Post by Okwes on Jun 21, 2006 20:32:46 GMT -5
Greetings!
This past Friday I lectured at Ohio University's Improved Healthcare Through
Cultural Awareness program with the topic: History, Health Care & Holistic
Healing: Breaking Health Care Barriers Within the Indigenous Community.
Those in attendance were from the medical, counseling and social work
professions. About 50 were in attendance.
I was asked at the last minute to speak, so this was thrown together in a
relatively short period of time. But I think it turned out well, and it
seemed to go over well... so I thought I'd send it out to the group.
I did my best to fact check every single fact and statistic, but if you
come across an error, please let me know.
Cheers!
Terri Jean
-------------------------------------------------------------------------------------------------------
The first thing you need to know is that Indigenous Americans are the
smallest self identified racial-ethnic group in the United States, yet
studies show they are far more likely to die from tuberculosis, diabetes,
influenza and alcoholism than that of the general population. Their infant
mortality rate almost doubles the white population, they have the poorest
cervical cancer survival rate, AIDS is a staggering 40% higher than the
white community, and life expectancy is 6 years below the national average,
with 33% not making it to the age of 45.
Despite all these health problems, American Indians receive grossly
inadequate health care, especially when compared to other ethnic and racial
groups. But the indigenous have experienced such deplorable service for more
than a century. Slow service, refusal of treatment, denial of coverage,
funding shortfalls, exhausting read tape, and a lack of adequate facilities,
personnel and equipment are just part of the problem. The truth is a complex
layer of broken promises, apathetic politicians and tragic policies.
The second thing you need to understand is that the United States and the
First Nations have a unique relationship that is not based on race, rather
it's a political relationship developed from treaty rights, supreme court
cases, and legislation. In exchange for land, services was to be provided to
Native people... services that included free health care. Unfortunately, the
spending is discretionary, rather than mandatory, which has produced a
inept, unreliable system with a history of incompetent care, a lack of
funding and facilities, cruel practices and, of course, corruption.
At first, the health care services were part of the Department of War, but
it was later turned over to the Bureau of Indian Affairs. In 1928 the status
of indigenous people were surveyed and then detailed in the Merriam Report,
which brought to light the poor to non-existent health care of Native
people. President Franklin Roosevelt's administration sought to reform the
policies, one of which was to solicit medicine men to provide care for their
people, something that was illegal and punishable by imprisonment prior to
their solicitation. Still, poor and non-existent health care continued.
Then, in the early 50's the Indian Health Services was founded by the
government. At that time, 95% of all indigenous people lived on reservations
where there were only a few health clinics. Most tribal people had to travel
great distances, in Alaska it might have been a day or two, to reach an
Indian clinic. Also in the 50's the government was implementing termination
policies to end not only tribal Nations and the entire classification of the
Native American race, but they also wanted to wipe out all obligations to
provide services to indigenous people, services guaranteed for life via
treaties and court cases. If Indians no longer existed, the responsibilities
no longer existed. People were bribed and coerced off reservations. The
federal trust was again broken.
In the 60's First People's started demanding the return of treaty and tribal
rights, individual civil liberties and their own cultural identity. Lawsuits
were launched, protests were staged and a movement called Red Power fought
for tribal preservation. At this time, over 34,000 children were still in
Indian boarding schools, reservations were one of the poorest communities in
the country, and Native people had a higher rate of foster care than any
other racial group. In Idaho alone, it was 640% higher than the national
average. I have met many people inside Indian country who were taken from
their families and adopted out to white families. Some of them are called
Lost Birds and the children still feel the trauma of their separation even
today.
By the late 70's reforms, laws, acts and tribal recognition - for some - was
reestablished. Strides were made in education, child welfare and health
care, but passing an act and making good on that act are not one in the
same. Native health care remains in a state of crisis even today. Some of
the problems are too much red tape, language and cultural differences, a
lack of physicians and facilities, and a lack of funds.
But the biggest problem is far more complicated... and tragic. Historically,
Native people have endured policies of extermination and then assimilation
for centuries. Manifest Destiny allowed our government, military and people
to believe that genocide was a reasonable solution to the "Indian Problem"
and L. Frank Baum, who later wrote the Wizard of Oz series, penned several
harsh editorials while editor of a South Dakota newspaper suggesting
extermination as a humane solution to Indian suffering. Much like putting
down a sick dog, many citizens of that time wanted to put down the displaced
Natives, most of which were confined to overcrowded concentration camp -
like reservations, full of sick and dying people who were starving, eating
rotten potatoes, spoiled meat and bugs from animal dung, living without
shelter or proper water and bathrooms. As many as 1/3 died from the
relocation process, and from the conditions of the reservation itself. And
many historians believe Baum's editorial was the fuel behind one of the
saddest and most tragic events in indigenous history - the massacre of the
innocents at Wounded Knee.
