Toronto Trailblazers 2020: Janet Smylie is tracking COVID-19 in Indigenous communities

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For over 25 years, Janet Smylie, one of Canada’s first Métis doctors, has made it her mission to bring awareness to the injustices faced by the Indigenous community and to foster progress in the country’s health-care system.

Not only has she practised and taught medicine in urban, rural and remote Indigenous communities, but Smylie developed and directs Well Living House, the Indigenous health research unit at St. Michael’s Hospital in Toronto. There, she is also a public health researcher at the Centre for Urban Health Solutions, and holds a Canadian Institutes of Health Research Applied Public Health Research Chair in Indigenous Health Knowledge and Information – all the while continuing her work as a staff physician.

Having grown up in a large family that always encouraged advocating for your people and speaking out on injustice, Smylie was raised to be a torchbearer.

“Much of my family had already done a lot of heavy lifting in their lives, which meant I grew up with opportunities and privileges that mitigated some of the harms linked to anti-Indigenous racism and gender inequality,” she says. “I ended up not really understanding why we have a society in which some people are devalued and have less access to social resources because of gender, identity, race, ethnicity, economic status, sexual orientation, ability. 

“Of course I get many of the ‘isms’ – I have my intersectional share of them as a two-spirited Métis mother and grandmother,” she continues, “but at a fundamental level, I still try and question, ‘Why does it have to be this way?’  The tension between the values I was brought up with and the day-to-day injustices fuels my commitment to action.”

Smylie has worked hard to develop guidelines for health-care workers treating Indigenous peoples, new procedures to address racism among health professionals and to help produce previously unavailable population-based health needs assessment data for urban Indigenous populations in Canada.

More recently, with the help of Indigenous Services Canada, Smylie has lead the charge in assessing the impact of the COVID-19 pandemic on Indigenous communities that live both on- and off-reserve. More than anything, the pandemic has put a spotlight on just how underserved many are, with COVID-19 case identification – a government funded public health service – primarily focused on First Nations who live on reserve and ill-equipped to support Indigenous people living in urban epicentres like Toronto or Montreal. In both cases, First Nations, Inuit and Métis (FNIM) peoples are at higher risk of being hospitalized or dying from COVID-19 than a non-Indigenous person, and they are likely to experience additional barriers in accessing services, including attitudinal and systemic racism. 

“Since the beginning of my research career, I have been very concerned about FNIM peoples who aren’t ‘counted-in,’” says Smylie. “Over recent years, I’ve become increasingly focused on naming and addressing the gaps between the truthful demographics and unmet health needs of FNIM peoples across geographies and jurisdictions, and the information that is gathered and disseminated by provincial/territorial and federal governments, academics and sometimes even our own political leaders.”

In order to bridge the data gap – not only during the pandemic but well after – Smylie’s hope is to ensure that FNIM peoples are leading the governance, management, analysis and dissemination of information that is about them. 

“Clearly, it hasn’t worked well having others in charge,” she says, her passion evident with every word. “COVID-19 has shed light and magnified these issues. A health information system premised on the exclusion of people if they live in cities or if they don’t meet a certain externally imposed definition of Indigeneity doesn’t work. What happens is everyone ends up losing, because we can only see COVID-19 impacts in part of our kin networks. The pandemic presents a unique and unprecedented opportunity for people to come together and work to ensure FNIM peoples are counted in wherever they live.”

In order to get there, Smylie believes in teaching and training the Indigenous community so people can move forward on their own. She refers to this as a “nothing about us without us” ethos.

“To do anything different risks perpetuating the very harms that one is trying to address, and also commonly results in solutions that have reduced utility and social value,” she says. “There are incredible strengths in Indigenous communities that can be built upon. For example, strong and resilient social networks, spirituality, traditional ecologic knowledge, the ability to pull together during a difficult time and the ability to adapt rapidly and resiliently to change. None of these things can be bought with money.”

That faith in her community has been Smylie’s guiding light, one she says shines brighter in those following in her footsteps.

“I am motivated by all the amazing people who cut a trail before me and those who are coming behind,” she says. “The ones that went ahead of me had many more challenges and fewer supports. Those that are coming behind have new and impressive ideas. But they also have creativity and so much talent.”

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