With the tragic news of 14 year-old Gussie Bennett’s death in Nain, Labrador I am reminded of the work I was involved at Labrador-Grenfell Health in Happy Valley-Goose Bay (HVGB) most of which dealt with Tuberculosis (TB). Now that I’m removed, I’m able to reflect on how little I knew about our Indigenous Peoples, health inequity, the colonial nature of research/health all topped with my naïve approach to epidemiology within the sphere of northern, remote and rural health.
My role was a collaborative one with the public health nurse who managed TB clinics for a physician that lead TB treatment for all patients in HVGB and those from coastal communities. I collected patient level information for each outbreak, including laboratory results, treatment plans, contacts, transmission, and adherence to treatment. TB is rampant in some of Labrador’s remote coastal communities where resources are scarce, health facilities and their staff are spread thin and access to a primary care physician requires a chartered flight to HVGB. Everyone, from doctors and nurses to janitors and receptionists worked well beyond their means. That was what struck me most about Labrador, everyone always did more than just their part. As you can imagine, when you are involved in an area of health care that has so very many ties to the social determinants of health, you naturally become personally invested in the cause and the patients that are affected. I can remember countless nights thinking about what I could do as an epidemiologist that could potentially help reduce the burden of the workload for my colleagues. Tracking treatments more effectively, identifying gaps by conducting a needs assessment, evaluating current services and operations, learning about transmission patterns using software like pajek, all in an effort to be of some use to the staff on the ground. With it, however, came a sense of entitlement and ownership of the work I did, I wanted to be able to share it with the research and academic world to potentially have some positive impact. There was no malice or ill-intention in wanting to share my findings within the realm of academia; it was what I knew best. Publications, academic conferences, reports and presentations were the fruit of the endless hours of researching.
When we’re young, we are sold on the idea that we could be the next revolutionaries. We worship stars, world movers and shakers and are bent up on wanting to have the same positive impact on the world. For me, I dreamt of being with Doctors without Borders, being a sort of Dr. James Orbinski. While this is a noble thought and very well intentioned, it’s not needed or right. Someone else’s world is not mine to provide suggestions for and I most definitely cannot under any circumstances solely choose to present on any findings that I happen to stumble upon thinking I have the solution. These startling realizations came during the opening remarks at the Northern Remote & Rural Health Conference in Labrador (October 2017) by Natan Obed (President of ITK). I remember sitting in the audience with the feeling of a spotlight shining above my head, my face flushed and fists clenched in disbelief because all I had ever wanted was to help be part of the solution. But it was clearly indicated that I was on the side that was part of the problem. I felt ashamed, a feeling I never associated with wanting to help, which led me to feel defensive.
As the day wore on, I reflected on the underlying root of my anger. I identified with, stood in solidarity with and supported the rights and freedoms of our Indigenous Peoples. I appreciated that there were long-lasting impacts due to colonization, trauma and discrimination that I could never understand, feel or experience. There is a shared sentiment amongst both refugees and immigrants with the Indigenous Peoples of Canada. We share histories of being colonized, brutalized and told our way was the wrong way. It’s as if I could say, I understand your pain because it’s in some sorts, it’s a pain I recognize and feel quite frequently. Yet, I failed to recognize that I, despite my personal will to understand, could never undo the damage of the past that Indigenous Peoples experience no more than anyone could undo the damage the Russians and Americans did in Afghanistan. I was ironically in a position that represented the oppressive system that collected, analyzed and made decisions for the Indigenous Peoples of Canada. I came in the form of those researchers that took first and never asked. I wanted to be a solution when in fact, I was part of the problem within the system that created injustices in not just healthcare but also in civil, judicial, social and cultural arenas.
The biggest pitfall of our system is that its an institution that was built on the principles of routine and hierarchy: do as you are told and do not question the legitimacy, intent and ethical code of our institutions practice because that’s how it’s always been and that’s how everyone else does it. Change isn’t easy and for large institutions and long-standing practices, it’s daunting to consider where one might begin. I don’t claim to have answers for our governments, our institutions and our research practices but there is a dialogue now with expressions of deep pain, suffering and a need for acknowledgement for the endless suffering of our Indigenous Peoples. This dialogue helped me realize how erroneous my own practices were and how much I needed to learn and grow. I hope it’s a conversation I continue to hear, learn from and implement.