A settler’s journey towards reconciliation
After Maytree hosted Bob Goulais’ Five Good Ideas for being inclusive of Indigenous Peoples, Dr. Chandrakant P. Shah reached out to offer to share his personal story towards reconciliation. Dr. Shah is Professor Emeritus at the Dalla Lana School of Public Health, University of Toronto, and a retired physician, public-health practitioner, and advocate for improving the health and wellbeing of marginalized groups in Canada. He’s also the author of the memoir To Change the World: My Work With Diversity, Equity & Inclusion in Canada.
The road we travel is equal in importance to the destination we seek. There are no shortcuts. When it comes to truth and reconciliation, we are forced to go the distance.
The Honourable Justice Murray Sinclair,
Chair of the Truth and Reconciliation Commission of Canada,
Presentation to the Senate Committee on Aboriginal Peoples,
September 28, 2010
I immigrated to Canada in 1965 as an intern at Vancouver General Hospital. Like most immigrants, I had no knowledge about the Indigenous Peoples in Canada for almost ten years; I never met one, and even if I saw them in the emergency room, it did not register in my mind. The only glimpse of them I had was through “western movies,” which did not depict “who they were.”
My mentor, late Dr. Geoffrey Robinson, a renowned pediatrician, kept giving me books as a gift about the Indigenous Peoples such as Guests Never Leave Hungry: The Autobiography of James Sewid, a Kwakiutl Indian; and, upon my departure from Vancouver to Toronto, he gave me a pair of silver Haida cufflinks depicting the totem pole. He was planting a seed in my heart, which germinated later on.
In 1972, I moved to Toronto at the University of Toronto as a professor in its newly created Department of Preventive Medicine in the Faculty of Medicine; as a pediatrician, I was also cross-appointed with the Department of Pediatrics and the world-renowned Hospital for Sick Children (HSC). The chief of pediatrics (the late Dr. Harry Bain) had witnessed firsthand the sorry state of healthcare for the Indigenous Peoples living in very remote and isolated First Nations Communities in Northwest Ontario leading to excessive deaths amongst infants and children and many individuals suffering from acute infections and chronic illnesses such as heart disease, diabetes, and mental illness.
Moved by these observations, together with the Federal Government, he established a medical hub in the town of Sioux Lookout, which attempted to provide services of family doctors and medical consultants to 26 First Nations communities with a total of 16,000 Indigenous People.
I learned about this program and volunteered my service as a physician. During my visit to these remote communities, I had to fly in a small two- or four-seater Cessna plane which landed on either water or ice depending on the season as there were no landing strips in many communities.
What did I find in these communities, which were both tranquil and friendly?
Most of these communities had no infrastructure such as potable water, electricity, indoor heating, or toilets. There was a cooperative store, but prices were exorbitant as food and household items had to be flown in from the south. Their homes were dilapidated and overcrowded. Schools were staffed by teachers from the south, and a small clinic was staffed by nurses and community health workers. Winters were long and harsh, and summers were short.
Why is my Canada so indifferent to the plight of Indigenous Peoples — the First Inhabitants of this beautiful land?
Initially, I went to these communities at least once a year for one to two weeks and later two to three times a year. When I was there, I not only provided medical services but did research and a lot of soul-searching to answer a question: “Why is my Canada so indifferent to the plight of Indigenous Peoples — the First Inhabitants of this beautiful land?”
I read the history of colonization by the British and French, the treaties signed by the Crown, our treaty obligations to Indigenous Peoples, the impact of residential schools and its long-lasting effects on children and families, the Royal Commission Report on Aboriginal Peoples, and, more recently, the report of the Truth and Reconciliation Commission of Canada.
I reflected on these facts. Coming from India and witnessing the independence movement, I also could associate with the Indigenous plight for self-determination and self-government. Initially, as a first-generation immigrant with a poor command of language and social connections, I felt helpless and hopeless. I was lost!
However, a few things happened, and I realized that as a professor I had credibility when I spoke or wrote about an issue. I had a voice, which needed to be heard, and I had an obligation and social responsibility as a Canadian to make wrong right! My research should address the pressing problems of our society. All I had to do was keep my mind open, and when I saw injustice or a need for change, I should act and not be a mere bystander. I should speak out. As someone has said, “Silence is violence.” I decided to act with the tools I had in my toolbox.
Here are a few examples of my successes and failures — and lessons that I learned.
Inclusion of Indigenous contents in the Canadian citizenship examination
In 1988, my family and I visited Europe. My two sons and I were Canadian citizens, while my wife had still retained her Indian citizenship even though she had been in Canada for more than twenty years — a common thing amongst first-generation Canadians. She encountered significant difficulties obtaining visas for different countries.
