Native American health care: where does cultural safety come in?

Native American health care: how is it different?

Hello all!

I was recently asked to write a little something about the concept of “cultural safety” in regard to Indigenous people. At first my thoughts were “what is that?” and “what the heck am I going to write?”. But quickly it became obvious that cultural safety in the health care system referred to a practice of health care appropriate to Native people, respectful of the traditions and sensitive to the history of intergenerational trauma. But let’s not give everything away right now! I am writing this article in continuation to my article about Native American therapy and my article about historical trauma. Let’s see what it means to practice health care in a culturally safe way.

History of the White man looking down

As I discuss in my article on Native American historical trauma, the Native people have a history of power differential with the White men. The Aboriginal ways were not only ridiculed for many years but at some point banned. With colonization and what followed (e.g. residential schools), culture, language and traditions were banned and severe consequences were to follow if one was to even try to celebrate their culture and people. Beautiful regalia that we see today at Pow wows was forbidden. Can you imagine a life without regalia? Without Pow wows or ceremonies? I can’t!

But here, we are talking about centuries of the White man looking down on the Indian, denigrating the Indian, trying to control the Indian. Very unfortunate but true. The Native people’s lives were controlled in all their aspects. The colonizing of the Indigenous people led to terror on their part, led to an incredible loss of freedom and power (they could not even vote on policies affecting them!). What followed was significant trauma for numerous generations. Therefore, if we keep that in mind, our health care system and its professionals working with Native people, can certainly reactivate past trauma, as it is felt in the body, the mind and the soul.

Why a reactivation of trauma?

Well, health care professionals are authority figures and Native people could feel that the White way is imposed on them. Within the health care system, there is already a power differential between professional and client. if that professional is White and the client is Aboriginal, then the differential is even more pronounced. What does that lead to? A lack of trust from the Native clients and a shutting down of the clients. Because if one is feeling controlled or feeling oppressed, one will not feel like collaborating.

The effects of colonization are long standing and profound as they were felt in subsequent generations and are still felt today. And those effects affect the health of Native American people today. Indeed, long-term consequences such as unhealthy lifestyles leading to poor health, substance abuse or a high suicide (or suicide attempts) rate are all realities of today’s world. And too often the clients are blamed by using denigrating stereotypes such as “the drunk indian”. In a way, for the dominant culture, it is much easier to think in terms of stereotypes than looking at its role in the trauma….

So what is Native American cultural competency or safety?

I would say that cultural competency and safety is letting go of those stereotypes. And meeting the person where they are at (which should really be done with every client). It also means that the health care professional has to be aware and recognize the history of intergenerational trauma within the Native population (if not, one runs the risk of reactivating the trauma). Which translates in understanding that numerous generations are involved in the dynamic presenting itself in front of the healthcare professional.

It means keeping an open mind to different perspectives of a situation, a perspective that might involve acknowledging the patient’s ancestors who are there to guide him or her. At the very least, it means respecting the client’s belief that they are. Respect, it’s all about respect and keeping an open mind. Cultural safety also means to listen, to listen to the patient’s worldview and to work to gain their trust by respecting their ideas and beliefs rather than imposing them. To have an open dialogue about those beliefs, which might include remedies/medicine from Mother Earth and the land, remedies that were used by previous generations. Past generations used so much of what is provided by the land. No synthetic stuff for them. Natural all the way, and far less illnesses. If the Aboriginal client does not feel heard or respected by the health care professional then chances are that treatment compliance will be very low. A lose-lose situation.

Should “white” health care methods be then eliminated?

In three words: of course not! A division between the two worlds is not what should be the goal. Working together should be the goal. Every human being contributes to this world and many modern practices are influenced by traditional ways of healing. And let’s face it, there are more illnesses in this world, illnesses that our ancestors did not have to face. However, it also means that modern medicine has made tremendous progress over time to cure illnesses that were deadly before.

