MJM MedTalks
A Conversation with Dr. Samir Shaheen-Hussain

S01E01

Susan Wang, Tom Lee, Saman Arfaie and Samir Shaheen-Hussain for the McGill Journal of Medicine1
Published online: May 1, 2023

1McGill University
mjm.med@mcgill.ca

Abstract

McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the McGill Faculty of Medicine and Health Sciences are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where faculty members can share information and advice for trainees in healthcare and medical sciences. In this episode, McGill medical student Susan Wang interviews Dr. Samir Shaheen-Hussain about his new book, “Fighting for a Hand to Hold: Confronting Medical Colonialism Against Indigenous Children in Canada”. The conversation is divided into three parts: 1) personal questions about Dr. Shaheen-Hussain’s work in social justice, 2) questions regarding the book, in particular on aspects of anti-indigenous systematic racism and its interplay in Canada’s current healthcare system, and 3) advocacy and burnout-related advice for medical trainees. This podcast interview is also accompanied by a book review and reflection, titled “A Medical Student’s Perspective on Fighting for a Hand to Hold”, available at mjmmed.com. The show notes include a transcript of the podcast, time stamps, and resources and references. This podcast is produced and edited by MJM’s social media team, Tom Lee, Saman Arfaie and Susan Wang and transcribed by S. Wang.

     

Content overview

0:15 Introduction and Abstract by Saman Arfaie;

2:00 Introduction to book by Susan Wang;

2:45 Land Acknowledgement;

3:25 Interview Part 1: Dr. Shaheen-Hussain’s background and work in social justice;

9:42 Interview Part 2: questions about the book, “Fighting for a Hand to Hold: Confronting Medical Colonialism Against Indigenous Children in Canada.” ;

24:30 Interview Part 3: Advocacy and burnout-related advice for medical trainees;

32:14 Conclusion;

Glossary

Links and papers

Transcript

0:17 Saman Arfaie (SA): Hi everyone. Welcome to McGill Journal of Medicine Podcast Series: MedTalks. This is the first episode in a series where we interview faculty from McGill’s Faculty of Medicine and Health Sciences focussing on advice for medical trainees on topics pertaining to career, research, advocacy, and more. My name is Saman Arfaie and I am a first-year McGill Medical student at McGill and the Social media Co-lead at McGill Journal of Medicine. It is my pleasure to introduce this highly informative interview that was conducted by my colleague, Susan Wang, also a medical student at McGill interviewing the physician-author Dr. Samir Shaheen-Hussain about his new book, “Fighting for a Hand to Hold: Confronting Medical Colonialism Against Indigenous Children in Canada”, published with the McGill-Queen’s University Press. This conversation is divided into three parts: Part one) personal questions about Dr. Shaheen-Hussain’s work in social justice, part two) questions regarding the book, in particular on aspects of anti-indigenous systematic racism and its interplay in Canada’s current healthcare system, and finally, part three) advocacy and burnout-related advice for medical trainees. This podcast interview is also accompanied by a book review and reflection, titled “A Medical Student’s Perspective on Fighting for a Hand to Hold”, also written by Susan Wang, available on our website at mjmmed.com. Hope you enjoy!

2:03 Susan Wang (SW): Welcome to MJM’s first podcast. My name is Susan Wang and I’m a second year medical student at McGill University. Today, we will be interviewing Dr. Samir Shaheen-Hussain, an emergency pediatrician at the Montreal Children’s Hospital and associate professor at McGill’s Faculty of Medicine. He is joining me today to discuss his new book, “Fighting for a Hand to Hold”. It was published in September 2020 by the McGill Queen’s University Press, and centers around the topic of medical colonialism against Indigenous children in Canada. La version française, “[Plus] aucun enfant autochtone arraché”, a été publiée en février, 2021 par Lux Editeur.

2:45: Before beginning, I would like to acknowledge that at the time of recording this interview, we are located upon unceded Indigenous lands. Tiohtià:ke, or Montreal, is historically known as a gathering place for many First Nations. Particularly, the people of the Kanien’kehá:ka Nation, who are the rightful custodians of the lands and waters upon which we are situated. Today, Tiohtià:ke is home to a diverse population of Indigenous and other peoples. We respect the continued connections with the past, present and future in our ongoing relationships with Indigenous and other peoples within the Montreal community. This land acknowledgement has been adapted from the Concordia Indigenous Directions Leadership Group.

