Integrating Traditional Healing and Western Medicine March 30, 2017 Matthew Lorentz Sheridan College

Integrating Traditional Healing and Western Medicine March 30, 2017 Matthew Lorentz Sheridan College

Contrasting worldviews have caused communication difficulties between Indigenous people and western society. Probably the most glaring difference between Indigenous people and western society is the importance of knowledge and whom it belongs too. For example, Indigenous people believe knowledge belongs to everyone and should be shared. Contrastingly western society economizes knowledge by having it directly affect wages and occupational advancement. In addition to educational views and values, Indigenous people and western society view healthcare very differently. Indigenous people have always connected their physical, emotional, and spiritual health as a large part of traditional healing is achieved by practicing spirituality through ceremonies. On top of a sense of spirituality traditional healing focuses on healing the client s relationship to their community and looks at a person s whole life focusing on creating harmony with all aspects. In contrast western society purposely separates spirituality and health. The biomedical approach creates an isolating environment which points out the clients flaws. With more than half of Canada s Indigenous population living in an urban setting there is more of a need than ever for integrated health services. The major difference between social determinants of Indigenous health and the general population is the affects of assimilation tactics such as colonization, and the residential school system. As a result of the aforementioned assimilation tactics, many indigenous people have lost a connection with their culture and spirituality. Because of the direct link between spirituality and traditional healing many traditional healing practices have been lost. It is understandable that Indigenous people have a distrustful relationship with western society, which is only compounded by the contrasting worldviews\. There is now an overrepresentation of Indigenous people among the poor, the homeless, injection drug users, and sex trade workers residing in urban settings (Seaborn, E. 2010. p. 4). Many people start using drugs as a coping mechanism; for Indigenous people either childhood or intergenerational trauma leads to addictive behavior and poor health choices. Mistrust has become a common coping mechanism for many Indigenous people. The repetitive unfulfilled promises by western society, have led Indigenous people to live with a perpetual suspicious attitude toward them. What many biomedical practitioners fail to realize is before presenting conditions can be treated trust must be formed. Western society has alluded to the increasing number of Indigenous alcohol and drug users and how addictions have lead to the overrepresentation of Indigenous people in the prison system, however, they have failed to take

responsibility. It is no wonder Indigenous people distrust western society: since the two cultures met the European colonists have been dismissive and believed it was their right and duty to civilize Canada s Indigenous people. It has only been within the last 20 years that any real attempt has been made, by Canada s government, to apologize for the atrocities resulting in cultural genocide. Steven Harper s apology in 2008 was the first time the Canadian government publicly admitted to the national mistreatment of Indigenous people. It was pointed out that most, if not all, of the intergenerational and historical trauma experienced by Indigenous people was the fault of the Canadian government. During the apology the Canadian government failed to take responsibility for how to make improvements and instead only admitted its past actions were wrong. When traditional healing is offered some Indigenous clients feel mistrustful of the motivation behind it. Because of the historical trauma created by colonialism, Indigenous people live in a constant state of suspicion. Mistrust extends to most non-indigenous people and has created the hostile relationship between Indigenous clients and western medicine. After generations of deception by western society, many healers are leery letting non Indigenous people in the sacred circle. Before Indigenous people feel comfortable sharing their knowledge with western society again they want some assurances, some protocols put in place, protecting the ownership rights of their knowledge (Hill, M. A. 2003). Sharing knowledge is one of the Indigenous peoples core values: they freely shared their knowledge of the land, and how to survive with the European colonists upon their first encounter. The aforementioned mistrust stems from colonialism and the subsequent Canadian governments that used this knowledge to segregate Indigenous people to reserves. Indigenous people want integration of health services but not at the expense of their beliefs, culture, or knowledge. The integration of health services is not only a good place to start rebuilding trust but it is also an excellent way for western society to question its own values and worldview. As Indigenous people and the rest of Canada begin to work together more often, the hope is that both cultures will learn from one another and use their collective history to improve policies and attempt to grow together. For example, Indigenous people can learn to create written histories; allowing them to pass on their cultural and spiritual beliefs, and western society can learn to be

