The author is a pediatric emergency physician and associate professor in the Faculty of Medicine and Health Sciences at McGill University. He is involved in the Soignons la justice sociale collective and wrote the award-winning book No more aboriginal children torn away. To end Canadian medical colonialism (Lux editor).
After having broken its promise during its first term in government, the Coalition avenir Québec (CAQ) finally tabled its Bill 32 (Law establishing the cultural security approach within the health and social services network) on last day of the parliamentary session.
I mentioned in my last column that the CAQ’s colonial approach to cultural safety depoliticizes a tool of self-determination — cultural safety — that is inherently political. But beyond the major shortcomings related to the content of PL32, there is a rigorous process leading to its development that is missing. In a joint press release referring to the inadequate involvement of Aboriginal communities and expertise in this area, the Office of Joyce’s Principle and Quebec Native Women stress that it is “essential to include and take into great consideration, in upstream, during and downstream, Indigenous organizations, people and experts in the development of this bill as well as in the evolution of the concepts of cultural safety”.
However, this is not the first time that the CAQ government has failed to involve Aboriginal communities in a respectful manner and as true partners in the development of directives, policies and laws that have direct effects on them, particularly in the area of of health. The Ministry of Health and Social Services (MSSS) had adopted a similar approach during the online deployment, in June 2021, of its mandatory training on “awareness of Aboriginal realities” for all network staff. health and social services (RSSS).
Disputed training
The desire to deploy mandatory training was expressed by the CAQ government when it announced an investment of $15 million in cultural security a few weeks after the death of Joyce Echaquan. However, the training that was selected had been sponsored by the First Nations and Inuit Relations Secretariat and the Quebec Department of Justice, and was generally intended for “public service employees, and this, in all sectors of activity”. It was developed in 2019, but, as Sipi Flamand, chef of Manawan, has already said: “In 2019, it was a different context. Since September 28, 2020, it’s a whole different story. »
The formation is highly contested today. In September 2022, Darlene Kitty, a Cree family doctor and expert in Indigenous health, deplored the inadequate consultations carried out with Cree communities: their opinions were solicited, but ultimately largely ignored. The DD Kitty had explained to Radio-Canada that “this mandatory training could harm relations with Aboriginal communities because of the lack of information developed by Aboriginal people”. Glenda Sandy, a Naskapi-Cree nurse and advisor to the public health department of the Nunavik Regional Board of Health and Social Services, has previously told the CBC that the training does little to combat racism, prejudice or discrimination. harmful misconceptions in the health care system. According to her, the training “does more harm than good”.
Moreover, many (if not all) of the Aboriginal stakeholders featured there were not even invited to view the content before its deployment. What about consultation and consent?
Despite calls to immediately cease the deployment of this training, it is still promoted by the MSSS with the objective of reaching 100% of RSSS personnel (more than 300,000 people). All new employees are also required to follow it, even if it is not accredited with professional orders at the provincial level.
A colleague from Quebec had told me of her serious concerns about the harmful effects on the care provided to Aboriginal people resulting from the ideological biases of the CAQ embedded in the training. I was therefore challenged and I followed the compulsory modules in February 2022. Indeed, beyond the embarrassing factual errors (for example, we are told that the word for “thank you” in Inuktitut is ” migwech !”), I was struck by the historical shortcuts and the obsolete “intercultural” approach that allow the training to avoid addressing the current manifestations of colonialism in Quebec and Canada.
There is no mention of medical colonialism or the role of the medical establishment in the colonial genocide of Indigenous peoples. How can RSSS staff understand “Indigenous realities” today without acknowledging the role of colonization and colonialism in producing the health inequalities and injustices experienced by Indigenous communities in Quebec?
Moreover, the MSSS actively fuels the confusion between cultural safety and other outdated approaches, in particular “cultural sensitivity” and “cultural competence”. However, the MSSS’s Frequently Asked Questions state unambiguously that this training is intended to “train RSSS workers who interact directly with Aboriginal users in the cultural safety approach” and to “support managers, members of senior management and the Board of Directors in the sustainable implementation of cultural security”. What a paradox when there is not a single mention of cultural safety in the compulsory modules!
Tellingly, the passing of Joyce Echaquan, an event that sent shockwaves through the RSSS still felt to this day, passed under a deafening silence during the training. Indeed, Joyce’s Principle is not addressed at all. Nor, of course, systemic racism.
And that’s where it hurts. To return to PL32, Jennifer Petiquay-Dufresne, Director General of the Office of Joyce’s Principle, denounced the fact that “the government is ignoring our recommendations and showing inconsistency, on the one hand by drawing inspiration from Joyce’s Principle , but on the other hand refusing once again to adopt it”. Inconsistency, of course. And also yet another example of the systemic hypocrisy of the CAQ in terms of cultural safety.