Senior officials identify problems of racism in N.S. health-care system

Nova Scotia doctors and health-care professionals who are not white face racism from colleagues and patients, unequal access to job opportunities and promotions, and barriers to even entering the medical field.

Those problems are now prominently on the desks of the province's most senior health-care leaders, identified in a report advanced by the former CEO of Nova Scotia's health authority and in the briefing book prepared for Health Minister Michelle Thompson when she was sworn in last year.

None of the information is new or comes as a surprise, particularly for those who live that reality. But Dr. Babar Haroon, a critical care and internal medicine physician who also teaches at Dalhousie University's medical school, said having such problems highlighted for health-care leaders at the highest levels means it's in front of the people who need to hear it.

"It's that allyship that I talk about often, that it shouldn't really be myself and my colleagues who are from a minority — either visible or non-visible — advocating for equity in this realm," he said in an interview.

Thompson's briefing book, a copy of which was released under freedom-of-information legislation, includes frank assessments about equity in the health-care system, such as:

• There aren't enough non-white doctors and health-care workers.

• Immigrants and internationally trained practitioners face barriers entering the field.

• Practitioners face racism from within institutions and from patients.

• There is a lack of engagement, or over-engagement without action, with racialized communities.

The Nova Scotia Health report is equally blunt.

• Read the provincial health authority report

Just a few months before he was dismissed from his post by the incoming Tory government, then-CEO Dr. Brendan Carr delivered a report called Addressing Racial Injustice Within Nova Scotia Health.

Stories of racism

In that document, Carr writes that the intention is to begin a conversation within the organization about how racism and health inequities manifest and what can be done to address the barriers Black, Indigenous, people of colour and other marginalized communities face.

Carr writes that the report, which lays out next steps, is the result of work by a variety of committees and meetings with people and groups inside and outside the health authority willing to share their experiences.

"The stories I heard reflect ignorance, implicit and/or unconscious bias and racism that ranges from overt to subtle," he writes. The report goes on to say:

"We need to become an organization that truly values diversity for what it brings in [terms] of improvement and outcomes — not simply because it's the right thing to do."

The problems are pervasive throughout the system, including for medical school students and residents.

Maritime Resident Doctors, the group that represents the approximately 600 medical residents training through Dalhousie University, does an annual survey of its members on a variety of issues. The most recent results show 25 per cent of 300 respondents reported experiencing harassment or intimidation at work, while 15 per cent said they experienced discrimination.

Dr. Courtney Gullickson, president of Maritime Resident Doctors and a third-year pediatrics resident, said the numbers show there's still much work to do. She pointed to the recent example of Dr. Hayam Hamodat, a medical resident who spoke out last year after a patient refused treatment from her and asked for a white doctor.

It can be a challenge for people to come forward, however. Medical students and residents might worry speaking out could affect career prospects, while practitioners in general could be worried their concerns will not be supported.

"Feeling safe and comfortable bringing up those concerns is sometimes a challenge because of those power dynamics," said Gullickson.

Dr. Gaynor Watson-Creed, assistant dean of serving and engaging society at Dalhousie's medical school, said these sentiments stem from lived experience for health-care professionals in a system that too often looks the other way when confronted with racism.

Watson-Creed said the dismissal of such concerns doesn't have to be overt.

"It can be as simple as somebody in the system saying, 'Are you really sure that what you think you saw or heard is actually what you think you saw and heard, and not an overreaction?'"

Such responses compound situations that are already disheartening, she said.

"And so you only have to go through that a few different times or see it — somebody else, you know, another colleague go through it a few times — before you think twice about wanting to engage in a system that might treat you that way instead of bringing some compassion to your claim, particularly when you're already feeling damaged by the circumstances that have happened."

Thompson, the province's health minister, said these are issues she's working on and is committed to finding ways to improve.

Thompson said she heard similar concerns from people directly during the listening tour she did in the fall with Premier Tim Houston and senior health-care executives. She also has regular meetings with a variety of community groups in an effort to build relationships and understand the access challenges patients from diverse backgrounds face.

"I think being available to people and being willing to listen and hear and act on their concerns is important," said Thompson. "People need to see that we support them, and that there's action behind what we say."

The minister's work is aided and informed by the department's division of equity and engagement, which was established last spring. John Ariyo, the division's director, said the purpose is to guide department officials, do community engagement and collect data, all with the aim of making a plan that can improve outcomes.

"At the same time, that will make ourselves also accountable to the public," he said.

A need for education

For both Watson-Creed and Haroon, any progress must include education.

That means white practitioners learning about the experiences of their non-white colleagues, as well as developing an understanding of challenges unique to diverse patients.

Non-white patients can often be dismissed as being difficult, said Haroon, without practitioners considering the reasons why they might approach the health-care system with skepticism or fear in the first place.

This is where learning about and trying to understand differences becomes vital, he said. Contrary to what some people might think, said Haroon, it isn't about learning to "not see colour."

"If you don't see colour, you're really not seeing that person or that individual. You need to see colour and acknowledge the differences and then understand what it is."

Increasing awareness

Watson-Creed said she's seeing signs that people are ready to have these conversations and that they want to learn, something she attributes to growing awareness since 2020 of movements such as Black Lives Matter.

Along with other colleagues at Dalhousie, Waton-Creed has been helping run a voluntary clinic where faculty and staff can discuss the role whiteness plays in the health-care system and how it contributes to racism. In the spring it will open up to students and medical residents.

Her colleagues are receptive to having the conversations and the efforts are contributing to more awareness, said Watson-Creed.

"That fact that my colleagues are willing to come to these clinics and willing to have these conversations … I think is a testament to how hungry people are to actually get into the realness of this conversation and maybe not the superficial type of conversation that we have been used to be having up until two years ago."

For more stories about the experiences of Black Canadians — from anti-Black racism to success stories within the Black community — check out Being Black in Canada, a CBC project Black Canadians can be proud of. You can read more stories here.

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