3:25: For this MJM podcast, my guest discovered his interest in advocacy during the formative years of medical school, whereby global and local electives exposed him to pervasive health inequities that exist in Canada and beyond.

3:40: We will start the interview with a few personal questions for Dr. Shaheen-Hussain. Can you please speak a bit about your involvement in social justice work?

Dr. Samir Shaheen-Hussain (SS): My involvements initially were definitely Indigenous Solidarity, but then after that, I also got involved in migrant justice, and anti-police brutality work, among other things. And I guess it’s hard to separate out these things… one example that many of us talk about is the example of Kimberly Gloade, who is a Mi’kmaq woman from out east, but who was living in Montreal. She basically was not feeling well, this was in 2016, went to the McGill University Health Center for care, and she didn’t have her Medi-Care care with her. She was told she would have to pay $1400 upfront to be able to get care. She couldn’t afford that, she went home and then she died at home, like several weeks later. She was, you know, treated horrifically, because effectively she was denied care, but the fact that she was told that she has to pay $1400, that policy is actually a government policy that’s in place essentially to dissuade people who are uninsured from accessing healthcare. So, in fact, the same cost for example if you go to the emergency room for a regular visit, it costs several hundred dollars, let’s say, the system? But they, basically, the provincial government has this policy in place where, for people who are uninsured, they multiply that cost by three, essentially. So it’s a 200% surplus, that then they charge people who don’t have insurance. And so, in Kimberly Gloade’s case, she actually made this connection herself in a letter that she had written to her mom that she had never got around to sending to her mom, where she basically said something to the effect of, you know, ‘being someone without my MediCare care in Montreal is like being a migrant in Alabama’. And so she kind of made these connections between anti-migrant sentiment and anti-Indigenous sentiment. And it also just speaks to how many Indigenous Peoples are forced to migrate within Canada, but they’re migrating to places that are not their historical lands as a result of forced displacement and things like that. So- so all these things kind of I guess, connect, in these different ways, so some people when they, I guess, hear those of us who are involved in things like migrant justice and then police brutality or… they kind of don’t really see the connections? But then if we step back, it’s easier to, I think, see how these things are connected.

6:19 SW: How has your clinical practice changed since you started the campaign and since you’ve been writing the book?

SS: To be honest, I’m not sure that my clinical practice persay has really changed that much in the sense that I’m even more aware and attuned, I guess, to circumstances and situations where we are kind of part of this system that actually seems to inflict harm on the people that we are trying to care for at times. And it’s- I think it’s less in pediatrics, to be fair, than it is in the adult world, but as exemplified by, you know, this practice that was in effect until 2018 of, like, separating caregivers from their kids, it’s still there. And so, I think it’s kind of forced me, even though, it’s like, these issues are not new, but even for me there was kind of like this artificial separation of like, when you go in to the hospital, you know, you still see these things, but sometimes, a lot of these practices and policies seem like they’re so firm and so set, it’s difficult to change them? And I guess, in its own way, the involve - my involvement in the campaign made me realize that we need to push to change these things because if people who are aware of these issues don’t do it, then it’s not gonna kind of happen. And, I mean, as I mentioned in the book, and it’s not new but, it’s not neutral terrain, it’s a territory of work that is imbued with a history, and that we can’t ignore that history, basically.

SW: You quoted a lot of inspirational figures in the book. Is there one person you could consider your number one role model?

