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An Indigenous health leader in Niagara is hoping that a deep-seated fear that many Indigenous people feel in hospital is something that is being chipped away. 

Charity Beland, who is a member of Six Nations of the Grand River, Mohawk, Turtle Clan, is the manager of Indigenous Health Services and Reconciliation at Niagara Health, which operates three hospitals and two urgent care centres. There, she leads a team who make it their mission to create hospital settings where Indigenous people feel safe and valued.

The ongoing efforts by Niagara Health to improve Indigenous patients’ experience has earned the acknowledgment of a major Indigenous umbrella group in Ontario, with the caveat that there is still a long road ahead to regain trust.

It was the death of Heather Winterstein in 2021 at Niagara Health’s hospital in St. Catharines — now known as the Marotta Family Hospital — that led the hospital system to embark on a process of self-examination on the experience of Indigenous patients.

At the coroner’s inquest into her death earlier this year, testimony revealed that Winterstein, 24, sought care for extreme pain on two consecutive days but ended up collapsing after languishing for hours in the emergency department waiting room.

The inquest jury ruled she died from septic shock due to sepsis with delayed treatment, caused by a bacterial infection.

Testimony at the inquest suggested treatment decisions by some hospital medical staff may have been influenced by Winterstein’s Indigenous background, her history of substance use and anxiety. 

Ingrained racism a reality, expert says

Suzanne Shoush, a family physician who examines the experiences of Indigenous people trying to access care, testified at the inquest that bias in the healthcare system, where fewer than one per cent of doctors are Indigenous, makes many Indigenous people fearful of seeking care.

For generations, many Indigenous people have felt a sense of dread if they had to seek treatment for a medical condition at a Canadian hospital, where they often came face-to-face with anti-Indigenous bias or outright discrimination, says Shoush.

Shoush, Indigenous faculty lead at the University of Toronto’s department of family and community medicine, said that ingrained racism contributes to shorter lifespans, increased chance of preventable death and longer wait times for Indigenous people.

She stressed that cultural safety training must apply to everyone working in a hospital, from security and housekeeping staff, to top management and board members.

After Winterstein’s death, Niagara Health conducted an internal review and initiated an independent, third-party emergency department review that resulted in recommendations such as instilling cultural safety throughout Niagara Health’s staff, physicians and volunteers; promoting an Indigenous patient navigator team; seeking out Indigenous representation for governance; working on recruiting and retaining Indigenous employees, doctors and volunteers; and creating a separate Indigenous space for reflection and gatherings.

Niagara Health accepted all the recommendations.

In 2024, Niagara Health launched its first Indigenous health services plan to improve hospital services and experiences for Indigenous patients and their families.

The plan includes initiatives designed to improve access to healthcare services, enhance cultural safety, promote traditional healing practices within the hospital, strengthen relations with Indigenous groups, outline strategies for recruiting and retaining Indigenous healthcare professionals, and provide education and training for staff on cultural safety.

Some of the initiatives launched by Niagara Health include:

• Installing Indigenous artwork at all its sites.
• Allowing smudging ceremonies, which any patient or family member identifying as Indigenous can request. At the Marotta hospital, ceremonies can take place in patients’ rooms.
• Opening of an Indigenous community room, the Gathering of Good Minds, at the Marotta hospital. 
• Launching specialized training focused on cultural sensitivity and awareness.
• Planning an Indigenous healing centre at the new South Niagara hospital under construction in Niagara Falls. The hospital will also have an Indigenous healing garden.

Cultural sensitivity and awareness training

Beland said cultural sensitivity and awareness training began with top leadership, and has moved on to front line staff. The training is mandatory.

“Last I checked, I think we were at 77 per cent completion,” she said. “For a large organization we’ve had really, really good buy-in.”

Sean Longboat, chief executive officer of the Ontario Federation of Indigenous Friendship Centres, acknowledged the efforts of Niagara Health. 

“We are encouraged to see the direction Niagara Health has taken to advance Indigenous health equity within their network system,” he said in a statement to CBC News. “Other hospital systems can and should learn from Niagara Health’s efforts.”

Other hospital systems can and should learn from Niagara Health’s efforts.– Sean Longboat, chief executive officer of the Ontario Federation of Indigenous Friendship Centres

But, “it will take time to regain Indigenous people’s trust, especially after losing a treasured family and community member like Heather Winterstein,” Longboat said.

Trust can only be repaired through sustained action and allowing Indigenous people to exert their autonomy and self-determination in the design and delivery of health services, he said.  

