Structures of Indifference: An Indigenous Life and Death in a Canadian City by Mary Jane Logan McCallum and Adele Perry (review)

In September 2008, Brian Sinclair, a middle-aged, non-status Anishinaabe man, spent 34 hours in the emergency room of the Health Sciences Centre (HSC) in downtown Winnipeg, Manitoba. During those fateful hours, hospital staff left him unattended, incorrectly assuming that his presence in the HSC was the result of homelessness or intoxication. As a result, Sinclair passed away from a treatable infection. A subsequent inquest found that no single individual was to blame. The negligence of the hospital staff, according to the inquest, was not linked to Sinclair's age, indigeneity, or visible disabilities. Instead, the inquest framed Sinclair's death as the singular and unfortunate result of a "perfect storm … [caused by] a coincidental mass collision of multiple errors" (130). However, as historians Mary Jane Logan McCallum and Adele Perry argue in their timely and incisive new book, the records of the inquest reveal a determined effort to erase the "structure of indifference born of and maintained by colonialism" that led to the death of Brian Sinclair (1).

In Structures of Indifference: An Indigenous Life and Death in a Canadian City, McCallum and Perry build upon the work of the Brian Sinclair Working Group (BSWG), which formed in response to Sinclair's death, to discuss "the questions it raised for health care, the justice system, Indigenous people, and the province of Manitoba" (2). As McCallum and Perry point out, the BSWG is part of a long legacy of organizing by Indigenous people and their allies to pro-mote equity and raise awareness surrounding critical issues impacting Indigenous communities. The authors draw on this activist legacy, as well as on scholarship in Canadian history, Indigenous studies, and settler colonial studies, to expose the violence of settler colonialism, while still emphasizing the resilience and endurance of Indigenous people.

The first chapter of Structures of Indifference, "The City," tracks larger patterns of nineteenth- and twentieth-century colonialism as they came to bear on the Cree, Anishinaabeg, and Metis who made their homes at the forks of the Red and Assiniboine Rivers. McCallum and Perry demonstrate that such patterns – colonial efforts to dispossess and erase Indigenous people and Indigenous resistance against these forces – have continued to the present day. In recent decades, they point out, Winnipeg has confounded journalists and analysists, because it is at once a visibly and vibrantly Indigenous city and one that remains deeply racist and segregated. The life and death of Brian Sinclair, as McCallum and Perry put it, "can only make sense when we think about the long and ongoing histories of colonialism that have made and remade this difficult, complex place" (58–59).

The second chapter, "The Hospital," focuses on the history of the HSC and its place within both the medical infrastructure of Winnipeg and the Canadian health care system. McCallum and Perry argue that the HSC should be understood as part of a "range of institutional systems in Canada shaped by settler colonialism" that has included residential schools, hospitals, jails, and foster homes (62–63). As scholars have shown, medical research has often characterized Indigenous people as primitive and unworthy of care, which has impacted their treatment and resulted in unnecessary illnesses and avoidable deaths. McCallum and Perry build upon this literature, showing that even as Canada developed its celebrated "universal health care system" and integrated Indigenous people into it, "prejudice and communication barriers in hospitals continued," and contributed to ongoing health inequalities (92–93).

However, Indigenous people have hardly been passive recipients of unequal and inadequate medical care. Structures of Indifference demonstrates that the efforts of Indigenous people, particularly those working in the health care system, have led to improvements in the quality of medical care available to Indigenous communities. For instance, the HSC created a Native Services Department in 1971, primarily tasked with translation, interpretation, and advocacy on behalf of Indigenous patients. In subsequent decades, as...