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Native American health care: where does cultural safety come in?

Native American health care: how is it different?

Hello all!

I was recently asked to write a little something about the concept of “cultural safety” in regard to Indigenous people. At first my thoughts were “what is that?” and “what the heck am I going to write?”. But quickly it became obvious that cultural safety in the health care system referred to a practice of health care appropriate to Native people, respectful of the traditions and sensitive to the history of intergenerational trauma. But let’s not give everything away right now! I am writing this article in continuation to my article about Native American therapy and my article about historical trauma. Let’s see what it means to practice health care in a culturally safe way.

History of the White man looking down

As I discuss in my article on Native American historical trauma, the Native people have a history of power differential with the White men. The Aboriginal ways were not only ridiculed for many years but at some point banned. With colonization and what followed (e.g. residential schools), culture, language and traditions were banned and severe consequences were to follow if one was to even try to celebrate their culture and people. Beautiful regalia that we see today at Pow wows was forbidden. Can you imagine a life without regalia? Without Pow wows or ceremonies? I can’t! native american regalia

But here, we are talking about centuries of the White man looking down on the Indian, denigrating the Indian, trying to control the Indian. Very unfortunate but true. The Native people’s lives were controlled in all their aspects. The colonizing of the Indigenous people led to terror on their part, led to an incredible loss of freedom and power (they could not even vote on policies affecting them!). What followed was significant trauma for numerous generations. Therefore, if we keep that in mind, our health care system and its professionals working with Native people, can certainly reactivate past trauma, as it is felt in the body, the mind and the soul.

Why a reactivation of trauma?

Well, health care professionals are authority figures and Native people could feel that the White way is imposed on them. Within the health care system, there is already a power differential between professional and client. if that professional is White and the client is Aboriginal, then the differential is even more pronounced. What does that lead to? A lack of trust from the Native clients and a shutting down of the clients. Because if one is feeling controlled or feeling oppressed, one will not feel like collaborating.

native american flute

The effects of colonization are long standing and profound as they were felt in subsequent generations and are still felt today. And those effects affect the health of Native American people today. Indeed, long-term consequences such as unhealthy lifestyles leading to poor health, substance abuse or a high suicide (or suicide attempts) rate are all realities of today’s world. And too often the clients are blamed by using denigrating stereotypes such as “the drunk indian”. In a way, for the dominant culture, it is much easier to think in terms of stereotypes than looking at its role in the trauma….

So what is Native American cultural competency or safety?

I would say that cultural competency and safety is letting go of those stereotypes. And meeting the person where they are at (which should really be done with every client). It also means that the health care professional has to be aware and recognize the history of intergenerational trauma within the Native population (if not, one runs the risk of reactivating the trauma). Which translates in understanding that numerous generations are involved in the dynamic presenting itself in front of the healthcare professional.

It means keeping an open mind to different perspectives of a situation, a perspective that might involve acknowledging the patient’s ancestors who are there to guide him or her. At the very least, it means respecting the client’s belief that they are. Respect, it’s all about respect and keeping an open mind. Cultural safety also means to listen, to listen to the patient’s worldview and to work to gain their trust by respecting their ideas and beliefs rather than imposing them. To have an open dialogue about those beliefs, which might include remedies/medicine from Mother Earth and the land, remedies that were used by previous generations. Past generations used so much of what is provided by the land. No synthetic stuff for them. Natural all the way, and far less illnesses. If the Aboriginal client does not feel heard or respected by the health care professional then chances are that treatment compliance will be very low. A lose-lose situation.

indian at wrk magazine

Should “white” health care methods be then eliminated?

In three words: of course not! A division between the two worlds is not what should be the goal. Working together should be the goal. Every human being contributes to this world and many modern practices are influenced by traditional ways of healing. And let’s face it, there are more illnesses in this world, illnesses that our ancestors did not have to face. However, it also means that modern medicine has made tremendous progress over time to cure illnesses that were deadly before.

Therefore, combining Indigenous ways to treat and heal with modern medicine provides a more holistic approach. An approach that attends not only to one’s physical side but also mental, emotional and spiritual sides. A balance of all four sides is what true health is. Remember the Medicine wheel people! We aim to find that balance between our four sides. Respecting the client’s beliefs, inviting an occasion to share treatment with the client’s Medicine medicine wheelman or Elder for example. Working together as a team. Because that is what the Aboriginal culture is about: respect all of our relations. It’s not about one being superior while the other is inferior.

We need to respect the medicine we take from Mother Earth, taking only what is needed and giving back to nature. But respecting others’ way of proceeding and their medicine is also essential. A mutual respect is the highest form of respect. We need to see the approaches as being complementary rather than competing. As we are all one. We are all related and so are our ways. That what I call Native American cultural safety.

medicine man

A Navajo medicine man in ceremonial dress-1904










What are your thoughts? Do you agree? What is cultural safety for you? Would you add anything? Comment below!