“More importantly, trust can only be regained when Indigenous people directly see the benefits of these initiatives on their lives and in their community.”

In 2025, Niagara Health entered a formal partnership with the Indigenous Primary Health Care Council to develop joint initiatives aimed at improving Indigenous health outcomes and addressing healthcare inequities. It was the first agreement of its kind with a hospital system, Niagara Health said.

The health council works with Indigenous primary healthcare organizations across Ontario to promote the health and well-being of First Nations, Inuit and Métis communities.

“This partnership is an important step towards creating a healthcare system that is responsive and respectful of Indigenous needs,” Caroline Lidstone-Jones, CEO of the health council, said last year.

Beland said it’s important not to shy away from using terms such as racism and discrimination when describing the Indigenous experience in hospitals, as uncomfortable as that may be.

“If we don’t use the words and we don’t use the language… then we’re doing the work a disservice,” she said. 

Beland said it’s “been really inspiring and surprising” to see a major hospital system commit to and follow through on efforts to policies aimed at improving the Indigenous experience.

“Our driving force is really making sure that the approaches we’re taking and initiatives that we’re moving forward are based on what the community identifies as important to them,” she said.

Coroner’s recommendations

The coroner’s inquest jury made 68 recommendations, most of which target Niagara Health alone or in conjunction with other agencies.

Longboat said the inquest recommendations provide a “roadmap for meaningful change” that other hospital systems should take seriously, and said discrimination and anti-Indigenous racism must be confronted head-on. 

Longboat said the provincial government, which plays a key role in accountability mechanisms that govern healthcare, must commit to holding itself to a higher standard to ensure the healthcare system cares for everyone living in Ontario.

“We cannot have another death like Heather Winterstein’s.”

Niagara Health president and CEO Lynn Guerriero, who testified at the inquest that discrimination and biases are ingrained in the healthcare system in Ontario and Canada, said in a statement to CBC News in April that Niagara Health will move forward in a “careful and deliberate way” to implement the recommendations.

“We know that systemic racism exists in healthcare, and addressing it is essential to improving safety, trust and outcomes for Indigenous patients and their families,” she said.

The most comprehensive study yet of maternal health in Canada has found Black Canadians face a much higher risk of serious complications during pregnancy, labour, delivery and postpartum than white people — underlining the urgent need for better data tracking and tools to eliminate systemic anti-Black racism in our health-care system, researchers and advocates say. 

The research, published Monday in the Canadian Medical Association Journal (CMAJ), looked at more than 108,000 in-hospital deliveries to Black people, and more than 1.3 million in-hospital deliveries to white people across the country between 2012 and 2023. 

Researchers found that severe maternal morbidity, encompassing complications such as pre-eclampsia, hemorrhage and sepsis, occurred at a rate of 47.8 out of 1,000 live births for a Black parent compared to 27.7 out of 1,000 live births for a white parent. 

Even when researchers accounted for other factors like age, immigration status or other health conditions, Black people still had a 66 per cent higher chance of experiencing these potentially life-threatening complications. 

The data lines up with what advocates have been saying for years — that Black women have their pain dismissed and routinely face barriers when navigating maternal care. 

“It’s huge to finally have this, you know, so-called proof and evidence that we’ve been told that we need to have in order to really prioritize Black communities and reproductive health,” said Cheyenne Scarlett, co-founder of the Black Birth Project, a non-profit aimed at improving reproductive outcomes for Black people in Canada. 

She told CBC News that she has first-hand experience with the cracks in Canada’s maternal care: She once went to the ER with an ectopic pregnancy, and says she was sent home without receiving proper treatment. 

“This report is not at all shocking to me,” she said. 

‘Less equitable outcomes’

Official data shows Black women in the U.S. are three times more likely to die in pregnancy or childbirth than white women. They are twice as likely in the U.K., while a 2021 study from The Lancet found that Black women had a 43 per cent higher risk of miscarriage. 

But similar long-term demographic data has been lacking in Canada until now, despite years of calls for it.  

“As Canadians … we’ve been able to distance ourselves from the very real reality of the fact that although universal health care is so important, it still doesn’t mean universal access for everyone,” Giulia Muraca, associate professor of obstetrics and gynecology at McMaster University, told CBC News. 

The higher rates of complications for Black people persisted when researchers controlled for conditions that occur in different rates in Black and white populations, such as sickle cell disease, with authors noting in the study that the consistent disparity “suggests broader structural influences on maternal health.”

