Last Thursday, Carol Dube travelled almost 400 kilometres (249 miles) from his home in Manawan First Nation to address federal government officials in Canada’s capital, Ottawa. Three days earlier, his 37-year-old wife, Joyce Echaquan, had died at the Centre Hospitalier de Lanaudiere in Joliette in Quebec.
She had live-streamed some of her last moments on Facebook – a video that shows Echaquan writhing and shouting in pain while hospital staff taunt and degrade her, calling her a “f***ing idiot” and telling her she is only good for sex.
With a trembling voice, Dube told Canada’s Minister of Crown-Indigenous Relations Carolyn Bennett and Minister of Indigenous Services Marc Miller he was there to claim justice for his wife.
“I’m asking you to give me some answers. Because all I’ve gotten are questions and condolences, but no answers,” said Dube, breaking down in tears as the couple’s son consoled him. The meeting was streamed via the Aboriginal Peoples Television Network.
“I need to know what happened. It’s my children that have lost the most. I wasn’t even able to tell her I love her nor hold her hand until the end,” he added.
‘A kind, generous person’
The Atikamekw of Manawan community is located approximately 183km (114 miles) north of Joliette and is reached via a long stretch of unpaved forest road. It is one of the only Indigenous communities in Canada where all nation members speak their native language. Nestled on the southwestern shores of Lake Metabeskega, Manawan has a population of approximately 2,400 members living on the reserve. Many residents practice traditional ways of living such as fishing, hunting and trapping. But access to healthcare services is limited and most travel to central Quebec to be seen by doctors.
Dube described Echaquan as a kind, generous person who “paid attention to the littlest things”. The two had a good life together, raising their children in Manawan. But that life is now destroyed, and the future of his children is uncertain, he said.
The Atikamekw mother of seven – the youngest just seven months old – had travelled from Manawan to Joliette on Saturday seeking treatment for severe stomach pain and was admitted to the hospital. According to family members Echaquan suffered from a heart condition and had a pacemaker. By Monday, her pain had worsened, and she began live-streaming on Facebook as she pleaded for help from her hospital bed.
Speaking in her Atikamekw language Echaquan asked for someone online to help and to “come see me”. According to family members, Echaquan said she was over medicated and had been administered morphine, despite being allergic to it. In the seven-minute video, Echaquan can be seen writhing and shouting as a nurse and healthcare aide are heard telling her, in French, that she was “stupid as hell” and would be “better off dead”.
“You made some bad choices, my dear,” one of them says. “What are your children going to think, seeing you like this?”
Alluding to the fact that taxpayers were paying for Echaquan’s treatment, one of the women asks: “And who do you think is paying for this?”
Echaquan died soon after.
Women hold up red dresses to raise awareness about the issue of missing and murdered Indigenous women as they attend a rally demanding justice for Joyce Echaquan in Montreal, Canada on October 3, 2020 [Christinne Muschi/Reuters]“I am convinced my wife died because systemic racism contaminated the Joliette hospital,” said Dube. “She spent her final days in agony, surrounded by people who held her in contempt, people who were supposed to protect her.”
Guy Niquay, the school director from the Atikamekw Nation, travelled with Dube to Ottawa. He got down on his knees to address the ministers.
“Mr Miller, Madame Bennett, I beg you to help me. I don’t want to wait for one year. I want action,” pleaded Niquay.
Echaquan’s 16-year-old son Thomas-James Echaquan kneeled beside Niquay, his head lowered.
‘I hear her screams’
Karine Echaquan is Joyce’s cousin. She is also Atikamekw of Manawan but lives in Joliette, where she works as a court interpreter.
She told Al Jazeera the whole family is saddened by Echaquan’s death. “They have all lost a spouse, mom, daughter, cousin, niece and friend,” she said.
“Death is very hard, it’s sad, but it’s even sadder when we treat each other this way.
“[In the video] we wait for the screams, and when I close my eyes, I hear it, and when I wake up, I hear it.”
Karine says she wants justice for her cousin and to be sure other people will never be treated in such an inhumane way.
‘The worst face of racism’
At a news conference earlier in the week, Bennett described the video and Echaquan’s death as “heart-wrenching”.
She has been having weekly conversations with Indigenous doctors since April, she added, and had been hearing stories about why their patients are reluctant to go to hospitals.
“This is the worst face of racism … This is someone who is at their most vulnerable,” said Miller. “And they are dying, having heard racist words expressed towards them.”
A year ago, Quebec Superior Court Justice Jacque Viens released a report on the treatment of Indigenous people that concluded it is “impossible to deny” that they face systemic racism in Quebec. Several people from Echaquan’s community testified at the inquiry about experiencing dismissive treatment, racist slurs, intolerance for their language and lack of interpreters at the Joliette hospital.
On Saturday, the Quebec government announced via a Twitter post it is launching a public inquest into Echaquan’s death.
The Indigenous Physicians Association of Canada has issued a statement, saying: “As Indigenous physicians collectively, who work in various settings including on reserve, in small communities, in large urban hospitals, we know the realities of Indigenous People who are reluctant to access the health system in part because they fear for how they will be treated. It is telling that Ms. Echaquan felt the need to record her interactions with the nurses charged with providing her with culturally safe services that meet the standards of their profession. Their racist behavior documented in her video is disturbing and repugnant.”
Death by racism
It is not the first time there have been accusations of racism around the death of an Indigenous person in a Canadian hospital.
