Campbell Drohan – FNIS 100

The Hidden History of ’s Indian

Over the past decade, the Canadian state has begun to publicly address its troubled history of colonialism and marginalization of Indigenous peoples, as Indigenous issues have begun to permeate the national consciousness. The movement, the work of the Truth and Reconciliation Commission (TRC), and the activism surrounding missing and murdered Indigenous women are just a few examples of how the voices, concerns, and histories of Indigenous peoples in Canada have begun to be heard. However, one aspect of Indigenous history in Canada that is not frequently discussed is the Indian system. Although the Indian Hospitals are no longer in operation, it is only through understanding the history of Indigenous that the healthcare disparities that currently exist between Indigenous and non-Indigenous can be addressed. Despite having some of the best health outcomes in the world, Canada’s Aboriginal population experiences poorer health status compared to the population at large1. These disparities are rooted in the colonial past (and present) of Canada, and through examining the tumultuous history of healthcare delivery for Indigenous peoples, we can begin the process of reconciliation.

History of the Institutions The system was a network of racially segregated federal healthcare institutions for Indigenous peoples that existed from the 1930s to the 1970s2. Beginning in the late 19th century, the Department of Indian Affairs oversaw all health and healthcare initiatives aimed at Indigenous peoples. Beginning in 1936, the DIA began to offer healthcare services to , and occasionally Metis and , peoples through a system of federally operated Indian hospitals that were mainly located in the south. The hospitals were initially quite selective in the patients they admitted. Preference was given to patients who were most likely to be “cured”, which often meant that the most seriously ill remained in their home communities to spread and other diseases3. Following the Second World War, there was an increase in public pressure for Indigenous peoples to receive better social services in the aftermath of Germany’s human rights atrocities. There was also a large level of concern about “Indian diseases” spreading to the non- Indigenous population4. Because of this mounting public concern, and because of the prevalence of tuberculosis in Indigenous communities, the Indian Health Service (IHS) was developed under the Department of Health and Welfare, and all healthcare services for Indigenous peoples was transferred from the DIA to the IHS2. Although the government

1 Campbell Drohan – FNIS 100 recognized the federal responsibility to provide healthcare to Indigenous peoples, the obligation was perceived as humanitarian in nature rather than imposed by treaty or law. An explicit goal of the IHS was to “improve assimilation” of Indigenous peoples, as the government believed that healthy individuals were more likely to join the nation’s workforce and become economically independent2. The hospitals varied in size from four to over three hundred beds. Some were old federal facilities such as closed residential schools or military barracks, while others were specifically built by the Indian Health Services3. The hospitals ultimately closed in part due to declining tuberculosis rates among Indigenous peoples, and due to the dismantling of the “welfare state” that began in the late 1960s. The federal government began to shift healthcare services for Indigenous peoples to the provincial level following the implementation of , seeing this as a move towards “equality” and integration of Indigenous peoples into the general population. Unfortunately, this shift has led to many administrative and economic challenges for Indigenous communities, and has fuelled a conflict over the treaty right to healthcare that continues to this day3.

Immediate & Lasting Impacts of the Indian Hospitals Immediate Impacts Admission to the hospitals frequently happened through coercive means. Patients were not told where they would be going, and did not have a choice of staying home. “We certainly do not feel that our program should be left to the whims of an Indian,” one IHS beaureaucrat stated3. Virtually no long-term treatment for tuberculosis was available in the Indigenous peoples’ home territories, forcing patients to travel far from their communities to receive medical care. This led to widespread feelings of and loneliness for those who were taken far from their families. Although families were permitted to visit, several days’ notice were typically required. Even then, as a former patient stated, “some days the hospital would let our family visit and some days not”2. Since most facilities were in the south of the country, the sense of isolation and loneliness was even more potent for patients from northern communities. In the 1950s, the IHS began promoting a policy to force northern tuberculosis patients to receive care in the south, and to forbid the establishment of sanatoria in the north2. This was a cost-cutting mechanism, as northern hospitals were frequently running far below their maximum capacity. Patients at the hospitals could also leave with worse ailments than the ones with which they were admitted. Although many of the IHS hospitals were developed in response to the tuberculosis epidemic, they also served as general hospitals for Indigenous patients as the