I happened to read the Canadian citizenship guide and was horrified to read how it completely ignored the devastating impact of colonization and post-colonial policies.
Upon return from our trip, she decided to obtain her Canadian citizenship. For this, she had to study two citizenship booklets published by the Government of Canada to write her citizenship examinations. One day, I happened to read the guide and I was horrified to read the following statement as it completely ignored the devastating impact of colonization and post-colonial policies such as the creation of reservations, residential schools, the Sixties Scoop, and the reneging on our treaty obligations on health and wellbeing of Indigenous Peoples. It stated,
The Indians and Inuit (also called Eskimos) lived in this country long before it was also known as Canada. They developed many languages and cultures. Their different ways of life developed in relation to the land and vegetation, wildlife and weather unique to different parts of the country. Corn, potatoes and tobacco were first cultivated by natives of America, and they invented the kayak, canoe and snowshoes.
Government of Canada, 1986
Being an immigrant myself, I realized that to develop a harmonious relationship (reconciliation was not in my vocabulary at that time) with the Indigenous Peoples, new Canadians need to know more about them. I started a single-person letter-writing campaign in 1991 to the ministers of the day, leaders in opposition parties, municipal governments, social organizations, heads of the various Christian churches, Indigenous organizations, among others, to change the content of the guide. I suggested that these changes be done in consultation with the Indigenous Peoples, and they should be reflected in the citizenship examination. As a professor, I knew people remember their material if it was on examination.
I also solicited the head of the citizenship judge who agreed with my suggestions. It took three years of writing letters and a meeting with the Assistant Deputy Minister of Citizenship to change the guide, which included a lot more content about the Indigenous Peoples in 1994 and subsequent guides.
I am proud to say that since the inception of this change, over six million new Canadians know more about Indigenous history, residential schools, and treaties. This change preceded the Truth and Reconciliation Commission’s Recommendation 93: “We call upon the federal government, in collaboration with the national Aboriginal organizations, to revise the information kit for newcomers to Canada and its citizenship test to reflect a more inclusive history of the diverse Aboriginal peoples of Canada, including information about the Treaties and history of residential schools.”
Visiting lectureship on Indigenous health
The next example deals with the “unconscious bias” we carry about individuals or groups. Unconscious bias refers to a bias that we are unaware of, and which happens outside of our control. The presence of such implicit bias among health and social service providers further suggests that it could play a role in health care disparities just as it plays a role in differential outcomes elsewhere in society. In 1980 as a professor, I became aware of such bias towards Indigenous People among undergraduate and graduate learners and researchers at the University of Toronto, healthcare workers in general, and the population at large.
Realizing that the voices and lived experiences of Indigenous People were missing in curricula contents across health and social sciences faculties, a three-week program (“Visiting Lectureship Program on Indigenous Health“) was developed in 1990. The objective of the program was that if the future and present healthcare workers were cognizant of Indigenous issues, their services would be more culturally sensitive; if they became policymakers, their policies would be more relevant; and, in future, they would become advocates for Indigenous People.
The presence of such implicit bias among health and social service providers further suggests that it could play a role in health care disparities just as it plays a role in differential outcomes elsewhere in society.
The program ran for eleven years from 1990 to 2001. It developed a different theme of Indigenous issues each year, and knowledgeable Indigenous speakers from all walks of life were recruited across Canada to deliver classroom sessions at three universities in Toronto. The speakers also provided continuing education sessions to various teaching and community hospitals and health professional groups. In addition, they delivered public forums at the university and Toronto City Hall.
Evaluation of the program indicated Indigenous speakers were extremely well received and the contents of lectures were valuable. Indigenous speakers rated the utility of the program high for their audience and their personal growth. In 2000, an endowment fund of two million dollars was obtained to establish an Endowed Chair in Aboriginal Health and Wellbeing at the University of Toronto, the first of its kind in Canada to hire an Indigenous professor (Professor Jeffrey Reading held the first endowed research chair). This initiative is congruent with what the Truth and Reconciliation Commission recommended for the education of healthcare professionals to remove their unconscious bias.
Aboriginal cultural safety initiative in health sciences curricula in colleges and universities in Ontario
My third example deals with the development of educational modules with the help of Indigenous professors on Indigenous cultural safety and training Indigenous preceptors to deliver such modules across health sciences programs in Ontario’s colleges and universities. The concept of the need for not only culturally sensitive but also culturally safe health care started to emerge at the beginning of this century.
I realized that over 57,000 students in post-secondary health sciences programs across Ontario had little to no content about Indigenous cultural safety in their curricula. The environmental scan revealed that this was largely due to the lack of available Indigenous faculty members in these institutions. I secured a grant to tackle the issue. Following this, I commissioned the two Indigenous professors to develop of cultural safety curriculum and train lay Indigenous volunteers across the province to provide the course.