The 2008 death of 45-year-old First Nations man Brian Sinclair in a Winnipeg, Manitoba emergency room triggered an investigation into that province’s treatment of Indigenous people. Sinclair was a double amputee and used a wheelchair. He sat in the Health Sciences Center hospital emergency room for more than 34 hours waiting to be seen. By the time medical staff checked on him rigor mortis had already set in. An autopsy later revealed he had been dead for between two and seven hours and had died from a treatable bladder infection.
The inquest into his death found that medical staff assumed he was drunk, had already been discharged and had nowhere to go, had been triaged and was waiting for a bed, or was homeless and seeking shelter from the cold weather.
People hold signs reading ‘Native Lives Matter’ as they attend a march for Joyce Echaquan in Montreal, Canada on October 3, 2020 [Christinne Muschi/Reuters]Then in 2017, a group of Canadian doctors claimed Sinclair died due to racism and recommended sweeping changes to the medical industry, including the adoption of anti-racist policies and the provision of anti-racism training.
In June, the province of British Columbia on Canada’s west coast launched an investigation into allegations that hospital emergency room staff played a game in which they guessed the blood alcohol levels of patients, most of them Indigenous. The game was called “The Price is Right”.
The Metis Nation of British Columbia and the British Columbia Association of Aboriginal Friendship Centers said in a press release Indigenous people seeking emergency medical services are often assumed to be intoxicated and denied necessary medical assessments as a result.
‘A condescending patriarchal attitude’
Indigenous distrust of the medical establishment has deeper roots than these cases. The practice of forced or coerced sterilisation of Indigenous women in Canada is thought to have taken place as far back as the 1800s. But it did not end then.
Saskatchewan-based lawyer Alisa Lombard represents more than 100 Indigenous women in Canada who have come forward with accounts of forced or coerced sterilisation. The lawsuit is awaiting certification.
People take part in a smudging ceremony organised by the First Nations Indigenous Warriors and the American Indian Movement on the Cote First Nation, near the town of Kamsack, Saskatchewan in 2017; smudging is a common practice among some Indigenous peoples in North America and is believed to cleanse a person or place of negative energy [Zachary Prong/Reuters]Crystal Semaganis is a Cree mother of four who says she was sterilised against her will after the birth of her son in 2007 at an Ontario hospital. Her doctor encouraged her to get her tubes tied at each of her prenatal visits, she said.
“I told him, ‘no, I don’t want my tubes tied. I want a big family,” Semaganis recalled, speaking by phone from her home.
She felt triggered by Echaquan’s death, she said.
“I know what it’s like to be helpless. Her death resonated with me. It was sheer hatred. And every Indigenous person in this country encounters racism.”
During an emergency caesarean section further on in her pregnancy, Semagnais says her doctor tied her tubes without her knowing.
“For it to be done while I was incapable, I was vulnerable. I would have loved to have more children,” she explained, breaking down. “But we have little proof, little advocacy. There’s a condescending patriarchal attitude from healthcare systems that say, ‘we know better than you’.”
During a candlelight vigil outside the hospital where Echaquan died, organiser Chantal Chartrand advocated for justice.
“She asked for help and they strapped her down on the bed because she was reacting to the pain and didn’t want to receive morphine,” said Chartrand, who is First Nations and a friend of Echaquan’s family. “For me, I think it is criminal.”
A young boy approached Chartrand, who is a criminologist, asking for candles. When she asked who he was, she learned that he was Echaquan’s five-year-old son, Luca. Already in tears, Chartrand said meeting Echaquan’s son was heartbreaking.
Through tears, Chartrand described how he kissed the picture of his mother and said “goodnight mom”.
“He said [to me] ‘why are you crying?’ And he was the one who was taking my tears. And he doesn’t know, he doesn’t realise that his mom had died. I said, ‘because your mom is a hero. She’s a star and she’s in your heart.’”
Chartrand said the encounter made her reflect on some of the degrading words Echaquan heard before she died.
“In the video when she was dying, fighting for her life and the nurses have the guts to say, ‘what would your kids think about you?’” she said, her voice breaking with emotion.
‘Because they could’
The Grand Council of the Crees in Quebec expressed frustration at Quebec’s refusal to address already documented widespread systemic racism and called for Echaquan’s death to “be the shock that ends the culture of impunity and establishes accountability throughout the public services in their dealings with Indigenous persons”.
“The racist slurs and degradation she suffered at the Joliette Hospital were the same they might have been 50 years ago. The hospital staff did not see her as a human being, but as something that they could abuse with impunity,” read a statement released by the council.
“And that is the heart of the problem … Such conduct could only happen in an environment that tolerated it. The staff abused Joyce Echaquan because they thought that they could, with impunity, without consequences.”
The Chief Commissioner of the Canadian Human Rights Commission also decried Echaquan’s death.
“What happened to Joyce Echaquan is graphic proof that systemic racism against Indigenous Peoples is real and its impacts are devastating,” said Marie-Claude Landry in a statement. “Outrage is not enough. The time to address anti-Indigenous racism is long past due.”
‘No human being deserves to die with indignity’
Many advocates and legal experts are calling for a criminal investigation into Echaquan’s death.
The family’s lawyer, Jean-Francois Bertand, is initiating a series of legal actions, including a lawsuit against the hospital as well as the nurse and aide heard in the video.
Bertrand also plans to file a complaint with the police and to push for a criminal investigation.
Meanwhile, as demonstrations and vigils took place across the country, her widower is scrambling to make sense of it all and to plan her funeral.
“She didn’t deserve that, she deserves justice,” he told federal ministers in his address on Thursday.
“She’s Canadian, Indigenous also … There’s no human being that deserves to die with indignity, with humiliation and in fear.”
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