Campbell Drohan – FNIS 100 the Hidden History of Canada's Indian

Campbell Drohan – FNIS 100 The Hidden History of Canada’s Indian Hospitals 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 Idle No More 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 hospital system. Although the Indian Hospitals are no longer in operation, it is only through understanding the history of Indigenous healthcare in Canada that the healthcare disparities that currently exist between Indigenous and non-Indigenous Canadians 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 Indian Hospital 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 First Nations, and occasionally Metis and Inuit, 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 tuberculosis 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 Medicare, 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 isolation 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 Alberta 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 Saskatchewan’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 British Columbia 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 3 Campbell Drohan – FNIS 100 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

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