SS: It’s funny because, actually I was a bit torn about using all those quotes and some people, including my partner, made fun of me for that, because I’m actually kind of critical of culta personalities and, like, elevating individuals to the stature of, like, monuments. But at the time, a lot of the people I quote, when I read their work or when I heard about their work, did have an influence on me historically. So a lot of the quotes that I used and traced, in some ways, obviously I wasn’t able to use everybody, people who had an influence on me and my own politicization process, I guess? But I don’t feel I’d be able to suggest one role model, and in fact, I have to say that for me to be completely honest, the most I’ve learnt, the people that have helped me grow the most are actually people who will probably never be recognized in books or in documentaries or in newspaper articles, because the people that I’ve organized with, that are basically part of different collectives, or that I’ve met, and through that work to do kind of this work on the ground, but who are brilliant people, who are really caring people. I think those are the ones I’ve actually learnt most from. And often, in a true sense, I guess, as in role models, in the sense that a lot of what I’ve learnt from them is based on just their own, you know, their modeling certain actions and certain behaviours and also sharing their knowledge and then so much of that comes through when people work together and organize together, and it’s so much more powerful than a some quote I end up using to start different chapters of a book.

9:44 SW: The next section of the interview is comprised of questions pertaining to the book. More of a commentary than a question, on page 11 of Fighting for a Hand to Hold, you were introducing the Hand to Hold campaign when you wrote, “I didn’t expect the issue to become as political as they did, in retrospect, it was a silly assumption. For some reason, I had failed to recognize this ongoing injustice as one that went beyond a simple Medevac practice. Like most other injustices, it was rooted in political, economic, and social oppression. Ending the practice would require digging to the roots of the problem.” This quote really resonated with me. It made me realize that we have to get political if we want to enact change, even if it’s uncomfortable most of the time to do so.

SS: For sure, yeah. And I think there’s often, yeah, this feeling, that you know, people hesitate to get involved out of concern of being too political, but I try to address this in the book, as well. There’s just no such thing as being neutral, right? Like you can choose to ignore political realities and historical realities, but that’s not being neutral. That’s still being, you know, then in that case, being ignorant, but as a result, complicit in injustices that, that continues. So I think it’s just a question of - everyone, everything is kind of political. It’s just really a question of how much we engage with it and how much we are conscious of it in terms of how, how it impacts us and the world around us.

SW: I personally found that the book was really hard to read. Especially part three, where you detailed medical colonialism using Indigenous children as an example. In your research, what did you find was the most shocking injustice towards Indigenous people?

SS: It’s tough to answer that because it’s really difficult to find or suggest one particular example that’s like the most egregious or that’s the most horrific? Between, like, colonizers, you know, intentionally spreading smallpox, like, on the West Coast, in the mid-1800’s, to kids being enrolled in nutritional deprivation studies, to Indigenous girls being sterilized, to… you know, like, how do you… you can’t… I feel like you can’t choose a single injustice. I think the most shocking element to me… there’s actually two, there’s… one is that, even the examples, and like you said, I know that, that part three is hard to read, but even then, there was a lot of stuff I didn’t include. I think that’s… that in and of itself, is shocking, is that this is not an exhaustive or comprehensive study of the issue, I mean I basically wanted to make the argument that medical colonialism is very much a real thing, and that Indigenous children have been targeted, historically. But if we wanted to be detailed and comprehensive, there are a lot, a lot more examples that could be included. And so that’s I guess, one element that is shocking? Is that this is not comprehensive. And the other is that these examples are not more widely known. I think that in and of itself is shocking, too, right? Like, and I’ve noticed it now, I mean the last few weeks, I’ve had the chance to, you know, speak at different events, but including often times with, you know, medical students and often healthcare students and trainees and in many of these events people are surprised at many of the examples I bring up. Some people don’t even know about like several entire chapters, basically, that I talk about. That’s not necessarily you know, that’s not their fault, it’s kind of, like, the fault of our curricula, like our medical curricula that do not include this history. That to me is shocking. And these are things, this has come up in talks, in presentations that I’ve given too, is that when there have been Indigenous people that have been attending, some of them have shared how they have been bringing up these issues for years, right? And the Indigenous communities have been bringing up these issues for decades and it’s often ignored. Those voices are often ignored or silenced. And so, that’s significant to me. That’s shocking to me, that, you know, this history that goes up until the present is there and we… still many of us didn’t know about it. I think in medical school, the other element is just that, you know, I think there’s just going to be a certain level of discomfort. It’s going to be unsettling that this establishment, this institution that many people who come into it, you know, and think that it’s like this benevolent institution, and truthfully, you know, I think that most people who get into medical school and caring professions and caring work, do just want to, you know, like , help people and make a difference… And I don’t doubt that sincerity, but yeah, but I think that the establishment and people involved with it really have... it’s hard to be able to recognize that there is this history, but I feel like it has to be dealt with, otherwise we’re not going to be able to move forward.

