Essentials of Cultural Competence in Pharmacy Practice: Chapter 7 Notes

Chapter Author: Dr. Stephen Saiz

Native American Patients

Learning Objectives1. Articulate ways assimilation and

acculturation have impacted the identity of Native Americans.

2. Identify key ceremonies and practices that may have interactions with medication.

3. Discuss the unique identity development of Native Americans.

4. Identify ways medicine and wellness are defined within the Native culture.

Native Americans in the U.S. Census numbers for people who identify their

ethnicity as Native American. Census numbers for people who identify themselves

as Native American in combination with one or more other ethnicities.

Percentage in the total population.

History of Native Americans in U.S.1820’s Supreme Court Justice John Marshall tries to

protect tribal interests from claims of individual states.1830: President Andrew Jackson defies Marshall’s

ruling and gets the Indian Removal Act passed.Removal policy resulted in what is now called the Trail

of Tears, 4000-5000 Cherokee died during the extradition.

When land could no longer be secured through physical removal or war, Congress passed the 1887 Dawes Act.

1950s: BIA undertook an Employment Assistance Program. Forcibly moved thousands of people off reservations for education, job training and housing.

Health and WellnessCree term Miyowichehtowin = “having good

relations”Iriquois term Shen-nen Kowa = “maintaining

peace between parties”Lakota term Mitakuye Oyasin = “all my

relatives”Navajo term Hozho = “walking in beauty”Each expression describes a life of balance

and harmony in all living things.

Traditional HealersMay be sought when things are out of balance.The patient will talk, pray and make a tobacco

offering to the healer.If the healer decides he/she can be of help, the

healer will take the tobacco.Healer will draw from his/her knowledge of the

power and qualities of plants, minerals and animal life and prescribe an herbal tea or ingestion of minerals or participation in a healing ceremony.

The intent of the medicine is to heal the spirit, to bring that person back into harmony with Nature where all his/her relatives reside.

CeremoniesMuch of traditional Native American healing is done

through ceremoniesInipi = sweatlodge (water (pejuta) is medicine). Water is

taken in 2 ways during sweat: 1. poured on heated rocks for steam. 2. passed between each round of steaming to cool and refresh participants.

Hanbelaycha=Fasting Ceremony (vision quest). To give thanks, pray for the wellbeing of the community, or receive guidance/direction for future actions. Go alone to wilderness and pray without access to food or water for up to 4 days and nights.

Sundance = Wiwang. During the hottest part of the summer, individuals pray for the welfare of their community. Sundancers sacrifice in hope their pain and effort will alleviate pain and suffering in their community.

Notable concerns for sunlight, heat and psychotrophic medications.

Views of Health/Health CarePatient and healer are seen as equal. Relationship between patient and healer is

a source of healing.Distinction between curing and healing:

Native medicine takes care of the spirit, the life force that all things share. Western medicine addresses cures (tumors shrink, bone is set, heart valve repaired).

What Constitutes Medicine?Western: drugsNative: simple as ingesting water,

breathing deeply, or making an herbal tea.VA and American Indian health programs

have begun to reimburse Native healers for providing traditional health care to native peoples.

Wellness/Red Road“The path to wellness in indigenous

communities is often referred to as the Red Road: a journey and a way to well-being that First Nations people must travel in order to be truly healthy human beings.”

Red Road=the proper way to live in harmony among the distractions of surrounding cultures.

Health IssuesLower life expectancy (2.4 years less than

the U.S. all races population; 74.5 vs. 76.9)Lacking safe and adequate water supply

and waste disposal for 12% (1% of general population)

Younger population, more rural than general U.S. population

Health Disparities Among Native Americans in the U.S.Alcohol induced death 42.1 6.9Breast Cancer 16.5 6.9Cerebrovascular 59.9 57.9Cervical Cancer 4.5 1.4Diabetes 73.2 25.3Heart Disease 236.2 247.8

More Health Disparities…HIV Infection 2.9 5.0Homicide (assault) 11.4 7.1Infant Deaths 8.5 6.8Maternal Deaths 12.5 9.9MV Crashes 50.4 15.3Pneumonia/Flue 31.0 22.0

o NA US Population

Things to Remember Each Native American participates differently in

their culture. A model of acculturation is important to consider when providing services to Native peoples

Native people may be wary of health care professionals. Often a relationship needs to be established if you are to get a comprehensive picture of the person you are serving.

Policies of assimilation and the introduction of foreign illnesses have resulted in the presence of P.T.S.D. like symptoms in many Native people (historical grief/trauma).

Native belief systems value balance and harmony with nature.

Participating in traditional ceremonies may require great personal sacrifice and deprivation. The practice of these ceremonies may complicate the effectiveness of Western medicines.

More Things to Remember…Medicine to Native people is usually a compound found in

nature (water, plant or mineral) and is administered to bring the patient back to harmony and balance with the life force that all of Nature shares.

Studies have established that as many as 70% of Native people have used traditional medicine.

Most dominant culture images of Native people are derived from inaccurate, costumed charades of real Native people.

Native Americans do not possess a large enough number of assimilated individuals to effectively challenge the veracity of racist caricatures. Understanding authentic Native ways requires effort and respectful curiosity.

The protective role the government plays in the life of Native persons has fostered paternalism towards Native people. It can result in behaviors that make Native peoples less than full partners in their health care decisions.

Movie…Culturally Competent Patient Navigation

on Reservations in SD (50 mins)

http://videos.med.wisc.edu/videoInfo.php?videoid=203

Reflection Questions1. What strategies will you use to treat

patients who supplement contemporary medical treatment with traditional Native American healing rituals?

2. How will you use your understanding of the spiritual background of Native Americans in your pharmacy practice?

3. In what ways did the information presented in this chapter affect your view of Native Americans?