Submitted to the Faculty of Graduate Studies and Research
in Partial Fulfillment of the Requirements
for the Degree of
Master of Arts
in the
Department of Native Studies
University of Saskatchewan
Saskatoon
by
Mellisa Margaret Layman
1989
The author claims copyright . Use shall not be made of thematerial contained herein without proper acknowledgement,as indicated on the following page .
7o o
In presenting this thesis in partial fulfillment of therequirements for a Master of Arts degree from the Universityof Saskatchewan, I agree that the Libraries of thisUniversity may make it freely available for inspection . Ifurther agree that permission for copying of this thesis inany manner may be granted by the professor or professors whosupervised my thesis work or, in their absence, by the Headof the Department or the Dean of the College in which mythesis work was done . It is understood that any copying orpublication or use of this thesis or parts thereof forfinancial gain not be allowed without my written permission .It is also understood that due recognition shall be given tome and to the University of Saskatchewan in any scholarlyuse which may be made of any material in my thesis .
Requests for permission to copy or to make other use ofmaterial in this thesis in whole or part should be addressedto :
Head of the Department of Native StudiesUniversity of Saskatchewan
Saskatoon, Saskatchewan S7N OWO
ABSTRACT
Little research has examined the role traditionalhealth care systems play today among Native populations . Thepresent research examined the role these systems play amongthe urban Native population of Saskatoon, Saskatchewan .The research was conducted at the Westside Community Clinic,located in the downtown core area of Saskatoon . This area ofthe city has previously been identified as having a highconcentration of Native people . The present studyrepresented one component of a much larger project whichexamined both Native and non-Native utlization patterns ofthe Western health care system at the Westside clinic . Aninterview schedule was used to gather data, with a total of103 Native and 50 non-Native interviews being conducted .Since no sampling frame exists for the Native population ofSaskatoon, an availability sampling technique was used ."Native" was defined in this study as status Indian,non-status Indian and Metis .
It was discovered that traditional health care systemsplay an important role in the health care of thispopulation, with the use of these systems being quiteextensive . It was determined that the variable of languagewas a somewhat useful predictor of the utilization oftraditional health care systems, although language retention(the ability to speak a Native language) was found to bemore important than the frequency with which a Nativelanguage was spoken . It was also discovered that use oftraditional health care systems was not found only amongolder respondents, but rather was generalized among therespondents. The economic variables of income and educationlevels were also found to be related to utilization oftraditional health care systems, with those respondents withhigher income and education levels reporting greater use ofthese systems . Use of traditional health care systems wasnot found to be restricted to respondents with Indianstatus ; rather, use was generalized among status Indian,non-status Indian and Metis respondents .
Respondents who utilized traditional health caresystems also fully utilized the Western health care system .Further, use of traditional health care systems was notfound to be related to difficulty respondents may haveencountered in using the Western health care system, such aslanguage or economic problems, or experiences of racism,although such problems were found to exist . Clearly,respondents did not turn to traditional health care systemsbecause of difficulties in utilizing the Western health care
iii
system . Rather, traditional health care systems were used tosupplement the Western health care system . It was furtherfound that the majority of the respondents in the studydesired access to traditional medicines and healers withinthe city of Saskatoon-and, again, this finding was notconfined to any sub-group (I .e . older respondents) of thestudy but was generalized . The extent to which this accessis presently available is questioned, and this couldrepresent an important unmet health need of this population .
iv
ACKNOWLEDGEMENTS
Firstly, I would like to thank my advisory committeemembers, Dr . F .L . Barron, Head of the Department of NativeStudies ; Dr . B . Singh Bolaria, Head of the Department ofSociology ; and Dr . A .M . Ervin, of the Department ofAnthropology and Archaeology for their valuable insightsduring the initial stages of this research . I would alsolike to thank the external examiner on my committee, Dr .John Owen of the Department of Community Health andEpidemiology .
The staff of the Westside Community Clinic mustgratefully be acknowledged for graciously allowing thisresearch to take place in their clinic and forenthusiastically supporting the aims of the research . Inparticular, I would like to thank Marg Cloak of the Westside-Community Clinic for all her help over the course of manyweeks while the research was being conducted . I would alsolike to thank the Friendship Inn, and particularly theformer director Lee Smith, for generously allowing me accessto the Inn's clientele .
I am deeply indebted to the College of Graduate Studiesfor providing financial support during the course of myMaster's program in the form of a graduate scholarship .
I would like to extend my sincerest thanks to myresearch supervisor Dr . James B . Waldram, of the Departmentof Native Studies, for originally inspiring and thenencouraging my interest in Native health issues, and for hisimmeasurable help and guidance in the realization of thisthesis .
Finally, I would like to thank Daxl .
I dedicate this thesis with much loveto my mum and dad .
V
Table of Contents
ABSTRACT III
ACKNOWLEDGEMENTS v
LIST OF TABLES ix
1 . SIGNIFICANCE OF THE PROBLEM 1
2. CONCEPTUAL FRAMEWORK
REVIEW OF THE LITERATURE
3 .1 Urban Native Health Research17
3 .
3.2 Contemporary Native Health Issues21
3 .2.1 Accidental and Violent Deaths223 .2.2 Alcoholism and Drug Abuse30
3 .3 The Western Health Care System33
3 .3 .1 Utilization by the Native Population333 .3 .2 Socio-Cultural Barriers Facing the
Native Population 39
3.4 Traditional Health Care Systems : DiseaseEtiologies and Treatment Modalities45
3 .4 .1 The Shaman 473.4 .2 Diagnostic Strategies553 .4 .3 Spirit Intrusion and Spirit-Caused
study of Native (Indian and Metis) mortality In Alberta
which determined that : "Natives encounter death under
very different circumstances and from different causes
than do Canadians and the style of death reflects a
style of life that is different from that of the
general population ."78 The different circumstances
Natives encounter include the finding that Natives die
younger than non-Natives and die in clusters of two or
more people (52% died in the company of other Natives) .
Further, it was found that 60% of Natives die outside
of hospitals, and 25% of these deaths were in the
26
company of nine or more other Native people . According
to Jarvis and Boldt, the death of a Native is a "social
event ." Jarvis and Boldt also discussed the different
causes of death between the Native and non-Native
populations : 32 .4% of Native deaths were accidental
compared to 8 .6% for the non-Native population ; and
3 .5% of Native deaths were from homicide, compared to
0 .6% for the non-Native population . The researchers
make two major conclusions about Native mortality :
firstly, that alcohol plays an extremely important
role ; secondly, that the special life circumstances of
Natives, namely their low socioeconomic position, makes
them vulnerable to accidents . 74 In March of 1986 the
Cree Indian settlement of Peerless Lake In Alberta
received national attention when five people at a party
died from drinking duplicating machine fluid . 75 This
settlement, which suffers from rampant unemployment,
likely created the "special life circumstances"
referred to by Jarvis and Boldt .
Several recent studies have looked at mortality
patterns on Canadian Indian reserves . In 1986 Mao et
al . reported that the violent death rate among the
reserve Indian population was three to four times
higher compared to that of the Canadian non-Indian
rate . They also found the age-specific suicide rates of
Indian males and females to be significantly higher
than the non-Indian population (Indian male =
27
53/100,000, non-Indian male = 19 .9/100,000; Indian
female = 17/100,000, non-Indian female
6 .4/100,000) . 76 In a 1986 analysis of mortality data
for Indian reserves, Morrison et - al . reported a
significantly higher rate of infant deaths due to fires
than that found among the non-Indian population . 77
Similarly, in 1982 Evers and Rand found a significantly
higher rate of injury-related morbidity among Canadian
Indian children compared to non-Indian children in
their first78 and second year 79 of life .
