Addressing racial discrimination in the health system

The death of Mireille Ndjomouo on 7 March shook the entire province. Her death came two days after she published a video where she denounced the treatment she was receiving at Charles-Lemoyne Hospital in Longueuil. The case is still under investigation. Recently, several Aboriginal patients have complained of abuse received. Barely six months after the death of Joyce Echaquan, which occurred at the Saint-Charles-Borromée hospital in Joliette, this event awakens pain. While we still don't know what happened when Ms. Ndjomouo was hospitalized, this tragedy started a conversation about racism in hospitals.

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A hospitalization that turns into a nightmare

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The story of Mireille Ndjomouo, like that of Joyce Echaquan, had a punching effect on Ismaëlle Rose. The latter relives the painful memory of an important operation she underwent last June at the Maisonneuve-Rosemont Hospital. “I had to recover not only from the operation, but also from the violence I experienced,” she said about her hospitalization. In addition to her recovery of two months, post-traumatic shock was added, which forced the 43-year-old woman to interrupt her studies. “I don't know how or why I am alive! ” she exclaims, referring to her hospitalization. Ismaëlle was not at her first procedure for a recurring health problem. However, this intervention was very different from the previous ones. The young woman says that when she wakes up, she is struck by unbearable pain. She would have been left in this condition for a full day before relieving her with epidural medication. A nurse checks her health condition later. She would have said to him: “Do you remember me? I was next to you all day after your surgery, I had to fight for the pain to be treated. In the end, you were dying,” reports Ismaëlle, who remains deeply traumatized.

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The patient was in the care of several caregivers during the six days she stayed in the hospital. She considers that several of them took good care of her. Ismaëlle also testifies to several other incidents and problems that would have afflicted her during her hospitalization: faulty doorbell that is refused to be checked, malnutrition, allergic reaction that is not taken seriously, medication administered irregularly. Each time, she would have tried to report it in order to rectify the situation. “I was treated horribly, insulted, told it was in my head,” she says of some hospital staff. Before she was released, a nurse tried to make her feel guilty. “I was told that no one liked going to my room, that my doctors talked to each other, that I was a difficult patient,” she quotes. However, I was extremely weak during most of my stay.” Ismaëlle wonders what could have caused some of the hospital staff to behave this way. “I have the impression that misogyny is the cause, and I don't rule out racism,” she says. As the pandemic was raging, the young woman could not be accompanied during her stay in the hospital. “There were no witnesses or relatives; this can have an impact on behavior,” she believes. This is the first time she has told this story. “We know that no one is going to believe us, that we are going to say that we are exaggerating,” she regrets. “It's only recently that we've heard about this kind of thing.”

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Between taboos and stereotypes

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“We hear this type of story a lot in racialized communities,” says Ariane Métellus, a perinatal consultant. “When you experience racism, you know it, you feel it. But how do you explain it to someone? We got wind of these incidents because they were filmed, she continues. What if that's not the case? ”

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The perinatal specialist sees the fact that more and more people are choosing to share their experiences positively. “There is a taboo. Before, we didn't talk about people who suffer violence and racism in the medical field,” observes Ms. Métellus. As part of her profession, she conducts research, provides training, and focuses on procedures undertaken in the hospital environment. It was her own experience that prompted her to launch her practice, first as a birth attendant. The first birth left her with a bitter taste. “A doctor told me: 'You black women have a small pelvis, so it often ends in a c-section, '” she says.

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Ariane Métellus evokes other unfounded beliefs that persist, whose existence is confirmed by several other professionals interviewed in the context of this report. There's what's called “Mediterranean syndrome,” a racist stereotype in which Arab, black, or racialized people exaggerate their symptoms and pain. Management and treatments can be greatly affected. The specialist also points to erroneous theories that Black people feel less pain. She herself, like Ismaëlle, considers that this misconception may have played into the treatment she received during her hospitalization. “The health system was created on a racist basis. For example, the father of modern gynecology practiced and experimented on black slaves. There are things that are perpetuated”, the perinatal consultant tells us. She believes that prejudices and racism do not spare health professionals, who nevertheless take an oath to practice. “There are individuals who, in their daily lives, are racist, and these individuals work in this system,” says Ms. Métellus. She explains that racism can also be systemic, meaning that structure and practices can cause some people to receive inadequate treatment.

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Unencrypted cases

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According to the sexual and reproductive health consultant, it is even more difficult to broach the subject and make a case without being able to rely on numbers. In the meantime, you should rely on the situation in the United States or Europe to hypothesize about the experiences of certain groups of the population. “It's not because they don't exist or that they're isolated cases,” she says about differential treatments. She cites the United States as an example, where, according to the Centers for Disease Control and Prevention, black women are 243% more likely to die from causes related to pregnancy or childbirth than white women. This is one of the biggest health disparities. There is still no data on this subject in Quebec, but several independent researchers are currently looking into the question. “If it is happening there, among our neighbours, why should Quebec and Canada be exempt? asks the perinatal consultant. “The problem can be solved when we talk about it seriously, when we give voice to people who are victims of violence and when we believe them,” she declares.

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The discrimination behind the lab coat

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Interventional cardiologist Dr. Alexandra Bastiani regularly observes patients who are treated differently. “I have seen situations where people comment, commit microaggressions or have certain behaviors,” says the specialist. As a black woman, she says she is sensitive to this kind of conduct and adds that she has already received derogatory remarks from patients, but also from colleagues. Nevertheless, the cardiologist remains cautious, stressing the tiring work that hospital staff do on a daily basis. “I don't want to turn a blind eye to what's going on,” she says about these types of incidents, which she considers to be systemic racism. “We have knowledge, but we need to be able to have adequate answers,” she believes. “It's not a problem of knowledge, but of perception.” the doctor, before adding that a black person is less likely to be released from a hospital following a heart attack that a white person. Dr. Bastiani would like to see training on racism in hospitals integrated into the curriculum of medical students.

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Social justice as care

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Dr. Samir Shaheen-Hussain, a pediatric emergency physician, observes the effects of social injustice on patients' health. He reports on this in his latest book, No more Indigenous children snatched away — Ending Canadian medical colonialism. In it, the pediatrician exposes systemic racism and its impact on the delivery of care in Quebec and Canada. He believes that the culture in which the health system operates is heavily influenced by ideas of white supremacy and patriarchy. “Injustices don't come out of nowhere. They are created by people and by the systems in which we live.” The physician supports the practice of cultural safety, an approach that he believes can make a difference in the health system. “This concept teaches health care practitioners and providers to understand and reverse the power dynamics inherent in health care and to reverse them, to recognize the dignity of the person they are treating, and to recognize the dignity of the person they are treating, as well as their history, social and political contexts.” explains Dr. Shaheen-Hussain, who is also an assistant professor at the Faculty of Medicine at McGill University. He believes that as health professionals better understand the role of history and power dynamics, there is hope that this awareness can have an influence on the type of care they provide. “If this initiative is implemented properly, the benefits will be felt by everyone. The lessons learned could be applicable to all sorts of people: Indigenous, Black, migrant, LGBTQ+ communities, and more.”