It is quite fortuitous that on the occasion of Canadian Federal Election, I finished reading” Fighting for a Hand to hold, Confronting medical colonialism against Indigenous children of Canada” written by Samir Shaheen-Hussain. This is a relatively new book published an year ago (September 2020), which I haven’t heard of until I came across Shaheen-Hussain’s interview to New Scientist magazine. The author, Samir Shaheen-Hussain, is a paediatric emergency physician cum indigenous rights activist who played a pivotal role in successful campaign against non-accompaniment rule in Quebec in 2018 (Parents of Indigenous children living in remote areas of Quebec were not allowed to accompany their children when they need emergency medical evacuation). In that interview, he points out that the indigenous children of Canada were used by the Canadian medical establishment, backed by political policies, for scientific experimentation such as tuberculosis treatment, with the fruits of the studies only going to a wider Canadian population while indigenous communities were at the bottom of the list in accessing tuberculosis treatment. They were considered not to be able to be ‘compliant’! Now that hundreds and hundreds of unmarked graves of Indigenous children have been recently discovered in Canada from the sites of former residential schools, mostly run by Catholic churches backed by the government, and that has shocked the entire world and exposed the dark history of Canada, I felt this book was a timely read. The fact that the book is authored by a paediatrician made me think that the book could only be a sort of memoir. However, the author has accounted the real-time experiences from the victims and survivors, insights from peer-reviewed research articles and historical archives, which makes the book richer and its non-linear narrative style makes the readers understand the relevance of the topic even today.

The book is divided mainly into four parts with each part having multiple chapters. The opening part sheds light on the successful #aHandtoHold campaign and the grassroot level collective efforts behind its motive to end the decade-old non-accompaniment rule implemented on Quebec’s indigenous community. These efforts unfolded how Canadian medical field was under the claws of medical colonialism, and that how does it still continue its violent legacy. By the term ‘medical colonialism’ the author describe the genocidal role played by the Canadian health care system in the colonial domination over Indigenous people. The book starts with an individual example from Quebec, to make the reader easy to progress into a bigger picture of the classic, deep rooted colonialism. The author comes across two seriously injured Inuit children who demanded emergency medical beyond their local clinic’s capacity. Accordingly, these kids were airlifted by medical evacuation flight to the Montreal Children’s Hospital, where the Dr. Shaheen-Hussain works. Now the problem comes, their parents are not allowed to accompany them in the same flight. Apparently, the kids reach at the emergency room. They cannot speak any other language other than their native language and there is no translator. This disturbs the author about the parental rights . Their parents were never been consulted for any of the treatments provided nor obtained any consent before any medical procedure, and that these children were sent into trauma as they were left off amidst strangers around and not knowing their language. Later, the author takes the lead to work with the bureaucrats and politicians, however the response was cold. Such initiatives followed by a series of events later, which culminated in the success of #aHandtoHold campaign. At this juncture, the author doesn’t forget to admit to the readers that he is also no different than us, who enjoys all privileges.

After engaging the readers in an active dialogue of how does the medical establishment and the government deals with such scenarios even today, and leaving a message that things like this are not at all a surprise, the author uplifts us to the ‘must read’ parts of the book; part two and three. Second part starts with a thoughtful quote by George Orwell, taken from Animal farm: “All animals are equal , But some animals are more equal than others“. Here, the author describes in detail on the concept of social determinants of health, equality and equity, also discussing their limitations. It makes the readers understand how the “causes of causes” allowed the practice of indigenous people to be marginalised in health care persist for so long due to systemic racism and colonial policies rooted in capitalism. A social-justice approach is used to explain how the government’s non-accompaniment policy, though equally applied to every children, had inequitable consequences on indigenous children, stemming from the underlying inequalities in their basic life. It is quite clear that colonialism was always the mediator in separating indigenous children from their communities, in a most ‘rational’ way in the label of residential schools and later the contemporary child welfare system and now the foster care system, with the trauma being infiltrated to several generations. By discussing equality and equity, and clearly defining various type of racism that have been used by us interchangeably, Fighting for a Hand to Hold chronicles how structural racism works in health care, including in medical training. Shaheen-Hussain points out that even today, women and transgender community are underrepresented in clinical trials generating a gender-based data gaps that continue to be ignored by the medical establishment, and the same applies to racialized people.

The third part is heavily interwoven with history, on the multiple ways that indigenous children have been harmed at the residential schools (that was “supposed to be” for the welfare of indigenous children) by Canadian medical professionals, sponsored by colonial policy of the government, corporates, bureaucrats and institutionalised racism. The most painful read is regarding how unethical medical experiments were conducted on these children. At one point he says:

Nutrition scientists considered malnourished children at Indian Residential Schools as perfect experimental materials, and the worst part was that they were further subjected to malnourishment ‘to create a baseline’ for their studies. Author also discusses how unethical medical experiments on Tuberculosis, skin grafting and other blood works were performed on the children in residential schools and that they were not benefitted. Once died, the bodies of the children were mostly not handed over to the parents but were used for autopsy and further studies without the consent of the families. To exemplify this, the author shares an instance happened to an indigenous mother. An autopsy was performed on her adolescent son, against her disapproval. The mother figured this out by happenstance from one of the staff members of the funeral home. After burial, the mother later learned that the medical team had removed her son’s brain for running various tests. Finally, after lots of fights, she retrieved that brain and she had to do wait until the snow to be thawed to do a decent reburial.Eugenics and ‘purity’ are also being discussed, and it was not too long back that it was among the indigenous people of Canada, as recent as 1970s. It is shown that ‘hundreds to thousands of indigenous women were coercively sterilized up until the 1970s outside of Alberta and British Columbia. The book also shed light on how mining, corporates, Christian missionaries joined hands in this mission and the message was to ‘civilize the wild, barbaric heathen Indians’ and was violently and enthusiastically carried out by aggressive racist officers.

In the last part, Shaheed-Hussain describes the mass separation of indigenous children through foster care, which still happens today. Not unlike the experience of residential schools, these children placed with white foster parents were often abused and suffered from identity dilemma, low self-esteem, addictions, lower levels of education and unemployment. The author leaves an eye opening thought that the reality is colonial governments have little interest in ending injustices they’ve created and maintained because they profit from them so significantly, also citing an instance of present Prime Minister of Canada, Justin Trudeau’s response. In short, Fighting for a Hand to Hold deserves a broad readership among those who all are compassionate and are willing themselves for reconciliation, non-Indigenous medical professionals, politicians, social workers, and of course the youth, and that all must raise voices for decolonising health care. Now that from this year onwards Canada is observing holiday on National Day for Truth and Reconciliation on 30th September to honour the lost children and survivors of residential schools, their families and communities, let’s recall Malcolm X’s words here:

” If you stick a knife in my back nine inches and pull it out six inches, that’s not progress. If you pull the way out, that’ s not progress. The progress comes from healing the wound that the blow made”