The Saskatchewan status Indian population has a
much higher accidental and violent death rate compared
to the non-Indian population (it is necessary here to
speak strictly of the status Indian population because
vital statistics are only compiled for this
population) . Accidents and violent deaths were the
leading cause of death among the status Indian
population from 1972 to 1984, but were never above a
number three ranking in the non-Indian population . In
1984 there was still a large discrepancy between the
two populations, with the status Indian rate being 2 .6
times that of the non-Indian rate (Indian rate =
173 .5/100,000 ; non-Indian = 65 .2/100,000) . It is
alarming that from 1972 to 1984 the percentage of
status Indian deaths from accidents or violence was
never below 36%, and in 1984 this figure reached 37 .5%,
meaning that over one-third of all status Indian deaths
were accidental or violent . In contrast, the highest
percentage of accidental and violent deaths among the
Saskatchewan non-Indian population was 10 .05% in
1981 . 80
The percentage of accidental and violent deaths
among the Saskatchewan status Indian population saw a
generally steady and significant increase from 1960 to
1984 . In 1960, 10% of all status Indian deaths were
from accidental or violent causes ; but by 1984, 37 .5%
of status Indian deaths were accidental or violent .
Throughout the mid-twentieth century infectious and
parasitic diseases (largely pneumonia) were the leading
cause of death among thestatus Indian population, and
accidents and violence ranked number two . In 1965,
accidents and violence became established as the
leading cause of death among the status Indian
population (170/100,000) and remained as the number one
ranked cause of death to 1984 . 81 In the 1984-85 period
the second ranked cause of morbidity/ mortality among
Native patients at St . Paul's Hospital, Saskatoon was
found to be injuries and poisonings . 82
The status Indian population of Saskatchewan has a
much higher suicide mortality rate compared to the
non-Indian population . In 1984 the status Indian rate
was 40 .6/100,000, while the non-Indian rate was
13 .2/100,000 . Further, there is a very sharp increase
in the suicide rate of the male status Indian
28
29
population in the age group of 15-24 years, which
reached an alarming 117 .5/100,000 In 1984 compared to
37/100,000 among the Saskatchewan non-Indian male
population of the same age group . 83 A recent study by
the Saskatchewan Alcohol and Drug Abuse Commission
found that alcohol and drug abuse were involved in a
75% of Native suicides as compared to 64% of non-Native
suicides . 84
A study by the Federation of Saskatchewan Indian
Nations compared Saskatchewan status Indian accidental
and violent deaths by health zone from the years
1981-1983. The study revealed that motor vehicle
accidents were the most frequent type of
accidental/violent death in all the health zones . The
North Battleford zone had the highest motor vehicle
death rate at 94 .5/100,000 which was over two times the
rate of the other zones . The second most frequent type
of accidental/violent death was in the "other" category
which includes deaths by assault, suffocation, and
homicide . The Prince Albert zone accounted for 50% of
all deaths in the "other" category in the province with
a rate of 43/100,000 . The researchers esimated that
approximately 62% of all deaths in the "other" category
are alcohol, drug or substance-abuse related .85
As Moffatt has pointed out, in any discussion of
Native accidental and violent deaths it is important to
remember that there is a "tremendous variation" in the
suicide rates across Indian communities, with some
areas having rates which parallel those of the general
Canadian non-Native population . 86 However, it is clear
that a serious problem exists and steps must be taken
to begin to ameliorate the situation .
3 .2 .2 . Alcoholism and Drug Abuse
An issue which is closely tied to the discussion
of accidental and violent deaths among the Native
population is alcohol and drug abuse . A wide body of
literature has sought to explain Native alcoholism in
terms of analyses of the role played by acculturative
stress . Researchers have examined both American 87 and
Canadian88 Indian populations, concluding that the
stress these groups faced was the causative factor in
their alcoholism .
Numerous studies have attempted to determine the
prevalence of Native alcohol and drug abuse . The high
alcohol and drug use rate among American Indian
adolescents89 and adults90 has been described . Little
information exists on the prevalence of alcohol and
drug abuse among Canadian Native populations . However,
a 1984 study on alcohol and drug abuse by the
Federation of Saskatchewan Indian Nations provided some
important information . The research involved a survey
of almost nine hundred adults on twelve reserves and
four hundred adolescents on eleven reserves . It was
30
31
determined that between 35 and 40% of the adult
Saskatchewan status Indian population and 10 to 15% of
the adolescent population (15-19 years) had an alcohol
abuse problem, and 20-25% of the adult and 5 to 10% of
the adolescent population had a drug abuse problem . 91
Several studies have also examined the prevalence
of, alcohol and drug abuse by urban Native populations
in Chicago, 92 Minnesota,93 and Sioux City, 94 with
researchers commenting upon the high degree of
alcoholism among these populations .
The paramount role of alcohol has often been
emphasized in studies of Native accidental and violent
deaths and some prevalence data for Canadian Native
populations have been produced . In 1966, Schmitt et a] .
discovered that alcohol was a contributing factor in
28% of all accidental deaths among the Indian
population of British Columbia . 95 In 1969, the Standing
Committee on Indian Affairs and Northern Development
noted the significant role alcohol was playing in
Canadian Indian accidental and violent deaths . 96 In
1973 The Grand Council Treaty 3 determined that 73% of
all accidental deaths among the Indian population of
Kenora, Ontario involved alcohol . Further,
categorization of the accidental deaths by blood
alcohol level revealed that 11% of the alcohol-related
accidental deaths had a "heavy" level of intoxication
(defined as .16 to .23% blood alcohol, or "staggering
32
drunk" ; legal limit Is .08% blood alcohol) .
Alcohol-related acccidental deaths in the blood alcohol
category of "very heavy" ( .24 to .34% blood alcohol, or
the "pass-out stage") stood at 21%; and such deaths
stood at 7% In the blood alcohol category of
"extreme"( .35% blood alcohol, or the "comatose" stage) .
The Council also discovered that Indian males died from
alcohol-related accidents almost two times more than
Indian females (males=46 .5% ; females=24 .8%) . 97 In 1982,
Jarvis and Boldt reported In a study of Native
accidental and violent deaths in Alberta that alcohol
was directly involved in over 40% of these deaths . 98
It is very difficult to make any generalizations
about. the extent of alcohol and drug abuse among Native
populations based upon the prevalence studies cited .
Mostt of the studies do not provide adequate data on the
prevalence of this abuse and when data is provided it
usually reflects a small population, making
generalizations about the entire Native population
difficult . Heindenreich has made a very good point in
arguing that not enough substantial comparisons of
alcohol and drug abuse between tribal-geographical
groups have been done, and he has suggested that
significant differences In abuse patterns exist between
Natives communities . 99 Thus while it is not always
appropriate to make generalizations about the entire
Native: population in regard to accidental and violent
deaths and alcohol/drug-abuse, a serious situation does
exist . The role of traditional Native treatment
modalities in alleviating alcohol and drug abuse, and
thus possibly lessening the occurance of accidental and
violent deaths, will be discussed- in _ section 3 .4 .
