Dr. Evan Adams is often asked a question that has nothing to do with playing Thomas Builds-the-Fire in the movie Smoke Signals.
Now a medical doctor, and in charge of public health for the First Nations Health Authority (FNHA), Dr. Adams often gets asked why there is a B.C. health authority making a special effort for indigenous people. Shouldn’t we all be treated the same?
“Treating everyone the same — that’s a very sweet and simple idea,” said Dr. Adams, closing a keynote speech about resiliency at the eighth annual Early Learning Forum in Skidegate last Wednesday.
“But we’re facing reality,” he said. “We must be way more sophisticated in our approaches than that.”
For a start, Dr. Adams pointed to the 1996 Royal Commission on Aboriginal Peoples, which found that on average, indigenous people in Canada are at the bottom of nearly every available index of socio-economic wellbeing. By the same measures, non-indigenous Canadians have among the highest living standards in the world.
“We come last in our own territories, in our own lands,” said Dr. Adams, a member of the Sliammon (Tla’amin) First Nation.
Also, despite a myth that First Nations people use the healthcare system more than others, the numbers in B.C. show the opposite.
First Nations people actually use the healthcare system about half as much, and more likely to hold off seeing a doctor, meaning a later diagnosis and less effective care.
“We don’t trust the system, I think,” he said, adding that there are likely several other reasons, from geographic isolation to unwelcome past experiences with the healthcare system.
To give one example, Dr. Adams showed a chart that illustrated a striking difference between indigenous and non-indigenous people when it comes to HIV.
Around 1996, anti-retroviral drugs began turning HIV from a terminal illness into a chronic one — with the right treatment, people with HIV today can live as long as those without.
But while anti-retrovirals dropped the death rate for everyone else beginning in 1996, for indigenous people in B.C., the rate continued climbing well into the 2000s.
“The magic pill didn’t reach us for years.”
Created in 2012, the First Nations Health Authority is a first in Canada. It is led by First Nations, and handles health-promoting and disease-preventing programs that were previously run out of Ottawa.
“We knew that we needed more of a say in what was happening,” said Dr. Adams, adding how in the old system, a nunni would have to apply to a Health Canada clerk to get her Aspirin covered.
“Having governments make decisions on our behalf was a really strange model.”
Speaking about his own experience in healthcare, Dr. Adams said it was an extra challenge to go to medical school from a working-class background, which meant juggling work and studying at the same time (He remains a film producer, most recently of a CBC documentary called Colonization Road).
Dr. Adams also said he has never had more racist experiences than he did while in medical school.
Even after graduating and going on to work at St. Paul’s — a huge Vancouver hospital with some 500 doctors — he got an ugly welcome.
Wearing a white coat, stethoscope, and long hair, Dr. Adams was surprised when a security guard approached and said someone had just reported an Indian in the doctor’s lounge.
“This had happened to me many times,” he said.
“I just laughed and said, ‘Yeah, you’d better damn well get used to it.’”
A recent survey of indigenous medical students at UBC found that 31 of 32 reported similar incidents of racism.
Dr. Adams said it may be inevitable, but today’s students must not be discouraged, nor expected to shoulder the problem by themselves — it’s the system that needs to change.
Already, there are signs of change in health outcomes from the First Nations Health Authority, including early evidence of declines in infant mortality and youth suicide.
Dr. Adams also spoke about one patient, an elder and matriarch he knew well as a boy, who fixed in his mind just what a doctor can be.
On his last shift at a small health clinic — the same day his sister happened to be graduating as a social worker — the elder came in just before 5 p.m. with an irregular heartbeat.
Another doctor wanted to send her to hospital by air ambulance straight away — the clinic didn’t even have a proper heart monitor. But she didn’t want to go.
“I’m old, I’m ready, let me stay,” she said.
Dr. Adams wound up staying the night, holding her pulse in his hand. Around 7 a.m., her heartbeat spontaneously returned to normal. She was fine.
Later, the woman’s grandchildren saw Dr. Adams on the street. She had lived another six months, they said, and they tried to thank him for saving her that night.
Dr. Adams told them that really, he hadn’t done anything — he just sat there.
“No,” they told him. “She said to us she didn’t want to die on your watch.”
Dr. Adams took the words to heart, and a guide for his work as a doctor.
“Even at the end of her life, she was still thinking of others,” he said.
“Being someone who our ancestors would be proud of.”
The Early Learning Forum is organized by Haida Gwaii Child Care Resource and Referral, School District 50, Maternal Child and Health, and Success by 6.