2 Campbell Drohan – FNIS 100 government wished to segregate them from non-Indigenous peoples. Tuberculosis patients were frequently placed in the same ward as general hospital patients, which increased the risk of tuberculosis transmission. As the Indian Association of stated in 1949, “We see old people in the same wards as TB patients and children playing in the same rooms where old people are lying sick. We fear there is great danger of infection spreading under such conditions”3. An Inuit woman developed measles and pneumonia after being treated at an Indian hospital, and upon her return she spread measles in her home community, resulting in at least three deaths3. Overcrowding and poor sanitation was also a frequent issue. Many of the hospitals regularly operated above their maximum capacity to increase “efficiency”, which was measured as the per-diem spending per patient. This measurement depended on the operating costs and the number of patients in the hospital at any given time, and since operating costs were constant, bringing more bodies into the hospital was the main cost-cutting measure undertaken by the hospitals. In the 1950s, the Charles Camsell Hospital held 560 patients, almost 100 patients over its maximum capacity3. Conditions were also often unsanitary. Kathleen Steinhauer, a First Nations nurse who worked at the Camsell Hospital, states that, “the conditions there were pretty bad. The babies were all dried with the same towel. I had to petition hard to get separate towerls and towel racks for each patient”3. It should be noted that this was at the Camsell, the “crown jewel” of the Indian Hospital system5, so it is likely that conditions at smaller facilities were much worse. The hospitals were also frequently a site of medical experimentation. In 1933 at ’s Fort Qu’Appelle Sanatorium, the infants born within the Indian Health Unit were the subjects of a tuberculosis vaccination trial (Drees, 2013). Furthermore, legislation enabling sexual sterilization was enacted in from 1933 to 1973, and Alberta from 1928 to 19726. These provinces’ sterilization of Indigenous peoples occurred with the knowledge of the federal government. In 1937, the Department of Indian Affairs stated that consent should be obtained prior to sterilization “if at all possible”6. In practice, consent was only sought in 17 percent of Indigenous sterilization cases. The remainder were frequently deemed “mentally incompetent, which circumvented the need for permission. The proportion of Indigenous peoples who were sterilized in British Columbia tripled from 1949 to 1959, which can be attributed in part to the growth of the Indian hospital system. Increased governmental control over the bodies of Indigenous peoples rendered mass sterilization more feasible. The rampant experimentation was justified by many members of the healthcare system who did not believe they were under an obligation to provide the same standard of care to

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Indigenous peoples. This was frequently rationalized by stating that, despite the decrepit hospital conditions, “patients themselves were better off than in their primitive conditions at home,” as one IHS superintendent stated3. Due to this lack of scrutiny from the general medical community many hospitals, and the Camsell Hospital in particular, became sites for experimentation on what the hospital staff called “interesting material”3. In the late 50s, while the general Canadian population began to shift towards chemotherapy rather than invasive thoracic surgery as a tuberculosis treatment, Indigenous patients continued to receive surgical interventions. The more aggressive treatment was rationalized by assuming Indigenous patients were careless in their own health and needed to be prevented from endangering the national health3. Lasting Impacts The hospital system had many parallels to the residential school system, and as a result it shares many of the lasting impacts on survivors. An Aboriginal nurse observing patients at the Camsell hospital stated that “Most of the patients demonstrated that sense of despairing resignation so evident at a residential school”2. Marie George, another former patient, stated that “the hospitals were just as bad as the residential schools”2. She was a patient for years at the Coqualeetza Indian Hospital, where she and other patients were beaten for complaining or disobeying the nurses’ strict rules. Furthermore, for children and teenagers the Indian hospital system often acted as a pipeline to and from the residential schools. Upon discharge from the Nanaimo Indian Hospital, for example, Sainty was told he was returning to his family in Saanich, but was instead taken to the Kuper Island residential school without his family’s knowledge2. The residential school system also acted a breeding ground for disease, spreading tuberculosis and filling even more beds in the Indian hospitals. However, there were some stories of hope. At a local level, many nurses were willing to circumvent the colonial and assimilative forces of the IHS to accommodate Indigenous patients’ traditional healing practices. “Aboriginal people did not give up their belief in their own medicine and its role in preserving their health,” as one researcher states7. There was also an increase in Indigenous participation in health professions that was brought about through the Indian hospitals. Aboriginal people were trained in health and sanitation beginning in the 1960s as health aides and sanitation aides, stemming from the IHS’ realization that involvement at a local community level was required for healthcare to be effective8. Ex-patients would also sometimes choose to work in the hospital following their treatment. The Indian hospital system was dismantled in the 1970s, which caused many issues with healthcare delivery to emerge as health services were shifted away from the federal