At the beginning of the 1900's the US decided that genocide of an entire
race might not be the best idea, so assimilation became the policy of
choice, as is it today. An end to the entire Indian race would end
obligations, freeing the US of financial, moral, and legal obligations - and
all reservation land would be free for the taking.
One of the biggest methods for assimilation was to target the children with
the off-reservation "boarding school" - which was more like a cold, cruel
military school or juvenile detention center. Starting in 1879 in old army
barracks in Carlisle, Pennsylvania, the schools targeted children as young
as 4, stealing them away from their parents, holding them hostage, forcing
tiny, terrified homesick children into overcrowded rooms, where the policy
was "kill the Indian to save the man." It has now been admitted by the
Bureau of Indian Affairs that these children were often molested, raped,
used as servants, mentally and emotionally abused and, of course, beaten...
sometimes to death. In what is now called one of the grossest human rights
violations in American history, more than 250 graves pepper Carlisle alone.
It is unknown how many actually died, since many were sent home dead or
dying.
The sexual abuse problem continued until 1987 when a white teacher was
caught in the act of molesting a young boy on a government run Hopi school.
The teacher was later found guilty of molesting more than 142 boys from 1979
to 1987, and the principal and BIA officials had to admit that numerous
abuse complaints were never investigated. Not one of them. And the abuse
only stopped when the teacher was caught in the act. He received life in
prison and now anti-abuse laws are enforced in today's Indian schools. But
these acts left behind generations of victims, many of which are alive
today. The victims live with the legacy of incompetent, uncaring officials
who ignored their cries for help for nearly 2 decades. It's no wonder so
many of them turned to drugs, alcohol and even suicide.
Fortunately, the inhumane sterilization policies did not make it to the
80's.... but they were a big part of the 1970's after the Indian Health
Services initiated a sterilization campaign in 1970. A decade later, more
than 25,000 women were permanently sterilized. How, you might ask? They were
coerced, threatened, and misinformed. Accurate information was not
presented, women were spoken to in a language not their own, consent forms
were improper, and there was a definite lack of appropriate waiting periods.
And many simply did not know what was going on. 2 15-year-old girls went in
for their tonsils and came out without their ovaries. Another woman went in
for migraines, she was told to get a hysterectomy. The migraine problem was
never explored and she was later diagnosed with a brain tumor. By the end of
the 70's this policy, like many others, was deemed inhumane and the
sterilizations stopped. The government later said that 25,000 women were
sterilized, but the Native community said it's more like 60,000 to 70,000...
roughly 40% of ALL child-bearing Native women.
Cancer is a growing problem in communities such as the Navajo where uranium
mines continue to contaminate the air, the earth, the livestock and the
water. Tunnels closed in the 70's remain unsealed, with pits open and
radioactive uranium ore remaining within a few feet of residential homes and
communities. In these areas, there is an especially high rate of
reproductive cancers in teenage Navajo girls, and of the 150 miners who
worked those mines, 133 died from cancer or fibrosis by 1980.
Another issue is the placement of toxic waste on more than 300 reservations.
The United States has a long tradition of using reservation land as a
dumping ground for toxic and nuclear waste, poisonous solvents, pesticides,
unexploded bombs, radioactive materials, fuel, sewer sludge and human
garbage. Though some reservations were paid to house landfills, many of them
were tricked by crooked politicians and businessmen who said the dangerous
poisons would not pose any health problems for reservation inhabitants. But
it took less than a decade for residents to get sick. Their water, air,
plants, rivers, lakes, livestock, and soil were contaminated. In California,
dumping ground residents had higher than natural levels of arsenic,
chromium, lead, mercury, and nitrates in their hair and urine. Alaskan's
fish and wildlife - food supply for many Native communities - had concerning
levels of PCB's in their system, and a recycling plant that was supposed to
be harmless to the environment actually produced extremely harmful toxins
that were burned and released into the air. Cancer, leukemia, fibrosis, and
other diseases now plague these reservations. And the pollution continues.
