Illness experiences and settler colonialism: an ethnography with Indigenous Peoples receiving in-centre hemodialysis in Winnipeg, Manitoba
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Date
2023-07-19
Authors
Ferreira da Silva, Priscila
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Abstract
In 2015, the Truth and Reconciliation Commission (TRC) set a national agenda, calling for institutions to develop concrete plans to advance the health and socioeconomic status of Indigenous peoples in Canada. Indigenous peoples experience a variety of health disparities, including alarming rates of end-stage kidney disease, also known as kidney failure. In Canada, most people with kidney failure start in-centre (hospital-based) hemodialysis. Manitoba has the highest prevalence and incidence of kidney failure in Canada, and Indigenous people are disproportionately represented.
This qualitative ethnographic study employed Indigenous methodologies, including a conversational approach with people living with end-stage kidney disease. I conducted 11 in-depth individual interviews—six with people undergoing in-centre hemodialysis, three with caregivers, and two with healthcare providers working in renal health. Drawing upon critical anti-colonial and social determinants of health frameworks, colonization is reconceptualized as a present structure rather than a past event. This perspective brings into view how institutional practices continue to produce health inequities. Specifically, this study pursued a multi-sited approach to examine the interplay between the social determinants of health and people’s personal journeys amid a sense of dislocation. I followed the trajectories of people who were displaced from their communities and forced to relocate to Winnipeg for hemodialysis. As people navigated abrupt life changes and rebuilt their lives amid crisis, I portray their experiences of grief and disconnection from kinship networks as well as their diverse conceptualizations of health and wellbeing. I also portray their experiences of discrimination and racism in hemodialysis units, emergency departments, specialized care, and while seeking health and social services, such as housing. These experiences demonstrate the urgency for mandatory cultural safety training for those working in healthcare.
This thesis project is unique in its approach to examining barriers and facilitators to care in the context of kidney failure by exploring the relationship between broader structural forces, including settler colonialism, and the lived experiences of Indigenous people receiving hemodialysis in Winnipeg. As health institutions direct resources to address the TRC Calls to Action, I provide recommendations to the Manitoba Renal Program to increase relevant resources for Indigenous people on hemodialysis.
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Keywords
Indigenous health, First Nations, End-stage renal disease, Health care access, Health disparities, Chronic Kidney Disease, Hemodialysis, Manitoba