3 .3 The Western Health Care System
3 .3 .1 Utilization by the Native Population
In 1969 a study on health services for Canadian
Indians done for the Canadian government concluded
that :
Many Indians exhibit little awareness of what ismeant by good health and they tend to bothover-utilize and under-utilize health careresources . Medical care is often sought for minorproblems . . . on theother hand, Indians frequentlyfail to recognize significant symptoms and delaYseeking treatment until they are acutely ill . 100
The researchers employed a "blame the victim" ideology,
suggesting that the difficulties Indian people face in
utilizing the health care system are the result of
their inability to properly understand how it is to be
utilized . Subsequent research has recognized, however,
that barriers are often in place which prevent maximum
utilization of the Western health care system by Native
people . Clearly, the -soclo-economic status of the
Native population acts as a major barrier to health
care . Also very important to understanding the
33
34
utilization patterns of the Native population is the
population's knowledge of the Western health care
system . This can be particularly significant in the
urban context . Kirchner reported that minority groups
seeking health care in city clinics may face problems
in utilizing services because of their unfamiliarity
with the Western health care system . 101
On the reserve the Western medical system is
usually represented by the nursing station or similar
facility. Thenursing station, and thus the Western
health care system, is very accessible and many of an
individual's primary health needs can be met by this
single facility, either through resident nursing staff
or through the physicians, dentists and other health
care professionals who provide services to reserves . In
the urban centre a Native individual is faced with a
very complex Western health care system in which one
must utilize various subcomponents (eg . clinics,
hospitals, dental offices) to have one's primary health
needs met .
Research on the utilization of the Western health
care system by Native populations, although limited,
indicates that the complexity of this system in the
urban centre can be a factor preventing maximum
utilization . Fuchs discovered that a major reason for
the under-utilization of medical services by Natives in
San Francisco was that they did not know where to go
35
for services . 102 Similarly, Miller's study of an Indian
free clinic in Los Angeles revealed that one of the
most significant barriers to health care was a lack of
a clear understanding of the clinic's procedures and
who to contact within the clinic for health care . 10 3
A 1982 position paper by the Joint Saskatoon
Hospital Planning Group argued that Native people
migrating to Saskatoon have problems utilizing the
Western health care system because of the difficulties
in following directions by health care providers, often
given rapidly in English, and, because of difficulties
In keeping scheduled appointments . 104 Nemetz has also
argued that the health of urban Canadian Natives is
jeopardized by their lack of familiarity with the urban
Western health care system . 105 Shah and Farkas have
pointed out that status Indians migrating to urban
centres may not realize that their medical coverage
shifts from a federal to a provincial responsibility
and thus may not have adequate coverage in the urban
centre . 106 Thus the urban Western health care system
can be particularly difficult to utilize for Natives
coming from reserves or rural area .
In a major 1979 study, McCaskill reported that
Native people in major Canadian urban centres
(Toronto, Vancouver, Edmonton and Winnipeg) were
generally satisfied with the health care services they
received . 1 0 7 Similarly, several studies in the 1980s
36
have also investigated the health care utilization
patterns of urban Natives . Studies in Calgary108 and
Edmonton 109 concluded that Natives in these centres did
not face any significant barriers in obtaining health
care . A 1988 study by Waldram and Layman determined
that while the Native population of Saskatoon did face
some barriers Inutilizing the Western health care
system, a high level of utilization was occurring . 110
One specific area of concern identified by some
researchers is the under-utilization of prenatal health
care services by Canadian Native women . In 1967,
Graham-Cumming suggested that while pregnant Canadian
Indian women were increasingly using prenatal services,
only approximately 30% were currently making adequate
use of these services . 111 This problem has also been
identified by American researchers . For example, in
1970 Littman reported that many pregnant Indian women
did not fully utilize prenatal medical services in
Chicago, which resulted in many of these women being
seriously undernourished . 112 Similarly, a 1984 Native
Needs Assessment determined that Native women in
Calgary did not utilize prenatal medical services or
well-baby clinics extensively, with 25% of these women
receiving no prenatal services . 113 In a recent article,
Glor reported that few Native women in Regina attended
pre-natal classes, but a prenatal program begun under
the auspices of the Regina Native Women's Association
37
resulted in a significant increase in the number of
Native women attending these classes . 114 The Westside
Community Clinic in Saskatoon provides a "Healthy
Moms-Healthy Babes" program, with three Native health
workers . 1 15
A great deal of research has been concerned with
determining the extent to which particular groups in
North America utilize the mental health care system, as
well as evaluating the quality of the psychotherapeutic
services received by these groups . Some of the first
studies to examine utilization of the mental health
care system focused upon the relationship between one's
socio-economic class and utilization patterns, and
generally concluded that patients from lower
socio-economic classes received a lower quality of
mental health care compared to patients from upper
socio-economic classes . 11 6 Another maJor area of
research focused upon the utilization of mental health
care services by minority groups, again concluding that
these groups-have lower utilization rates and received
lower quality mental health care services compared to
Caucasian patients . 117
Researchers have also focused upon the utilization
of the mental health care system by Native North
American populations, although not to as great an
extent . In 1974, Barter and Barter described the urban
Indian as being "invisible" to mental health agencies
38
and found a low level of utilization of mental health
services by urban Indian populations in California- 118
In 1978, Sue et al . examined the psychotherapeutic
services received by Chicano and Native Americans in
seventeen community mental health clinics in the
Seattle area and found that Natives were
over-represented in the centres but failed to return
for treatment in 55% of the cases . 119 In another 1978
study, Borunda found that Indians in Portland had a low
level of utilization of mental health services . 120 In a
1980 study of minority utilization of over two hundred
American community mental health centres, Wu and Windle
discovered that Natives had a low level of utilization
and also that few of these- centres had Native
professional staff . The researchers suggested that
increasing minority staffing In thesecentres would
increase minority utilization . 121 In a 1980 study,
Rhoades et al . examined the prevalence rates of
utilization of mental health services by Native
Americans and discovered a rate of 235 .1/100,000 among
the 45 to 49 age group, representing nearly one
consultation with mental health services for every four
Indian people . 122
Information on the utilization of mental health
services by Canadian Native populations is very sparse .
In a 1972 study, Hendrie and Hanson discovered that
Indian and Metis patients at the Winnipeg Psychiatric
39
Institute received significantly fewer follow-up
appointments and had shorter hospital stays compared to
non-Native patients . The researchers suggested that
this was related to the staff's attitudes on the
benefits of psychotherapy for minority patients . 123 In
an examination of Indian rates of public sector
outpatient psychiatric treatment services in
Saskatchewan, Fritz and D'Arcy found that the Indian
population received at least 40% fewer outpatient
services per, capita than the non-Indian population . 124
Because there is a dearth of information on the
utilization of health and mental health services by
Native populations it is difficult to develop an
accurate understanding of the utilization patterns of
these populations . However, it does appear that the
Native population faces real problems in utilizing the
Western health care system, as will be discussed in the
following section .
3 .3 .2 Soclo-Cultural Barriers Facing the Native
Population
As well as being very complex to utilize, research
indicates that the urban Western health care system
presents cultural barriers to Natives in the form of
communication problems with non-Native health care
providers . In an early article, Kadushin commented upon
the strict social distance which is maintained between
40
physicians and patients, 125 which can likely be
expected to magnify when the patient is Native . In a
1984 study of the interaction between Cree and Ojibwa
clients and non-Native nutrition educators, Farkas
observed that while probing and direct questions are
considered appropriate etiquette within Euro-American
communication patterns, they are not considered
appropriate in Ojibwa or Cree . Further, within Ojibwa
and Cree communication etiquette a reply is not
obligatory . 126 Shah and Farkas also noted the emphasis
placed upon barriers in communication between Native
and non-Native health care providers by an 1981 Ontario
Task Force on Native People in Urban Settings . The Task
Force also reported that social service staff
recognized that problems in communication existed
between themselves and their Native clientele . 127 A
1981 study of the health status and health needs of
Vancouver's skid row Native population by Mears et al .
discovered that health care providers were not well
informed about the health problems of Natives and were
conscious of the fact that the clinical relationship
between themselves and their Native clientele was
poor .128 A 1986 survey of Canadian public health
departments by Farkas and Shah discovered that most
city public health departments have no data on the
health needs of the local Native population and no
41
specific public health programs had been developed for
this population . 129
Layman's 1986 study on the status of Native health
care in Saskatoon determined that health care
providers, both Native and non-Native, believed that
communication problems existed between some health care
providers and Native patients . 130 A 1982 position paper
on Native health care in Saskatoon by Matthews and Hart
stressed the role cultural barriers play in the
utilization of the Western health care system by this
population . 131 Out of this position paper grew a
specific proposal for a Native health liaison project
in Saskatoon . This proposal stressed that the "unique
health needs of Native people have been overlooked,"
and that while increased health care services for
Natives must be provided it can not be at the expense
of ignoring the cultural philosophy of Native people .