Lastly, indigenous people often live within a constant state of post
traumatic stress disorder. Having to deal with daily super-saturation of
their identity to hock everything from carpets and beer to campers and
butter. Their chiefs, a tribal position of great respect and honor, is
mocked at high school football games, and they remain the most
under-represented minority in journalism today. Most of their issues are
debated and polled, often without the perspective of the Native person. They
know their people were invaded and their land was stolen. That disease was
spread purposely with diseased blankets, and that the people who control
their land have deemed them unable to control their lives, their reservation
land and their monies. Each year more than $300 MILLION dollars flows
through the US treasury from business leasing and mining reservation land,
and yet the money continues to go unpaid to Native people. Today more than
20 BILLION - yes BILLION - dollars is owed to Native people for royalties
from mining, timber, farming and so on... but the treasury has no idea where
it is. Native people continue to live in the poorest communities in the
United States, where they die from cancer, disease, and an inapt health care
system, and YET the treasury receives 300 MILLION a year for their benefit.
Statistics show that indigenous people have the highest risk for mental
disorders than most ethnic groups. Depression is 20% more than whites, and
suicide is the highest per capita. Illicit drug use is higher than both
African Americans and whites, and they're 7 times more likely to die from
alcoholism than the general population.
Given all that you know now about the indigenous experience, wouldn't you be
depressed to if this was YOUR history? Your life? Your ancestry?
Can you
imagine how it would feel? On today's reservations, the ISH receives about
$1300 per capita from the federal government to care for Indian patients,
which is about half of what's given to federal prisoners. The average
non-Native receives $2600. The people I've spoken to used words like angry,
frustrated, suspicious, and desperate when describing their medical care.
They said services are often inaccessible, and some feel an obsessive need
to keep outsiders under constant surveillance, especially government
officials and medical personnel. They do not feel that their care is
important, and because the funding is discretionary, their lives are in the
hands of those they trust least. And this is not new to our federal
government. Arizona Senator John McCain said, "The federal government has
continually reneged on its trust and moral obligations to meet the
educational, health care, and housing needs of Indians."
But all is not lost. Despite insurmountable neglect by the federal
government, many Native tribes, villages and organizations banded together
to form health care coalitions on their own. More than 40% established
clinics, private health institutions and non-profit health maintenance
organizations. Some of the progress is due to Indian gaming. And an example
of that is with the Pueblos. Before gaming - their unemployment was 75%.
Many lived without sewage, kitchens, running water, telephones, electricity,
or proper roads, schools, and medical facilities. They were living a
depressive life, and health care was extremely poor, barely even existing.
Now, because of Indian gaming, the 6 Pueblo communities have unemployment in
the single digits, with the Sandia Pueblo having only 1% unemployment. They've
built good roads, new homes, cultural centers, medical buildings, and
grocery stores. The children study their cultural language, tribal banks
offer 0% mortgages, businesses are sprouting up, and they're buying their
land back. One community put in an Olympic sized pool for exercise, and
others have their own health programs, including a full service dialysis
unit. Though their method of splitting casino profits is not common among
all tribal nations, they definitely set an example as to what can be done
with gaming money... and many tribes are following suit. But not all nations
have this opportunity. Of the 562 federally recognized tribes, less than 33%
have some form of commercial gaming - from bingo halls to casino's. And in
the United States, only 5% of all casinos are from Indian Country.
The rest rely on the government and their own traditional healing practices.
Negotiating between two cultures, indigenous people rely on both alternative
and contemporary medicine. Prior to contact, medicine men were well
respected and sought after. They knew the language, history, spirit and land
of their people, and their role as a healer was a lifetime commitment. For
some nations, this knowledge was nearly lost, but the old ways are now
returning. For others, the healer has always been an important part of their
community, and when it was illegal and punishable by law to heal one's own
people traditionally, some medicine men went underground. Healing out of
sight of those who could imprison them.
Today there is a definite resurgence of traditional medicine, which is more
of a holistic healing practice which engages all part of the patient -
spiritual, mental, physical, and emotional. Healing the body takes more than
contemporary medicine. It may take teas, sweats, herbs, prayer, healthy
foods, fasting, counseling, ceremonies, community service, and honoring the
sacred. And though actual beliefs and practices vary from nation to nation,
most of the healers strive to make the patient whole. To expel negative
thinking, an unhealthy lifestyle, and re-connect man to his community, his
planet and his higher power. Often the entire community is involved with the
healing, and many of the people I've spoken to said they prefer to cure
white man's illnesses with white man's medicine, but all other illnesses are
thought to be from an imbalance of the spirit and body, and they prefer
healing through traditional means.
