Challenges of Culture

Some observations regarding Reservations, Indigenous Peoples by Robert C. Bowman, M.D.

From a city kid who had much to learn about rural, and had some great mentors and books and experiences, fortunately less personally painful than most...

There is much to consider regarding health or education efforts regarding people of different cultures. The cultures are usually driven by family and relationships. This is very different to the driven folks who often attempt to "provide" health care and creates interesting situations.

Often there is a administration by indigenous folks with services by those alien to the culture. Connections with the people can make difficult decisions impossible. Government regulations also can hamper the efficient delivery of quality health care (can't hire a dog catcher for $30000 a year but can pay $30,000 a year for rabies vaccine).

Formal administrators and leaders, even if elected, sometimes not really the ones in charge. Unelected and informal leadership able to control without accountability for elections due to personal, traditional, or political power. This can be very helpful, or very destructive depending on those in control. Those not aware of such situations are usually clueless when things fall apart.

Nursing and public health and what people consider real medicine delivered by indigenous personnel in addition to native healers

Physicians who are not native to the culture often there, usually very temporary assignments. Sometimes physicians and providers from a different, non-indigenous, minority group can do a good job and are accepted if they have good skills and versatility, and because they are different or considered also an oppressed group. I saw a black physician assistant, there at a reservation only a few months, but who understood who to work with and how to collect info and how to get things done better than physicians there for years. She was wise and versatile and accepted.

Indigenous people who leave the reservations or homelands to go to do college and medical school are immediately suspect.

Higher education is suspect since it involves kids leaving the tribe and family, and they may not return.

Researchers often come in an publish the worst and provide little in exchange.

Medical education, government, and "do gooder" programs are often temporary and cost more than they are worth.

Those who translate or act as go-betweens between the cultures are often the most stressed and burn out fast and need to constantly work to develop more and more of these folks and hold on to those you have, often some of the lowest paying lowest respect jobs but very important to acceptance, communications, and quality of care.

Solutions

1. long term relationships building trust

2. Education and training as much as possible on tribal lands

3. Connections between medical and other health professions schools and healers such that students who leave the reservation stay connected, return frequently, and receive dual training in formal medical arts and tribal medicine and customs.

4. Programs to involve parents in better education such as science fairs and demos for kids - the parents and chaperones were often more interested than the kids and this would be a bridge to remove the suspicion regarding higher education, it would also help tribal members pursue training for health care jobs such as techs and assistants and even administrators, as well as some second or third career providers.

The Spirit Catches You and You Fall Down by Anne Fadiman (Author)

Good one for age 9 - 12    Native American Doctor: The Story of Susan Laflesche Picotte by Jeri Ferris
 

Robert C. Bowman, M.D.

rbowman@unmc.edu