According to the contemporary medical ethics, a physician must treat a patient not only in the technically correct way but also with due attention to his or her wellbeing. Such approach presupposes the respectful attitude towards the patient’s nationality, which often shapes the worldview, mental state, communication style, and even the rituals one should follow or avoid. The complex belief system of Native Americans and their predisposition to certain types of illnesses makes the safe treatment nearly impossible until the race is known. Moreover, the mere racial identification is not sufficient as each among 566 federally accepted tribes has its own restrictions and traditions. Thus, qualified medical personnel should be aware of the Native patient’s peculiarities to deliver mentally comfortable and physically safe care.
The Importance of the Issue
To choose the proper treatment methods, one should study the representatives of the nation one attempts to medically assist. Particularly, the native people constitute a racial minority and yet live throughout the country separately, in tribes. Moreover, each tribe has its own local recognition, name, and culture, which consequently requires an individual approach. Nevertheless, American Indian nation meets the challenges common for each native person; particularly, the health issues connected to the level of life and racial illness predisposition. Understanding the nature of each tribe and the national health level becomes an important part of cooperation.
Native American Society Structure
Diversity of tribes. Indian Americans are not a single national group with indivisible culture. There are about 566 federally recognized tribes, each of which adheres to own rules and traditions and, thus, can be addressed as a micro-nation. Moreover, 66 tribes are either recognized by both state and local areas or solely by the state (Moss, 2015, pp. 5-6). Federal recognition presumes the provision of support and comfortable treatment conditions, while their absence indicates negligence. Each tribe has a specific name bound to its history and unique traditions. Moreover, certain people do not belong to any tribe due to the various reasons, particularly as a result of the family loss or foster care (Moss, 2015, p. 6). In fact, American Indians tend to settle everywhere in the US regardless of the existence of the local tribe.
Critical life conditions. Each year, the population of American Indians grows as a considerable number of people accept their heritage, and yet the statistics of the total wellbeing is startling. Native Americans have the lowest life expectancy in Western Hemisphere. Particularly, there are 750% more fatal tuberculosis cases than in all other US nations together. Diabetes rates reached record numbers in 1996, and the level of harassment against Native women remains extremely high (Moss, 2015, p. 25-26). Native Americans also suffer from alcoholism, mental health problems, as well as chronic and viral illnesses. The reasons for poor healthcare include isolation, underdeveloped transport connection, and the lack of financing and local healthcare provision. Additionally, American Indians often tend to suffer from “intergenerational anger and grief” caused by the experience of living as a colony (Haverkate, 2010, p. 15). However, “The Indian Health Service” provides the federally recognized tribes with available support since its establishment in 1955 (Moss, 2015, p. 44). Nevertheless, underfunding and abundance of technical limitations, such as the lack of computers, excessive paperwork, and language barriers complicate its work.
Importance of Recognition in Each Specific Case. Not considering the life conditions, Native Americans are vulnerable to numerous unobvious diseases inherent to the nation. The list of illnesses threatening Natives includes “high blood pressure and heart diseases, arthritis, obesity, bipolar disorder, depression”; also, it is prevalent to have “lactose, drug and alcohol intolerance” (“American Native Health Issues”, 2017). The latter is important while choosing the medications for surgery and treatment or during the child feeding. Moreover, indigenous people may be allergic to certain food additives and chemicals that are normally accepted by non-natives. Some may also have extra teeth and an extra bone in feet. Part of these issues is crucial for one’s health, and, thus, both a patient and a doctor should be aware of every eventuality.
Native American Belief System
The belief system and traditions of Native Americans unite a variety of human life aspects into indivisible health influencing power. The concepts of health, mind, spirit, and emotions comprise a single circle of life which should maintain a balance. A physician cannot treat an American Indian if he or she constantly disrupts the processes which the patient may consider vital. In general, the healing traditions and culture create a complex picture where doctor’s medical interventions relate to healer’s spiritual practices.
The Holistic concept unites body, mind, emotions, and spirit into an indivisible system. Consequently, one simultaneously takes care of wellbeing and spirituality. Care presumes not only medications but also a food choice, atmosphere, psychological stabilization, and control of the patient’s surroundings that will ensure his or her spiritual relief. A holistic approach is closely connected with the medicine wheel of the Native culture. The circle “is divided into four segments in relation to four sacred parts of the world” (Moss, 2015, p. 8). East is related to childhood, south to youth, west to adulthood, and north to oldness respectively. Each side also corresponds to "physical, mental, emotional and spiritual health despite the fact that their names may differ depending on the tribe” (Moss, 2015, p. 8). Such approach is closely connected to the nurse’s duties which mainly lie in providing both mental and physical relief.