WATCH | Advocates fight for better data in 2021:

Calls for more data about health risks to Black women in pregnancy

Black women in Canada face more risks in pregnancy compared to other demographics, but there’s little data in this country compared to the U.S. and U.K. on what is causing the inequities.

And while a higher income correlated with an improvement in maternal outcome for white parents, the study found that rates of severe complications increased for Black parents along with their income — an example of a “diminishing returns” phenomenon, Muraca suggested, in which those who experience structural marginalization don’t receive the same advantages of an increased income.

The study didn’t look at causes, but its authors stress that these differences don’t stem from race itself.

“Being Black is not the cause of these differences,” Muraca said. The evidence that Black patients are experiencing “less equitable outcomes,” she said, should prompt us to start examining “inequities in access … differences in communication, in escalation of care, in differences in treatment, for example.

“These are things that we can start to now collect routine data on and hold institutions accountable for.”

‘We are dying’

The struggles Black people face in Canada just trying to access health care is something that community organizations have been studying independently for years.

“So me, as a Black woman, when I go into the hospital, when I’m in front of a practitioner, how are they responding to me?” Kearie Daniel, executive director and founder of the Black Women’s Institute for Health, said. “Are they going to see my pain the same way that they’re seeing someone else’s?”

A national survey released by the Black Women’s Institute for Health in 2025 looked at the experiences of nearly 2,000 Black women and girls with Canada’s health-care system. It found that 42 per cent avoid seeking medical care because they were afraid of how they might be treated. 

When it came to maternal care, some women reported fearing their children might be taken from them after staff summoned social workers with no justification, Daniel said. Others dealt with miscarriages at home rather than risk poor treatment at the hospital. Many reported their pain was ignored.

“They’re giving birth in the emergency bathroom, in the waiting room, they are being turned away,” Daniel said.

She said during her own pregnancy, her mother kept stressing she needed to dress well when going to the hospital, concerned that she wouldn’t be taken seriously. 

“Having to go into a system that really isn’t seeing your full humanity when you’re depending on them to do so for your survival and the survival of your baby is just so — ‘demoralizing’ is not the right word. It’s not a heavy enough word to really articulate just how excruciating it is.”

WATCH | Ancestral Hands Midwives opens its doors in this 2024 video:

Scarborough facility offers prenatal and postpartum midwifery care for Black families

Ancestral Hands Midwives is a new facility in Scarborough that offers prenatal and postpartum midwifery care for Black families. CBC’s Shannon Martin spoke to the team behind the organization to learn more about how they’re striving for better accessibility, education and empowerment around Black maternal health.

Government action needed: advocates

Research has shown that Black people in Canada often suffer higher risks of negative health outcomes, including with breast cancer and during the COVID-19 pandemic. Enduring disparities have their roots in historical injustices that shaped modern medicine, according to a recent report in the Canadian Ethnic Studies journal.

To ensure equitable maternity care, what’s needed now, Daniel said, is real action from governments and health-care organizations.

Better staff training is important, but it must be paired with the tracking of race-based data along with other socioeconomic differences, she said, to monitor if interventions are actually improving health outcomes for Black people. 

Although some regions began tracking race-based health data after the pandemic, it’s still fractured across the country.

“There has to be accountability,” Daniel said. “We are dying as a result of not having that.”

WATCH | Documentary digs into the need for race-based data:

Canada’s health-care system also needs to work with community organizations to create truly informed care, advocates say.  

Althea Jones founded Ancestral Hands Midwives in 2024, meant to help Black people get better pregnancy care. She said it’s frustrating to have to prove what community members have known for years, but she’s still hopeful this study might lead to more funding for interdisciplinary, Black-led care.

“I think people need care that reflects them,” she said. “They need to be seen and heard.”

Jenelle Ambrose Dash, chair of the Black Maternal Health Collective Canada, echoed the call. Every April, her organization runs Black Maternal Health Week in Toronto, bringing together groups like Ancestral Hands to share research and educate others.

She added that there needs to be more funding for health care in general, noting that the current “overwhelmed” system only exacerbates inequity.

When she heard about the CMAJ study, she saw her own story — a previous traumatic experience with pre-eclampsia — reflected in the data. She’s determined to ensure that no Black parent has to go through what she did. 

“There are real people behind the numbers,” she said. 

“I hope that something will be done coming out of this study. We’re well past the point of awareness. We are looking for accountability now.”