SW: What was the research process like for you?

SS: In fact, when I’d pitched doing the book… It’s perhaps a combination of my own ignorance of the process and possibly a little bit of arrogance, I don’t know… but I actually thought that I’d be able to write it in like, a few weeks? In fact that’s kind of when I, you know, when I was discussing with my editor I was like ‘yeah, I could probably write it in a few weeks, like three or four weeks’, even in my head. And the reason it was already written in my head, I thought, is because a lot of the research I had already done for the testimonies I did on behalf of the campaign in 2018 at the Viens Commission. Because that required a fair amount of research and I also, a lot of, you know, a lot of people helped and sent references and sources. And so basically in 2018, I feel like I did a fair amount of the, like, preliminary research that ended up being used in the book, and in 2018 I had absolutely zero intention of writing a book. At least initially, when the campaign was launched, it was kind of written in my head, or so I thought, and when I initially writing the manuscript in like, May-June 2019, I still thought that up until July, when I started working on the medical colonialism section, and it’s when I started working on that, even though I thought I had, again, like everything I needed, but then when I started reading more and more and more, then it was like I was mentioning earlier, it’s just that it was just so much. Which is kind of horrific, as well, right? And I think that was what was a bit jarring, was that there is so much out there, and including in different forms, right? Like, some of the research just also meant just talking to people. Including folks from different Indigenous communities about their experiences with healthcare and through some of those conversations, you know, someone would mention, ‘oh, there’s this documentary’, and ‘oh, there’s this book’. A lot of it ended up being that way. So yeah, it kind of like, you know, a lot of the core work I feel had been done, the framework was kind of a lot already there, but definitely the medical colonialism section I really had to focus on a bit more… and the other element that changed things, how the research and the writing went was in June of 2019, was when the National Inquiry into Missing and Murdered Indigenous Women and Girls came out with their report, their final report, which concluded that a genocide has taken place here. And I mean, I mentioned this in the book, but they got backlash for that conclusion. What I don’t mention in the book is that’s actually when I decided actually to reframe the whole medical colonialism section based on the UN convention on genocide. It was kind of to support the National Inquiry’s report and their conclusion and so, and so again that, once I decided to do that, then it also meant that I would have to dig deeper, cause I knew just like they did that there would be a lot of backlash when this book comes out, because people are not going to wanna accept that there’s been a genocide that’s occurred. So that was a significant element of the research. And the other thing that was tough and that I had to decide on was… you know, at one point it felt like it was just too heavy, and at one point I was also not sure whether I should be the one who’s writing this. But, ultimately, I think I kind of decided to go ahead for two reasons, one is that I felt that the story around the campaign needed to be told, and part of that I feel was also tied to many of the kids and families I had seen and worked with throughout the course of the campaign. Like, I kind of feel like, that their voices I felt like needed to be shared. And then the other element was I did not want to tell the story or the stories of Indigenous children and their families and their experiences but what I wanted to do was to tell or to convey the role that the medical establishment has played, and I kind of feel like I’m in a unique position to be able to do that? So that’s kind of, those are the two reasons why I decided to go ahead and complete the manuscript, I guess. But at one point in the middle of it I was definitely, like, hesitating, I was struggling with these questions. But at the end of the day, I think it was the right, the right decision, and I think especially in conversations I’ve had with, again, folks from different Indigenous communities, many of whom I’ve never met before, it seems like that’s been appreciated. It’s really kind of just, not appropriating the voices of Indigenous children and their families but really speaking from within the medical establishment to be able to highlight and point out all the injustices that it's been part and partial of over the last decades.

SW: What are some of the key things that you would like medical students to take away from the book? What are the takeaways for the general public?