One of the main points of the proposal was that giving
Native people who are not fluent in English the
opportunity to receive health care in their own
language through the use of Native health liaison
workers would preserve the dignity of Native patients
and allow health care to take place in a manner which
is consistent with Native culture . 132
Kleinman 133 and Good and Good134 have stressed the
role that different explanatory models of illness can
play in preventing maximum utilization of the Western
42
health care system by non-Western patients . For
example, a Native patient may employ an explanatory
model for a specific illness episode with the etiology
of disease-object intrusion, or more generally a form
of "bad medicine ." This patient . may or may not exhibit
physical symptoms with this illness, such as
contortions or swelling of the face and limbs . A
Western physician may be unable to successfully treat
such an illness if in the patient's mind he/she is the
victim of the evil machinations of another individual,
usually an enemy, evil shaman or witch . Since a
physician's explanatory models are derived ultimately
from the biomedical model of medicine, the physician
does not normally recognize illness due to supernatural
causes. The Native patient may leave the clinical
encounter feeling that he/she has not been adequately
treated, believing that until the evil causing the
illness is counteracted through the medicine of a
powerful healer he/she will remain ill . A traditional
healer may then be consulted who may effect a cure .
Mental health programs for Natives have also been
criticized as being culturally insensitive . 135 Bittker
has stresssed that mental health programs for the urban
American Native population are inadequate, and he has
described this population as being "conspiciously
ignored" by contemporary mental health service delivery
systems . 136 Shah and Farkas have suggested that the
43
data on the mental health needs and utilization
patterns of the urban Canadian Native population are
"minimal," and that there is an urgent need for more
research in this area . 137 The researchers have argued
that it is clear that the mental health needs of urban
Natives are not being met and there Is evidence of a
high prevalence of solvent sniffing, suicide,
depression, and family crises among this population . 138
In their review, Farkas and Shah noted that the Native
population was Identified by public health departments
as suffering mental health problems associated with
poverty, unemployment, and adjustment to urban life . 139
One of themajor barriers identified by Farkas and Shah
as preventing the urban Native population from
utilizing mental health services were cultural
differences between this population and mental health
care providers . 140 Carlson 141 and Barter and Barter 142
have also commented upon the difficulties encountered
by Natives seeking counselling due to language barriers
between the Native clientele and the counsellors .
A 1978 Task Force on the Mental Health of Canadian
Natives suggested that while Native people suffer "more
than their fair share of what can be termed the
negative indices of mental ill health," there are few
Native people Involved in the delivery of mental health
services to Natives . 143 According to the task force,
many human services for Natives are in the hands of
44
non-Natives who do not understand or empathize with the
culture or world-view of Natives . The task force
concluded that Natives lack control over their lives,
and in order to obtain some control, Native human
services, including mental health services, must be
turned over to Native people . 144 Similarly, a 1983 task
force suggested that the mental health services
available to Native people often undermine Native
culture and history, and assimilation is often a
prerequiste to receiving adequate mental health
care .145
In a comparison of the Western psychiatrist and
the Native patient, Jilek-Aall argued that there are
several important differences which can hinder
effective psychotherapy . For example, while the
psychiatrist sees physical and mental illnesses as
distinct entities, the Native patient may not make such
a distinction ; also, the psychiatrist sees disease as
primarily a phenomenon of nature, while the Native
patient may see it as a phenomenon of the supernatura .
According to Jilek-Aall, an effective psychotherapist
must . be able to distinguish between genuine psychiatric
illness and culturally-determined mental illness, and
must recognize when a traditional Native healer would
be of more benefit to a Native patient than Western
therapies . 1 46 Likewise, Duran has argued that Western
psychotherapists must alter the role they play when
45
treating Native patients and should assume a more
active and "knowing° role rather than their usual
passive role . Thus the psychotherapist would play a
role more like that of a shaman, who informs the
patient as to the cause and treatment of his/her
illness . 147
Clearly, Native patients face cultural barriers
when utilizing the Western health care system . Health
care providers can be insensitive and often are simply
uneducated as to the needs and beliefs of their Native
clientele . The following chapter will explore
traditional Native health and health care belief
systems .
3 .4 Traditional Health Care Systems : Disease
Etiologies and Treatment Modalities
No single source exists which has extensively
examined traditional North American health care
systems ; rather, only scattered-references to
traditional Native healers, traditional disease
etiologies, and traditional treatment modalities exist .
It is felt that if one is going to attempt to discuss
traditional health care systems in any meaningful
manner a discussion of these systems, and particularly
the role of the healer (traditionally the shaman) and
traditional disease etiolgies and treatment modalities
is necessary . A cross-cultural survey of Native
traditional health care systems is provided in order to
46
demonstrate the cultural variability of these systems
within North America . This is also felt to be very
important in order to provide a complete discussion of
traditional health care systems and to dispel the often
held conception that there exists one traditional
health care system in North America which contains
homogeneous elements in all geographic locations . In
fact, traditional health care systems are often unique
and to agglomerate them all into one category is to do
them a great disservice .
The following chapter represents an amalgamation
of a wide range of sources on traditional Native health
care systems, including medical, psychiatric and
anthropological journals, as well as numerous books and
classic ethnographic and ethnological monographs . It is
often assumed even today that traditional health care
systems are simplistic and represent superstitions from
which peoples must be liberated . Similarly, traditional
healers are attimes referred to pejoratively as "witch
doctors" who are felt to be clearly inferior to
physicians trained within the Western_ health care
system . This is especially disconcerting when such
beliefs are held by Western health care providers . It
is hoped that the following discussion adequately
conveys both the complexity and sophistication of
traditional Native health care systems, as well as the
great diversity of these systems from cultural group to
47
group . Whenever possible, emphasis will be placed upon
cultural groups found in Saskatchewan, Including Cree,
Saulteaux, Dakota and Dene groups .
3 .4 .1 The Shaman
The central figure in aboriginal North American
healing traditions is the shaman, often referred to
today as a traditional healer or medicine man/woman .
