Thank you. Elders, colleagues, guests thank you for this wonderful opportunity and honour to address you today.
In talking to archivists, librarians, and other historians about my research on the so-called Indian hospitals, I was constantly surprised by an almost complete lack of knowledge that such institutions ever existed in Canada. I was intrigued by the reactions. "Canada didn't have racially segregated healthcare!" they told me.
Yet, when I spoke with people in Indigenous communities everyone had either personally experienced the institutions or knew someone in their immediate family that had.
So how to explain this apparent erasing of Indigenous experience from public memory? The boxes of archival documents though restricted and difficult to access where there in front of me. The bureaucratic record of the Hospitals was mostly intact though many patient files were destroyed in the 1950s.
Yet 20th century health care history tells a progressive story of the 'road to Medicare' that embraced all Canadians. It took me probably far too long to finally understand that the isolation and segregation of Indigenous people in Indian hospitals was integral to the dominant project of modernizing healthcare for non-Indigenous Canadians.
On the rare occasion that Indian Hospitals intruded into this story of progress, it was to congratulate Canadians on their humanitarianism. As Minister of National Health and Welfare, Brooke Claxton put it when announcing the new Indian Health Service or IHS and Indian hospitals in 1946 quote "Neither law nor treaty impose an obligation on the Dominion government to establish a health service for the Indians and Eskimos...however, for humanitarian reasons and is very necessary protection to the rest of the population of Canada it is essential to do everything possible to stamp out disease at its source wherever it may be within the confines of the country."
And this would remain government policy for more than 30 years that it's only obligation to provide healthcare was immoral or humanitarian duty, allowing it to change policy frequently - which it did.
Now I'll use the term "Indian Hospitals" throughout to reflect the historical usage that denotes the particular character of these institutions. And this deals with the constants of life and death and the material is somewhat dark and disturbing.
Imagine if you will a young boy sent from his Arctic village by ship then alone by airplane eventually reaching Edmonton's Charles Camsell Indian Hospital. None of the staff could pronounce his single name, so they simply called him "Harry Hospital." After 7 years in hospital, or most of his childhood, he was woken one night, and sent by train across the country to Ottawa, with no chance to say goodbye to the only people he could remember. He spent many years attempting to reclaim his identity, his family, and his community.
Imagine, if you will, undergoing lung surgery under local, instead of general anaesthetic. Sixteen-year-old Dave Melting Tallow spent 3 years in the Camsell Indian Hospital pictured here and in 1959 underwent lung resection while awake. At a time when tuberculosis treatment for Canadians meant outpatient drug therapy, Indigenous patients were assumed to be careless in their health, and spent many years in hospital and many underwent invasive surgery before being returned to their communities.
As Dave told me: “They removed three ribs...And the removed part of my lung. Now I've got these stumps in my back on my left side and no ribs there. They used a saw. I was awake and I could hear the saw. They got partway and then they told me, now we're breaking the ribs off... When they did that it felt like someone hit you inside to chest. And they did that three times. I just heard the saw buzzing away and cutting stuff."
Or imagine the distress that would cause two Inuk women dressed only in bathrobes and slippers to walk out of Parc Savard Hospital in Quebec City and into the February night. With a 198 patients, the hospital had only three physicians on staff; the buildings were literally crumbling and we're infested with cockroaches, fleas, bedbugs, mice, and rats. The women had been in the Indian Hospital for four years and with no one on staff who can speak their language they assumed they would remain there forever, forgotten indefinitely. Is not clear where they hope to go in bedclothes in February, but they could be forgiven for thinking they'd be better off somewhere else.
Now imagine being told that the Canadian government deemed all this necessary, indeed mandated, in order to contain the threat that Indigenous people posed to the national health. And that those in charge of this Indian Health Service were hailed as medical humanitarians in the service of a benevolent state.
These are just a few of the stories that I found in the archival and oral history research from my recent book "Separate Beds."
I also want to share today some images created by the gifted portrait photographer Yousuf Karsh who visited the Charles Camsell Indian Hospital in Edmonton in 1952. To reproduce Karsh photographs is usually expensive and well beyond the means of an academic, but the Karsh estate asked only for a copy of the book in return for permission to use these images. His compelling portraits capture patients’ loneliness and frustration.
In the year surrounding the Second World War Canada embraced a system of racially segregated hospital care - Indian hospitals - 22 of them by 1960. They were operated by the Indian Health Service, a branch of the Department of National Health and Welfare and most were in borrowed buildings and redundant military facilities.
But why now? Why in the 1940s?
One reason was a shifting medical discourse. Doctors and bureaucrats had previously rationalized health disparities in Indigenous communities as somewhat inevitable struggle with the challenges of civilization - crudely put: the last gasp of a "dying race."
By the 1940s as First Nations presence increased in cities and towns the medical discourse shifted from the "dying race" to a shrill medical rhetoric that focused on the threat and the danger that Indigenous contagion, particularly tuberculosis, posed to the nation. As Dr. David Stewart, of Manitoba’s Ninette Sanatorium warned, quote "reserves were not diseased-tight compartments." And that Indigenous populations were not dying out, but, as he put it, quote "mingling with the general population."
