Indigenous Solidarity in Western Medicine
Alexandra Thomas
MClSc candidate, Western University
Recently, I had the opportunity to work on a literature review on indigenous conceptualization of solidarity in health and wellness in New Zealand and Australia. This experience allowed me to gain an understanding of concepts that provide wellness among Māori communities, expanding my knowledge of what can count as health promotion activities. I have a particular interest in mental health, having seen first-hand impacts of ongoing and intergenerational trauma directly caused by colonialism, finding a sense of wellbeing is very important to me. Working on this project also has allowed me to reflect on why and how non-Western, Indigenous conceptualizations of health and well-being provide such a distinct and important alternative to Western approaches when it comes to mental health.
The mental health inequities among Indigenous people in Canada are attributed to the nation’s colonial past and ongoing neo-colonial policies and racism. Despite this being well-documented, policies and programs in health and social services evolve without the awareness of the impact of structural violence and social suffering on the lived experience (Smye et al., 2023). Standing in solidarity with Indigenous populations requires active and consistent learning and unlearning and is a life-long process of building relationships built on trust, consistence, and accountability with marginalized individuals and communities (The Anti-Oppression Network, 2016). While emerging evidence in Western medicine highlights the importance of Indigenous led healthcare partnerships benefit Indigenous communities through the connection of traditional knowledge and practices, this concept is well known and understood among Indigenous communities (Allen et al., 2020). Among six First Nation communities in Northwestern Ontario, the integration of traditional counselling, land-based activates, and elder-run healing sessions within mental health and substance use centres were found to have a high retention rate and led to a dramatic reduction in suicide across the communities (Mamakwa et al., 2017). There are many examples across the world from countries that have successfully integrated indigenous ways of being and knowing into health practices. In what follows, I discuss some of the ways the Māori People of New Zealand have been included in the health system, towards decolonizing healthcare.
The concept of health and wellness among Māori indigenous communities extends beyond the body. For example, the Māori ways of knowing and being provide wellness within their communities. Māori understandings of health are holistic and use Tikanga (cultural beliefs and values) to guide actions. Such understandings are based on respect and reciprocity and take into consideration of the social and physical environment, in addition the participation within settings (Reweti, & Severinsen, 2022). Whare Tapa Wha, one Māori understanding of health, is founded in enhancing taha wairua (spiritual), taha hinengaro (mental), taha tinana (physical), and taha whanau (family, community) health, in conjunction with the land which one belongs (Durie, 1985; Hughes, Cottle, & Gremillion, 2013). Engagement with the land has been viewed as a source of wellbeing through strengthened identity and empowerment, access to traditional food sources, enjoyable physical activity (Graham, 2009; Schultz et al., 2018).
Among a group of Māori individuals accessing psychiatric care for bipolar disorder, care informed by whanaungatanga, which highlights the importance of connection and relationships, created a safe space for those receiving care. This study used Māori knowledge and was led by community members to understand the voices and perspectives of participants. Kaupapa Māori, a research framework is guided by several principles including the respect for people; to present yourself face to face; to look, listen, then speak; to be generous; to be cautious, to not trample over the mana (authority, status) of the people; and to not flaunt one’s knowledge (Smith 1999). Participating in tikanga (culture, customs) allowed individuals accessing care to feel comfortable in their identity. The recognition of cultural needs from healthcare providers is of immense importance to those receiving care.
Understanding the belief systems of Māori is crucial to providing respectful but also effective care. Clinical insights may be less useful for addressing distress and disease for some Māori, compared to Māori worldviews and ways of being. For example, among those receiving Māori mental health services in New Zealand, the diagnosis within the DSM-IV was viewed as being of less high importance compared to obtaining the highest quality of life, which includes the participation in tikanga. (Staps, Crowe & Lacey, 2019). Acts of tikanga such as shared meals with family members, were further identified as important to feeling comfort and acknowledged within healthcare settings. Understanding the person as a part of a larger whanau (family) was central to providing effective care. The involvement of family members in each step of their care supports whanaungatanga and provides a sense of wellbeing and togetherness during vulnerable times (Brown et al., 2012). Western models of health may not be as effective when applied to Indigenous communities as they do not consider other ways of knowing and doing. At least one study found that the shared understandings of the needs of Māori through engagement informed by whanaungatanga, diagnosis, treatment adherence, and the process of recovery are likely to be more effective for Māori with bipolar disorder then Western models of health (Staps, Crowe & Lacey, 2019).
