'We can't be afraid to talk': Young Montreal nurses call out mistreatment of Indigenous patients

WARNING: This story contains medical details related to rape

A group of young nurses and their professors say they need to speak out about the mistreatment of Indigenous patients they've witnessed within Montreal's health-care system, particularly involving people experiencing homelessness.

"We can't be afraid to talk. We can't be afraid to speak up, and that's what we're doing," said nurse Tanya Giapitzian, because "those prejudices led to medical errors."

The nurses, all in their early and mid-twenties, work a clinical rotation at the Native Women's Shelter and described how they saw discrimination play out in hospital emergency rooms and with paramedics.

They describe a lack of access to rape kits, language issues, and seeing an injured man being dropped on the ground.

They've chosen not to name the Montreal hospitals where the incidents occurred because they've witnessed similar experiences at several institutions and see it as a widespread, systemic problem.

"We should be exposing [these stories to] not only the population but to our colleagues, other nurses, other doctors," nurse Sabrina Bedard-Theriault, said. "It just helps us give better care."

Going public is not easy. It's even harder to speak up when a derogatory comment or biased decision comes from a colleague - especially one with more seniority.

But their professors at McGill University's Ingram School of Nursing are training them to do it if they can.

"Everybody has to be treated humanely, and you have to be open-minded and try as much as possible to speak up," said assistant professor Francoise Filion. "But it's hard. It will take courage, and it takes also someone to support you."

DENIED ACCESS TO RAPE KIT

A few months ago, the nurses convinced a woman with severe vaginal bleeding to go to an emergency room for a rape kit examination.

"Our women on the street are living a lot of harassment. Some are raped after being drugged," said Lucie-Catherine Ouimet, a faculty lecturer who runs the community clinic and supervises students.

The woman was afraid to go to the hospital because of past experiences.

"Sometimes the context makes it so that if we go to that hospital, they won't let you be seen because you're Indigenous or because you're under the influence," Ouimet said.

The patient's fears were realized.

"The social worker that was filling in the criteria didn't speak English that day, so she said she couldn't see that person," said Ouimet.

Two nursing students, both fluent in French and English, were with her and advocated on her behalf.

"They were very frustrated at the situation," she said, especially since they were then asked to take the ailing woman to a different hospital by ambulance.

The experience at the second hospital was no better.

"My student nurse wasn't even listened to. She arrived, told the whole story, [shared] the nursing notes that we had and she was set aside, ignored," said Ouimet.

"That person finally never saw anyone [at a hospital] and is even more traumatized," said Ouimet, adding that it was not an isolated incident.

Language is regularly an issue regarding access to care, said Native Women's Shelter director Nakuset on Twitter.

"Indigenous folks that don't speak French have been routinely turned away from Notre Dame Hospital," and it's been going on for years, she wrote.

Ouimet agreed it's a problem.

"We have to look beyond all the language issues and language fights and beyond where you come from and where you live, and we need to be a community," she said.

'DROPPED ON THE FLOOR'

The community nursing clinic at the Native Women's Shelter is one of six community clinics in the city set up by McGill's nursing school.

Sometimes the struggle to get their patients the best care starts on their doorstep, they said.

This time, a man outside the clinic had significant injuries and was under the influence of drugs or alcohol, "a reality we often face," Bedard-Theriault said.

They were two nurses and their nursing teacher, yet the paramedics brushed them aside when they arrived, they said.

"We watched the man really be dropped on the floor without any precautions for his head or his spine, when he had pretty significant facial injuries and so that in itself made us -– I felt angry," said Bedard-Theriault.

"I couldn't even put words to my emotions… you're telling them, 'Be careful, he has significant injuries,' and they're not listening. And it's a lot of the reality that happens in the street," she said.

Giapitzian, who was also on shift, said all they wanted was for the ambulance team "to give the same amount of care to that person as they would to somebody else."

ADVOCACY BY SHARPIE

The nurses say they've had to find creative ways to clear some of the roadblocks to care.

Instead of using paper, Bedard-Theriault recently resorted to asking a man if she could write information on his leg with a sharpie before she sent him to an ER.

"I was worried that those assumptions and those biases that I'd come across for the past couple of weeks that I had been doing my stage [internship], would come through in the hospital system," Bedard-Theriault said.

"As much as we want to say that as health-care professionals, we're not guilty of being biased, it's not the truth," she said. "This nurse could avoid looking at that paper, wouldn't care and would just judge the person by the way that they looked."

The man's clothes were threadbare.

"He wasn't even wearing shoes," she said, and he suffered from a severe addiction.

"This guy wouldn't be seen for hours, which means he would go into withdrawal while waiting in the waiting room, which is a disaster," she said, adding that opiate withdrawal can be fatal.

"I took a Sharpie which I always carry around in my bag, and I wrote down on his legs, 'High risk of withdrawal.' And I signed my name and my licence number," she explained.

She was hoping that when personnel saw a message scrawled on his body in marker, they would know he'd already been examined by a nurse and take his leg infection and his situation seriously.

She's unsure if the man ever made it to the hospital but said she did her best to help him.

"It's the most we can do," she said.

'CULTURAL HUMILITY'

Writing on a patient's body might sound drastic, but it's that type of out-of-the-box decision-making she and her classmates are taught at McGill.

They'll come away with a Bachelor of Nursing (Integrated) degree, building on their nursing certification earned in CEGEP.