more accepting; shifting the importance away from a symptom focused approach to a more holistic approach to healthcare. The creation of hybrid healthcare facilities is beneficial to both Indigenous and western society. Hybrid facilities attempt to combine traditional healing and western medicine by combining the spiritual aspects of traditional healing and the solution focused structured approach of western cognitive therapy (Heilborn, C. L & Guttman M. A. J. 2000). One example of a hybrid facility is the South-western Ontario Aboriginal Health Access Center. The S.O.A.H.A.C specializes in holistic integrated services by offering both traditional cultural services and western medical services. S.O.A.H.A.C is unique because they offer services such as Nurse Practitioners who are able to examine patients, diagnose illnesses, provide counseling and education, write prescriptions, order lab tests and refer to specialists when necessary (SOAHAC, 2015. website). There has been a relatively smooth combination of traditional healing and western medicine in facilities run by Indigenous people, however, western facilities are once again changing more slowly. In March of 2012 The National Aboriginal Health Organization put a fact sheet together explaining the creation of its new initiative; the Team for Aboriginal Anti diabetic Medicines or TAAM. The difference between TAAM and other scientific based programs is it aims to alleviate the effects of type two diabetes by trying to scientifically prove the safety and reliability of traditional healing. It is note worthy that the purpose of the TAAM project was not focused on creating new western medicines but to combine traditional knowledge and western medical practices for treatment and prevention purposes (National Aboriginal Health Organization. 2012). Through TAAM western society is trying to integrate traditional healing into its medical model and points out the importance of combining traditional healing and western medicine. That being said, it is interesting that even through their efforts to integrate, western society feels the need to test the effectiveness of traditional healing. Once again western society is attempting to use traditional knowledge but refuses to change its worldview in the process. In essence, though championing integration, western society still wants to control the application of traditional healing through scientific experimentation. There have been positive outcomes during the integration process: By studying Indigenous healing methods western society has been able to utilize the most comparable aspects of the cognitive model to help smooth the integration process. For instance, it has been

recognized that group counseling is more effective than a one-on-one approach (Heilborn, C. L & Guttman M. A. J. 2000). Because of their collective worldview, Indigenous people often have a different reaction to conventional cultural competency. Concepts such as cultural competency first emerged in social services in the early 1980 s and have been evolving since. Cultural Safety is a natural progression of cultural competency, however, instead of just aiming to be culturally knowledgeable, cultural safety goes further and focuses on how certain groups are positioned, perceived and treated in society (Polaschek, 1998 as cited in Seaborn, E. 2010. p. 11). Essentially, cultural safety explains the power dynamic between the dominant and marginalized groups involved. There are culturally targeted services and public services available for Indigenous people, however, targeted services don t offer a wide enough range of services and public services are often not culturally safe. Indigenous people benefit most from a broad approach to healthcare that offers culturally appropriate services, such as sweat lodges, and cognitive programs such as conventional addictions therapy. Sweat lodges are used to promote meditation and assist in detoxification by creating a controlled dehydration. When trying to be culturally sensitive many agencies have a hierarchical approach, which is counterintuitive to how Indigenous people understand the world. Ironically the power dynamic between Indigenous people and western society is not taken into consideration when offering culturally appropriate services (Seaborn, E. 2010). Cultural Safety takes into consideration the vulnerability of a culture, and in the case of Indigenous people, the impact intergenerational and historical trauma has on their current experience. Because of intergenerational trauma, caused by residential schools and laws banning Indigenous people from practicing their cultural beliefs, many of these beliefs and traditions have been lost. Traditional healing practices were no exception: the decimation of knowledge passed from one generation to another was part of the methodical dismantling of Indigenous culture. As the Royal Commission on Aboriginal Peoples points out, by relying on western medical services Indigenous people, give away their healing power (Royal Commission on Aboriginal Peoples 1996). The connection between the ability to heal and power should not be overlooked: Because Indigenous culture is largely oral it has been difficult for traditional healers to train apprentices (Mear M. A. & Shawande M. 2010). The aforementioned barrier causes a gap in the amount of traditional knowledge available and is one of the reasons it has taken so long to even attempt integrating traditional healing and western medicine.

