Hidden Wounds: Tuberculosis, Colonialism, and the Unsettling Story of Indian Hospitals

by Sara Shariati

Graphic design by Geneviève Groulx

In the forgotten folds of Canadian history lies an unsettling narrative, where colonialism, segregated hospitals, and tuberculosis intersect, casting a long shadow over Indigenous communities. Although the history of segregated hospitals is not as well-known as residential schools–which were government-funded religious schools that aimed to forcefully assimilate Indigenous children into the Euro-Canadian culture during the 19^th and 20^th centuries–these so-called “Indian hospitals” have left a lasting scar on Indigenous survivors and their families across Canada.^1,2

What is tuberculosis?

Tuberculosis (TB), caused by the airborne pathogen Mycobacterium tuberculosis, is the world’s top infectious killer.³ TB mainly affects the lungs, and its symptoms include prolonged cough (sometimes with blood), fever, chest pain, fatigue, and weight loss.³ This disease was first introduced to Indigenous communities in Canada by European settlers.⁴ TB is a disease of poverty; poor ventilation, crowded living conditions, malnutrition, and limited healthcare access contribute to its spread.⁵ As a result of these risk factors, TB spread rapidly among Indigenous peoples upon its introduction to this population. The burden of TB in Canada disproportionately affects Indigenous peoples to this day. Despite constituting only 4% of the population, Indigenous peoples account for 19% of TB cases in Canada.⁴

History of Indian Hospitals and Tuberculosis Sanitariums

The first Indian hospitals originated from Christian missionaries associated with residential schools in the late 19th century; children of these schools constituted the majority of patients in these facilities.⁶ The federal government began aggressive expansion of the racially-segregated hospital system following World War II in the 1940s, and Indian hospitals remained in operation until the 1980s.^2,6

These hospitals, in addition to tuberculosis sanitariums, were aimed to control TB transmission and provide care to TB patients across Canada. TB sanitariums were first focused on managing TB cases among the general Canadian population; however, with the advancement of modern medicine and development of effective antibiotics against TB, non-Indigenous patients began to leave these facilities and were gradually replaced by Indigenous patients from remote areas.²

One of these sanitariums was the Queen Mary Hospital for Tuberculosis Children in Toronto, which began its operations in 1913.² Survivors who were hospitalized there recall being subjected to physical torture and barbaric punishments for “bad behaviour”. They also recollect memories of loneliness and homesickness, as they were separated from their communities and support systems.² Queen Mary Hospital was shut down in 1970; it was later turned into another healthcare facility, named West Park Healthcare Centre.²

Thousands of Indigenous children were removed from their communities and placed in Indian hospitals during the 19^th and 20^th centuries. This photo shows a group of children in one of these hospitals in 1945.
Source: A Brief Look at Indian Hospitals in Canada. Indigenous Corporate Training https://www.ictinc.ca/blog/a-brief-look-at-indian-hospitals-in-canada (2017).

Mistreatment of Indigenous Patients in Indian Hospitals and TB Sanitariums

In an interview with CBC, Dr. Maureen Lux, author of Separate Beds: A History of Indian Hospitals in Canada, describes that the same mindset applied to both Indian hospitals and TB sanitariums. She notes that these facilities were not meant to help Indigenous peoples but rather to keep “disease-ridden Indians” separate from the rest of the population.²

Indian hospitals and TB sanitariums were under-staffed, under-funded, and over-crowded.^6,7 Questionable treatment methods, aggressive surgeries without anesthesia, and medical experimentation were common in these facilities.⁸ Records also indicate that numerous cases of forced sterilization were performed in Indian hospitals across Canada during the 20th century.²

Patients in Indian hospitals were forcefully removed from their communities; they were treated with biomedicine and not allowed to access the traditional healing methods common in Indigenous tribes.² Staff at Indian hospitals also enforced a strict dress code, communicated exclusively in English, and addressed patients by English names.² Since numerous Indigenous patients were forced to spend years in Indian hospitals or TB sanitariums, isolated from their communities, many–especially children–forgot their culture and language.^2,8 After spending years in Indian hospitals, many children who returned home found themselves unable to communicate effectively with their families.²

Furthermore, survivors of TB sanitariums recall memories of the differential treatment of Indigenous and non-Indigenous patients. While non-Indigenous TB patients received pills for treatment, Indigenous patients endured daily injections with large needles and occasional invasive chest surgeries.²

It is also important to acknowledge the symbiotic relationship between residential schools and Indian hospitals. The over-crowded setting of residential schools contributed to the spread of TB, resulting in many transfers to Indian hospitals.⁸ This cooperative link between Indian hospitals and residential schools ensured both institutions maintained their funding and remained operational.⁸ Enduring such painful experiences in these facilities for years has left lifelong scars on survivors and led to collective trauma amongst Indigenous communities.

Truth and Reconciliation

Indian hospitals and TB sanitariums operated while state-of-the-art local hospitals were being developed for non-Indigenous patients across Canada.² This created a two-tier system of care that exacerbated the effects of colonialism and systemic racism on Indigenous peoples.

Researchers estimate that approximately 20 to 30 Indian hospitals operated in Canada until the late 20th century.² These government-run facilities, like residential schools, were part of the colonial system that aimed to erase Indigenous people’s identity and isolate them from the settler Canadian population. Colonialism has had profound impacts on Indigenous communities across Canada, resulting in a legacy of discrimination, marginalization, and substantial health disparities. The discourse surrounding Indian hospitals highlights the susceptibility of healthcare to integration within an overbearing societal framework and underscores the importance of diversity in healthcare leadership positions in averting such integration. We must acknowledge the trauma the Indigenous communities have endured as a result of colonial practices and collaborate with Indigenous peoples to address the harm caused to the greatest extent possible.

Rates of TB remain higher amongst Indigenous peoples compared to the non-Indigenous population in Canada to this day.⁴ A comprehensive plan is required to tackle this issue, which addresses sociodemographic factors including poverty that contribute to the spread of this disease. During the development of such a plan, it is especially important to engage with Indigenous scientists and experts in order to ensure the plan is culturally sensitive. Without taking sociodemographic factors and cultural sensitivity into account, health disparities will continue to prevail in Canada.

References