STEP ONE: HEAL THE SYSTEM

By SHAGORIKA EASWAR

Dr Anna Banerji was appalled at the conditions and the health disparities she witnessed in the Canadian Arctic back in 1995.

Seeing the number of children suffering from respiratory infections was particularly upsetting. It led to a ground-breaking study, her first, on the condition.

“I wanted to be sure that research reflected what I was seeing, that the numbers were, in fact, that high,” she says. “The chief medical officer of health asked me to conduct a case control study to help identify some of the reasons.”

Her study revealed overcrowding, lack of breast-feeding and exposure to cigarette smoke as some of the causatory factors. And the presence of the respiratory syncytial virus, or RSV, in high levels.

It is a common respiratory virus that usually causes mild, cold-like symptoms, with most people recovering in a week or two, but it can be serious, specially for infants and older adults.

It is also easily addressed, with a vaccine. Which, as Dr Banerji points out, is much cheaper than the cost of hospitalization. The paper she published garnered much attention, Everyone agreed vaccination was the way to go.

And yet, so many years down the road, it remains a goal.

Something health practitioners like her are still waiting for with over 212,000 people having signed a petition.

“These are experts,” she stresses. “Physicians, respirologists, and community members with lived experience. This just comes down to discrimination.”

There is a commonly held belief that the Indigenous communities misuse or abuse the generous funding they receive from various levels of government. Dr Banerji has come up against this attitude often. Her response is characteristically blunt: “Get educated. People who say this don’t know the story – it’s easy to think like this if you don’t know the facts. But all the information is well documented, there’s the Truth and Reconciliation Report – how can anyone ignore that?”

The highly-respected physician with a string of letters after her name that attest to her work in the field is the recipient of the Order of Ontario and was recognized by the P.H. Bryce Award Committee for her outstanding contributions to improving the health and well-being of First Nations, Métis, and Inuit children and youth.

Dr Banerji is also Conference Chair, Indigenous and Refugee Health, and past director of Global and Indigenous Health at the University of Toronto.

In spite of overwhelming evidence in support of her work, she has faced challenges in conducting the research, in getting published, and in seeing action in response.

The cost of airfare to the Northern territories alone is daunting. Lack of funding, and of trained of manpower also hamper efforts. And yet, she perseveres. Has she ever felt overwhelmed at any point? Ekla chalo re, the famous song by Rabindranath Tagore, urges people to walk alone on the path of truth and righteousness if no one is willing to follow. Has she had her own Ekla chalo moments?

Yes, she says candidly. Ten years ago, someone claimed she was conducting research without a licence, that she was working for a drug manufacturer.

“It was basically slander, libel, but he said it on television and people saw it,” she says. “That was heartbreaking.”

She had been advocating for the rights of the Inuit for so many years and now this? What was she going to do? For three days she “lay like dead”, she says. Then on the fourth day, she shook herself together.

“I don’t care,” she said.  “There’s so much at stake here. I’m going to continue. I’m not going to let someone’s efforts to discredit me stop me.”

She would go on to found the Canadian Refugee Health Conference and co-found the North American Refugee Health Conference (NARHC). She is also the co-founder and president of the North American Society of Refugee Healthcare Providers. At the COSTI Pediatric Clinic she created in 2014, she screens government-assisted refugee children coming to Toronto. In 2016, she screened over 700 Syrian refugee children at a clinic she set up at a hotel in response to the mass resettlement of Syrian refugees.

Renowned for her work, her research interests include international health, communicable diseases, child health, public health, Aboriginal Health (especially Inuit), and adoption and tropical medicine.

While most people have a basic understanding of what the first few entail, Dr Banerji explains adoption and tropical medicine.

Refugee children and internationally adopted children are among the most vulnerable, she says. They are often malnourished, under-vaccinated and may have parasites. Both groups tend to come from lower socioeconomic strata, under-resourced, and the most marginalized. While adopted children are likely to go into families with resources, many may have developmental delays arising from having been in an institution.

As an Associate Professor of Pediatrics at Dalla Lana School of Public Health, she brings her knowledge to bear on the plight of these children.