The integration of Indigenous healing into a western clinical setting has brought up some interesting questions surrounding what cultural competence means to Indigenous communities. Integration of healthcare is so important because not all Indigenous people use traditional healing techniques, due to lack of resources or a differed cultural identity. By offering both traditional services and western medical services clients are empowered to choose the services that best fit their lives. Though integration of traditional and western healthcare has been proven to be highly effective there are barriers. Because the worldview of Indigenous people and western society are so vastly differed, before integrating traditional healing and western medicine both cultures need to be self determined. In order for Indigenous people to become self-determined they will need the support of the Federal and Provincial government. Essentially, Indigenous governments and health agencies must be able to decide what place traditional health and healing will have in their care services (Indigenous and Northern Affairs Canada, 2015). In addition, the government of Canada needs to enact some of its, currently symbolic, agreements. Canada has signed 22 agreements promising Indigenous people self governance: Many of these are either minimalistic or have not been enacted (Indigenous and Northern Affairs, 2015). Though the Canadian government has publicly apologized for the atrocities Indigenous people have suffered at their hands, creating stagnate documents, only affects perception and does not create solutions. Until Canada accepts the values of Indigenous people the integration of healthcare between the two will be fraught with barriers. Compounding the systemic barriers to integrating Indigenous healing and western medicine is the intergenerational, physical, emotional and mental trauma many Indigenous people experience. In many cases integrating Indigenous healing and western medicine takes place in specialized clinics. For example, mental health concerns continue to be a dominant social determinant of health making facilities such as Noojmowin Teg Health Centre extremely important. Indigenous people and western society are both taking a holistic approach when it comes to mental health concerns, however, the compounding issues of historical and intergenerational trauma continue to be extremely prevalent with Indigenous communities adding stress western clients don t face. The main reason for the continued relevance of the residential school system is, many survivors are either still alive themselves or have had children they were not mentally prepared to take care of. The children of parents who were sexually

abused feel abandoned because their parents are still coping with trauma. A toxic environment is often created, as a result of absentee parents, making coping more difficult for parent and child alike. One of the few places Indigenous people can receive addictions help, and cultural education is, unfortunately, in prison or in a healing lodge. In 1995 the first Correctional Service Canada approved healing lodge was opened. Members of the Indigenous community run healing lodges, they are located on Indigenous lands and are partnered with the CSC (Government of Canada, 2016). Though they are correctional facilities healing lodges are an excellent example of how Indigenous healing and western medicine can be experienced simultaneously. It is interesting it took until 1995 for the first healing lodge to be opened and it is more interesting that once again a hybrid facility has to be approved and governed by western society. Preventative measures, such as, mental health and other support services will have a positive effect on the incarceration rate. Though healing lodges are relatively new, there very existence proves integration of health services can be successful. The approach being taken currently, in hybrid health services, is an interdisciplinary support system designed to benefit clients and staff members. For interdisciplinary programming to be successful clients have to be able to be seen quickly and have culturally appropriate services available. It is easier to provide culturally appropriate services for Indigenous people by creating an environment conducive for staff members to learn more about local Indigenous communities and cultures (Mear M. A. & Shawande M.. 2010). In some cases Indigenous facilities focus entirely on traditional healing and miss the role of western medicine. Instead traditional healing methods, such as sweat lodges, should be combined with western cognitive practices to offer the most inclusive services. On top of the services offered the opportunity for staff members to learn about, and network with local Indigenous communities is indispensable when trying to conceptualize the efficacy of traditional healing. By learning more about the local Indigenous communities staff can learn the importance of spirituality when discussing Indigenous healthcare. For instance, sharing original teachings in the form of stories, Indigenous people effectively create a group reflection, by explaining how the story applies to their lives (Heilbron, C. L & Guttman M. A. J. 2000). Because Indigenous people continue to respect oral traditions, the importance of story telling in healthcare is paramount. The goal of sharing original stories in

