Indigenous stroke survivor says health system repeatedly failed her
Alberta Health Services says relationship with Indigenous Albertans must improve
Valerie Sawdo wokeup at 6 a.m. on May 22 with blurred vision. She was unable to walkand the left side of her body felt numb. She had to crawl down the stairs to get to the ambulance that took her to theemergency department at the Royal Alexandra Hospital in central Edmonton.
She'd had a stroke.
But when she arrived at the emergency room, the doctor there didn't see it that way.Instead,he told her it was anxietyand that it was a chronic condition, notan acute care situation.
"I got a lecture about how I shouldn't be there," she said,"because the problem wasn't life-threatening."
A nurse brought Sawdo a wheelchair to help her leave the hospital.
It was her sixthhospital visit in a six-week span. It would take yet another visit for a doctor to order a CT scan and confirm she had had a stroke. The experience has left her thinking racism in the health system which researchers say is a persistent problem in Canada is what to led to so much confusion and pain for her.
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Sawdo is Anishinaabe, from Lac Des Mille Lacs First Nation in northwestern Ontario. This isn't the first time she felt disregarded by health-care staff, she said.
"I expect to be dismissedand demeanedand ignored, becauseI'm Indigenous," she said."I don't want this to happen to anyone else. I'm tired of giving up."
Alberta Health Services confirmed it is reviewing Sawdo's case and is aware of her family's concerns.
"[We] acknowledge that institutional racism and stereotyping has kept people from getting the care they need," AHS said in a statement.
"We also know that the relationships between AHS and First Nations, Mtis and Inuit Albertans must continue to improve, and we have more work to do."
7 emergency visits, 1 prescription for anxiety
As a 48-year-old mother of two, Sawdo said she tried to avoid the hospital as much as possible given past bad experiences. Her symptoms became increasingly alarming: she would feel dizzy, experience numbness andhave difficulty seeing. Sometimes she would feel so disoriented she would vomit.
At the beginning of April, she started having "episodes" about once a day for a few minutes at a time. Over the course of the month, her condition became more severe. The symptoms started happening eighttimes a day or more, and lasting 30 to 40 minutes at a time.
Sawdo said her family doctor recommended she go directly to the hospital if her symptoms persisted.
She ended up at the hospital seven times, including two visits on the day of her stroke. She went to the MisericordiaHospital,the StrathconaCounty Health Centre, the Northeast Community Health Centre and the Royal Alexandra Hospital.
After every visit her symptoms became worse, she said.
Indigenous patients in particular need to be very aware that racism and bias can impact their care.- Dr. Alika Lafontaine, Indigenous Physicians Association of Canada
On April 23, the Northeast Community Health Centre referred her to a neurologist, who in turnreferred her to a lung specialist, she said.
She went to the ER department at the Royal Alexandra Hospital on April 26 because her symptoms felt extreme that day.The ER doctor gave her a prescription for Ativan to deal with anxiety.
Every hospital ran a blood test. Sawdo and her family said they wondered if doctors suspected she was drunk or intoxicated because of her slurred speech.
A stroke specialist later told Sawdo her episodeswere transient ischemic attacks (TIAs), temporary artery blockages that pass after a period of time and cause similar symptoms to a stroke. The symptoms are common warning signs of an impending stroke.
Sawdo's sister Kathleen posted a video on Facebookabout the treatmentwhile Sawdo was still in the hospital.
A CT was never ordered by any of the emergency physicians leading up to her stroke, she said.
The Canadian Stroke Best Practices online guide recommends that people with suspected stroke have a CT scan.
CBC also consulted an ER physician who said that it would be unusual, in a case where apatient was presentingwith TIA symptoms, for emergency doctors not to conduct further investigation or provide a referral to a stroke prevention specialist.
On May 22, after being turned away from the hospital yet again,Sawdo lost balance and fell down multiple times at home. Her 20-year-old daughter Veronica insisted she go back to the hospital one last time.
Sawdo's mother drove her to the Northeast Community Health Centre that evening. The doctor there called a stroke specialist who ordered a CT and diagnosed her with a basilar artery stroke.Her scan also revealed a prior smaller carotid artery stroke, but the exact date of that is unknown.
In some cases, a basilarartery strokecan be fatal or cause paralysis.
A full 24 hours after the stroke and 12 hours after she first visited the ER that day she was admitted tothe Royal Alexandra Hospital.
Sawdo's mother, Roberta Jaggard-Schulte, is non-Indigenous and her father is First Nations. She believes herdaughter has experienced a lifetime of racism inhealth-care system.
Jaggard-Schulte wanted to go to the hospital with Sawdo, because she said care tended to improve when she was present. During all Sawdo's recent emergency visits, she was prevented from joining her daughter in the hospital because of COVID-19 restrictions.
"As soon as they see a white person with her, then it changes," Jaggard-Schulte said.
Chronic discrimination in health care
Racism against Indigenous patients remains a problem in the Canadian health-care system, according to providers.
"It's well-established that Indigenous patients, in particular, need to be very aware that racism and bias can impact their care," said Dr. Alika Lafontaine, an anesthesiologist in Grande Prairie, Alta., and former president of the Indigenous Physicians Association of Canada.
Lafontaine said racism can range from blatant hostility toward patients to more subtle expressions, like a doctor settling on a diagnosis that doesn't align with the clinical symptoms.
"Anytime that you have a situation where you receive care that you're not satisfied with and I mean this for all patients I think you do have to think strongly about whether the assumptions your providers make influence your care," he said.
Lying in her hospital bed, the week after her diagnosis, Sawdo thought back on her experience.
"I was full of rage, and angry every single day," she said,"[I was] angry at everything, mainly the system."
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