In her work with newcomers and refugees, Dr Banerji also sees a lot of people with parasites, tuberculosis or typhoid. Because she has travelled so much, worked in different parts of the world, and is familiar with tropical diseases, she can spot them and can help.

She is often quoted in the media and was outspoken about the inequities in access to vaccines at the height of the pandemic. She was hailed for her advocacy for marginalized communities that were impacted.

“I just speak the truth – what I believe to be the truth,” she says. “I don’t necessarily try to be an advocate, but I am candid. I don’t try to sugar-coat. If I think a policy is discriminatory, I’ll say so. I’m not afraid to challenge the status quo.”

There’s another kind of inequity – the challenges foreign-trained physicians face in Canada. According to a CMAJ report, racialized leaders are considerably under-represented in high-level healthcare leadership in Canada. Is racism the only lens with which to view this?

“Racism has a lot to do with it,” she says, unequivocally. “Visible minorities don’t get the same support as others. And that’s not by chance, it’s through systemic racism.”

But she is hopeful of better times to come. “I think things are changing.”

Born in Kolkata, India, she came to Canada at the age of one when her engineer father moved his family here for a better life and more opportunities.

“I’m sure it was very hard – there weren’t as many Bengalis, or even as many Indians here at the time. They faced some discrimination. And went through a very stressful period when he was without a job and a wife and three kids to support.”

As for her, like most kids born here or ones who come at a very young age, she fitted in better.

“I grew up in a very white neighbourhood in Toronto, one that is now very multicultural, but I didn’t experience a lot of overt racism. It was more subtle.

“But then I have always in some ways been a minority. Sometimes the only female in a group, or the only non-white. One gets used to it!”

It was on a visit back to Kolkata when she was 11 – her first since coming to Canada – that she knew she wanted to be a doctor.

She witnessed poverty and decided she could help the poorest of the poor as a doctor.

Medicine being high on the list of “approved” professions for desi parents, one might think she received immediate approval.

Not quite, she says with a laugh. Her father thought it might be a difficult path for his daughter and suggested engineering. But though before this she had wanted to be a writer and a teacher, the young Anna’s mind was made up, she didn’t waver in her choice.

“I have written a book and I run conferences so I get to do a bit of both!”

Her book is about Nathan, the son she lost four years ago. She had adopted the Inuit baby and he was raised in a loving, secure home. She made sure to take him back with her on periodic visits to stay connected with his birth family. Visits he enjoyed immensely. However, as he grew older, he became intensely aware of the extreme poverty, substance abuse and suicides that plagued his community. His 14-year-old biological brother took his own life and that was a crisis point for Nathan. He became depressed and anxious, he asked for help. But even as a physician who had access to the best physicians, Dr Banerji was unable to get him the help he was crying out for.

“The mental health system failed to recognize inter-generational trauma,” she says.  Twelve days after his own 14th birthday, the troubled teen took his own life.

 A family is left with so many questions at times like these. Is there a way forward, through medicine, or as a society?

Dr Banerji says at the conferences she hosts, they educate people on the true history of Indigenous people. On the trauma they carry. In Inuit-specific and Métis-specific meetings, they discuss issues specific to different groups.

They’ve had distinguished speakers including David Suzuki address participants. And they have job fairs to get people to work in under-serviced areas.

“We’re making change,” she says, softly.

Three years ago, she set up a perpetual award in Nathan’s name with Grant’s Desi Achiever Diana Ali D’Souza for Indigenous students pursuing medicine . 

When it is suggested that her 21-year-old daughter must be very proud of the work she does, Dr Banerji chuckles. “Oh, I don’t know! I’m just mom , she’s used to what I do!”

For those who see a role model in her, Dr Banerji has this:

“It’s important to realize what’s important to us. If you feel disparity or discrimination, bring it forward, talk about it. Change is hard, but if you believe in something, don’t give up. Persevere. Go for it.”

Of all the work she does, she finds one aspect the most rewarding.

“Seeing the children I work with, the ones who are so vulnerable, seeing them blossoming makes me want to do more every day.”

• Grant’s is proud to present this series about people who are making a difference in the community. Represented by PMA Canada (www.pmacanada.com).