I write in response to the article, “Care as Colonialism: Immigrant Health Workers at Canada’s Frontiers” by Baijayanta Mukhopadhyay. I am a registered nurse and a white settler working and living in Toronto: Treaty 13. I work in harm reduction and am active in health care organizing; specifically, the fight for health care access for those without status. Mukhopadhyay offers a thoughtful examination of the complicity of health care providers in the development of medicine as a key colonial institution and the devastating result for Indigenous peoples. Understanding this history, the central question emerges: How do we endeavor to improve the health of Indigenous nations while participating in the same systems of dispossession? Despite our best intentions—and, as Mukhopadhyay points out, many of us enter this work out of an earnest desire to right injustice—our stake is in the system.
The question is an important one, but Mukhopadhyay does not provide a strategic response for movement-building. The focus instead is limited to suggestions of how to build solidarity through our work as individual clinicians—efforts, for example, to “develop an ethical practice in the spirit of anti-colonialism” (131). This is of course a necessary step, and even this level of reflection is egregiously lacking within healthcare, so it does make sense to start the discussion at this point. The absence of a discussion on how this reflective work falls within a broader movement strategy, however, runs the risk of allowing us to indulge in the acknowledgment of our relative privilege and complicity in colonialism without actually working to change the conditions that allow such disparities to exist.
Nurses are obligated by our standards of practice to understand that our authority positions us as more powerful in our therapeutic relationships with patients, but there is no mainstream discussion about the historical basis—or legitimacy—of our authority. Unlike physicians and other healthcare workers, nurses are defined by our role as carers. In a historical setting where, “caring for the body paralleled caring for the soul,” (122) nursing nuns were a significant force for the nascent Canadian nation. In my work at a supervised drug-injection service, I have the least knowledge and experience of attending to overdoses compared to my non-clinical colleagues, and yet according to those government bodies that allow us to legally operate, I am the expert. Indigenous communities are among the most impacted by opioid criminalization and the current overdose crisis, and while I am celebrated for my work, I continue, through my ongoing participation, to uphold the system at the basis of this suffering.
Mukhopadhyay writes as a healthcare worker with personal experience of colonial displacement and subsequent resettlement in Canada. My history, in contrast, belongs to the settler Europeans who first violently established Canada as a colonial nation-state. There are key differences in our positions within Canada’s ongoing colonial legacy, and our corresponding responsibilities. Canada treats migrants differently than white settlers, both as healthcare workers and as patients. I have never worked as a nurse in northern Indigenous communities. My work—and my life—are firmly positioned within large urban centres. Unlike immigrant health workers who must serve rural, northern communities to secure their credentials, I am able to seek out work where I want.
The exclusion of migrants from Canada’s healthcare system follows a colonial logic of who is deserving of care, and who is not; who is allowed to be cared for, and who is not. In 2012, the Harper Conservative government mobilized racist narratives to justify gutting the Interim Federal Health Program (ifhp), Canada’s health insurance program for refugees, removing healthcare access for most refugees with the notable exception of vaccinations or medications deemed necessary to protect public health and safety, such as for tuberculosis. The ifhp cuts were eventually rescinded, but there are still half a million migrants in Ontario living without provincial health insurance coverage.
Beyond reflection and individual action, Mukhopadhyay’s discussion of the compromised position of healthcare workers in the maintenance of colonial relations leaves us with the opportunity to consider strategies to mobilize within our ranks. When the ifhp cuts were announced, healthcare workers and migrant justice activists in Montréal launched a non-cooperation campaign, and physicians and nurses with no experience of civil disobedience staged sit-ins and refused to comply with government orders. The eventual reversal of the cuts was due in no small part to these actions. Building on this momentum, a group of healthcare workers, myself included, launched the ohip for All campaign in 2016 that seeks to win healthcare access for all Ontario residents regardless of immigration status. In the process, we are building a coalition of physicians and nurses who understand that our desire to heal and care is only possible through a rejection of the existing institutional arrangements that uphold Canada’s colonial legacy.
The unique position of immigrant health workers to build relationships of solidarity with Indigenous communities also presents specific organizing opportunities. Mukhopadhyay mentions diabetes as a possible front for such movement-building as it disproportionately affects racialized people. Developing an analysis on how to strategize such a response could realize a powerful alliance with the potential to upend the role of immigrant health workers in maintaining colonial institutions.