What is the lesson here? There are a few. Within the context of providing care within New Zealand healthcare settings, the integration of Māori ways of knowing and being provides a sense of wellbeing among community members that cannot be achieved in the absence of such integration. I think from this, though, there is another important lesson for people like myself seeking to contribute to improvements in well-being and health services within Indigenous communities. Steps towards solidarity as a care provider within a Western healthcare setting takes more than just building patient-provider trust. It is salient to recognize one’s positionality and pre-existing biases, understanding health and wellness in one’s culture may not be subjected to a clinical definition. Methods to participating in solidarity as a healthcare provider may look like the recognition of culture or understanding how what health and wellness means to a community and their methods of achieving and maintaining wellbeing (Staps, Crowe & Lacey, 2019). Recognizing there is no one way, or correct way, to achieve a sense of health and wellness, Indigenous and Western knowledge can work in parallel with one another, towards the collective goal of enhancing the sense of wellbeing.
References
Allen, L., Hatala, A., Ijaz, S., Courchene, E. D., & Bushie, E. B. (2020). Indigenous-led health care partnerships in Canada. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 192(9), E208–E216. https://doi.org/10.1503/cmaj.190728
Brown, K., Worrall, L.E., Davidson, B., et al. (2012) Living successfully with aphasia: a qualitative meta-analysis of the perspectives of individuals with aphasia, family members, and speech-language pathologists. Int J Speech Lang Pathol. 14(2):141–155.
Durie M. H. (1985). A Maori perspective of health. Social science & medicine (1982), 20(5), 483–486. https://doi.org/10.1016/0277-9536(85)90363-6
Graham, J. (2009). Na Rangi taua, naTuanuku e takoto nei:Research methodology framed by whakapapa.MAIReview,1,1–9.
Hughes, C.R., Cottle , M., and Gremillion, H. (2013). A community cpproach to palliative care: Embracing indigenous concepts and practice in a hospice setting. Journal of Systemic Therapies, 32 (1), 56-69.
Mamakwa, S., Kahan, M., Kanate, D., Kirlew, M., Folk, D., Cirone, S., Rea, S., Parsons, P., Edwards, C., Gordon, J., Main, F., & Kelly, L. (2017). Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: Retrospective study. Canadian family physician Medecin de famille canadien, 63(2), 137–145.
Reweti, A., & Severinsen, C. (2022). Waka ama: An exemplar of indigenous health promotion in Aotearoa New Zealand. Health Promotion Journal of Australia, 33(S1), 246–254. https://doi.org/10.1002/hpja.632
Schultz, R., Abbott, T., Yamaguchi, J., & Cairney, S. (2018). Indigenous land management as primary health care: qualitative analysis from the Interplay research project in remote Australia. BMC Health Services Research, 18, 1-10.
Smith, L. T. (1999). Decolonizing Methodologies: Research and Indigenous Peoples. London, UK: Zed Books.
Smye, V., Browne, A. J., Josewski, V., Keith, B., & Mussell, W. (2023). Social Suffering: Indigenous Peoples' Experiences of Accessing Mental Health and Substance Use Services. International journal of environmental research and public health, 20(4), 3288. https://doi.org/10.3390/ijerph20043288
Staps, C., Crowe, M., & Lacey, C. (2019). Effective care for Māori with bipolar disorder: A qualitative study. International Journal of Mental Health Nursing, 28(3), 776–783. https://doi.org/10.1111/inm.12582
The Anti-Oppression Network (2016). Allyship. The Anti-Oppression Network. https://theantioppressionnetwork.com/allyship/
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