So.... what does that mean to you? What are the things you need to know
prior to entering an indigenous community? Prior to offering medical
services or even establishing a dialogue?
Well, the first thing you should do is to know who the people are, as
individuals, as a community and as a nation. And this lecture is a pretty
good introduction. At least you know some of their experiences and history
with other medical personnel, and hopefully this will allow you a place to
begin an understanding of your patients. What you need to do is to learn as
much as you can BEFORE you walk into that community or clinic. What tribal
nation will you be servicing? What is their history? What is the history of
the clinic? Call and ask people from the clinic. Ask the cross-cultural
liaisons. Google it. Research it. You need to do the same research as you
would if you were entering a foreign country. Learn the traditions, the
proper protocol and cultural manners of the people. Do what you can to
connect with the people you are treating, and not to offend or insult them
in any way. It is not your culture. You probably know very little about
their culture. So learn what you can beforehand and ask questions during.
Respect and honesty goes a long way in Indian Country.
But, there are a few tips I can give you today. Tips to keep in mind when
dealing with Native people in our own community, and yes, there are many
right here in Athens. And though these are general tips that may not apply
to every indigenous person you'll encounter, they are common in many
communities.
1. First assess patients background, looking not only for health history but
also experiences such as those mentioned earlier. Do not be shocked if they're
guarded about their health history or current problem. They might be
suspicious and guarded, and some might even act with mistrust until trust
can be earned.
2. When you meet the patient, introduce yourself. It's a sign of respect.
Don't be surprised if you only get a nod. Offer your hand for a light
handshake, and do so to everyone in the room.
3. Do not be concerned if there is a lack of eye contact, especially with
the elderly. It is not a trust issue nor is it meant to offend you. A lot of
indigenous people, especially those who adhere to traditional ways, do not
like eye contact. It is a part of their culture.
4. Ask questions in a non threatening manner. Be calm and direct, and
non-assertive . Control your emotions and body language. Slow down
questions, explain everything, and frame questions to convey caring.
5. Speak less and listen more, as listening is highly valued. Do not over
talk, interrupt or ask personal, non-medical questions. That's extremely
rude.
6. Become comfortable with silence. Long silence and pauses are common.
7. People might downplay their medical problems, including pain. Some might
even deny a problem at all, or will use metaphors when describing their
symptoms. For example, depression might be a "heavy heart" and pain might be
referred to as an "ache."
8. Don't ask "what's the problem" or talk about fixing their "problem." It
implies unequal power, in which one's life rest in the hands of another.
Rather, ask about their symptoms or their condition, and possible reasons
and solutions. Together, you can diagnose the condition and then, together,
co-manage the healing process.
9. Be aware of your physical distance between yourself and your patient.
Several feet is usually comfortable. Ask permission to touch, keep things
covered, and only use a gown when necessary.
10. Allow the community healer to be involved, when requested. Some, when
given a choice between a healer and a doctor, they will choose the healer.
So, rather than compromise the patient's health, involve traditional
medicines, practices and healing.
11. If the patient brings in a medicine bag, do not touch it, move it, or
remove it. If it has to be moved, ask the patient or a family member to do
it, and keep it as close to the patient as possible.
12. Be open to cultural practices such as chanting, singing, prayer, rituals
and even tobacco use - which is the most spiritual of all plants because it's
smoke carries messages and prayers to the Creator. Be sure to ask the
patient what is to be done with hair and removed body tissues, since they
might need to be returned for burial.
It can take years to build relationships and gain trust and acceptance. Be
patient, learn about the community, honor their traditions and customs, and
keep your promises. Trust is extremely important to indigenous people. Once
you earn it, you've earned a place within the community.
In conclusion I ask that you do NOT take everything I've said today as fact.
Doubt me. Set out to disprove me. Go on-line and research Native American
sterilization, toxic waste on reservations, and child abuse at Indian
boarding schools. Read Native-written books about the Native experience,
learn history from their perspective, and research government to Native
American relationships, especially as it applies to health care and funding.
Learn for yourself. Educate yourself. And use your knowledge to break
barriers... to relate to your indigenous patients.... AND to make
institutional changes.
The circle of trust has been broken between Native people and the outside
medical community. But the circle can be healed.