a group is to help heal individual issues through sharing experiences and attempt to heal intergenerational issues by promoting the importance of Indigenous cultural practices. The National Collaborative Centre for Aboriginal Health (NCCAH) has recently hosted a series of forums designed to focus on the social determinants of Indigenous health and finding preventative methods to the issues affecting them. The very existence of the NCCAH shows that collaborative health care is a concern and is being addressed. Unfortunately, these forums are in the awareness and education phase: Before Indigenous people see an improvement in the determinants affecting them, these forums need to lead to actionable change. What is hopeful about these forums is the audience. The first forum took place in Ottawa, Ontario, [and featured] 100 representatives from federal, provincial/territorial, and Indigenous governments; [as well as] academic and research institutions; Indigenous and non-indigenous health organizations; and national and provincial Indigenous organizations (National Collaborative Centre for Aboriginal Health, 2015). With the focus of these forums on the social determinants of health there has been a paradigm shift focusing on prevention rather than treatment. Because of the varied audience Indigenous people can use the aforementioned forums to educate all facets of society at once. The most important participants of the NCCAH forums are the non-indigenous medical organizations. It is western medicine that can learn the most from these forums; as they will help to acknowledge and address the differences between Indigenous healing and western medicine. For instance, Indigenous healing teaches the importance of understanding the root issue that leads to the presenting concern; whereas biomedicine treats the symptoms and explains their existence by pointing out a flaw with the person (Hyatt, A. 2013). With the creation of the NCCAH forums the gap between the holistic / trauma informed practice of the Indigenous people and the pathological / solution focused approach of biomedicine is being bridged. Both forms of medicine are extremely important and need to be recognized equally if Indigenous people are to overcome their current health challenges. The Canadian government representatives are extremely important audience members at the NCCAH forums because they can network with the Indigenous and non-indigenous medical organizations. The goal of Canadian government representatives is to create policies that will diminish systemic racism and promote national acceptance protocols for communicating with

Indigenous people. Currently there are two major policies that have set Indigenous people on the path to being in control of their own health, the Indian Health Policy of 1979 and the Health Transfer Policy of 1989. Today Indigenous healing methods, especially ceremonies, are gaining recognition due to effectiveness among Indigenous and non-indigenous people alike. Many provinces have started to exempt midwives and traditional healers from government regulations. Because many ceremonies require materials, such as traditional tobacco, to preform some provinces have modified their tobacco laws (National Collaborative Centre of Aboriginal Health. 2011) to accommodate Indigenous traditions. The increased recognition and popularity of Indigenous healing methods, specifically the importance of ceremony, has prompted governments to make legislation more culturally sensitive to Indigenous ways of knowing. On top of the culturally specific barriers, common challenges, such as funding, are a concern with specialized programing. For instance, due to high demand and limited recourses collaboration between mental health professionals and traditional healers is challenging. (Mear M. A. & Shawande M.. 2010). The assessment process is being done and culturally competent conclusions are being made, however, staff shortages continue to slow the integration process. Another major concern is the high turn over rate of staff, which causes a pause in services due to the high learning curve of non-indigenous staff members (Mear M. A. & Shawande M.. 2010). The constant disruption of services leads to the bitterness and mistrust of social services by Indigenous clients. No matter how non-indigenous clinicians try and understand Indigenous ways of healing and strive to be culturally competent it is difficult to understand emotional attachments and even more difficult to reflect unshared beliefs back to a client. Therefore, the bitterness that may come across in some Indigenous clients is more than understandable it is justifiable. Many clients feel that they are listening to a script and feel that clinicians don t actually believe in traditional healing (Mear M. A. & Shawande M.. 2010). The act of trying to logically understand a set of beliefs is contradictory in its very notion. Learning Indigenous beliefs and values can only be done in a limited way by non-indigenous clinicians. Essentially, traditional healing is directly linked to spiritual beliefs and without being raised believing in the efficacy of traditional healing it is difficult to project the confidence in it to clients. The integration of Indigenous healing and biomedical healthcare is a good starting point on the road to reconciliation between Indigenous people and western society. The term

reconciliation is slightly inaccurate, however, as it implies that Indigenous people and western society lived in harmony at one point. Ultimately there are three major considerations when attempting to integrate traditional healing and western medicine. First, at least an understanding of the communal / holistic worldview of the Indigenous people will allow western facilities to see the merit of traditional healing. Second, the affects of historical and intergenerational trauma must be taken into consideration, as they are often the cause of the distrustful relationship between Indigenous people and western society. Lastly, the integrated health services that do exist are targeted at specific demographics, such as Indigenous people living on a reserve; making it difficult for urban Indigenous people to get the services they want and need. If traditional healing is not successfully integrated with western medicine the perpetual cycle of intergenerational trauma and communication barriers will continue to see Indigenous people overrepresented in every social determinant of health.

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