Surgery more dangerous for Indigenous people, Prince George doctor says
Indigenous patients in Canada are 30% more likely to die after surgery than other patients, according to a new study.
Indigenous patients in Canada are 30% more likely to die after surgery than other patients, according to a new study. And that won’t change without transformational change to tackle anti-Indigenous racism in healthcare systems in British Columbia and across Canada, according to Canada’s first female First Nations surgeon.
A recent review of 28 studies co-authored by Prince George surgeon Dr. Nadine Caron, who also teaches in the medical programs at UNBC and UBC, found that after surgery, Indigenous people die in a rate 30% higher than other patients.
Indigenous patients also experienced higher rates of infections and postoperative complications than others, despite less frequent surgeries.
The data did not surprise Caron or his co-authors, Dr Jason McVicar and Dr Alana Poon, but it does raise critical questions about the cause of the poorer results. Are patients waiting longer for surgery or are they suffering from poor health that increases their risk?
Caron said it’s important to go beyond these basic questions and look for the underlying causes.
“Is it because of delayed access?” So why is there delayed access? Is it because of the lack of use of health services or their absence at all? Asked Caron, who is a member of the Sagamok Anishnawbek Nation in Ontario.
All of these problems are compounded by rampant anti-Indigenous racism in the healthcare system, as seen in the In Plain Sight report released in November.
Racism also puts Indigenous peoples at increased risk of chronic disease and premature death from causes such as toxic drugs.
Caron, who is co-director of UBC’s Center of Excellence in Indigenous Health, said the relationship between Indigenous peoples and the health system needs to be carefully considered.
“Isn’t the problem particularly access, but the lack of access to culturally safe care, to a racist-free health system anchored in the walls of the institutions into which indigenous peoples must enter? she asked.
Surgery is an essential part of health care, Caron said. But there is so much more to health than how well things go under the knife.
The need for surgery may represent a failure of health services to prevent a disease from worsening due to factors driven by systemic racism. Evidence of poorer outcomes demonstrates “the need to ensure that we address the In Plain Sight report and eliminate racism and racism specific to Aboriginal people as a whole in our health care system,” said Caron.
Many Indigenous patients have their concerns dismissed, delaying things like cancer screening. Others avoid care altogether because of past experiences of racism. Both contribute to worsening health, increasing the chances that they will need surgery, and delays in needed treatments.
“Screening for breast cancer, colon cancer or cervical cancer can actually play a preventative role in the need for surgery for these types of cancer,” Caron said.
Cultural safety and anti-racism work are essential in all settings, not just in the operating room, she said. Physiotherapy, massage, and follow-up appointments with a surgeon and family doctor can be essential to detect any complications in time to be treated and corrected.
And the underlying causes of poor outcomes, such as poverty and lack of access to clean water, adequate housing, drugs or medical supplies, need to be addressed, she added.
For Caron, there is a difference between natural barriers like distances to travel from remote communities and barriers that the health care system has the power to change.
Prince George, where Caron practices, serves as a hub for patients from many northern and remote First Nations communities who travel by air or travel long distances for treatment.
The city has even fewer specialized health services, such as physiotherapy or surgery specialists, than Kamloops or Vancouver.
The health care system has “a moral responsibility to remove” barriers, she said. “The fact that you have to travel further afield when you live in a rural remote northern community is something that you cannot control,” she said. But the health system must recognize the challenge and identify solutions that ensure effective care.
The First Nations Health Authority moved quickly to virtual health care during the pandemic, for example, a strategy, Caron says, can make follow-up care more easily accessible to rural and remote First Nations people now and in the future .
The province also pledged to implement the 24 recommendations of the In Plain Sight report, promising “transformational change” to address anti-Indigenous racism.
But Caron says that as the province works to create cultural safety in all corners of the health care system, First Nations, Inuit and Métis communities and individuals must be at the center of the process.
“We need to make Indigenous voices heard and we need to research specifically with and by First Nations, Métis and Inuit peoples in order to find answers and solutions for our people,” said Caron.