4 Campbell Drohan – FNIS 100 government to the provinces. The IHS unveiled the Health Plan for Indians in 1968, which used the language of “equality” to justify giving up the responsibility for health services to Indigenous peoples2. Letters were sent to individual bands informing them that their healthcare would no longer be subsidized, and no consultation with Indigenous groups occurred prior to the announcement. If the province was incapable of meeting the needs of the Indigenous communities, they needed to provide extensive evidence to the government and individual doctors, and only then would the HIS help cover some of the costs. The healthcare under the new Health Plan was also very limited, with the and practitioners operating under the HIS told to prioritize diagnostic and preventive care rather than curative treatment. In 1974, the DIA reiterated their belief that the responsibility to provide healthcare to Indigenous peoples was not imposed by treaty on the federal government9, and the treaty right to healthcare remains contested to this day. The argument for healthcare being provided by the federal government rests on the “medicine chest” clause that is a part of Treaty Six. In this treaty, which encompasses the Cree, Saulteaux, Nakota, and of the Plains, it was stated that the Nations would have access to a medicine chest would be kept at the house of the on each reserve10. In modern times, this has been interpreted by many as a federal promise to provide healthcare to these Nations, but a Saskatchewan Court of Appeal in 1966 stated that this clause only promised a “first aid kit” would be provided by the Crown10. A case examining the medicine chest clause has never been brought before the .

A Culture of Silence I first became aware of the Indian Hospital system through discussion with a Sto:lo Elder in Mount Currie, BC. She was sharing her story of life in a residential school, but also note that prior to her entry into school, she was already institutionalized, living at the Coqualeetza Indian Hospital with tuberculosis from birth until she was seven years old. As someone who is passionate about Indigenous issues and healthcare, I could not believe that this system of institutionalization and healthcare segregation had gone by unnoticed. The Indian Hospital system was in operation for decades, in many cases in major Canadian cities like . Why, then, is there such a lack of awareness surrounding the hospitals in modern Canadian discourse? In recent years, Indigenous issues have been gaining attention in mainstream Canadian society. The Truth and Reconciliation Commission (TRC) that collected the testimony of survivors of the residential school system has been instrumental in this growing awareness. However, despite most Canadians now being aware of the existence of the residential school

5 Campbell Drohan – FNIS 100 system, few non-Indigenous Canadians would cite the same awareness of the Indian Hospital system. Even among those who are interested in the histories of Indigenous peoples in our country, this awareness is lacking. The government has played an active role in covering up the history of Indian hospitals. has a page entitled “History of Providing Health Services to First Nations people and Inuit”9. There is no mention of the Indian hospital system. The only mention of the services offered between 1945 and 1974 is the creation of the Department of National Health and Welfare, and the merging of IHS and Northern Health Services in 1962. This clearly indicates the reluctance on the part of the government to address the racial segregation of healthcare that took place under the IHS. The page also does not acknowledge a treaty right to healthcare, instead mentioning that the 1974 “reiterated that no treaty obligations exist to provide health services to Indians”. Furthermore, much of the documentation from Indian hospitals has been destroyed6. This emphasizes that the federal government is attempting to erase the memory of Indian hospitals from Canada, and unfortunately it seems like to date that has been largely effective. Another reason that there is less awareness could be that the trauma is less fresh than that of many residential school survivors. The last residential school closed in 1996, while the government began shifting responsibility over healthcare to the provinces and individual Indigenous communities in the 1970s. The survivors of the residential schools were also all children during their time in the institutions, while survivors of the hospitals were of all ages, with the elderly more vulnerable to tuberculosis. Furthermore, there are mixed emotions towards the hospitals from former patients. Although life in the hospitals was challenging, many former patients are grateful to these institutions for allowing them to recover from tuberculosis. Many patients made strong friendships in the hospitals, and they were able to engage in Many patients made friends with one another, and had trouble leaving one another upon discharge2. Music was described as a key feature of hospital life, with musical entertainers sometimes coming to visit and perform. There were also opportunities to participate in arts and crafts run by the hospital, such as knitting, crochet, and some traditional crafts such as carving and beading. As mentioned above, the hospitals also provided opportunities for training and employment, with many former patients continuing to work in the hospitals after their recovery8. These mixed experiences in the institutions, as well as the length of time that has passed since their closure, have made the stories fade into obscurity over time, despite the pain still haunting many former patients.

