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Native American Cultural Competencies and Healthcare According to census figures, the American Indian/Alaskan Native (AI/AN) population is growing rapidly. Furthermore, the population is young and geographically scattered. AI/AN peoples experience high rates of unemployment and poverty, and many encounter substandard housing, insufficient health care, and other socioeconomic obstacles that make day-to-day living a constant struggle. Yet Native Americans show inspiring internal reserves and strategies for survival. Further, many tribal groups have been successful in managing their resources in a way that enhances life conditions for all members in their tribal communities. Concepts that are key to the cultural context, identity, adaptability, and perseverance of Native Americans include:
Balancing mind, body, and spirit: a holistic approach Traditional AI/AN healing systems focus on balancing mind, body, and spirit within the community context. Contrary to the Western approach to health and healing, AI/AN people find it peculiar to isolate one part of a person and only try to heal that part. Native American groups have practiced a holistic approach to healing for thousands of years. Their survival has depended on their wisdom of the interrelatedness and connectedness of everything in the world. Their holistic view involves a sense of connectedness with place and land. It also involves the practical application of methods for preventing naturally caused illnesses (e.g., disease, broken bones, etc.) as well as illnesses of the mind and spirit. Promoting the well-being of the group and its culture Traditional AI/AN healing practices center around benefits to the emotional, spiritual, psychological, and cultural aspects of the tribal group. Practices of ceremony, prevention, and healing are embedded in the fabric of traditional Native American life. Nearly all systems of healing among Native Americans share the belief that large, communal ceremonies serve as a way of promoting the well being of the entire tribal group. The role of the healer, as traditional practitioner, is one who reaffirms the group’s cultural values, integrates all the pieces into the cultural context, and considers all those involved in the community. Enduring spirit and sense of solidarity Hallmarks of traditional Native American culture include: community values and spirit permanence, patience, and sense of humor during periods of dissonance and necessity. AI/AN peoples have survived despite repeated governmental policies of extermination and genocide. Traditional AI/AN culture is marked by strong organizations, networks, and community ties as well as a sense of tribal purpose and solidarity, despite vast differences among and within tribal groups. AI/AN peoples actively pass along information to ensure the survival of the community and culture for future generations and to prevent the loss of their identity and well being. Making everyone part of the circle Traditional American Indians and Alaska Natives respect and share all ways of healing for all sorts of ills. They desire to meet all those in the art and science of healing and make great efforts to share and embrace new ideas and concepts. They seek to include in the healing circle all helpers who have specific knowledge or information about the physical, social, psychological, and spiritual ways of healing. Strengths and Protective Factors in Native American Families and Communities Community, context, culture, healing, journey, path, ceremony, traditions: these words fall short of describing what has been the core of American Indian and Alaska Native (AI/AN) survival since the beginning. Even so, these words and the language convey something of the wisdom and endurance of the Native American. It can be a challenge to providers with another worldview and unfamiliar with AI/AN culture to distinguish between mental health needs that are signals for intervention and the AI/AN cultural distinctiveness that has long provided Native Americans with strategies for prevention and survival. A strong identification with their culture Health services must include content and activities that are congruent with and promote the values, beliefs, and practices of the aboriginal people of the Americas. Services that show respect for the culture of American Indian and Alaska Native (AI/AN) communities are more likely to be accepted in those communities. Indian youth who have higher levels of identification with their native culture may demonstrate lower drug and alcohol use and other unhealthful behaviors. Family Family is of paramount importance among and within all AI/AN groups. While the central role of the family in the development of children and adolescents is recognized by most cultures, the traditional kinship and extended family structure of Indian communities add importance to this socialization source. In the AI/AN community, a family will often identify someone who has problems with alcohol and other drugs and whom they feel has the potential to benefit from a ceremony (healing). The same family will also involve others who might be involved with alcohol and other drugs, but, as yet, does not experience problems. As a result, an individual who might otherwise be lost in a system may become the focus of the communal ceremony that involves both healing and prevention. The Native American family may take precedence over the peer group as the most powerful contributor to use or non-use among youth. Connection with the past Native Americans have a keen awareness of a sense of well being, healing, and cultural context. This awareness serves as the connection to the "healthy" parts of the past which bring them to the present and show how they must continue into the future. Medicine healers are the communicators and connectors to the individual and the community. Native stories, ceremonies, and traditions help keep strong connections with the past. By revitalizing old practices and making the community aware of them, Native Americans have established (or re-established) constructive activities promoting health and healing. Traditional health approaches Traditional ceremonies, such as the sweat lodge ceremony, talking circles, and spirit camps reinforce and strengthen family and community. These healing practices and religious activities have taken