The circle MUST be healed.
Thank you.
This past Friday I lectured at Ohio University's Improved Healthcare Through
Cultural Awareness program with the topic: History, Health Care & Holistic
Healing: Breaking Health Care Barriers Within the Indigenous Community.
Those in attendance were from the medical, counseling and social work
professions. About 50 were in attendance.
I was asked at the last minute to speak, so this was thrown together in a
relatively short period of time. But I think it turned out well, and it
seemed to go over well... so I thought I'd send it out to the group.
I did my best to fact check every single fact and statistic, but if you
come across an error, please let me know.
Cheers!
Terri Jean
-------------------------------------------------------------------------------------------------------
The first thing you need to know is that Indigenous Americans are the
smallest self identified racial-ethnic group in the United States, yet
studies show they are far more likely to die from tuberculosis, diabetes,
influenza and alcoholism than that of the general population. Their infant
mortality rate almost doubles the white population, they have the poorest
cervical cancer survival rate, AIDS is a staggering 40% higher than the
white community, and life expectancy is 6 years below the national average,
with 33% not making it to the age of 45.
Despite all these health problems, American Indians receive grossly
inadequate health care, especially when compared to other ethnic and racial
groups. But the indigenous have experienced such deplorable service for more
than a century. Slow service, refusal of treatment, denial of coverage,
funding shortfalls, exhausting read tape, and a lack of adequate facilities,
personnel and equipment are just part of the problem. The truth is a complex
layer of broken promises, apathetic politicians and tragic policies.
The second thing you need to understand is that the United States and the
First Nations have a unique relationship that is not based on race, rather
it's a political relationship developed from treaty rights, supreme court
cases, and legislation. In exchange for land, services was to be provided to
Native people... services that included free health care. Unfortunately, the
spending is discretionary, rather than mandatory, which has produced a
inept, unreliable system with a history of incompetent care, a lack of
funding and facilities, cruel practices and, of course, corruption.
At first, the health care services were part of the Department of War, but
it was later turned over to the Bureau of Indian Affairs. In 1928 the status
of indigenous people were surveyed and then detailed in the Merriam Report,
which brought to light the poor to non-existent health care of Native
people. President Franklin Roosevelt's administration sought to reform the
policies, one of which was to solicit medicine men to provide care for their
people, something that was illegal and punishable by imprisonment prior to
their solicitation. Still, poor and non-existent health care continued.
Then, in the early 50's the Indian Health Services was founded by the
government. At that time, 95% of all indigenous people lived on reservations
where there were only a few health clinics. Most tribal people had to travel
great distances, in Alaska it might have been a day or two, to reach an
Indian clinic. Also in the 50's the government was implementing termination
policies to end not only tribal Nations and the entire classification of the
Native American race, but they also wanted to wipe out all obligations to
provide services to indigenous people, services guaranteed for life via
treaties and court cases. If Indians no longer existed, the responsibilities
no longer existed. People were bribed and coerced off reservations. The
federal trust was again broken.
In the 60's First People's started demanding the return of treaty and tribal
rights, individual civil liberties and their own cultural identity. Lawsuits
were launched, protests were staged and a movement called Red Power fought
for tribal preservation. At this time, over 34,000 children were still in
Indian boarding schools, reservations were one of the poorest communities in
the country, and Native people had a higher rate of foster care than any
other racial group. In Idaho alone, it was 640% higher than the national
average. I have met many people inside Indian country who were taken from
their families and adopted out to white families. Some of them are called
Lost Birds and the children still feel the trauma of their separation even
today.
By the late 70's reforms, laws, acts and tribal recognition - for some - was
reestablished. Strides were made in education, child welfare and health
care, but passing an act and making good on that act are not one in the
same. Native health care remains in a state of crisis even today. Some of
the problems are too much red tape, language and cultural differences, a
lack of physicians and facilities, and a lack of funds.
But the biggest problem is far more complicated... and tragic. Historically,
Native people have endured policies of extermination and then assimilation
for centuries. Manifest Destiny allowed our government, military and people
to believe that genocide was a reasonable solution to the "Indian Problem"
and L. Frank Baum, who later wrote the Wizard of Oz series, penned several
harsh editorials while editor of a South Dakota newspaper suggesting
extermination as a humane solution to Indian suffering. Much like putting
down a sick dog, many citizens of that time wanted to put down the displaced
Natives, most of which were confined to overcrowded concentration camp -
like reservations, full of sick and dying people who were starving, eating
rotten potatoes, spoiled meat and bugs from animal dung, living without
shelter or proper water and bathrooms. As many as 1/3 died from the
relocation process, and from the conditions of the reservation itself. And
many historians believe Baum's editorial was the fuel behind one of the
saddest and most tragic events in indigenous history - the massacre of the
innocents at Wounded Knee.