Role of physician. Both men and women traditionally perform actions similar to nursing as a responsibility for other people. Particularly, in Dakota, daughters undertake this mission, whereas in New Mexico, the aunt is responsible for both a mother and a child (Moss, 2015, p. 35). Nurses have to administer medications for both body and spiritual nurturing. The rituals include preparing herbs and also "prayers to ancestors, group signing, and corn grinding" (Moss, 2015, p. 38). In some tribes, healers replace rituals with therapeutic techniques, such as "massage, sweating, bloodletting and botanicals" (Moss, 2015, p. 37). The scale of performed actions includes magical herbal and medical influence.
Cleanness. The concept of cleanness strongly influences the understanding of health in the indigenous culture. Washing symbolizes the mind and body purification. The houses require cleaning, especially before entering and during the illness. Fasting is also honored as it presumes the greater openness to the spiritual world. The practice of abstention can differ from tribe to tribe and include "meat, fats, alcohol and sex" in certain periods (Moss, 2015, p. 36). Both mind and body should remain clean, and one cleans them with water, smoke, and rituals.
Illness. Becoming ill results in "imbalance" that stems from avoiding the predetermined path created by gods or ancestors. Retaining a balance becomes one of the healer's priorities. "Witchcraft, soul loss, taboo actions, bad thoughts, and deeds" (Moss, 2015, p. 36) can also disbalance someone's health and path. Tension, bad feelings, and conflicts may cause sickness as well. Also, one can become ill if one’s lifespan is over, or the purpose is finished. In the cases when the spirit has already departed from this world, an individual may develop dementia (Haverkate, 2010, p.66). The possibility to talk about the death depends on the tribe, and yet often, it is a part of the life that one should accept. At the same time, healing is aimed at balancing a person and should not meddle with handling the illness.
Treating a Native American with Due Respect
There is a list of specific requirements one should know to cooperate with the Native patient. American Indians are predisposed to certain illnesses and require a complex approach. Specifically, the physician should pay attention to communication methods, respect their rituals, be attentive to the unobvious signals of the patient’s health condition, and carefully interfere with food traditions. American Indians have their own manner of communication understanding which makes the cooperation easier.
The communicative tradition is basically common and should work in the majority of cases. First and foremost, American Indians are relatively silent. The patient would prefer to listen attentively and to be listened to as well. Inattention may assume disrespect towards the person. After relaying the information, one should wait until an interlocutor understands it so that he or she can properly answer. It is essential to have communication in the places where these conditions can be secured (Haverkate, 2010, p. 51). There is also a list of actions that one should avoid. Particularly, the loud talk is not acceptable as it is considered rude. Direct eye contact is undesirable for the same reason. Finally, medical personnel should refrain from unnecessary touching.
American Indians prefer modest behavior, which consequently can make the diagnosis more complicated. Particularly, the patient may use inner resources and attempt to overcome pain instead of visiting a doctor (Haverkate, 2010, p. 79). Pain manifests itself through the outer signals, such as immobility, high blood pressure, dilated pupils, or pallor. Personnel should be aware of this fact and observe the patient to distinguish pain timely. Moreover, it is necessary to ask the patient regarding his or her state and own understanding of the reasons for pain, as well as to request permission to start the direct examination (Haverkate, 2010, p. 47-48, 58).
Sometimes, the Natives combine the state-provided medicine with the services performed by the local healer. The diseases of the “white world” are treated with modern methods, while traditional medicine copes with its own list of issues (Haverkate, 2010, p. 22). According to a survey by Haverkate, “38% utilized the healer’s services, 1/3 patients received the advice different than of physician and preferred the healer’s opinion” (2010, p. 81). Notably, the performed manipulations from both sides should not conflict with each other. In case of necessity, the patient may also desire for alternative treatment methods accepted by his culture, such as massage, sweating, etc. It is recommended to allow everything that does not harm the patient or people around.
Food takes an important place in the lives of Native Americans. It becomes a part of everyday rituals, as well as of the situational fasting and abstention. The attempts to interfere with the patient’s worldview will not succeed in the majority of cases. Therefore, it is advisable to ask the patient regarding his or her food preferences and prohibitions not to disrupt his or her special diet or traditions. The physician should also ensure that the area is clean and allow rituals of additional cleaning if the patient asks for them.
In conclusion, addressing the culture of the minority is vitally important for proper treatment provision. Treating American Indian means that the physician should consider their predisposition to certain illnesses and intolerance to specific medicaments or food. Moreover, one should understand the complexity of approach regarding one’s health and bring relief to the body, mind, soul, and emotions. It is also important to remember and respect the specific understanding of illness the patient may express. One should maintain a respectful, even-tempered, and direct contact ensuring comfortable fulfillment of everyday needs. Sometimes, the physician has to cooperate with a native healer in order to gain the patient’s trust and maintain the cooperation. The Natives consider the mental health as an indivisible part of the wellbeing, and, hence, medical personnel should tolerate it. Consequently, as all the life aspects are united, probably, local acceptance level may improve health of the nation in question.