By SAMIR SHAHEEN-HUSSAIN (Montreal: McGill-Queens University Press, 2020), 360 pp. £23.50.
As I was in the middle of reading Fighting for a Hand to Hold, Joyce Echaquan, a 37-year-old woman from the Atikamekw nation, died in a Quebec hospital. Before her death, Joyce made a Facebook Live video as a call for help, where a nurse and orderly can be heard making racist remarks. While the current premier of Quebec, François Legault, calls the circumstances of the death ‘shocking’ and the behaviour by the nurse as ‘racist’, he denied this was an example of the existence of anti-Indigenous racism or systemic racism in this province of Canada. In contrast, Prime Minister Justin Trudeau’s acknowledgements of systemic racism have been critiqued by Indigenous leaders as empty rhetoric.
Samir Shaheen-Hussain’s Fighting for a Hand to Hold goes beyond treating moments like Joyce’s violent death as involving Legault’s claim of racist individuals and actions, or Trudeau’s empty reference of systemic racism. Samir provides important tools for unpacking how this event is a product of a history and the ongoing character of colonialism through medical institutions and practitioners.
The premise of the book is based on the campaign #aHand2Hold that began after Samir, as a pediatric emergency physician at Montreal’s Children Hospital, treated two Inuit children in the summer of 2017 who were transferred there via medical evacuation airlift service from Nunavik unaccompanied by a caregiver. For a number of decades, the practice in Quebec has been to deny parents or caregivers the right to accompany their child during a medevac airlift. The campaign that began on 24 January 2018 successfully challenged this practice.
The book unpacks the multiple layers of social and historical processes under- pinning the non-accompaniment practice. It begins with the problems that Samir, as a pediatric emergency physician, faced in treating Eeyou and Inuit children without a caregiver to inform about each child’s condition. He then moves towards an analysis that critiques government claims that this is not a racist policy by building from a social determinants of health approach. While non-Indigenous rural communities can also avail such services for emergency air transport to major cities in the south of the province where there are fully equipped hospitals, the social determinants of health demonstrates that northern Indigenous communities are disproportionately affected by the non-accompaniment practice. Samir shows the limits of the social determinants of health approach as it doesn’t take into account systemic dimensions, the ‘causes of causes’. A subsequent chapter examines how justifications by the government for the non-accompaniment practice were instances of systemic racism. Even reforms to allow for caregivers to accompany children with the seemingly neutral condition of not being intoxicated, were examples of employing the stereotype of the ‘drunken Indian’ even if the minister of health did not initially name Indigenous people.
The campaign #aHand2Hold argued that the non-accompaniment practice was part of a longer colonial history of separating Indigenous children in northern communities from their families that goes back to the history of Residential Schools and Tuberculosis (TB) evacuations. In this regard, Samir advances the concept of ‘medical colonialism’ that he defines as ‘a culture or ideology, rooted in systemic anti-Indigenous racism, that uses medical practices and policies to establish, maintain, and/or advance a genocidal colonial project’ (p. 118). Such a definition doesn’t do justice to a more expansive understanding of the concept that is elaborated in the book, where more than a ‘culture or ideology’, medical colonialism is a material force embedded in historical processes. The author shows how physicians and medical staff in Canada have historically been active players in the genocide of Indigenous peoples. Instances of the spreading of the smallpox epidemic in what is now western Canada was an important predecessor to the annexation of this territory to the federation. The poor health conditions in residential schools made them sites of large numbers of viral infections, including TB, and a cause for many deaths of children. The book accounts for how Indigenous communities have on numerous occasions been used in vaccination trials with lethal consequences and how Indigenous women were forcibly part of sterilisation programmes.
In one chapter, Samir outlines how treatment for TB during the mid-twentieth century became the basis for establishing federal medical institutions in northern areas, a shift from church-controlled hospitals and clinics. It is here that a system of evacuation treatment begins in the region. Rather than developing medical facilities in the north, the Canadian government evacuated Indigenous TB patients to southern hospitals. The book outlines the flaws in the government’s logic that this was a cheaper option, but it also shows how this had more to do with establishing a relationship of dependence. Wherever the government did develop medical institutions in the north coincided with the need for maintaining a rela- tively healthy workforce.
Samir argues the structural determinants of health are colonialism, capitalism and anti-Indigenous racism. Underlying the emergence of colonial medical institutions was a violent transition in northern Indigenous communities from kin- based subsistence societies to a colonial-capitalist mode of life. Fundamental in that shift was land appropriation that effectively destroyed Indigenous practices of hunting, foraging, fishing and cultivation as the basis of life and care. That relationship to land was vital for Eeyou, Inuit, Neskapi and Innu communities to care for themselves, through traditional medicines and foods. Yet, the transition to colonial-capitalism was premised on transforming land as relation to land as com- modity. Hydropower developed in the north allowed for Quebec citizens and industries to have a cheap source of energy at the cost of dispossessing the Eeyou, Inuit, Neskapi and Innu of land and sovereignty.
Where do we go from here? It may appear that colonialism is history, but the author argues that colonialism produced the present context of dispossession, dependence and domination. At the same time, colonialism is ongoing in that Indigenous land and sovereignty continue to be appropriated. If access to land is considered a determinant of health, the reclaiming of land and the return of self-determination similarly should be seen as integral processes for recuperating the health of Indigenous nations.
Whereas the defunding of the police has entered the public debate in North America since Black Lives Matter protests erupted after the killing of George Floyd, medical institutions have in general not been considered as spaces of racialised violence. However, as protests continue across Quebec demanding ‘Justice for Joyce’, the violence surrounding the death of this Atikamekw woman is generating important questions about the future of health care. Fighting for a Hand to Hold is important in encouraging us to reflect and rethink it. Samir’s call for the decolonisation of health care would entail reparations for Indigenous nations, which includes the return of land and sovereignty over the labour of care. Indigenous land defenders fighting colonial development, Indigenous projects of food sovereignty and agroecology, and the resurgence of Indigenous traditional knowledge, including practices of healing, all point to the importance of reclaiming sovereignty over care as pathways for decolonising health care.
Queen’s University, Ontario KASIM ALI TIRMIZEY
The review first appeared in Race & Class v. 62 #4.