Indian hospital
The Indian hospitals were racially segregated hospitals, originally serving as tuberculosis sanatoria but later operating as general hospitals for indigenous peoples in Canada which operated during the 20th century. The hospitals were originally used to isolate Indigenous tuberculosis patients from the general population because of a fear among health officials that "Indian TB" posed a danger to the non-indigenous population. Many of these hospitals were located on Indian reserves, and might also be called reserve hospitals, while others were in nearby towns.
History
Indigenous populations had been affected by various diseases brought by European settlers and missionaries, including tuberculosis, smallpox, measles, mumps, diphtheria, typhoid, and influenza, from the 19th century onwards. These exposures to new diseases reduced the population by as much as 90%. At best, waves of infection are partially documented. Tuberculosis moved more slowly, but by 1950, one in five Inuit were infected. Mortality rates in the 1930s and 1940s rose higher than 700 people per 100,000.Early hospitals for First Nations were mostly church-run, in a manner similar to the Indian residential schools. For example, the Grey Nuns opened a small hospital on the Blood reserve in southern Alberta in 1893 with the support of the Department of Indian Affairs, while the Anglican Church of Canada founded a hospital on the nearby Blackfoot reserve in 1896. Other "Indian annexes" were provided for segregated medical care, such as in the basements of hospitals for settler populations.
Slowly, the Department of Indian Affairs took control of the hospitals away from the churches. The Blood hospital was replaced with a new structure paid for by the department in 1928, and the Blackfoot hospital was replaced in 1923, partially with funds taken from the band's trust fund.
Government officials' request for the legal backing to forcibly remove Inuit and other Indigenous people from their communities is documented as far back as 1920. An amendment to the Indian Act was passed in 1927 to this effect.
National initiative
The newly-created federal Department of National Health and Welfare took over the building and running of Indian hospitals in 1946 as part of Canada's new welfare state policies following the Second World War. The national government began a large-scale operation, run under the auspices of the Advisory Committee for the Control and Prevention of Tuberculosis among Indians, to isolate and reduce the occurrence of the disease in northern populations. This included surveys of infection as well as forcible removal and confinement of those infected. The federal government made the choice not to build hospitals in the north but to evacuate infected individuals to the south of Canada and invest in facilities there. Several sanatorium, referred to as Indian Hospitals, were opened in Ontario and Quebec to accept evacuees, such as the Moose Factory Indian Hospital, opened in 1949, to "isolate the disease" on an island. The first state-run Indian Hospital was Charles Camsell Indian Hospital in Edmonton, opened in 1946 after converting an Indian residential school into a medical facility. By 1960, there were 22 federally-funded Indian hospitals. Most estimate that the cost of care in Indian hospitals was about half of what settler patients received, often in segregated hospitals side by side.Part of the national operation were ships dedicated to carrying TB-infected passengers from Northern Canada to the sanatorium. One such ship was, part of the Eastern Arctic Patrol or Eastern Arctic Medical Patrol, a ship which was specially fitted after 1946 with medical facilities quarantined away from crew quarters, which ran from 1950 to 1969. The C. D. Howe had 30 beds for Inuit patients and crew space for 58, as well as a helicopter for transferring patients. The ships were equipped with x-ray technology to diagnose infections, and patients were marked on the hand with identifying numbers and the results of their tests. The Western Arctic Patrol mostly delivered patients to the hospital in Edmonton; the Eastern, to Hamilton. It was more common in western parts of the country to airlift patients than to ship them by water.
Settler medical professionals believed the "Indian TB" was a strain that posed a threat to the settler population, misunderstanding at the time the process of immunity through exposure, and the Aboriginal populations' lack of resistance to the disease brought unknowingly by settler carriers. The Inuit populations was considered to be "racially careless" about their health and containing the spread of the disease.
A particularly strong wave of the epidemic started in 1952. Canadian settler medical professionals attribute the spread of the disease, besides the Indigenous populations' lack of immunity, to overcrowded living conditions in Inuit communities - after forcible relocation by the Canadian government - and weakened constitutions through limited food supplies. Tuberculosis spread easily through the Inuit and First Nations populations, including in Canadian Indian residential schools, where healthy children were routinely exposed to infected children and poor sanitary conditions and ventilation contributed to the spread. In one school, the death toll was as high as 69%. In some residential schools, TB infection rates were as high as 80%; schools that held infected children due to overburdened hospitals were given a stipend to provide healthcare to their students of fifteen cents per child per day.
In 1953, mortality rates from TB in the Inuit population was 298.1 per 100,000 patients, compared to 9.9 per 100,000 in southern and settler communities. It is estimated that by 1955, almost 1,000 Inuit had been removed for treatment in southern Canada.
In 1953 it was also made a crime for an Indigenous person to refuse treatment or to leave a hospital before being discharged. Patients who wished to return home to their communities were arrested and taken to jail or brought back to the hospitals.