Following this, I advertised the availability of these preceptors at no cost to all colleges and university programs dealing with health sciences students. We had quite a few requests for these volunteer Indigenous teachers. Beyond course material, volunteer Indigenous instructors were able to bring their lived experiences into the classroom. While this was a pilot project, the resoundingly positive feedback received from students and instructors indicated that the further implementation of this program permanently into curricula would be a successful venture. At the end of the successful pilot program, it was transferred to the Indigenous Peoples Educational Circle, which consisted of representatives of groups providing support services to Indigenous students in colleges and universities.
This program preceded the recommendation of the Truth and Reconciliation Commission that all health sciences students should receive training in Indigenous cultural safety. See here for the details about the program.
Development of an urban Indigenous health strategy in Toronto
This fourth initiative focused on the development of a strategy for Indigenous People in large urban centres. After my retirement from the University of Toronto in 2001, I was invited to work as a primary care physician at Anishnawbe Health Toronto providing primary care to Indigenous People in Toronto. There were approximately 60,000 to 80,000 Indigenous People living in Toronto; many of them transient moving back and forth from their First Nations communities; 15 per cent of them were unhoused, and many disenchanted with the care they were receiving in mainstream healthcare facilities, which they found to be discriminatory, culturally unsafe, and missing traditional healing practices.
In 2012, I was invited by three different Indigenous families to the memorial services of their beloved deceased family members and was asked to speak about them, as I had known them as patients. While I attended the services, I was taken aback by such a request as I had never heard or encountered such a request from a physician. I was also struck by how young these patients had been when they died. I asked my medical secretary to compile a list of patients who had died in the past three years.
As this was happening, I had a call from a young physician in family medicine training who wanted to do a three-week elective with me and was looking for a project. I put him to work to compile a report on deaths in Indigenous communities in Toronto. I was able to receive additional data from other Indigenous organizations.
What we found was a shock to all: despite many Indigenous and non-Indigenous health and social services, average age of death of Indigenous People in this group of 109 was 37.4 years compared with 74 years for all Torontonians!
Following this, we interviewed relatives or friends of twenty deceased individuals to ascertain the root causes of their deaths.
I had been advocating for the past several years to the Public Health Department, the City of Toronto, and Toronto Central LHIN to develop an urban Aboriginal strategy. Mainstream organizations were reluctant to develop any such plan because they were worried about jurisdictional issues and a relatively small number of Indigenous People in Toronto compared to all other ethnic groups.
I reported the findings of the study to the Toronto Public Health Department, the City of Toronto’s Indigenous Committee, and Toronto Central Local Health Integration Networks (LHIN). The media also picked up the story and provided extensive coverage. This was an impetus to form a Circle including the Indigenous elders, the Toronto Public Health Department, and Toronto Central LHIN and provided momentum to the development of Toronto’s First Indigenous health strategy (2016-2021).
While the above initiatives depict successes, I had, I must confess, also a few failures from which I learned the importance of community development and community consultation and, in the last instance, the improper timing of the initiative (or one may say I was unlucky).
Additive in gasoline for First Nations communities to reduce gas sniffing in children
From 1976 -1988, I visited Sioux Lookout Zone in Northwest Ontario as a pediatric consultant physician. It consisted of 16 First Nations isolated and remote communities, many of them only accessible by small planes. During this period, a few of the communities had almost epidemic problems with gasoline sniffing in children as young as four years old. As gasoline contained lead, one of the major effects of gasoline sniffing was impairment of cognitive functions in children. These children were brought to clinics I visited, with learning and behaviour problems.
While I used my clinical acumen in dealing with individual patients, my public health training directed me to consider it a “public health issue” and find public health measures to prevent it.
I became aware that Australia had a similar problem with their Indigenous People living near airports and sniffing airline fuel. They had found an additive which when added to fuel would provoke nausea and vomiting in those who sniffed it. I also discovered that in Canada gasoline for agricultural use and those supplied to First Nations communities were colour-coded.
I connected with the Petroleum Association of Canada based in Calgary asking for their help to put an additive in gasoline going to First Nations communities. While they were willing to help me, they needed more research and necessary funding. Similarly, the local First Nations communities had concerns about the impact of additives on their machinery such as skidoos and motorboats, which were vital for their survival. They needed evidence that additives would be safe.
I realized that to overcome many of the roadblocks, I lacked resources and know-how and finally I gave up; but I did learn many lessons which made me think differently before taking on other projects of such nature.
At that stage in my life, I did not appreciate the need for community engagement and community development before imposing my solution, i.e., putting an additive into someone else’s gasoline.
