Colonization, which often refers to direct imperialism and acquisition founded on force and military action, has evolved.
The role of health care in relation to colonialism has also evolved: so too have the roles of health care providers and sites of health care.
Many health care facilities across Canada today are located on both unceded lands, where no numbered treaty applies, and contested lands, where treaty obligations are frankly breeched. The very presence of these clinics and hospitals represents:
- Dispossession and displacement (including forcible confinement on reserve and coerced migration to no fixed address in large urban centers) which leads to unsafe and unstable housing.
- Chemical restraint (historically delivered by Indian Agents but now often administered by health care providers) have led and continue to lead to multi-generational polysubstance use disorder.
- Criminalization of Indigenous Peoples (including within the confines of health care facilities) can contribute to unorganized and organized illicit, and sometimes violent, effects.
Indigeneity continues to be geographically segregated, pathologized, “managed”, and either “cured,” certified or incarcerated.
These contemporary realities represent subtle yet deeply unsettling ways that ideologies and practices of Indian hospitals have shifted over time, allowing the concepts of health and health care to continue as antithetical to Indigenous personhood and wellness.
Unfortunately, we physicians who hold so much privilege and power in the health care system, along with our predecessors, have been unwitting participants in the colonial agenda. Without insight or intent, we have been trained to be tolerant of epistemic (bodies of knowledge and ways of sharing them) racism and developed dependence on a neo-colonial health care system.
We have been taught Indigeneity is a pathology.
Indigeneity is not the pathology. Coloniality is the pathology.
We have not learned how to stand against a state body that thrives on pathologizing others. Our hospitals embody and express the pathology of coloniality.
How will Indigenous peoples ever find good health outcomes when we continue to be pathologized?
As physicians, it is impossible for us to extricate ourselves from a colonial history. We are embedded within it, suffused in the ongoing legacies that our profession has been an agent of.
But like Indian hospitals, we physicians too can evolve. We can evolve in good and kind and culturally humble ways.
Before we can learn to hold space for Indigenous self-determination in health and wellness, we must first learn how to hold space for ourselves in our own recovery from the pathology of the coloniality of power and bolster protective factors against it.
With gratitude, for their contributions, to Tibetha Kemble (Stonechild) and Sarah de Leeuw.
Banner image: For the personal story behind this and other images in her collection, view Indigenous artist Lisa Boivin’sTEDxTalks – Painting the Path of Indigenous Resilience (embedded in the story above).