At the beginning of the 1900's the US decided that genocide of an entire
race might not be the best idea, so assimilation became the policy of
choice, as is it today. An end to the entire Indian race would end
obligations, freeing the US of financial, moral, and legal obligations - and
all reservation land would be free for the taking.
One of the biggest methods for assimilation was to target the children with
the off-reservation "boarding school" - which was more like a cold, cruel
military school or juvenile detention center. Starting in 1879 in old army
barracks in Carlisle, Pennsylvania, the schools targeted children as young
as 4, stealing them away from their parents, holding them hostage, forcing
tiny, terrified homesick children into overcrowded rooms, where the policy
was "kill the Indian to save the man." It has now been admitted by the
Bureau of Indian Affairs that these children were often molested, raped,
used as servants, mentally and emotionally abused and, of course, beaten...
sometimes to death. In what is now called one of the grossest human rights
violations in American history, more than 250 graves pepper Carlisle alone.
It is unknown how many actually died, since many were sent home dead or
dying.
The sexual abuse problem continued until 1987 when a white teacher was
caught in the act of molesting a young boy on a government run Hopi school.
The teacher was later found guilty of molesting more than 142 boys from 1979
to 1987, and the principal and BIA officials had to admit that numerous
abuse complaints were never investigated. Not one of them. And the abuse
only stopped when the teacher was caught in the act. He received life in
prison and now anti-abuse laws are enforced in today's Indian schools. But
these acts left behind generations of victims, many of which are alive
today. The victims live with the legacy of incompetent, uncaring officials
who ignored their cries for help for nearly 2 decades. It's no wonder so
many of them turned to drugs, alcohol and even suicide.
Fortunately, the inhumane sterilization policies did not make it to the
80's.... but they were a big part of the 1970's after the Indian Health
Services initiated a sterilization campaign in 1970. A decade later, more
than 25,000 women were permanently sterilized. How, you might ask? They were
coerced, threatened, and misinformed. Accurate information was not
presented, women were spoken to in a language not their own, consent forms
were improper, and there was a definite lack of appropriate waiting periods.
And many simply did not know what was going on. 2 15-year-old girls went in
for their tonsils and came out without their ovaries. Another woman went in
for migraines, she was told to get a hysterectomy. The migraine problem was
never explored and she was later diagnosed with a brain tumor. By the end of
the 70's this policy, like many others, was deemed inhumane and the
sterilizations stopped. The government later said that 25,000 women were
sterilized, but the Native community said it's more like 60,000 to 70,000...
roughly 40% of ALL child-bearing Native women.
Cancer is a growing problem in communities such as the Navajo where uranium
mines continue to contaminate the air, the earth, the livestock and the
water. Tunnels closed in the 70's remain unsealed, with pits open and
radioactive uranium ore remaining within a few feet of residential homes and
communities. In these areas, there is an especially high rate of
reproductive cancers in teenage Navajo girls, and of the 150 miners who
worked those mines, 133 died from cancer or fibrosis by 1980.
Another issue is the placement of toxic waste on more than 300 reservations.
The United States has a long tradition of using reservation land as a
dumping ground for toxic and nuclear waste, poisonous solvents, pesticides,
unexploded bombs, radioactive materials, fuel, sewer sludge and human
garbage. Though some reservations were paid to house landfills, many of them
were tricked by crooked politicians and businessmen who said the dangerous
poisons would not pose any health problems for reservation inhabitants. But
it took less than a decade for residents to get sick. Their water, air,
plants, rivers, lakes, livestock, and soil were contaminated. In California,
dumping ground residents had higher than natural levels of arsenic,
chromium, lead, mercury, and nitrates in their hair and urine. Alaskan's
fish and wildlife - food supply for many Native communities - had concerning
levels of PCB's in their system, and a recycling plant that was supposed to
be harmless to the environment actually produced extremely harmful toxins
that were burned and released into the air. Cancer, leukemia, fibrosis, and
other diseases now plague these reservations. And the pollution continues.