Part of that advanced study is focused on "cultural safety, about cultural humility, and patient-centred care," said Filion.

"We're talking about inter-generational trauma. We're talking about fear of institution," their professor said, referring to the Indigenous people they help in the community clinics she pioneered.

Filion said when she trained "a long time ago," it was with a "Eurocentric vision.”

If someone had addictions or led a hard life, there was the idea, she continued, that "it's just their fault, you know, it's just like they made bad choices. You were not really trying to learn more about this person."

"What we have to understand when they're coming to us, [is that] they have a family [history], they have baggage. They lived through something, and that's what we have to find," said Filion.

"They're not drinking alcohol because of just anything, like to them it's a coping mechanism, and a lot of people don't see it that way," Bedard-Theriault added.

And it's not just about what happened in the past.

Many don't have permanent homes and "have that lived experience of trauma and past histories in the hospital," said Ouimet.

That painful legacy shows itself regularly, said a third student, Cassandra Caron, who thinks about an interaction she had with one man in particular who came for help.

"You could tell they were in a lot of pain…they were holding their affected limb," Caron said. "And I remember he looked at me, he was crying, he said 'I can't go to the hospital, I can't go to the hospital, I'm drunk, I can't go... I think I'm just going to die like this. I'm going to kill myself because I don't want to go to the hospital,'" she remembered him saying.

"In that moment, I was just so sad because I was thinking, 'Wow, this person would rather kill themselves than go get medical care,'" said Caron.

That kind of darkness is something Ouimet understands better because of her own Indigenous identity and the stories she's heard. Her mother is Anishinaabe.

For First Nations and Inuit people, she said, "sometimes having to see a doctor or be sent to a hospital meant you were never coming back."

So the value of the personalized community clinics in Montreal cannot be overstated, she explained.

"[They] are here to create a link, a bridge, to get certain members access more easily to services that already exist."

But it's still difficult.

"We have to be strong, and we have to also not be discouraged because it's like you're swimming against the tide," Filion said of their efforts to change attitudes.

HOSPITALS, PARAMEDICS RESPOND

The team of five nurses also highlighted some of the successes they've had in creating "corridors of service," for their Indigenous patient group.

One community clinic forged an agreement with a detox centre where doctors there could see Indigenous patients without another doctor's referral, only needing one from Ouimet.

Caron and Giapitzian recalled building trust with a man who didn't take their advice to go to the hospital but sought them out later to tell them he felt better.

"After that, he was able to come talk to us to tell us more of his story, his concerns," Giapitzian said.

But they said more needs to be done to open minds within the health-care sector -- more than the government training that is currently mandated.

CTV News contacted two hospitals with emergency rooms near the downtown core, the CHUM and the MUHC, as well as Urgences Sante, for their reaction to the nurses' experiences.

We asked them if they acknowledge that there is sometimes prejudice against the Indigenous homeless population, and if so, what they are doing to prevent it and raise awareness among staff.

Both hospital centres said they are committed to becoming culturally safe environments for Indigenous people, and both have several related projects on the go.

Just three months ago, CHUM hired an 'Indigenous liaison.' The person will work on a research project on Indigenous wellness and use the findings to help develop training and services, according to spokesperson Andrée-Anne Toussaint.

Toussaint said the new employee would also act as a bridge between the hospital and community groups.

Addressing the language issue, she wrote they "make every effort to accommodate English-speaking clients when required," even though CHUM is not an English-designated centre."

The MUHC directly acknowledged the "particular challenges" faced by Indigenous people living in Montreal, "especially those experiencing homelessness," in a response provided by spokesperson Gilda Salomone.

She said the hospital is committed to increasing efforts "to offer more equitable access to quality care and services, and a culturally-sensitive patient experience."

It will also launch a similar project to the CHUM's, seeking to understand the histories of Indigenous people better so they can include them productively in future decision-making about care and services.

Other initiatives involve changes at the MUHC Birthing Centre, making it easier for people to have a birth experience that incorporates their traditional practices. Patient information will be translated into Cree and Inuit languages.

Salomone said the hospital centre has social workers and liaison officers who work with Indigenous populations.

Urgences Sante's spokesperson Marléne Lessard also addressed the issue, telling CTV that it "does not tolerate any form of racism on the part of its 1700 employees."

Lessard said if an incident is brought to their attention, "immediate action will be taken to correct the behaviour. If necessary, sanctions up to and including dismissal may be implemented."

Paramedics take courses in ethics, she explained, and in recent years received training "to equip workers to interact with people from cultural communities and to combat prejudice."

Lessard said they are "proud to have Indigenous people in our paramedic workforce."

'THE BEGINNING OF A CHANGE'

Rather than getting discouraged by what they see, the young nurses all said they have a newfound sense of humility in nursing and the power to make a difference.

"It lit a fire under our butts. Something our teacher said was, 'Always remember this incident because it will drive you, it will push you to keep working, and it will push you to do better in your community setting,'" Bedard-Theriault said.

Their teachers are grateful the students have picked up their passion for community and public health.

"I would really like the whole population to be aware that there is this movement," Filion said.

"When I hear them speak, it makes me proud," said Ouimet. Most had "never had contact with First Nation or Inuit community members before."

They are part of a new generation of nurses who will "create a safe space to discuss those things," she said. "So it's the beginning of a change."