Indian hospitals were rationalized to isolate this presumed threat of tuberculosis, but, unlike sanatoria - the accepted treatment standard for tuberculosis at the time Indian Hospitals treated all conditions maternity, pediatric and including tuberculosis, based on race, not disease.
As for racially segregated institutional care, this had a fairly long history, especially in the West. In British Columbia, Chinese and Japanese patients in the early 20th century suffered in St Joseph’s Oriental hospital. Community hospital set aside basement "Indian wards" or Indian annexes. The Yellowknife hospital confined Indigenous patients to its ten-bed Indian wing with a separate entrance and waiting room.
So the colour line in hospital care, was drawn by community prejudice, but it was also maintained by Indian Affairs policy. Where it consistently paid hospitals about two-thirds of what they charged for the care of Indigenous people.
Not surprisingly, community hospital boards resented the practice and thus felt justified in providing inadequate care in basement Ward's, or in refusing care altogether.
So policy and practice actively shaped inequality and constructed an image of Indigenous people as less worthy of care. But at the 2 Indian Hospitals established in the 1930s at Fort Qu'Appelle in Saskatchewan in 1936 and Dynevor in Manitoba. Indian Health Service found that they could operate at half the cost of care in community hospitals. How this was accomplished is left to the imagination - but we will see some of the consequences.
Indian hospitals then we're considerably cheaper than care and community hospitals, if it could be had. This more than anything recommended the post-war expansion of the segregated hospital system. The subsequent Indian hospitals open in the 1940s were in old military facilities - such as North Battleford in Saskatchewan; Miller Bay near Prince Rupert in British Columbia; and Nanaimo on Vancouver Island; 22 in all. They were established on the premise, indeed the promise, that they would operate at half the cost of care in increasingly expensive community hospitals. But the large dormitory style ward suitable for military purposes treating only men were completely inadequate for general hospitals treating men, women and children.
And we saw this Charles Camsell slide earlier this is the rear and the wards so the brick building is on the left hand side there. The Indian Association of Alberta, though never asked for their input, at their 1949 annual meeting praised the Camsell Hospital's good work, but the Association also voiced some concerns quote "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 a great danger of infection spreading under such conditions." Their concerns were dismissed as the work of “malcontents.”
But the hospital superintendent knew well that cross infection was a constant problem he cited the example of a young boy admitted for minor surgery, he had a middle ear infection, so surgery was delayed, when that infection subsided he developed in turn chicken pox, measles, bronco-pneumonia, rubella and another ear infection. Unit 3 at the Hospital, where women and children with all manner of illnesses were kept together had developed into what the superintendent called "more or less a pest-house." Nevertheless, he judged the patients were still better off than in their homes.
This became a common justification; Indian hospitals were not compared to accepted hospital standards but rather to the patients' supposed it inadequate homes. A justification also used by bureaucrats operating the residential schools. The ruthless economizing and overcrowding at Indian hospitals stands in sharp contrast to the millions invested, at the same time, by the same National Health and Welfare bureaucracy, through the National Health Grants. Beginning in 1948 for two decades the grants provided matching federal funds - $13 million dollars annually – for provincial projects of hospital construction.
In the first 5 years of the program Canada added 46,000 new hospital beds; 30 new, modern hospitals were added every year for a decade. Public funds aided hospitals to attract paying patients, while Indian hospitals assured Canadians that they would not need to share their modern hospitals with Indigenous people.
Underfunded by design Indian hospitals would never draw qualified staff or resources away from new community hospitals, with dire consequences for Indigenous patients.
At the North Battleford Indian Hospital in Saskatchewan, in 1955 a 4-month-old infant, admitted with "severe bronchopneumonia,” but whose condition according to the physician was "fairly good," was found dead in his crib the next day.
With one Registered Nurse, one nurse's aide on the ward of 14 seriously ill infants, there was neither the time nor the hands to adequately care for the patients. The accepted nursing standard at the time required 5 hours of nursing for seriously ill infants, but with current staff levels they could only provide 2 hours.
There's no evidence in the documentary record of any repercussions and staffing levels remained the same. Putting racial segregation at the core of the nascent welfare state, Indian hospitals stood alongside their more modern white counterparts.
Literally. At Sioux Lookout, Fort Alexander, Manitoba and the Blood Hospital at Cardston, Alberta the Indian Hospital sat next to the community hospital.
And First Nations, many of whom welcome the Indian hospitals as a belated acknowledgement of the treaty right to healthcare and is a first step towards improved health, found instead that the state's commitment ended with hospitalization, while reserve poverty, contaminated drinking water and overcrowded housing continued unabated.
The Indian Health Service encouraged this vertical or treatment specific approach to health services and all but ensured continued health disparities. Hospitals treated those made ill by reserve poverty only to return them to it.
Canada was consciously defining something called the National Health that began with the health grants for hospital construction and then National Hospital Insurance when even the middle classes couldn't afford the burgeoning costs of care: and finally, health insurance or Medicare.
This is a familiar 20th century healthcare narrative a progressive march from hardscrabble provincial plan to Medicare, with heroes along the way. But the other familiar 20th century narrative that is the continued and continuing health disparities in many, though not all, Indigenous communities.
And while Canadian see these narratives as discrete and unrelated my research explores how these narratives are intimately connected. Perhaps, by remembering the history of Indian Hospitals and racially segregated care, we can begin to see how our privilege came at such a terrible cost.
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