place for centuries. They have been passed on to medicine men and women in an organized and ritualized way so that these people may serve not only to treat but also to prevent illness of a psychological or physical nature. Traditional healing ceremonies contribute to the healing of the individual, reaffirm the norms of the entire participating community, and continue the training and practice of the traditional healing perspective. Adaptability AI/AN strength, wisdom, and adaptability involve knowing how to survive the many "life-rope" systems thrown to them over the years. New solutions, ideas, and creativity evolve within the ceremonial life of the community. Providers can build on this strength in providing culturally competent health services. Wisdom of elders The presence of elders is critical to the impact and the quality of culturally competent services. Elders can provide specific advice and emotional support and assist in identifying how to approach counseling or other forms of intervention and prevention from an AI/AN perspective. Elders can share knowledge about how to understand, solve, and prevent problems, as well as knowledge about treatment methods that have been used for generations. Elders speak strongly about cultural values and rules for how to conduct oneself within the family and community. Through elders, wisdom becomes a living, oral knowledge applied to current contexts. Challenges to Health and Well-Being of Native American Communities Health programs using a Western approach to health have dominated traditional American Indian and Alaska Native (AI/AN) models for healing and prevention. To be culturally competent, health programs must begin to define community, prevention, networking, collaboration, and healing as it relates to cultural understanding and awareness. In order to be effective in working with AI/AN communities, providers and programs must incorporate all elements of healing and prevention and include communities in developing appropriate interpretations and analyses of health and dimensions of vulnerability. Ideally, this collaborative process is ever expanding and inclusive of the role of culture, context, and community. Cultural competence will lead to the development of new understandings and models that better meet the health care needs of AI/AN peoples. Alcohol misuse Alcohol misuse is considered by most of America’s indigenous population to be their most serious and significant health problem; it is a problem that affects almost every facet of life. Discussions about mental and physical health, deviance, familial problems, and community structure and function among Native Americans must include, in some form or another, alcohol use and misuse influences. Clashes between Indian and non-Indian views of mental health The non-Indian concepts of personal insight, individual awareness, and self-actualization are seen as agents of separation between traditional Native Americans and their world. This separation between self and other can be problematic and dysfunctional to the AI/AN experience and worldview. Trying to balance the two systems of mental health and native health, both conceptually or through application, can create multifaceted problems for clients and programs and can be difficult for programs to implement. Long memories Many traditional AI/AN communities and villages are face-to-face, kinship, and relational-based. Everyone relates through kinship. Everyone has long memories and significant experience with each other. This serves both to facilitate and to hamper change. For the person working in health, it means that they must know the community and take the time to build relationships and trust. People and communities are the authors of their lives, and community-based helpers must orient themselves to work with the community members to strengthen their ability to develop solutions to their problems and not do the developing for them. Trauma is communal AI/AN communities and groups have suffered a great deal of trauma. This trauma is communal and often historical. Traumatic experiences include epidemics and "deculturational" stressors, such as formal schooling, boarding schools, imposed religions, and economic oppression. Each village and group has its own history of trauma. When an elder dies, a suicide happens, an accident kills, the whole community is affected, and other communities in the region may also feel the impact. Grief and loss are contagious. To promote healing, providers must look beyond the individual to the community and family as a whole. Principles for Culturally Competent Health Care for Native Americans Providers must seek to understand the culture of the Native American: Moreover, it is imperative to support existing Native American practices related to healing and prevention. It is important to understand your role as a provider and discover how to fit into the client community’s model of health and healing. By integrating traditional and Western healing practices, providers can create realistic and culturally congruent services. Respect traditional healing practices: Culturally competent health care for American Indians and Alaska Natives (AI/AN) must respect traditional healing practices that aim to restore balance and harmony to the mind, body, spirit and community. Furthermore, providers must define and value health and mental health as they are defined and valued in traditional Native American communities. Traditional models are valuable because they connect Native Americans with their traditions and true selves and "because nature is a sacred and healing place that helps us to be wise and creative as we work toward our future. Involve family and community Strengthen and build on family ties that are a source of spiritual and cultural pride. Especially in prevention work, the interaction between healer and client should involve family, tribal, and community members who may also benefit from the exchange between the individual, the group, and the sociocultural environment. Involving everyone and everything in a collaborative and cooperative manner for the benefit of the community affirms the cultural context. Individual healing ceremonies and prayers are a means of accomplishing community solidarity and affiliation. Used with permission from Management Sciences for Health |
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