Dissonance in Kashechewan

From the airplane window, I was awestruck. Northern Ontario stretched endlessly. Lush evergreen as far as the eye could see, met by striking grey-blue arctic sky. Our home—on—Native land. Landing in Kashechewan was another story. As I stepped out of the aircraft, a knot settled in the pit of my stomach. “Where am I?” I thought. The Air Creebec charter flight, available exclusively to locals and medical staff, took only an hour to reach Kashechewan from Moose Factory Island, where I had spent the past month practising rural family medicine. Yet this place felt foreign, otherworldly. Grey. Abandoned.

The driver smiled as he picked me and the other medical staff up from the airport, which was about the size of my 37-square-metre Kingston, Ont, apartment, and drove me to the nursing station in Kashechewan. The pothole-laden roads stirred up a cloud of dirt that followed us queasily into town. By the time we arrived, the surrounding foliage was barely visible, camouflaged by dust.

Most of my friends and family had never heard of this Cree First Nation commonly known as “Kash.” Those who had recalled the drinking water crisis in 2005; seemingly the only way to garner nationwide attention to the community’s needs, or so the book¹ I was reading at the time alluded. The book had gone so far as to label Kashechewan a “fourth-world”¹ country, citing disparities between relative income and cost of living akin to war-torn countries such as South Sudan or Afghanistan.

Within my first few hours in Kashechewan, an eeriness began to take hold of my senses. Kash felt parallel to another inhospitable place: the land of my Persian ancestors. My parents fled Iran during the 1979 revolution owing to religious persecution and were no longer welcome to return home and prosper. Here in Kash, where prosperity felt unattainable, the short physical distance north of my home in Ottawa, Ont, started to feel much farther.

Once I arrived in Kashechewan, I went straight to work. In a full day of clinic, I was immediately faced with the legacies of colonialism. Colleagues cautioned me to, understandably, expect several patient no-shows, especially as a new provider yet to build any trust with the community. Despite physician access being limited to once or twice a month, this counsel held true. Those I saw were playing catch-up. Each visit began with the patient’s primary concern, but quickly expanded to include overdue vaccines and other screening tests, because who knew when they would feel comfortable re-presenting.

One of my first patients, a woman with jet-black hair and a sweet warmth to her, presented with features worrisome for esophageal cancer: weight loss, night sweats, dark stools, and a strong family history of the same diagnosis. She had missed 2 appointments to fly south for endoscopies and her last referral seemed to have gotten lost in the system. Months passed, and the patient’s symptoms only worsened.

When I asked why she missed those flights, the patient shared that her family’s history carried painful memories caused by the very institutions to which she was referred. Her ancestors had historically been dismissed, neglected, and mistreated in hushed slurs. Through tears, the patient confided she was terrified to board her flight and be handled in this way. What she feared most was to never return home again, never to be reunited with her family. I sheepishly apologized for her family’s experience, assuring her she deserved high-quality care. Stunned by her story, I walked to my portable billet home at the end of the day and wept.

The day before I arrived in Kashechewan, a drinking water advisory was issued: bottled and boiled only. Parched one day, I asked a travel nursing colleague for bottled water. She handed me a sealed sterile water container. It tasted talcy. I could not finish it. Macaroni and cheese soon became my daily lunch and dinner. A balanced diet was not within budget, given the produce prices at the Northern Store, where a box of Chex cereal cost $13.49. Counselling patients with diabetes about dietary changes soon started to feel performative and disconnected from reality.

I was warned that Kashechewan was a bit tough, but by the time I returned to Moose Factory Island, my mood had hit an all-time low. In time, I realized my shock in being confronted with such extreme poverty in my own backyard occurred during an already heightened period of heartbreak. It was 2022, and I had been closely watching the women-led protests in Iran following the death of Jina Mahsa Amini at the hands of the morality police for allegedly wearing her hijab improperly and exposing her hair.^2,3 Living in Canada, gratitude is something I have always held in my heart. It still is. The child of refugees, I am acutely aware of the freedoms I am granted on this land. Basic human rights that would have otherwise been denied: to pursue higher education, practise my minority faith as a Bahá’í without fear of persecution—even the ability to let my hair down.

Confronting Canada’s dark history with ongoing intergenerational trauma and myriad health implications while holding gratitude for the refuge it offered my family left me in an uncomfortable state of cognitive dissonance. How could my family’s intergenerational trauma be mitigated on the same Canadian soil that bred the exact opposite outcome for generations of its oldest inhabitants? Holding these 2 seemingly opposing truths together is difficult to digest, but necessary. It is possible to be both thankful for my family’s ability to prosper on this land, and fair in my judgment of adversities not yet reconciled for its Indigenous communities.

Much like those religious, ethnic, and other minority groups continually persecuted in my motherland of Iran, I recognize the people of Kashechewan, our hosts along James Bay, as a reservoir of undervalued potential. Both sharing a fortitude and resilience that extends beyond a mere tough exterior.

I ran into that same female patient the morning before I boarded the charter flight home. She flashed me a smile and insisted on paying for my coffee. I am not sure what came of her medical investigations but I think of her often and pray she got the care she always deserved.

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