Mary Jane Logan McCallum
Winnipeg, 2023[1]
In January and February of 2023, the College of Physicians and Surgeons of Manitoba (CPSM) released its “Statement and Apology on Truth and Reconciliation and Indigenous-Specific Racism in Medical Practice.” The CPSM is the body that regulates the practice of medicine in Manitoba to promote safe, ethical, and high-quality care by physicians in Manitoba. The core functions of the CPSM are to ensure everyone registered to practice medicine in Manitoba is competent and meets established requirements; to monitor professional competency and promote safe care through education and other initiatives; and to handle complaints and investigations regarding care provided by, or the professional conduct of, registered physicians and surgeons in Manitoba.[1]
The CPSM undertook two in-person apology ceremonies to deliver its statement and apology – one before the Assembly of Manitoba Chiefs addressing “Anishinaabeg, Anishininewuk, Dakota Oyate, Denesuline, and Nehethowuk”[2] and a second apology to the Inuit[3] before the Manitoba Inuit Association. The crux of the apology was an acceptance of responsibility for failing to regulate medical professionals’ current and past racist treatment of Indigenous people in Manitoba. This formal and public acceptance of responsibility by a medical professional association could be historic: there have been no similar official apologies for failing to regulate racist treatment of Indigenous people from other medical professional bodies before or since, although it is possible that others may be in the works.
The apology events occurred about half way through my Winter-term Indigenous health history course at the University of Winnipeg. This course focuses on the twentieth century and the themes of Indian health policy, treaty, and colonial and Indigenous health science. Students had read Part One of Samir-Hussein’s Fighting for a Hand to Hold: Confronting Medical Colonialism against Indigenous Children in Canada about the “non-accompaniment rule” that prevents parents from accompanying children on emergency medivac flights, forcing children to travel alone. They also read “Quarantined Within the New World Order,” a chapter of Ryan Eyford’s book White Settler Reserve: New Iceland and the Colonization of the Canadian West which describes how the temporary public health response to the 1876-77 smallpox epidemic hardened spatial boundaries between Indigenous and settler people, and initiated what became permanent removals and land dispossession that have never been compensated. The class had read Sara Komarniski’s “From the Sanatorium to the Museum and Beyond,” which places production and sale of Inuit carvings in the context of racially segregated health care in Canada and later global Inuit art circuits, as well as Brenda Child’s chapter “Jingle Dress Dancers in the Modern World” which argues that the Jingle Dress Dance was a “radical tradition” that applied Indigenous medical thinking to address the global influenza epidemic in a context where by Indigenous dancing was criminalized. Students had begun to read Maureen Lux’s Separate Beds: A history of Indian Hospitals in Canada, 1920s-1980s, which explores Indian Hospitals and federal government’s mismanagement of its treaty responsibilities. The class had also hosted two open access lectures, one by Senator Yvonne Boyer about her efforts to legislate consequences for medical professionals who sterilize patients without their informed consent; and another by Miranda Jimmy, a historian and expert on the history Charles Camsell Indian hospital entitled “Three Sides to Every Story: Official Records, Community Knowledge, and Living Memory Tell the Truths of the Indigenous Hospital Experience.[4] In addition, together we as a class had worked through the Canadian federal government’s 1947 advice manual Book of Wisdom for Eskimo which told us a lot about the nature of racist attitudes within public health and northern administration at the time .
A senior post-secondary Indigenous history class in Winnipeg is a specific kind of political and intellectual context, and one which in this case was invested and engaged with the apology in ways that are unique. The experience of the pandemic, and students’ everyday experiences of an under-funded and structurally racist provincial health care system added important dimension to the class response to the apology. The CPSM apology too has its own specific context, being rooted in a response to the Truth and Reconciliation Commission’s Final Report. Apologizing was one of seven[5] recommendations of the CPSM’s Truth and Reconciliation Advisory Circle, which meets regularly and is guided by Indigenous physicians, scholars, Elders, and Knowledge Keepers. The Circle itself was established in June 2021 when the CPSM made addressing Indigenous-specific racism in medical practice a Strategic Organizational Priority. Importantly, days following the CPSM’s public apology to First Nations, the province announced that it will begin a system-wide program to collect race-based patient data in Manitoba hospitals to track disparities treatment and health outcomes and ultimately “disrupt and dismantle racism in healthcare.”[6]
One student compared the CPSM apology favourably to statements like then Prime Minister Stephen Harper’s at a 2009 G20 meeting in which he bragged that Canada had “no history of colonialism.” Indeed, in contrast, the CPSM apology identifies and acknowledges historic and ongoing anti-Indigenous racism in the profession in part as rooted in the history of settler colonialism. However, many students in addition found the CPSM’s apology still appeared to them as in some way trying to “score points” while doing little justice to the past.
In addition to the CPSM’s intentions, students also expressed misgivings about what the apology offered, including its commitment to create a land acknowledgement for the CPSM and its vague language around building the prevention of racism into the Standard of Practice. The promise of professional training sparked significant discussion. One student explained that the revised procedures for students entering the University of Manitoba Faculty of Medicine now include an understanding of racism and that preparation for this was a generally positive experience. However other students felt that having to wait ten to fifteen years for a new generation of well-trained doctors to replace the old one was “messed up.” Another student discussed their experiences of professional training about Indigenous people, arguing that it was not offered to, or understood by, students as a basic component to professional practice.
Students in my Indigenous Health History course were interested in how the CPSM would ‘develop ways for Indigenous patients to better access and participate in the complaints and investigation process” and described their experiences of the complaints and investigations process itself as demeaning, distressing, and obstructive. Armed with an understanding Indigenous history of health care in Canada, one can see how this evaluation of the current process is troublesome. Students also wanted to know what consequences there would be for those “unconvinced racists” within the profession who refuse to be educated or accept newly developed Standard of Practice trained; in short, what could a College of Physicians and Surgeons born and matured in a context of settler colonialism offer in the way of regulation and how would it measure efficacy?
Admittedly, a public statement and apology is not a place for such detailed specifics however for history students grappling with the Indigenous experience of healthcare in Canada, the CPSM’s acknowledgment of its racist past and “pledge” to “start now” on a “journey” to “take action” raised highly relevant and engaging questions.
[1] See the Webpage of the College of Physicians and Surgeons of Manitoba: http://www.cpsm.mb.ca/protectingthepublic
[2] The full apology can be found at the website of the College of Physicians and Surgeons of Manitoba: https://cpsm.mb.ca/assets/TRC/Statement%20and%20Apology%20on%20Indigenous-Specific%20Racism.pdf
[3] The full apology can be found at the website of the College of Physicians and Surgeons of Manitoba: https://cpsm.mb.ca/assets/TRC/Statement%20and%20Apology%20to%20the%20Inuit.pdf
[4] Recordings of these lectures as well as two others can be found under “HIST 3590 Open Classroom Series” at the Manitoba Indigenous Tuberculosis History Project website under “Resources” (scroll down to the bottom): https://indigenoustbhistory.ca/resources.
[5] For all seven recommendations of the Truth and Reconciliation Advisory Circle endorsed by the to the CPSM see: http://www.cpsm.mb.ca/news/honouring-national-day-for-truth-and-reconciliation
[6] https://www.cbc.ca/news/canada/manitoba/university-manitoba-shared-health-race-based-data-hospital-patients-1.6734641
[1] As always thanks to Jill McConkey for ripping up my drafts. You’re the best.