First published in Canadian Dimension.

Book Review: Samir Shaheen-Hussain (2020). Fighting for A Hand to Hold: Confronting Medical Colonialism against Indigenous Children in Canada. Montreal: McGill-Queen’s University Press. 326 pages.

Anyone who thinks that racism in Canada is more benign than it is in the United States, or that Canada has left its genocidal policies in the past, must read this book.

Written by a Montréal physician specializing in children’s emergency care, Fighting for a Hand to Hold begins with a shocking symptom: sick or injured Indigenous children from northern Québec being airlifted to southern hospitals unaccompanied by a parent or caregiver who speaks their language. The author investigates this outrageous practice to reveal a racist system of medical colonialism.

Part One describes the history of the non-accompaniment policy, the #aHand2Hold campaign launched in 2018 to end it, and the intransigence of policy-makers who defended a practice that separated families, traumatized children, and denied parents any say in their children’s treatment.

Racist

The campaign was also attacked by those who argued that the family-separation policy was not racist because it applied to all northerners, even though Indigenous families were primarily affected.

Racist policies also harm people outside the targeted group. While most prisoners in Canada are white, Indigenous people are disproportionately incarcerated. This racist practice increases prison populations, justifying more funding for police and prisons and less funding for social services that benefit the majority.

The #aHand2Hold campaign prevailed precisely because it identified the non-accompaniment policy as a continuation of Canada’s genocidal policies.

As Shaheen-Hussain documents:

Separating Eeyou and Inuit children from their parents fit into a larger history of forced removal of Indigenous children from their families, notably through residential schools, youth protection services, and disappearances within the health system itself.

Part Two documents how colonialism was baked into Canada’s medical system from the outset. Not all medical professionals supported the colonial project, and the book identifies prominent physicians who campaigned against it. However, only those who serve the colonial agenda are promoted to positions of power. A prominent example is Dr. William Osler (1849-1919). Revered as “the father of modern medicine,” Osler insisted that “Canada should remain a white man’s country.”

Genocide

Part Three explains that Canada’s past and present treatment of Indigenous people qualifies as genocide, as defined by the 1948 United Nations Convention on the Prevention and Punishment of the Crime of Genocide. This fact is obscured with talk of “cultural genocide,” implying a lesser crime, and with superficial cultural gestures that serve to whitewash continuing genocide.

Canada’s medical system has been steeped in genocide since its inception, partnering with government to remove Indigenous peoples from their lands, reduce their numbers, and trap them in such abject conditions that they cannot mount an effective defense. Specifically, medical professionals enabled the spread of smallpox and tuberculosis, withheld medical treatments, and conducted malnutrition experiments on starving children imprisoned in ‘residential schools.’

Indeed, as Shaheen-Hussain shows, “physicians not only inflicted suffering but also sentenced hundreds, if not thousands, of children to their deaths.”

When tuberculosis ravaged Inuit communities, the federal government refused to build treatment facilities in the north. Using the pretense of medical quarantine, it assigned physicians to supervise the forced mass evacuation of Inuit to southern, segregated ‘Indian hospitals’ from which many never returned. Resisters who tried to escape were captured by helicopters. Those deemed too sick for treatment were left to die.

Medical professionals continue to conduct experiments on Indigenous peoples without their consent, sterilize them without their consent, and remove their children. By the 1970s, one-third of all Indigenous children in Canada had been separated from their families. The number of Indigenous children in state care today exceeds the number incarcerated during Canada’s residential school era.

Medical colonialism is based on the racist assumption that Indigenous people are mentally deficient and cannot make good decisions, so their children must be removed “for their own good.” This racist victim-blaming is embedded so deeply in medicine that, as the author notes, family separation “had become normalized for us”:

As a pediatrician working in a medical system that condoned this family separation, wasn’t I complicit in the trauma this caused?… How had I ignored the broader impact of [this] practice on these families and their communities?

The author quotes a colleague, “We knew it was the rule, we knew it was awful, and yet we just kept going.”

Solutions

Part Four explores what it means to “decolonize health care,” that is, to end medicine’s participation in the colonial project. This is a thorny problem. While individual medical professionals can choose to reject racist ideas and practices, the medical system has developed as an arm of the colonial state. What’s more,

Colonial governments have little interest in ending the injustices they’ve created and maintained because they profit from them so significantly.

The root of Indigenous oppression is land theft. The British Crown owns more than 90 percent of all land in Canada, which it stole from the original inhabitants. To prevent them from reclaiming this land, the state deploys the medical system to dehumanize, traumatize, and subjugate Indigenous peoples. The author concludes, “Breaking away from colonialism requires a complete reformulation of Indigenous-settler relations.”

While Shaheen-Hussain does not elaborate, the land question is central. Because the root of Indigenous oppression is land theft, colonial oppression can be ended only by replacing private land ownership with common land stewardship. This revolutionary transformation cannot be achieved by Indigenous peoples alone, raising the question of “Indigenous-settler relations.”

The State clearly benefits from Indigenous oppression. Do non-Indigenous peoples also benefit? In one section, the author affirms that they do. In another section he states,

There can be no meaningful reconciliation in Indigenous-settler relations unless institutions that have been built on domination, exploitation, and oppression are dismantled.

These same institutions dominate, exploit, and oppress most Canadians, creating the potential for a mutually beneficial struggle for self-determination.

Fighting for A Hand to Hold is a powerful and well-documented analysis of medical colonialism that deserves further discussion and, most important, action.