Lastly, indigenous people often live within a constant state of post
traumatic stress disorder. Having to deal with daily super-saturation of
their identity to hock everything from carpets and beer to campers and
butter. Their chiefs, a tribal position of great respect and honor, is
mocked at high school football games, and they remain the most
under-represented minority in journalism today. Most of their issues are
debated and polled, often without the perspective of the Native person. They
know their people were invaded and their land was stolen. That disease was
spread purposely with diseased blankets, and that the people who control
their land have deemed them unable to control their lives, their reservation
land and their monies. Each year more than $300 MILLION dollars flows
through the US treasury from business leasing and mining reservation land,
and yet the money continues to go unpaid to Native people. Today more than
20 BILLION - yes BILLION - dollars is owed to Native people for royalties
from mining, timber, farming and so on... but the treasury has no idea where
it is. Native people continue to live in the poorest communities in the
United States, where they die from cancer, disease, and an inapt health care
system, and YET the treasury receives 300 MILLION a year for their benefit.
Statistics show that indigenous people have the highest risk for mental
disorders than most ethnic groups. Depression is 20% more than whites, and
suicide is the highest per capita. Illicit drug use is higher than both
African Americans and whites, and they're 7 times more likely to die from
alcoholism than the general population.
Given all that you know now about the indigenous experience, wouldn't you be
depressed to if this was YOUR history? Your life? Your ancestry?
Can you imagine how it would feel? On today's reservations, the ISH receives about
$1300 per capita from the federal government to care for Indian patients,
which is about half of what's given to federal prisoners. The average
non-Native receives $2600. The people I've spoken to used words like angry,
frustrated, suspicious, and desperate when describing their medical care.
They said services are often inaccessible, and some feel an obsessive need
to keep outsiders under constant surveillance, especially government
officials and medical personnel. They do not feel that their care is
important, and because the funding is discretionary, their lives are in the
hands of those they trust least. And this is not new to our federal
government. Arizona Senator John McCain said, "The federal government has
continually reneged on its trust and moral obligations to meet the
educational, health care, and housing needs of Indians."
But all is not lost. Despite insurmountable neglect by the federal
government, many Native tribes, villages and organizations banded together
to form health care coalitions on their own. More than 40% established
clinics, private health institutions and non-profit health maintenance
organizations. Some of the progress is due to Indian gaming. And an example
of that is with the Pueblos. Before gaming - their unemployment was 75%.
Many lived without sewage, kitchens, running water, telephones, electricity,
or proper roads, schools, and medical facilities. They were living a
depressive life, and health care was extremely poor, barely even existing.
Now, because of Indian gaming, the 6 Pueblo communities have unemployment in
the single digits, with the Sandia Pueblo having only 1% unemployment. They've
built good roads, new homes, cultural centers, medical buildings, and
grocery stores. The children study their cultural language, tribal banks
offer 0% mortgages, businesses are sprouting up, and they're buying their
land back. One community put in an Olympic sized pool for exercise, and
others have their own health programs, including a full service dialysis
unit. Though their method of splitting casino profits is not common among
all tribal nations, they definitely set an example as to what can be done
with gaming money... and many tribes are following suit. But not all nations
have this opportunity. Of the 562 federally recognized tribes, less than 33%
have some form of commercial gaming - from bingo halls to casino's. And in
the United States, only 5% of all casinos are from Indian Country.
The rest rely on the government and their own traditional healing practices.
Negotiating between two cultures, indigenous people rely on both alternative
and contemporary medicine. Prior to contact, medicine men were well
respected and sought after. They knew the language, history, spirit and land
of their people, and their role as a healer was a lifetime commitment. For
some nations, this knowledge was nearly lost, but the old ways are now
returning. For others, the healer has always been an important part of their
community, and when it was illegal and punishable by law to heal one's own
people traditionally, some medicine men went underground. Healing out of
sight of those who could imprison them.
Today there is a definite resurgence of traditional medicine, which is more
of a holistic healing practice which engages all part of the patient -
spiritual, mental, physical, and emotional. Healing the body takes more than
contemporary medicine. It may take teas, sweats, herbs, prayer, healthy
foods, fasting, counseling, ceremonies, community service, and honoring the
sacred. And though actual beliefs and practices vary from nation to nation,
most of the healers strive to make the patient whole. To expel negative
thinking, an unhealthy lifestyle, and re-connect man to his community, his
planet and his higher power. Often the entire community is involved with the
healing, and many of the people I've spoken to said they prefer to cure
white man's illnesses with white man's medicine, but all other illnesses are
thought to be from an imbalance of the spirit and body, and they prefer
healing through traditional means.
