Paddle with Me
It is not uncommon for Indigenous Peoples to distrust outsiders – particularly outside health officials and practitioners. In East Africa, during the Ebola breakout, local people did not trust the healthcare workers from outside their home country and sought care from their own traditional healers. The local East Africans did not trust the outside health officials because their own cultural traditions were not honored. See the article “How the Fight Against Ebola Tested a Culture’s Traditions” for more information. What went wrong?
In the Downing article, issues of indigenous culture, “otherness” and the absence of systemic responsibility for culturally appropriate health care provision is discussed. Let’s walk through it:
The article refers to a “gap” in measured health outcomes between indigenous and non-indigenous Australian peoples. Access to care is defined as the existence of an affordable, local health service and available transport, but also incorporates cultural accessibility and appropriateness. Think about that for a minute – if the care needed is not culturally appropriate, it is not accessible. Get it? If it is culturally inappropriate, it is not desirable thereby not accessed by those who need it.
In other words, the “care” might as well not exist. For example, if a dietitian were to use nutrition education resources made from a Western organization (i.e. American Heart Association) with foods and language well-known to the mainland US, would it be culturally appropriate for the Pacific region? Do you think it would be relevant to people in the Pacific? For example, the “Tips for Heart-Healthy Grocery Shopping” does not mention foods relevant in the Pacific. In this type of resource, there are assumptions – such as access to a grocery store and refrigeration in the family home.
The Downing article also shares, “there are many accounts of hostility, trauma and degradation resulting from the ‘overtly racist treatment’ of Indigenous peoples by health workers”. While it is recognized that training in cultural competency is important, the way it is presented can, in itself, be creating more of a gap between those receiving the training and the intended populations to be served. See bottom of page 7,
“What is notable here is the emphasis on teaching health workers about Indigenous peoples ‘special health care needs’ in their ‘sociocultural context’, as opposed to considering processes of culture and identity, including those of the health worker themselves or the health system they work in (Paul et al.)”
Do you see the shift? Instead of focusing on cultural competency training, which has not been proven to be very beneficial, we should be looking at our systems addressing health in the Pacific – are they culturally adapted? And, we need to look at ourselves – our own identity, our own tendencies. What’s your worldview? And, the bigger question is – how is your approach received by the individual or community you are addressing?
A Paddler’s Perspective
What a great article! I have shared this article with many of my colleagues and classmates. We have discussed the concept of “otherness” and how there is tendency in our world to do this without being cognizant of it. We may think it is not a big deal, but systemically, it causes hurtful damage. It can be a very human tendency to want to put people in categories, and if they’re not “like us” then they are the “other folks”.
This article should prompt you to do some self-reflection. What IS your worldview? Realize that some of your own beliefs and tendencies could be ingrained from how you were raised, experiences you’ve had, etc. This isn’t your fault. What you ARE responsible for is recognizing them and asking yourself how your own worldview impacts how you interact with others. Cool stuff.