In 2008, Brian Sinclair was referred from his physician’s office to the Health Sciences Centre in Winnipeg for treatment. A double amputee, the 45-year-old Indigenous man wheeled himself in, spoke to someone and waited in the emergency room to have his catheter changed.
He languished in the same spot for 34 hours without being seen.
He died in his wheelchair.
The inquiry into his death brought forth 63 recommendations, but stopped short of saying whether Sinclair being Indigenous played a role in the outcome.
Inspired by incidents like these, Western Geography PhD student Vanessa Ambtman-Smith focuses her research on how to support structural changes in health-care environments with a central focus on hospitals.
Along with fellow Geography PhD student Steven Vanloffeld, Ambtman-Smith stands among only 20 individuals nationwide to be named 2019 Pierre Elliott Trudeau Foundation Scholars, a doctoral scholarship program focused on the social sciences and humanities. Trudeau Scholars receive $60,000 bursaries annually, for three years, to subsidize tuition fees and living expenses and allow the students to travel for research and scholarly networking and knowledge dissemination.
Scholars were chosen for their work within four themes: Human rights and dignity; responsible citizenship; Canada and the world; people and their natural environments.
“My research has drawn from the fact hospitals have been as unsafe places for Indigenous people. We have seen a bunch of public cases about Indigenous people who have come into harm in hospitals,” said Ambtman-Smith, noting the Sinclair case. “Was this an isolated incident at the institution? Is this a matter of not having good communication between staff?”
Ambtman-Smith spoke with Sinclair’s lawyer and began to look at factors around implicit bias, around whether the face Brian Sinclair presented as a First Nations man influenced the way he was treated or, in this case, not treated.
“This is part of a much bigger dialogue around anti-Indigenous racism in health care,” said Ambtman-Smith, who is of Nêhiyaw-Métis ancestry. “There are a number of studies that have surfaced on the impact of racism and being Indigenous as a social determent of health. So people who are Indigenous, and are presenting in places like hospitals, are getting treated different – and not in a good way.”
Historically, hospitals, institutions and Indigenous people have not had a great history. The history of hospitals has been very violent and very negative and, to this day, Indigenous people don’t have a trust with mainstream institutions, added Ambtman-Smith, noting even though Indigenous people may be described as having the worst health of any population in Canada, they are chronic under users of the system.
“There is a lot that needs to be reconciled in order for Indigenous people to even have fair and equal access to places like hospitals,” she said, which has since begun through the implementation of the findings of the Truth and Reconciliation Commission, by providing Indigenous Peoples with access to land-based medicine and cultural within institutions like hospitals.
“Once sterile institutions are now creating access to space for land-based medicine so people are able to have a fire, participate in sweat lodge ceremonies, smudging – things that never would have taken place, and were in fact illegal, only a couple of decades ago.”
Throughout her 17-year career in Indigenous health, Ambtman-Smith has sought ways to re-design systems to enable access to culturally safe care and advance models of care that go beyond the traditional view of health care. Her research, Indigenous traditional healing spaces within a hospital context: Examining relationships between health, healing and reconciliation, will now examine the meaning and use of traditional healing spaces within hospitals.
“Nobody has really evaluated whether these spaces are meeting their intended use, whether they have an impact, whether they are bettering health and wellness, whether they increase safety,” she continued. “This is going to help us to provide a case study for not just health care, but beyond health, even looking at universities. I want to be the first to examine these traditional healing spaces and see whether this is contributing to, ultimately, reconciliation.”
She noted Indigenous people are leading the change within the institutions, a change for places that normally look at scientific models, data and quantitative evidence to make and inform decisions.
“It’s important to start to focus on research that is drawing on Indigenous knowledge systems and how they inform solutions that are not going to come out of that medical system,” she added.
Ambtman-Smith sees herself in a context beyond academia – one where she can have an even greater influence on the future direction of reconciliation and decolonization.
“I’m an Indigenous mother of Indigenous children. Part of what I’ve come to know growing up Indigenous in Canada is there is still a need to fight for basic human rights. Part of my involvement in the community is looking at how Indigenous People, by having a voice and being included, are going to be successful in starting to influence positive changes,” she said.
“It’s a responsibility to my children to try and change the course of history that has made my life so difficult. If Indigenous people are not involved in developing decisions and solutions, we will continue to see more of the same. It’s about contributing to a collective movement.”