On Day 8, we asked how do we transform health care to become more indigenous friendly, whether it's mental health care of general medical care. The answer that jumped out was to implement narrative practice. Indigenous cultures are virtually uniformly cultures of story in which stories matter greatly. Being heard means having the opportunity to tell one's stories. "Treatment" begins by hearing and acknowledging stories.

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Day 8 began with a gentle rain which ended in time for us to burn prayer ties within a circle in which we offered tobacco in gratitude for the trip and the connections that were made, followed by another enormous lunch, after which we loaded our gear onto two boats that would take us off the island.   We transferred to a van which took us to Paynesville, a seaside town where we would stay for one night.   We arrived early enough to take the short ferry ride across the channel to Raymond Island, where we hoped to see kangaroos and koala bears.   The ferry is pulled across by a motorized chain and has no means of self-propulsion.   Pedestrians ride free.   When we reached the other side, we went straight to the map of the island carrying a description of the koala trail, which was 1.2 km.   The island appeared to be only slight bigger than that with an estimated circumference of 3 km (were we ever wrong!).   We ran around the island until we say a sign bearing a kangaroo silhouette, so we decided to follow the sign if we were ever to hope to see kangaroo.   We eventually found ourselves on private land, completely lost, but not without have seen 5 big kangaroos.   We kept walking and ventured through the middle of the most rundown trailer park I have ever seen, even including Mexico.   We joked that we had found the site where meth-heads retire.   Eight trailers appeared to be in use, though dilapidated, rusting, surrounded by paraphernalia (otherwise known as junk), with some cars that clearly hadn't worked in a long time.   We walked through quietly and carefully, lest anyone emerge with a weapon, but we saw no signs of life.   We then came upon a well-manicured house and barn and a fence and the sound of two people arguing.   We quietly climbed the fence and pretended to be invisible to the warring couple, who amazingly didn't notice us at all as we walked right past them.   We came out onto another dirt road, turned right, then left, and eventually reached the end of the road which was seriously marked with "Private Property" signs (unlike our last area which wasn't marked at all) coupled with barbed wire and electric fences.   We figured out that these people really didn't want visitors at all.   Marijuana? we wondered.   A yoga retreat for the wealthy?   We turned around and made a 5 km walk back to town, discovering that Raymond Island was much larger than its map, though our extra walk led us to see many kangaroos.   We were amazed at the ease with which kangaroos effortlessly and soundlessly bounded over 3 meter high fences between properties.   Were we ever sore when we got back to the hotel, which was The Mariner's Cove, by the way.   Its owner remembered us as the crazy group from the USA who had talked him out of a three bedroom suite last year for only one night without an extra cleaning charge.   He gave it to us again.

Now for the more serious conversations which happened over lunch and dinner.   We were asking how to begin to indigenize health services.   The consensus was to begin to acknowledge that we think in stories as David Morris has pointed out.   The clinical case is ultimately a story or series of stories, which can have a thoroughly transformative power, even to the point of what Chalmers has called "making you want to replace yourself."   Thinking in stories means recognizing that people bring their stories to the medical or mental health encounter and need to tell those stories.   We listen to those stories in order to truly understand the other person, and not just until we have enough information to make a diagnosis with the diagnosis then dictating the treatment.   Rather, indigenizing our practice means to recognize that good treatment arises from the story people tell about their illness, how it came about, and how they can get better.  

This means that "indigenous friendly" practice requires the cultivation of narrative skills, which Chalmers has noted, makes the difference between treating the story as adjunct to the presentation of physical signs and symptoms and understanding it as that presentation of the verbal equivalent of a complex state of being -- illness -- that includes, but is not limited to, physical manifestation of disease or dysfunction.   She says that "in telling our own stories, even the least sophisticated among us uses metaphors and speaks in symbolic terms.   A person's chosen symbols are oblique means of self-disclosure, often revelatory to a depth unacknowledged.

Thus narrative skills require the capacity to listen while suspending the search for our own "best match" story to tell back.   We listen for the metaphors and symbols told by people who may not even recognize what they are saying.   We listen for what is not being said and learn to ask questions about that.   We learn to request stories from others as they relate to our patients' stories.   We learn that the stories matter more than the diagnoses, for the stories are what we actually have with which to work and not the labels that are so freely dispensed by the aboriginal-unfriendly system.

Authors Website: www.mehl-madrona.com

Authors Bio:
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 Narrative Medicine.