SS: I mean, I think for medical students, one of the most important things, for me, would be first recognizing that medical colonialism exists. You know, in the book and the introduction actually, I share a quote from a former pediatric resident who used to work at the children’s and had actually taken care of a lot of these kids who were sent alone, and when the campaign had launched she wasn’t at the children’s anymore, but she emailed me a few weeks after the campaign was launched, and shared how she had taken care of a lot of these kids, and was glad that this campaign was happening. And she basically said, ‘we knew it was the rule, we knew it was awful, and yet we just kept going’. So ultimately I think for medical students, my real goal is that we don’t just keep going. And that’s one of the main reasons why I wrote the book. What that tangibly I guess would also mean is, it’s not just simply a matter of being aware. That’s a first step, for sure, but what matters is what we do with our awareness and what we do with our knowledge, right? We can make that analogy, even with medicine, in its own way, like if we have knowledge about physiology and pathology and pharmacology and all kind of this stuff, like, that’s great if you have knowledge, but it means nothing unless you apply it, right? And so, similarly, I feel like we can have knowledge about medical colonialism and know that it existed, but it means nothing just knowing that it existed, we have to actively make sure that we’re confronting it and probably one of the most important ways of doing that is figuring out how to be in solidarity with Indigenous communities fighting for social justice in that context. So that’s kind I guess my hope for medical students. And definitely, the hope is that medical students shake off the assumption that in medicine we’re apolitical or that we’re neutral. We need to get beyond that, because, again, that’s just not true. And then for the general public, I’m definitely hoping that the book is going to reach the general public, and my sense is that it will at least to a certain extent, maybe to a larger extent, maybe we’ll see with time… but the goal really… There’s a few. But one is even for the general public, I think it’s important to know that the veneer of the medical establishment, of being this benevolent institution, is kind of not really founded, right? Like there’s not really any basis to have that belief, and if we’re talking about, you know, the province of Quebec or even the rest of Canada or beyond that, I think the recent like, brutal death of Joyce Echaquan like from a few weeks ago, shows us that systemic racism is very much a core part of our healthcare system. And I think this book helps show that in a certain respect? Especially because in the book, that’s one of the reasons why I focussed on Indigenous children, I guess… I mean, I’m a pediatrician, so part of it comes from that as well, but, you know, I think for the general public, the question that it also raises, is when we’re talking about the Hand2Hold campaign, it focussed on, you know, relatively, you can argue, a marginal issue, but if the provincial government took decades to change it, to change that practice of non-accompaniment, of separating families, for a practice that disproportionately impacted Indigenous children, then what can we expect of different governments at different levels when it comes to broader issues impacting Indigenous communities, right? And I feel like there’s a very pervasive and dangerous framework around reconciliation that ignores history and ignores calls for reparations. And so, one of the points for the public I think is to bring these issues more to the forefront so that we can kind of yeah, engage… engage with these issues in different ways and find a way to pretend like we’re not a post-colonial society, or post-racst society which is obviously not the case.

24:35 SW: Next we’re going to move into a section about general advice. We hear a lot about physician burnout and compassion fatigue. Is this something that you have personally experienced? And what advice would you give to a student in healthcare who wants to devote their time towards advocating for important issues while balancing the demands of school or work?