Grim has noted that the origin of the term "shaman" is
from the Tungusic words saman or hamman, which as nouns
mean "one who is excited, moved or raised," and as
verbs means "to know in an ecstatic manner ." 148
According to Halifax, the origins of shamanism are
found in the Palaeolithic period when shamans came to
be linked to the animal world of the hunt and
eventually became metaphysically identified with
animals as they sought to become their master and
control their actions . 149 Johnson has suggested that
the Micmac believed that long ago everyone was a shaman
and performed acts which benefited all the people . 150
The shaman usually acquired his curing power
through forcible "election" by the supernatural . This
election could occur during an unsolicited dream or
visitation by the supernatural, or during the vision
quest when the supernatural informed the chosen
individual that he is to be a shaman . Election was
often characterized by serious illness, especially in
48
the classic Siberian shamanism, and during the recovery
period the secrets of curing were revealed . 151 Grim has
characterized the development of a shaman as occurring
in three stages : firstly, the call from the
supernatural ; secondly, sickness and withdrawl during
which the initiate suffered both psychic and physical
illness ; thirdly, emergence in which the initiate came
out of his dark period of illness, having suffered the
call from the spirits, and emerged as an integrated
healer . 152 Halifax has characterized the evolution of a
shaman as occurring through the crisis of death and
re-birth in which a profane individual was transformed
into one who is sacred . Through dreams and visions the
rules of the higher order are made known and the purely
sacred is obtained by the shaman initiate . 153
Benedict has noted that among Western Plains
tribes there was an absence of a laity-shaman
distinction, for it was obligatory for all young men to
go on a vision quest to obtain power at least once in
their life . 154 Mandelbaum has discussed the vision
quest. among the Plains Cree, during which young boys
fasted and prayed for several days and nights until
their spirit helper appeared. When the spirit helper
appeared it identified itself and led the boy to a
great tipi where there was an assemblage of spirit
powers who were in human form . The boy was then told of
the gifts he had been granted and often was informed of
49
a special ability granted him, such as the ability to
construct a buffalo pound, conduct a ceremony such as
the Sun Dance, or to heal the ill . The spirit helper
could impose a food taboo, such as against eating dog
meat, upon the, boy . Upon awakening the boy returned to
his camp but did not immediately relate his vision to
others . Often the vision quest was repeated because of
instructions in the original vision or because the
individual wished to secure additional power .
Mandelbaum has concluded that among the Plains Cree
many individuals had supernatural power bestowed upon
them ; thus shamanism was practiced by many in varying
forms and to varying degrees . 155
A strict laity-shaman distinction was also absent
among the Assiniboine, according to Lowie . 156 Similar
to the Plains Cree, tribesmen went out on vision quests
and, depending upon the nature of their communication
with supernatural powers, they could become a shaman, a
root doctor, a prophet, or the founder of a dancing
society . Thus, concluded Lowle, the religious
experiences of the shaman and laity were fundamentally
the same, with the only difference being the extent or
degree of the experience . 1 57 Gayton has commented that
among the Yokut of California a shaman's power was
derived through dreams but that these dreams were not
peculiar to novice shamans ; rather, they merely had
more of these dreams than the laity . Thus the
50
difference between the power of a shaman and a
non-shaman was one of quantity rather than quality . 158
Supernatural power was also secured on the vision
quest by other Plains tribes, including the Dakota and
Pawnee . 159 In contrast to the widespread access to
supernatural power found among Plains tribes such as
the Plains Cree - and Assiniboine, among the Dakota the
shaman alone had access to guardian spirits obtained
through the vision quest . While the laity had guardian
spirits, they were not obtained through the vision
quest but rather were assigned at puberty by a
shaman . 160 Among the Pawnee the vision quest was
accessible to the laity ; however, this did not give one
the right of entrance to the shaman class . This power
was obtained from animal gods "who dwell below," and
the shamans were organized into a number of esoteric
societies according to their animal guardian spirit .lbl
Once the shaman was elected he entered a training
period, a time in which spirit assistants are acquired,
which can last several months1 62 or many years, such as
in the case of Blackfoot shamans who passed through
seven "tents" of medicine which typically. could take
ten to fifteen years or NavaJo "singers" who often
trained for fifteen years . 163 In most areas of
aboriginal North America the shaman could be male or
female . A survey of North American tribes by Taylor
revealed no bias for sex amongst shamans, 164 In some
51
areas while both men and women could be shamans, men
were regarded as more powerful .165 According to
Mandelbaum, there were many women doctors among the
Plains Cree . 166 While girls never deliberately sought
visions through the vision quest, they could acquire
power during their menstrual seclusion when female
spirit helpers could appear .The Northern California
area was rather unique in that shamans in this area
were usually women . 167
A hierachy or division of traditional medical
practitioners existed in many aboriginal societies .
Usually shamans were distinguished by their use of
supernatural powers in healing, while medicine men or
healers relied primarily upon herbal remedies to treat
illness . The shaman was thus at the apex of the
hierachy of medical practitioners found in many
aboriginal socieities, including the Wisconsin
Chippewa, 168 the Navajo, 169 the Micmac, 170 the
Assinibione, 171 the Pawnee, 172 the Salish, 173 and the
Kwakiutl . 174 Some societies such as the Ojibwa, 175 had
a very specialized medical system with a number of
specialized practitioners . Often shamans were
distinguished by the source of their power,
particularly the animal which had bestoyed its power
upon them, such as a bear, buffalo or eagle . 176
Mandelbaum reported that among the Plains Cree
"shamanism was not confined to the few but was
52
practised in varying forms and degrees by a good part
of the tribe ." 177
The medicine bundle was the most important piece
of medical equpiment owned by the Plains Cree shaman
and was usually made of the skin of the shaman's
totemic animal . The bundle contained fetishes and
charms to ward off evil, botanical medicines, and
medical devices, such as glass slivers and a sucking
horn . 178 Among the Blackfoot, medicine bundles
represented power obtained from supernatural beings and
could be freely bought and sold . Taboos were observed
with the bundles ; otherwise illness, such as sore eyes
or mouth, boils or blindness, could occur . 179 Plains
Cree shamans kept their herbal medicines in small
packets, stored in the whole hide of a small animal .
These bundles could be purchased or inherited .
Mandelbaum has suggested that these medicines were
originally transmitted to the Plains Cree by the Plains
Ojibwa (Saulteaux) . 180 Tlingit shamans would keep a
number of split animal tongues, which increased their
power, and eagle claws and pebbles wrapped in a sacred
medicine bundle . 181
Also very important to the shaman were eagle
feathers, which Park has suggested were univeral among
tribes of Western North America . 182 Hultkrantz has
commented that the rattle and drum, which were used by
the shaman to summon helping spirits and frighten away
53
evil spirits, were common in aboriginal North
America .183 The use of rattles was common among the
Plains Cree ; 184 however, Mandelbaum has noted that they
rarely used drums for healing purposes . 185
Masks, representing the spirit which had taken
possession of the shaman, were also utilized in some
areas, particularly on the Northwest Coast 186 and among
the Iroquois . 187 The use of fetishes by shamans to
communicate with the supernatural was not common,
although they were utilized by Micmac shamans who
carved bone into animal fetishes, 188 and among some
Plains groups . 189
Many scholars and researchers, both past and
present, have commented upon the efficacy of shamans
and healers worldwide . In 1946, Ackerknecht argued that
many scholars of "primitive" medicine had overlooked
the psychological effects of the traditional healers'
treatments . 190 Holland and Tharp have noted that
psychotherapy is the oldest curing technique known to
man and attempts to "reintegrate the total person into
his universe," 191 and Calestro has pointed out that
psychotherapy has ancient roots in religion . 192 Frank
has stressed the role therapeutic ritual plays in the
alleviation of anxiety for the sick, 193 and McCreery
has suggested that therapeutic rituals serve to label
and explain illness and allow human beings to respond
to illness in "emotionally satisfying ways ." 194
54
Scholars have discussed "psychotherapy" within
aboriginal North American societies, often comparing it
favourably to Western psychotherapeutic strategies . In
1932, Pfister noted the ability of Navajo shamans to
"hear" the unconscious of the sick, and to
Instinctively treat them through psychotherapy and
psychoanalysis . 195 Leighton and Leighton have also
discussed the efficacy of the Navajo shaman, noting
that during the treatment the patient's mind is taken
off his illness and is focused upon the ceremonial
aspects of his/her experiences .196 According to
Sandner, traditional Navajo psychotherapeutic
treatments have a true efficacy, based upon ritual and
symbolic healing . 197 Devereux has commented upon the
compatability of Mohave psychiatric thought and Western
psychoanalytic theory, noting that Mohave shamans did
not adhere rigidly to one etiological theory of
Illness ; rather, each shaman would have his own
etiology of illness based upon his particular area of
expertise. 198 Attkinson has argued that the patient's
anxiety over his illness is switched to anxiety over
the condition of the shaman who may die during soul
flight- 199 The shamanic ritual goes beyond mere magical
techniques, however . The ritual allows for personal
contact with sacred powers which provides the means for
healing . Ritual itself frees the patient's mind and
allows him/her to temporarily forget the illness and
55
focus his/her mind on the moment Instead of the future .