Therefore, combining Indigenous ways to treat and heal with modern medicine provides a more holistic approach. An approach that attends not only to one’s physical side but also mental, emotional and spiritual sides. A balance of all four sides is what true health is. Remember the Medicine wheel people! We aim to find that balance between our four sides. Respecting the client’s beliefs, inviting an occasion to share treatment with the client’s Medicine man or Elder for example. Working together as a team. Because that is what the Aboriginal culture is about: respect all of our relations. It’s not about one being superior while the other is inferior.

We need to respect the medicine we take from Mother Earth, taking only what is needed and giving back to nature. But respecting others’ way of proceeding and their medicine is also essential. A mutual respect is the highest form of respect. We need to see the approaches as being complementary rather than competing. As we are all one. We are all related and so are our ways. That what I call Native American cultural safety.

A Navajo medicine man in ceremonial dress-1904

What are your thoughts? Do you agree? What is cultural safety for you? Would you add anything? Comment below!

14 thoughts on “Native American health care: where does cultural safety come in?”

I’m usually silent in most convos or debates about such subjects. After all, how can one see if he is blind?
My only regret after reading your post, was that I could not have a good conversation face to face with you.
simply awesomely written my Friend
Thank You…
Joseph

Hi, Firstly I love your website and basically everything about it 🙂 The background is beautiful also. This article is fantastic and I loved reading about native american cultural safety – fantastic topic. I truly believe like you said “the highest form of respect is a mutual one.” We all need to respect ourselves and especially our environments, nature and heritage. Thank you 🙂

An interesting and thought provoking article. I first became aware of cultural safety when I visited my daughter in Australia last year. Her husband was just finishing his psychology degree and was keen to work with Indigenous people.
He now has a job doing just that and explained to me the damage that has been done by the displacement of indigenous tribes. In the area I visited, there are now local health centers specifically for Aboriginal people, great to see. More work needs to be done, but at least now there is more awareness of cultural safety.

I worked in the past with the Inuits. And one of the mandatory training we had was called ‘Cross cultural training’ to better understand the Inuits, their cultures. For example, they don’t see work as we do, the Inuits will go to work if they feel like it and for them work is a place to socialize. As for us, we see work as a way of earning a living and a stressful environment.

And one thing I noticed is, if the Inuits don’t want to do something they just don’t and you cannot force them, they’ll just walk away.! So I guess when it comes to their health, you have to listen to them and any measures you want to implement, they have to feel included like they are part of the solution, otherwise you are wasting your time!

Alcohol and substance abuse appears to be a common side effect of oppression. I don’t know what the studies say, but I do feel it is something that the white man has taken advantage of over time.
The stereotype image doesn’t help the situation. In my country, we have a minority ‘travelling community’ who are often discriminated against and stereotyped as thieves
They are blamed for a lot of petty crimes and things that they don’t do.

I just wanted to add my 2 cents here, for what they’re worth 🙂
I’m currently studying Chinese Medicine in school, but I’ve always had an interest in traditional medicines, especially Native medicines as my family is of Dakelh (Carrier) descent. I was born to be a healer, or a medicine woman. I’ve known that ever since I was very little.

I did a report in one my classes in school, on traditional medicines, which spanned from Ancient Egypt to North American Natives. What I found to be really extremely interesting, is the medicine wheel with it’s 4 parts. It’s so incredibly similar to the Chinese 5 “element” theory (I put element in quotations only because it’s a very poor translation), that I was shocked but super giddy with excitement when I came across it. I just had to share it with my class. It’s certainly an interesting connection.

Anyways, that’s all I had to say. Just wanted to share how two different cultures separated by the worlds’ largest ocean, had very similar ways of viewing the human body.

thanks for sharing Jade! The Asian culture and the Native culture certainly have common elements. I think the medicine wheel is a universal concept (even used in the substance recovery system where it is called the wheel of wellness), it is just called by different names. Good for you for following your purpose. All my Relations