, other hospital staff, and is demanding a police investigation.

“I’m here today to reclaim justice,” Dubé said. “I am here for my wife Joyce Echaquan and her seven children. I don’t want her death to be for nothing.

“How many other similar situations are not denounced because we don’t know they’re happening? She heard the most degrading comments, and this shows just once again just how differently we are treated as Indigenous people.”

Dubé said his wife was the victim of systemic racism and called on Quebec Premier François Legault to ensure everyone in the province has the same rights.

In response, the Quebec government announced the provincial coroner’s office would launch an inquiry. However, Legault has steadfastly denied that Quebec institutions have a problem with systemic racism.

Assembly of First Nations of Quebec and Labrador (AFNQL) Chief Ghislain Picard wants the province to broaden its scope. “A coroner’s report will not change anything about the racism displayed by nurses,” Picard pointed out. “It is a question of attitude and a question of culture.”

The Council of the Atikamekw Nation noted that the Viens Commission report last year appears to already be forgotten by the Quebec government.

“It is unfortunate that in 2020 such behaviours can still occur,” said Atikamekw Nation Grand Chief Constant Awashish. “It is everyone’s responsibility to denounce them, especially in the context of health services.”

The Viens Commission looked at how Indigenous peoples are treated by public services in Quebec, finding widespread – “systemic” – discrimination. The commission issued several recommendations which then-Quebec Indigenous Affairs minister Sylvie D’Amours said the government was working on, though the government has come under criticism for not taking them seriously.

Premier Legault later made a public apology to Echaquan’s family from the National Assembly. “We must not be afraid to say it; the Quebec public service has failed in its duty to Madame Echaquan,” he said. Legault also met with Atikamekw leaders, who said they were cautiously optimistic the government would work to address their concerns.

However, the Atikamekw Council of Manawan stated that Legault would not be welcomed to Echaquan’s funeral service because of his refusal to acknowledge systemic racism in Quebec.

Manawan Chief Paul-Émile Ottawa pointed out that the problems with racism were discussed extensively during the Viens Commission, with a whole week devoted to people who had faced discrimination at the same hospital in Joliette. Chief Ottawa said he’s advised community members to seek services elsewhere.

Dr. Nel Wieman, the president of the Indigenous Physicians Association of Canada, said she was extremely sad to learn about the circumstances of Echaquan’s death. As an Indigenous physician, however, she wants to respond systematically in a search for solutions. The first step is for leaders to acknowledge the existence of systemic racism.

“If we have leaders who won’t acknowledge it exists, they’ll have a hard time being part of the solution,” Wieman observed.

She points to a current British Columbia inquiry into discrimination against Indigenous people in healthcare. It is expected to identify solutions at every level – including the province, regional health authorities, hospitals, licensing bodies, service agencies, all the way down to individual healthcare professionals.

“There can’t be any denying that it’s widespread, it’s an enormous issue,” Wieman said, noting that racism has a big impact on health, alongside economic and education factors. She says that Indigenous people may often become fearful and anxious about seeking out medical care until it’s too late.

“We have people who come forward to seek treatment and are misdiagnosed or dismissed as being under the influence, when they may have a stroke or heart attack,” she noted.

Another challenge is that in remote settings access to health care is limited, and people may not want to complain out of fear that it could affect them negatively in the future.

However, she is optimistic to see that healthcare professionals are receiving more training than ever before.

The Cree Health Board also issued a statement noting that no health organization is immune from systemic racism. The CHB called on the Quebec government to implement the Viens Commission’s recommendations.

The CHB also stated it had several strategies to ensure clients receive culturally safe care, including training staff in cultural safety and strengthening services in Eeyou Istchee so that community members could limit travel outside of the region.

Legault appointed former Montreal police spokesperson Ian Lafrenière as Indigenous Affairs Minister October 9. Lafrenière had been previously criticized for denying racial profiling by Montreal police.

Following his appointment, Lafrenière was quick to deny the existence of systemic racism. “I recognize that there is racism and profiling and discrimination,” he said. “I also recognize that currently the term of systemic racism is not accepted unanimously and instead of fighting over this, I think that what people want is action, concrete action.”

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