A 1983 study by S. Grzybowski and E. Dorken titled Turburculosis in Inuit found that:
In the 1950s tuberculosis became a grave problem with the mortality rate approaching 1% per annum and the incident rate almost 3%. The annual risk of infection has been estimated at 25% per annum. These are probably the highest rates recorded anywhere in the world in the 20th century.Medical professionals continue to congratulate themselves on successfully stemming the tide of the disease through such interventions of forcible removal of infected individuals from their homes. At several points when rates of TB diagnosis lessened, the efforts to prevent the disease were defunded, resulting in an increase in infection rates again.
Indian hospitals began being phased out in the late 1960s and every Indian hospital was closed or converted to desegregated institutions by 1981.
Conditions
Diagnosis
Research conducted by Oloffson, Holson, and Partridge describes the conditions endured by Inuit communities during the diagnosis process:Being told that they had to leave with the hospital boat or airplane to go to a hospital in the South was a frightening experience for most of the patients.... Many were diagnosed while still asymptomatic, and as such there was often great confusion as to why they were being taken from their homes and families. Even when they were aware of their condition, it was not always made clear to the patients where they were being taken or if they would ever be returned, contributing to an atmosphere of fear and desperation. In some cases, Inuit who knew that they were seriously ill would hide out on the land once they had heard that the hospital boat was arriving. In these situations, a helicopter, originally intended to fly ahead of the boat to check ice conditions or bring medical personnel to shore if the boat could not dock, was used to survey the land, find anyone hiding, and bring them to the boat for examination.Shawn Selway states that while leaving their homes for treatment was not mandatory, most Inuit felt pressured in a way that could not be considered consensual.
Because the skin test for TB was unreliable, diagnostic ships began to rely more on chest x-rays, exposing children and adults to yearly doses of radiation, for some community members over 40 years.
In 1928, doctors who later ran the Fort Qu'Appelle Indian Hospital were given federal funding to develop drugs to fight the TB epidemic. In 1933, they began running experimental vaccination trials on Indigenous children from nearby communities. The vaccination was declared a success despite limited validation; there were also several problems, including a need to re-vaccinate every two years. Also, people vaccinated with the drug would test as false positives by the Mantoux skin test for TB that was in standard use, meaning successfully inoculated people would end up in hospital anyhow. In 1952 two inoculated girls tested positive for TB, but this was hushed up by government officials. By 1954, this vaccination was a mandatory treatment across Canada.
Removal
When an Indigenous person had a tuberculosis diagnosis confirmed, they were rarely allowed back into their communities until deemed free of tuberculosis. Evacuees could not go ashore to collect their belongings, say good-bye, or make arrangements for their families - children were often adopted by neighbours and family members in Inuit communities.Children, even infants, who were diagnosed with tuberculosis would be taken from their parents and sent with the boat. Men and women would be forced to leave their families behind at times left without a father to hunt or a mother to make clothes or care for the children. Evacuees in turn faced great emotional distress, knowing that it would be difficult for their family to survive without them. As exemplified in the quote above, so great was the desperation, that the minister would often marry couples when one of them had to leave for the hospital, in order to sanctify the union while there was still time to do so.Fear of removal was a deterrent to getting tested, and even deterred remote Inuit from going to town while the ship was docked:
In 1955, RCMP reported that Inuit in the Kimmirut area were now avoiding the settlement at shiptime because they had no desire of “being evacuated to the Land of No Return.”
Medical ships' helicopters were sometimes used to seek out and forcibly pick up Inuit who were hiding in rural areas. Some former patients assert that they were sent to sanatoria for treatment without actually testing positive for tuberculosis:
" was told she had TB, but many years later, when she went to the doctor, they said to her, 'No — you would have had scars on your lungs,'" Hunt said.Some researchers agree with this assessment, indicating that some Indigenous community members were forcibly removed from their land by means of a TB diagnosis:
Declaring individuals contagious was a good means of control, keeping them out of trouble or out of circulation while the task of clearing the land was underway.Some rates of removal of Indigenous people from their communities have been quoted as 5,240 Inuit from 1953 and 1961, compared to a total population in the Eastern Arctic of about 11,500. The Nanaimo hospital saw 14,000 patients during its two-decade tenure.
From 1950 to 1965, 1,274 Inuit and Cree patients were removed from their communities and placed in institutional care in Hamilton, Ontario, alone. At this hospital, Inuit patients carved and sold around 200 soapstone pieces a month, with the hospital taking a 30% commission on all sales. The total value of Inuit art sold through this process was over $10,000CAD per year.
Some researchers assert that hospitals kept patients interned for years or decades to increase government funding received, and to provide a supply of patients for experimental medical procedures.
The average stay in sanatoria ranged depending on the availability of drug treatments introduced in the 1940s. In 1949, at the Mountain Sanatorium in Hamilton, a patient stayed for an average of 562 days; in 1956, the average stay was 332 days.