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Articles    H2'ed 4/22/10

Learning from Native North America for Health Care

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This weekend, I taught a sociology course on Native American ceremony in which we wondered how traditional healing could be incorporated more into mainstream health care, both as practice, but also as principle. We looked at the range of what is occuring across North American. Perhaps the most integrated and innovative program is at the Aboriginal Health Unit of the University of Manitoba. There, in downtown Winnipeg, a client can ask the receptionist to see either the traditional healer or the conventional physician. Both the healer and the physician are on salary and the services of both are a covered benefit for clients. As far as I know, anyone can see the traditional healer. One does not have to be a Native American person to use the services of the healers, and, as far as I know, these healers are willing to work with anyone who comes to see them. The healers have a beautiful thunderbird shaped building in which to do ceremony. Offices ring the outer circle with doors of entry at each of the four directions. A central open space includes a large grate in the middle that can be removed to build fire. Nearby, the City turned a parking lot into an environment for the healers to do sweat lodge and other outdoor ceremonies. Knowing Judy Bartlett,the medical director of this facility, I imagine that the healers and the physicians have some interesting discussions and engage in what has been called explanatory pluralism -- the idea that multiple,ovelapping levels of explanation can exist for any phenomenon, and our inability to see how the levels connect, or to explain one level in terms of another, doesn't invalidate any level. My favorite example of this comes from the life of James Walker, physician to the Pine Ridge Lakota Reservation from the 1880s through the early 1900s and first non-Native person to be taught to be a wicasa wakan, or healer. Early in his career, Walker attempted to convince his later teachers that tuberculosis was caused by a bacillus and not by an evil spirit. To convince them once and for all, he set up a slide in a microscope and urged the healers to look at it. "This is what causes tuberculosis," he proudly announced. The healers looked and got vey excited. "This is what we saw in our vision," they said. "This was our vision of the evil spirit." From then on, Walker was much more accepting of Lakota explanaations.

In our internet searching for other programs, however, my students discovered that not all people of Native North American ancestry agree with programs like Winnipeg's. Some believe that healers should never receive any compensation and should remain completely aloof and apart from the conventional medical system. Others object to healers helping non-Native people. Others believe that only those of "pure blood" should be healers. We found a tremendous argument about what is traditional healing and who should do it.

My students noted with irony a previous discussion we had in which they learned that the "blood quantum" system was only created in 1904 by an act of the U.S. Congress, the goal of which was to eliminate eventually all "Indians." The members of Congress and their advisors had been influenced by an offshoot of Charles Darwin and Gregor Mendell, the field of eugenics. In those days, race was supposed to explain everything criminality, laziness, intelligence, and more. Racial purity was sought as important. Members of Congress opined that Native American people would begin to marry non-Natives and they would marry members of other tribes. If a percentage of "Indian blood" was established below which services would end, perhaps they could eliminate the Bureau of Indian Affairs and close that faucet which they saw as draining money that should be going elsewhere. Theresa O'Nell, in her book, Disciplined Hearts, tells the story of the Flathead Tribe of Montana enrolling under the auspices of the Indian Agent in the late years of the 19th century. Anyone who identified as Blackfoot was enroled, regardless of "blood quanta" since that concept had not yet come into being. Elsewhere and earlier (in the 1820s), the head chief of the Cherokee Nation, John Ross, was 100% Cherokee, representing the Nation to Andrew Jackson in its delegation to prevent the relocation of the Cherokee from Tennessee to Oklahoma. Technically, John Ross was 7/8s Scottish, but that was barely noticed. Darwin was just writing On the Origin of Species. Mendell's work was not known in the Americas. The notion of genetics and percentage of race had not yet been invented, and, actually Darwin scoffed at the concept when he heard about it. He responded that no gene existed for race, that race was a social construct. Genes exists for skin darkness, for controlling height, for facial features, but these genes often varied as much within a group as between the groups. Darwin strongly objected to the categorization of people from Africa as inferior and to their subjugation as slaves on the basis of skin color.

We asked the question, is "Indianness" a social construction or a genetic fact. We found many definitions of "Indianness" including genetic, participation in ceremonies, living a traditional lifestyle, self-declaration, speaking the language, living on a reserve, and more. Many of the definitions overlapped and interacted to create a competition for "indianness", which was so well-described by O'Nell. Eduardo Duran, a Pueblo psychologist, and co-author of Native American Post-Colonial Psychology, describes what he calls the MITT syndrome, or "More Indian than Thou." In my own life, I have felt this scrutinizing gaze. As I described in Coyote Medicine, I was raised by Cherokee grandparents in an interesting (to me now) blend of traditional Cherokee cosmology and spirituality and their unique blend of Christianity. That was inevitable in the Kentucky of those days. It was hard to escape Christianity. I know of heritage from Lakota and French-Canadian on my father's side, and Scottish and Cherokee on my mother's side. Probably other influences exist. I felt Less Indian than Thou most of the time, at powwows, ceremonies, and other gatherings. Nevertheless, I have studied and practiced my own version of Native American spirituality for many years.

Another hero of mine is Charles Eastman, or Ohiyesa. He lived a traditional Oglala life until a teenager when his father resurfaced after having been given up for dead. Charles' father had been in a government prison for fighting the U.S. Cavalry and was finally released. He came home to encourage Charles to learn the ways of the mainstream world to help with his people's survive. Charles did just that, attending Dartmouth College and then Boston University School of Medicine. After internship, Charles returned to be the physician for Wounded Knee, South Dakota, for many years. He wrote 17 books, most of which are still in print, and helped found the Boy Scouts of America. In one of his books, Charles wrote that Oglala spirituality is a highly personal matter. There is no governing body to decide what is true or false, no priests, no ecclesiastical boards, no church hierarchy. There are teachers and holy men, but if one disagrees, he can just walk away and find another. Nature and Creator are the prime authority. That has been my perspective on my own spirituality.

The students and I discussed these various points of view. Being college-age, they pointed out that anything unappealing to young people will die out. They did not think the view of noble poverty and never being paid could last long. "Kids want stuff," they said. "They want what they see on MTV." That had certainly been my experience working on reservations. MTV and its culture is stronger often than traditional spirituality or Chistianity for youth. I suspected they were correct in believing that an insistence on poverty as a requirement for being a healer would turn many youth away. My own view is that healers should be a part of our health care system and they should be paid in the same way that physicians are. Personally, I would prefer being on salary with a panel of people for whom to care. As I have written previously, I believe that the piecemeal system of charging for each patient is wasteful and inefficient and encourages physicians to spend as little time with patients as possible.

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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