Further, the efficacy of traditional treatments for
mental illness through shamanistic techniques parallel
Western non-chemotherapy psychological treatments . The
elements of consultation and psychotherapy are present
in both aboriginal and Western treatments of mental
illness .
3 .4 .2 Diagnostic Strategies
The shaking tent ceremony, also referred to as the
spirit lodge or conjuring lodge, was a common
diagnostic tool among aboriginal diagnosticians and
shamans to ascertain the cause of a patient's illness .
Hultkrantz has documented that the spirit lodge complex
was generalized to Algonkian groups and was found
predominately among tribes of the Northeastern
Woodlands, the Plateau and the Plains, and also among
Eskimo groups .200 In 1886, Bell reported witnessing a
shaking tent ceremony among the Ojibwa Indians . He
noted that poles were driven Into the ground in a
circle about six feet in diameter and covered with bark
to form a tent . The medicine man would then climb
inside and begin singing . Soon the tent would begin to
shake violently upon the arrival of helping spirits who
would provide the shaman with information on the
patient's illness . 20 1
56
Common to the shaking tent complex were the themes
of the liberation of the shaman from bonds and the
magical removal of the shaman from the tent . Soul
flight was not common during the shaman's magical
removal ; however, it was found among the Central Eskimo
and several Plateau groups .202 Also common to the
shaking tent complex were reports that shamans were
often found suspended at the top of the shaking tent
after they had magically freed themselves from their
bonds. The spirits of nature (such as thunder, or
animals, especially the turtle) acting as helping
spirits in the shaking tent prevailed in Eastern areas,
while ghosts were frequently called upon on the Plains .
Curing rarely took place during the shaking tent
ceremony, except among the Arapaho and the Ojibwa .
Also, curing could occasionally take place during the
ceremony if the patient's illness was due to witchcraft
or a trangression of a taboo .203
Vecsey has noted that the Ojibwa diagnostic
specialist, the djessakind, performed the shaking tent
ceremony to determine if the cause of a patient's
illness was a witch, ghost or a manitou .204 . Among the
Menominee the diagnostic specialist was known as the
"juggler," 205 and among the Inuit was known as the
krilasoktoq . 206
Among the Plains Cree a select group of shamans
utilized a conjuring booth, called a koca .pahtcikan, to
57
call upon supernatural spirits to aid in diagnosis . The
conjuring booth was constructed inside a tips and was
approximately four feet high and four feet in diameter .
The booth was constructed out of logs and was covered
with robes and hides . The shaman stripped to his
breechcloth for the ceremony, which always took place
at night . The shaman's hands were bound behind his
back, with the similar fingers of the opposing hands
tied together . The shaman then knelt down and a thong
was repeatedly fastened around his neck and about his
ankles, and a rattle was stuck through the thongs on
his back . Soon after he entered the booth the shaman's
bindings would come flying out of the-top - of the booth,
with each loop still in its original place . The booth
then began to shake violently when the spirit powers
entered . 207 Hultkrantz has reported that Plains Cree
conjurors would call upon the spirits to identify the
exact physical location of a patient's illness by
directing the conjuror's rattle to the location and
hitting the spot .208
Several other diagnostic techniques were found in
aboriginal North America, including obtaining the
information from a "dreamer" (non-shaman who dreamt of
the patient's illness) among the Kwaklutl, 209 or gazing
through a quartz crystal among the Acoma of New
Mexico . 210
58
3 .4 .3 Spirit Intrusion and Spirit-Caused Illness
Illness within aboriginal North America could be
caused by the intrusion of spirits into the victim's
body . As well as illness resulting from spirit
intrusion, namely a spirit entering the body, illness
could be caused by a spirit which remained external to
the human being's body . This can be termed
spirit-caused illness, as opposed to spirit intrusion .
In his seminal monograph, Primitive Concepts of
Disease, Clements reported that spirit intrusion was
found among the Dakota, Eastern Cree and Northern
Sauteaux ; however spirit intrusion was not reported
among the Dene Indians . 211 . Murdock has suggested that
the attribution of illness to spirit intrusion is
universally one of the most wide-spread and common
theories of disease causation . 212 The intruding agent
was usually a supernatural entity, such as a soul,
ghost, or evil spirit . According to Fejos, the
patient's body could begin to waste away when the
supernatural entity entered it because the entity fed
on the food the victim consumed . 213
One of the most frequently commented upon
disorders of North American Indians, and in particular
the Northern Algonkian peoples, is Windigo, which
provides a good example of spirit intrusion . According
to the Windigo mythology, the Windigo figure is a giant
cannabalistic skeleton or monster made of ice who lives
59
in the winter, enters the body of human beings and
transforms them into Windigos . The mythology also
suggests that these individuals then come to crave
human flesh and that therewas typically no treatment
for a human-turned-Windigo ; rather, he/she had to be
killed . 214 The Windigo belief complex seems to
represent a mythology generalized to many Indian tribes
which grew out of environmental conditions . The threat
of starvation is evident in the Windigo or
Windigo-related myths, which all include a winter
cannibalism theme, and thus appears to have been an
environmentally-caused condition with
culturally-defined symptoms . 215 In an examination of
trials involving accused murderers of Windigos, Schuh
reported cases occuring on the Berens River reserve in
Manitoba in 1897, in Sturgeon Lake, Alberta in 1899, at
Smoky River, Alberta in 1900, and at Great Slave Lake,
N .W .T . in 1899 and again in 1921 . 216 In the course of
field work among the Athapaskan Beaver Indians of the
Peace River area, Rldington found the belief in a
parallel Windigo figure, Wechuge, to still be in
existence . 217
Spirits which remained external to their victims
could also be a serious cause of illness . A classic
example of this is ghost sickness which occurred when
ghosts deformed living persons by twisting their face,
hands and arms . Devereux has reported that the symptoms
60
of ghost sickness among the Mohave included a fear of
the dark, insomnia, nightmare and excessive crying . 218
Ghost sickness has also been reported among the
Apache,2 19 and the Comanche . 220 In the Swimmer
Manuscript,, Mooney and Olbrechts provide an extensive
discussion of the Cherokee disease belief system . A
major cause of illness among the Cherokee was ghosts,
which could be in human or animal form . 221 Luckert has
commented upon the contemporary belief in coyote
illness among the Navajo, which is quite similar to
ghost sickness in terms of its physical symptoms . 222
According to Mandelbaum, the Plains Cree believed that
the soul, ahtca .k, which resided along the nape of the
neck, entered the body at birth and left upon its
death . Upon death one's soul entered the land of the
dead, but some souls returned to earth to haunt men,
such as when a suitable funeral feast was not given .