SS: So I guess in terms of the first question, in terms of you know physician burnout, compassion fatigue… I mean there’s no question that you know working in healthcare takes a toll, right? It’s a significant - it’s a significant emotional, psychological, physical load, including dealing with suffering, dealing with death, having to be very present in many ways, in all kinds of different clinical contexts and clinical encounters. And so I guess in that context, it’s really important, and I think for me, what’s been grounding has actually been being part of you know, collectives and movements that go beyond the walls of the establishment? And because I kind of feel like if it wasn’t for that, I would feel way more isolated and overwhelmed if various parts of my, you know, when I was a medical student, when I was a resident, since I’ve been a staff. And it’s, a lot of my work, I guess, outside of the hospital that, it’s not that it’s lighter, when we’re talking bout doing migrant justice work, we’re talking about deportation and detentions, when we’re talking about police brutality work, we’re talking about people who have been killed by police, like it’s not like it’s lighter in any way at all. But being with people, and mobilizing and organizing with a common goal or a common view of living in a better world, basically, when I’m talking about social justice, that’s basically what we’re talking about, you know, where people you know are free to reach their full potential, and people aren’t depressed and exploited… Having those relationships and being involved in those movements makes it much easier, I think, to deal with the burden of putting in work. Not that it takes them away, and it’s still a tough balancing act, but I feel like it’s grounding, and it can be very difficult, but it can also be very inspiring. And so in terms of, you know, the kind of, segueing into your second question around, for students, how to balance? You know, I think it’s fortunate in a way that students have to balance what's considered as being as part of the, you know, medical curriculum, with “other” and I put these in quotes, things that are considered essentially curricular, when in fact students are doing work that addresses issues of all kinds of things, access to healthy foods or better schools or neighborhoods, or ensuring interpretation is present in hospitals, like I’m just thinking about different projects that medical students have been involved with in the years, let’s say. The fact that it’s kind of given a few hours per semester, but is not in my opinion, still yet regarded as being like a core, like it’s precisely this thing where students have to balance, I find that really unfortunate and I hope that in the next few years, with students kind of pushing back on these issues, there’s going to be a recognition of at the level of, you know, people who, you know, are at the various Deanery levels, basically, that essentially what it comes down to is addressing social and structural determinants of health actually makes way more of a difference on a population level, from a public health perspective, than does knowing various points around physiology or pathology or pharmacology, right? Like I’m not saying those are not important, but it’s really important to be engaged in the society that we live in, and unfortunately, medical school as it currently is framed, almost takes medical students away from the society that they’re living in and that I think is harmful longer term, cause then at some point we’re gonna be… you know, people are gonna be doing clinical work with people with whom they feel they’re completely disconnected.

SW: What advice would you give to a student in healthcare who wants to improve healthcare for Indigenous People?

SS: The easy, I guess, answer, is listen to what Indigenous communities are and have been saying for so long. And I think tangibly, a first step certainly would be, and it definitely doesn’t have to be my book, I just think people need to recognize the role that the medical system has played in colonization and colonialism. That’s important. And then tangibly, in terms of providing care, I think you know that the idea of cultural safety is really important, but this is one of those things, too, that I kind of worry that it’s going to get depoliticized over the next few years. Especially when, you know, like, the provincial government is fully supportive of it? Like, when that happened I sort of started wondering, why are they so supportive of it? Because in principle, you know, cultural safety, when you actually look back and understand where it came from, you know, it was.. It would, it goes without saying that it would… it goes on assumption that systemic racism is a real thing, right? Cultural safety? Whereas the provincial government says that there’s not, or acknowledge the very existence of systemic racism? And the reason I mention, like its original intent, is that one of the people who developed and popularized the notion of cultural safety was a from a Maori nurse in New Zealand, who in the 1980’s started thinking about this concept, but she very, very explicitly, and I kind of mentioned some of her work in the book, frames it in the context of colonialism and imposed cycles of poverty. So, for her cultural safety, like an element of it was kind of reversing the power dynamic that exists between a practitioner and a person seeking care, and forcing care providers to recognize our own privilege and power in terms of when we come into a given clinical encounter, and figuring out a way of re-equilibrating things, essentially, such that the person receiving care has more control and autonomy over the care that they’re receiving. So that’s kind of a core of cultural safety and if those kinds of trainings are led by folks from different Indigenous communities, I think that would go a really, really long way to improving clinical care for, you know, current trainees as they kind of go into practice in the next few years. And the other point that i think that, you know, many of us highlight is that cultural safety, even though it’s kind of, you know, its roots are tied to, you know, confronting colonialism, essentially, when you adopt a lot of the mindset and the thinking and the knowledge that comes from cultural safety training, the benefits rae actually gonna be felt by not only Indigenous patients, but everyone, in all likelihood, because it just focuses practitioners to frame how we approach clinical encounters all together, right? And so that’ll only have positive effects on various forms of care.

32:18 SA: This podcast was edited and produced by MJM’s social media co-leads, Susan Wang, Tom Lee, and myself, Saman Arfaie, with input from the rest of the editorial board. Be sure to check out the accompanying book review and reflection available at mjmmed.com. We hope you enjoyed the content and stay tuned for future episodes! Have a wonderful day. Good bye



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