So.... what does that mean to you? What are the things you need to know
prior to entering an indigenous community? Prior to offering medical
services or even establishing a dialogue?
Well, the first thing you should do is to know who the people are, as
individuals, as a community and as a nation. And this lecture is a pretty
good introduction. At least you know some of their experiences and history
with other medical personnel, and hopefully this will allow you a place to
begin an understanding of your patients. What you need to do is to learn as
much as you can BEFORE you walk into that community or clinic. What tribal
nation will you be servicing? What is their history? What is the history of
the clinic? Call and ask people from the clinic. Ask the cross-cultural
liaisons. Google it. Research it. You need to do the same research as you
would if you were entering a foreign country. Learn the traditions, the
proper protocol and cultural manners of the people. Do what you can to
connect with the people you are treating, and not to offend or insult them
in any way. It is not your culture. You probably know very little about
their culture. So learn what you can beforehand and ask questions during.
Respect and honesty goes a long way in Indian Country.
But, there are a few tips I can give you today. Tips to keep in mind when
dealing with Native people in our own community, and yes, there are many
right here in Athens. And though these are general tips that may not apply
to every indigenous person you'll encounter, they are common in many
communities.
1. First assess patients background, looking not only for health history but
also experiences such as those mentioned earlier. Do not be shocked if they're
guarded about their health history or current problem. They might be
suspicious and guarded, and some might even act with mistrust until trust
can be earned.
2. When you meet the patient, introduce yourself. It's a sign of respect.
Don't be surprised if you only get a nod. Offer your hand for a light
handshake, and do so to everyone in the room.
3. Do not be concerned if there is a lack of eye contact, especially with
the elderly. It is not a trust issue nor is it meant to offend you. A lot of
indigenous people, especially those who adhere to traditional ways, do not
like eye contact. It is a part of their culture.
4. Ask questions in a non threatening manner. Be calm and direct, and
non-assertive . Control your emotions and body language. Slow down
questions, explain everything, and frame questions to convey caring.
5. Speak less and listen more, as listening is highly valued. Do not over
talk, interrupt or ask personal, non-medical questions. That's extremely
rude.
6. Become comfortable with silence. Long silence and pauses are common.
7. People might downplay their medical problems, including pain. Some might
even deny a problem at all, or will use metaphors when describing their
symptoms. For example, depression might be a "heavy heart" and pain might be
referred to as an "ache."
8. Don't ask "what's the problem" or talk about fixing their "problem." It
implies unequal power, in which one's life rest in the hands of another.
Rather, ask about their symptoms or their condition, and possible reasons
and solutions. Together, you can diagnose the condition and then, together,
co-manage the healing process.
9. Be aware of your physical distance between yourself and your patient.
Several feet is usually comfortable. Ask permission to touch, keep things
covered, and only use a gown when necessary.
10. Allow the community healer to be involved, when requested. Some, when
given a choice between a healer and a doctor, they will choose the healer.
So, rather than compromise the patient's health, involve traditional
medicines, practices and healing.
11. If the patient brings in a medicine bag, do not touch it, move it, or
remove it. If it has to be moved, ask the patient or a family member to do
it, and keep it as close to the patient as possible.
12. Be open to cultural practices such as chanting, singing, prayer, rituals
and even tobacco use - which is the most spiritual of all plants because it's
smoke carries messages and prayers to the Creator. Be sure to ask the
patient what is to be done with hair and removed body tissues, since they
might need to be returned for burial.
It can take years to build relationships and gain trust and acceptance. Be
patient, learn about the community, honor their traditions and customs, and
keep your promises. Trust is extremely important to indigenous people. Once
you earn it, you've earned a place within the community.
In conclusion I ask that you do NOT take everything I've said today as fact.
Doubt me. Set out to disprove me. Go on-line and research Native American
sterilization, toxic waste on reservations, and child abuse at Indian
boarding schools. Read Native-written books about the Native experience,
learn history from their perspective, and research government to Native
American relationships, especially as it applies to health care and funding.
Learn for yourself. Educate yourself. And use your knowledge to break
barriers... to relate to your indigenous patients.... AND to make
institutional changes.
The circle of trust has been broken between Native people and the outside
medical community. But the circle can be healed.
The circle MUST be healed.
Thank you.