These souls were called tcipayak, or ghosts, and were
recognized by strange noises . Mandelbaum does not note
any specific illnesses caused by these ghosts ; rather,
their main mission was to frighten specific living
persons to compel them to provide the necessary feast
or ceremony . 223
The Coast Salish have traditionally been subject
to spirit illness (sy,)'a w n), a disease etiology which
is still prevalent today . This condition is
characterized by anorexia, insomnia and general
61
weakness . Whereas many forms of spirit intrusion are
the result of malevolent spirits, spirit illness among
the Coast Salish is associated with one's guardian
spirit . Jilek has suggested that spirit illness is very
similar to the illness associated with the ecstatic
initiation of shamans . In the winter those individuals
who have acquired dancing power become ill, ranging
from feelings of loneliness to severe illness with
localized pain . Newly initiated dancers often have
difficulty controlling their guardian power and can
easily develop power illness, which is pacified only
through participation in the Spirit Dance . 224 Haeberlin
has also noted that the Coast Salish traditionally
believed that the loss of one's guardian spirit could
cause psychic - illness . 225 An individual's guardian
spirit was carried to the land of the dead, and if it
was not retrieved by shamans the person could die .
Spirit illness among the Coast Salish presently is
cured through the Spirit Dance . The Spirit Dance was
traditionally a major ritual of the Salish-speaking
peoples of the Northwest Coast and was associated with
the guardian spirit complex . Jilek has reported that
the rhythmic drumming of deer-hide skins is of
paramount importance to this ceremonial . 226 The Spirit
Dance was renewed in 1967 among the Coast Salish and is
playing a major role in combating alcohol and drug
abuse among this population . The dance, held in the
62
winter months, is the means by which an individual
acquires his Indian power . Through the name-giving
ceremony an individual receives his ancestral name and
gains his Indian identity . Jilek has stressed that
there is a pressing need for such traditional therapies
in the Upper Fraser Valley because of high winter
unemployment and the concomitant degree of alcoholism
and drug abuse . Jilek has ranked the Spirit Dance as
being at least as successful for Indian people as other
major forms of therapies for alcohol and drug abuse . 227
Park has suggested that the principle prevailing
through shamanic curing for spirit intrusion is that
treatment will only be successful if the shaman has
among his spirit-helpers one who has power over the
intruding spirit . 22B Johnson has reported that exorcism
techniques to expel evil spirits from a victim's body
were generalized among Northern Algonkian tribes . 229
One of the most common means for forcing evil spirits
out of the body, not only amongst these groups but
universally, was the sweat bath . 230 Macdonald has
reported on the use of the sweat lodge by Indian groups
in New Brunswick for this purpose, 231 and Vecsey has
noted that the Ojibwa similarly utilized the sweat bath
to expel maleovolent supernatural powers from the
body . 232
3 .4 .4 Soul Loss
Soul loss illness usually occurs when the soul has
left the body either on its own through a dream or
through theft by malevolent spirits or human agents . 233
Murdock has . noted that the attribution of illness to
soul loss is found in cultures which see human beings
as having souls which normally reside in the body but
are capable of leaving temporarily during dreams and
leaving permanently upon death . 234 An individual
suffering from soul loss becomes ill and can die if the
soul is not retriaved . 235 The symptoms of soul loss,
according to Rubel, are loss of appetite and strength,
difficulty sleeping, introversion and depression . Other
symptoms include localized or generalized pains and
fever . 236
Clements notes that the concept of soul loss was
generally absent on the Plains, but was found among the
Dakota Indians, as well as the Eastern Cree, Northern
Saulteaux, Ojibwa and the Dene .237 Traditionally, one
of the most frequent causes of soul loss was
dreaming . 238 Shamans were especially subject to losing
their soul during sleep as their powers can be angered
when awakened . 239 The Ojibwa saw soul loss as a major
causative factor in disease, according to Vecsey, and
believed that the soul could wander in a dream . 240 Hahn
has noted that a person who was insane was said by the
Ojibwa to be kawin otcatca'kwst (no soul) . 241
63
64
Interestingly, Clements has reported that the Ojibwa
believed that the gall bladder was the seat of the
soul . 242 Hallowell has reported that among Saulteaux
groups it was believed that a shaman .could abduct the
soul of a sleeping victim . The shaman took the soul
into his conjuring tent and attempted to kill it . If
the soul managed to escape and return to its body the
individual would suffer illness but not death . 243
A second major cause of soul loss was the stealing
of one's soul by a malevolent spirit or human agent .
Clements has noted that among a number of groups of the
Great Basin, American Southwest, and Northwest Pacific
Coast the soul was closely associated with the heart
and was often known by the same name . It was believed
that sorcerers or evil spirits could steal the "heart"
(soul) of an individual . 244 Elmendorf has similarly
recorded that a number of Pueblo groups of the
Southwest believed that their "heart" could be
stolen . 245 Vogel has noted that some of the Huron
Indians believed that their souls were stolen by the
Jesuit priests . 246 The Netsilik Inuit believed that
shamans could have their souls temporarily stolen by
their tunrags (protective spirits) . 247 According to
Corlett, Western Inuit groups believed that the shadow
of a dead man could steal the soul of a living
person . 248 The Chinook of the Northwest Pacific Coast
believed that the stolen soul was eaten by its
65
captor .249 Kunitz has discussed the belief in
soul-related disease in contemporary Navajo society .
The ghosts of the very old and very young are not
considered potent causes because their souls are not
well attached ; however, the ghosts of those who die
while their souls are well-attached (the middle-aged)
can cause serious illness . 250
The most common port of exit for the soul appears
to be the head . This concept was found in the Great
Basin, Plateau, and Northwest Pacific Coast areas and
was present among the Dene . When the shaman retrieved
the lost or stolen soul he returned it to the body
through the patient's head . 251- Hultkrantz has noted
that it was the responsibility of the shaman to
retrieve lost or stolen souls in many cultures . 252 If
the soul had been carried away by the dead, the shaman
sent either his own soul or his guardian spirits to the
land of the dead . The shaman was in constant danger of
being caught while in this land and would often battle
for his life with the spirits of the dead . Johnson has
noted that shamanic soul flight in many cultures was
induced through hallucinogenic drugs such as peyote . 253
Menominee shamans would suck the patient's soul into a
reed whistle, plug it with cattail down and place the
whistle on the patient's chest . In four days the
patient's soul returned to Its body .254 The Haida
shaman would fast for several days and then walk
through the forest, looking for his patient's soul .
When he saw the lost soul he caught it between the
palms of his hands and then returned it to the
patient .255
3 .4 .5 Disease-Object Intrusion and-Witchcraft
Disease-object intrusion is the belief that
foreign objects have been projected into a victim's
body by a malicious human agent resulting in illness,
such as listlessness, fever, spasms, or swelling of a
region of the body .256 According to Clements, this
disease etiology was found among the Dakota, Eastern
Cree, Northern Saulteaux and the Dene . 257
The Ojibwa believed that feathers, shells, stones,
worms and insects could be projected into the body,2 58
and Western Inuit groups believed that pieces of bone
or wood could be projected into a victim . 259 Other
objects commonly projected were snakes, arrows, thorns,
and small animals . 260 The Crow Indians of the Plains
believed that insanity could be induced by inserting a
tooth or lock of hair from a dead body into a living
person .261 In a very unique North American aboriginal
example of disease-object intrusion, the Omaha and
Ponca Indians of the Plains believed that dental
disease was due to the intrusion of worms into the
body . 262 Hultkrantz has noted that the diagnosis of
disease-object intrusion is based upon bodily pains,
66
67
and has argued, contrary to many scholars, that the
etiology of disease-object intrusion is no older than
the etiology of soul 1085 .263
The human agent involved in disease-object
intrusion traditionally was either a witch, shaman, or
sorcerer . Murdock distinguished between witchcraft and
sorcery, with witchcraft defined as being restricted to
a special class of instrinsically evil human beings
believed to be endowed with special powers . In
contrast, sorcery can be practiced by anyone . According
to Murdock, sorcery theories of illness were
traditionally common in societies such as those of
aboriginal Western North America where access to
supernatural power was widely distributed among the
population through the vision quest . 264
Witches and shamans were closely identified with
bears in some regions . Among the Navajo, witches were
thought to be active at night, roaming about in bear
skins . 265 Bear doctors, who would commit up to four
murders per year, were found among the Pomo and other
tribes of California . 266 They would take unsuspecting
victims to their cave where the victims were slain . 267
Bear medicine men were also found among the Sioux of
South Dakota, although they did not necessarily
practice with evil intent . 26s The Ojibwa particularly
feared bearwalkers, witches who disguised themselves as
bears either by wearing bear skins or by
68
metamorphasizing into a bear, and travelled at night
causing disease in their victims . 269
Owls were closely associated with witches in the
American Southeast and on the North Pacific Coast .