Let me digress and tell you about a similar incident that happened in the early 1990s when I visited Darwin, Australia, as a World Health Organization Fellow. My host took me to a hospital built specifically for their Indigenous Peoples. It was a beautiful structure; however, I hardly saw patients in their rooms. I saw them sitting or lying on hospital grounds under the shades of trees.
Upon discussion with my host, I realized many of their Indigenous Peoples felt confined in their beds, as they were accustomed to living in open spaces; and, unless very sick, preferred an outdoor environment. However, when white Australians had designed the building, sitting in their offices in the capital city of Canberra, they were unaware of Indigenous Peoples’ cultural needs. I am not trying to find an excuse for my behaviour but just wanted to cite an example of a similar situation in another colonized country.
The Indigenous Peoples were rightly apprehensive about an unknown additive ruining their snowmobiles and small boats, which were their only means of hunting and fishing. They were probably afraid that their children would still be bored as there were no other available means to keep them busy and would resort to other dangerous activities. What they needed were infrastructure and organized activities for children. In retrospect, my solution was a band-aid that did not address their true needs. Before imposing my solution, I ought to have done community participatory approach to earn their trust.
No wonder I failed!
One of the Innu elders commented on the possible solution for gasoline sniffing in 2017: “We are Innu. We cannot be healthy or successful in life without understanding and embracing our culture, our language and our connection with our land and animals.”
These are the root causes for gasoline sniffing and many Indigenous issues, and they need collective actions from all Canadians.
Bakery project for remote First Nations communities to create community self-sufficiency and employment
In the summer of 1986, unexpectedly, I received a phone call from the Gannett Foundation to submit an innovative idea for community development as they were seeking to fund a $100,000 project. As mentioned earlier, I used to go to remote and isolated First Nations communities in Northwest Ontario as a pediatric consultant and realized that to improve Indigenous health, one needs to have a multi-pronged approach including addressing the social determinants of health.
During my visit to those communities in the early 1980s, I would visit local cooperative stores to see the cost and types of food available. As most of the food was flown in from the south, food prices were exorbitant, costing on average three to four times what you paid in the south; a loaf of bread was two dollars each compared to about 75 cents in Toronto.
As a clinician, I had also noticed that many individuals suffered from iron deficiency anemia.
I had an idea that if the bread was made locally, it could be fortified with iron, provide employment, and promote good health. People could finally eat fresh bread. It would be a win-win situation.
In my application to the Gannett Foundation, I put an idea of developing a bakery in a remote First Nations community. The Foundation had some 50 applicants from Toronto with their ideas, and my project won there. Similar competitions were held in Montreal and Winnipeg and my project was finally declared as a Canadian winner. I was asked to make a full-scale application with a business plan and approval letter from the Chief of the local community. Three First Nations communities provided such letters.
As the Gannett Foundation is US-based, I had to compete with fifty states for the final five successful applications that they intend to fund. The bakery project was amongst the top five. However, their Board decided against the project as it was in a remote corner of Canada and many people would be unaware of the location, and their benefactor, Media.com, would not receive the desired publicity.
Following this, I tried several venues including the economic development program for Northern Ontario, which was geared toward small businesses with private ownership. However, the idea of private ownership was at variance with Indigenous culture where the ownership is communal. Due to a lack of funding, the project was eventually aborted.
Compared to the gasoline sniffing project, I had followed all required practices, such as community engagement, community mobilization and cooperation, a proper business plan, and receiving wide support from both Indigenous and non-Indigenous opinion-makers.
Where did I go wrong? I thought it a system failure.
First, even though my project received accolades from the reviewers of the Gannett Foundation, and got placed in the top five, the decision to reject it was based on a business/political consideration — that it will not provide visibility to the funder. May I say, I did not understand the corporate greed or transactional nature of corporate philanthropy!
The second reason was the Ontario Business Development Corporation’s conditions needing a private corporate shareholder to allocate the funding; as far as the Indigenous community goes, it was a “square peg in a round hole.”
We all have unique talents and skills we can use to contribute towards Indigenous reconciliation. What many of us lack is convictions and sustained commitment.
In conclusion, during my personal journey towards reconciliation, I realized that I was not as helpless and hopeless as I had thought earlier. I was able to carry out many actions as an “ally” for the Indigenous cause. I realized that we all have unique talents and skills we can use to contribute towards Indigenous reconciliation. What many of us lack is convictions and sustained commitment.
September 30 is National Day for Truth and Reconciliation. To make our Canada truly just, each one of us needs to act toward reconciliation. As Justice Sinclair has said (quoted on CBC News), “Reconciliation is not an aboriginal problem — it is a Canadian problem. It involves all of us.”