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Towards Reconciliation The Canadian government has acknowledged its role in the residential school system, and has provided compensation for survivors. While the acts of reconciliation on behalf of the government are incomplete and still leave much to be desired, there is mounting public pressure on the government to adopt the recommendations of the TRC final report. The adoption of these recommendations is seen as key to healing Indigenous communities. Acts of reconciliation on behalf of the Canadian state and healthcare system could also provide opportunities for healing, and may help to improve health outcomes for Indigenous peoples. However, while there is at least an active national conversation surrounding reconciliation for residential school survivors, there is largely silence surrounding the Indian hospital survivors. There is no official policy or court case that requires the federal government to compensate those who suffered in the hospitals. This has led some survivors to pursue legal action by seeking inclusion in the residential school compensation programs. Survivors from the Fort William Indian Hospital in Thunder Bay filed a motion to the government asking that they be recognized as a residential school and receive compensation under the settlement agreement11. This request was denied. The government ultimately denied compensation for all ten sanatoria that applied to receive compensation, keeping sanatoria survivors excluded from the reconciliation process12. Still, survivors of governmental hospitals and sanatoria continue to be encouraged by some advocates to pursue compensation from the Canadian government for the atrocities they ensured.

Reflections and Conclusions Learning about the history of the Indian hospital system has provided me with some much-needed context to the current state of healthcare for Indigenous peoples in Canada. The government’s continued denial of its responsibility to provide health services to Indigenous communities colours many of the health issues that are present today. The reluctance of the government to acknowledge this chapter of Canada’s history is perhaps unsurprising, but disappointing nonetheless, particularly as the Trudeau government pays lip service towards reconciliation with residential school survivors. Reconciliation cannot be achieved if this component of Canada’s history continues to be obfuscated, particularly when our country presents itself as having superior healthcare to much of the world. The Indian hospital system has had a lasting impact on many Indigenous communities across Canada, and the healthcare delivered to Indigenous peoples continues to be subpar, particularly in rural and northern communities. There is a need to confront the past of our healthcare system to move forward.

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Until this happens, there can be no true justice for those who spent much of their lives institutionalized by the Canadian government.

References 1. Adelson, M. (2005). The embodiment of inequity: health disparites in Aboriginal Canada. Canadian Journal of Public Health. 96(S2): S45-61. 2. Drees, L.M. (2013). Healing Histories: Stories from Canada’s Indian Hospitals. Edmonton, AB: University of Alberta Press. 3. Lux, M. (2014). Separate Beds: A History of Indian Hospitals in Canada, 1920s-1980s. Toronto, ON: University of Toronto Press. 4. Lux, M. (2010). Care for the “Racially Careless”: Indian Hospitals in the Canadian West, 1920-1950s. The Canadian Historical Review. 91(2): 407-34. 5. Metcalfe-Chenail, D. (2016). Ghosts of Camsell: Unearthing stories from the Charles Camsell Hospital. Retrieved from https://ghostsofcamsell.ca/ 6. Stote, Karen. (2012). Coercive sterilization of Aboriginal Women in Canada. American Indian Culture and Research Journal. 36(3): 117-50. 7. Kelm, M. (2011). Colonizing Bodies: Aboriginal Health and Healing in British Columbia, 1900-1950. : University of British Columbia Press. 8. Drees, L.M. (2010). Indian hospitals and Aboriginal nurses: Canada and Alaska. Canadian Bulletin of Medical History. 27(1):139-61. 9. (2007). History of Providing Health Services to First Nations people and Inuit. Health Canada. Retrieved 16 Feb 2017 from http://www.hc- sc.gc.ca/ahc-asc/branch-dirgen/fnihb-dgspni/services-eng.php 10. Boyer, Yvonne. (2003). Discussion paper series in Aboriginal health: legal issues. National Aboriginal Health Organization. Retrieved 20 Mar 2017 from http://www.naho.ca/documents/naho/english/publications/DP_rights.pdf 11. Porter, J. (2014 Dec 29). “’Indian hospial’ survivors want in on residential school agreement”. CBC News Thunder Bay. Retrieved 20 Mar 2017 from http://www.cbc.ca/news/canada/thunder-bay/indian-hospital-survivors-want-in-on- residential-school-agreement-1.2873961 12. CBC News (2012 Mar 15). “Sanatorium residents urged to file for gov’t compensation”. CBC News Thunder Bay. Retrieved 20 Mar 2017 from http://www.cbc.ca/news/canada/thunder-bay/sanatorium-residents-urged-to-file-for-gov- t-compensation-1.1139323

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