Mooney and Olbrechts have noted that the word for
"witch" in the Cherokee language is the same as the
word for "hooting owl ." 270 In a survey of monographs of
shamanism of the North Pacific Coast, Barbeau has
recorded that witches were known by the same name as
the screech-owl (st!ao) . 271 According to Howard, the
Oklahoma Seminoles attributed a great deal of illness
to witchcraft and believed that witches took the form
of a horned owl when engaged in evil activities . 272
In the Plains and in the Great Basin regions evil
shamans were usually motivated by jealousy . The
Comanche puhakut, or healer, would "witch" an
individual they envied, inflicting witch sickness
through the use of ghost medicine . The symptoms of this
condition were spasmodic contortions of the face, hands
and arms, an inability to keep food down, fever, and
general listlessness . An evil puhakut would cause an
eagle- feather to enter the body of his victim ; this was
known as "shooting the feather ." The feather would
enter below the skin of the victim and move rapidly
throughout the body until it lodged, causing death
unless another puhakut could successfully remove it .272
69
Among the Plains Cree, objects were often sent by
jealous shamans who envied a person's accomplishments .
To send an object a shaman held it on the palm of his
hand, addressed his spirit helpers, and blew the object
pitcitcihtcikan or "something moving" toward his
victim . The evil object was then carried away and
entered the body of the victim .273 The Plains Cree
particularly regarded the Saulteaux and the Wood Cree
medicine man as practitioners of "bad medicine" who
fought through magical means, projecting objects into
their victims . Additionally, Saulteaux shamans were
known for their "love potions" or "love medicines"
which could cause an individual to fall inexplicably in
love with the individual sending the medicine . Hence,
the Plains Cree were very careful not to offend
visitors from these tribes . Indeed, Mandelbaum has
suggested that the concept of "bad medicine" was
transmitted to the Plains Cree by the Saulteaux . 274
"Bad" medicine men among the Plains Cree would
also utilize effigies in order to project an object or
evil medicine into a victim . The effigy could be made
out of clay in which case an intrusive object was
inserted into the body of the figure, or could be
fashioned out of hide in which case evil medicine was
placed over the area of the victim to be affected . 27b
Sorcerers among the Navajo also would create an effigy
of an intended victim, which was pierced with a sharp
70
object . 276 Shaman, or buowin, among the Micmac would
create a bone effigy of another shaman, which they
would pierce with a sharpened stick or a needle . They
would then concentrate their power and their victim
would become injured in the area analagous to that
pierced on the effigy . 277 Witches could also magically
poison their victims, 278 which Kennedy reported in 1984
to be the major disease etiology in Okanogan-Colville
society . 279
A sucking or cupping technique was commonly
utilized in cases of disease-object intrusion . Clements
has reported that the sucking technique was
traditionally generalized on the Plains although it was
not found among the Dakota Indians . This technique was
also found among the Dene, but not among the Eastern
Cree or Northern Saulteaux . 280 Through clairvoyance
the healer would determine the location of the disease
and remove the object through the application of a
sucking horn . 281 The sucking horn was usually a hollow
bone or animal horn . 282 Darby reported in 1932 that the
sucking technique was common among tribes of British
Columbia . 2B3
Several cultural groups had sucking doctor
specialists . Among the Ojibwa, the sucking doctor's
treatments included sweat baths, herbal cures and
prayers . Often a medicine stick (a nine inch long stick
which was filled with clay and had a hoop at one end
7t
and a leather thong at the other end) was utilized to
pry loose the disease-causing object by hitting the
patient's body and sucking out the object . 284
The Plains Cree did not have a cupping or sucking
specialist ; rather the shaman was responsible for
employing the sucking treatment . The shaman would blow
over the patient's body and then place his mouth over
the affected part and suck out the cause of the
illness . Sometimes the shaman would utilize a horn or a
piece of gun barrel to suck out the cause of the
illness . The illness was usually the result of an
intrusive object, such as an insect, piece of flint, or
a twig . Also, illness could be the result of a
foul-smelling substance which the shaman spat out upon
sucking the illness from the patient's body . The shaman
who was attempting to suck out the illness out had to
be stronger than the shaman who had sent the illness .
Once the intrusive object was removed the malicious
shaman would die . 285
Another method of treatment for illness due to
disease-object intrusion was blood letting . This was
done by making small incisions in the skin at the point
where the intrusive object lay . Ritzenhaler has noted
that the Wisconsin Chippewa cupping specialists
utilized blood letting in conjuction with the sucking
treatment . 286 Treatment of witch sickness among the
Comanche also involved blood-letting in conjuction with
72
sucking until the disease-causing object had been
removed . 287 The blood-letting treatment was also common
among the Choctaw and Creek Indians of the American
Southwest . 288 In 1883, Andros reported that
blood-letting was so common among the Dakota Indians
that, "You will scarcely see an Indian of any age who
has not the scars of scarification about the temples or
neck ." 289 The Arapaho- of the Plains also utilized blood
letting, 290 and Mandelbaum reported that the Plains
Cree frequently utilized this technique . 291
Several other techniques were utilized by healers
to treat patients suffering from disease-object
intrusion . Kluckhohn has reported that among the
Navajo, the victim of witchcraft could be cured if the
witch confessed to his actions . Gradually thevictim
would Improve and the witch would be afflicted with the
same illness which had been inflicted upon the victim
and would die within the year . 292
According to Howard, illness due to disease-object
intrusion among the Oklahoma Seminole was also treated
by killing the witch . In this case the witch was killed
by a witch hunter who utilized a special arrow (stikini
arrow) with owl feathers and small grooves cut near its
point, which were filled with herbal medicines . The
witch hunter would remove all of his clothing, except
his shoes, circle the witch's house once in a counter
clockwise direction and shoot the stikini arrow . 293
Barbeau has reported that to treat victims of
"wizardry", Northwest Coast shamans would expell the
white mice residing inside the wizard (often said to be
as many as ten mice) . Once the last mouse, which was
always white, had come out the patient would recover .
If the shaman did not know where the wizard was he
would take a live mouse and repeat the names of all the
town's members before the mouse . When the shaman named
the wizard the mouse would give him a sign by moving
its head . 294
3 .4 .6 Taboo Violation
Another very imporant disease etiology in
aboriginal North America was taboo violation . 295 A
major symptom of taboo violation was a generalized
feeling of malaise . 296 Taboo violation has been
reported as a cause of illness among the Dene, 297
Dakaota, Saulteaux 298 and Plains Cree . 299
Shamans or the laity could become ill because of a
violation of a personal taboo . 300 Individuals could
also become ill because of the sin of a parent or
ancestor . This "sins of the fathers" concept of disease
was not widespread and was found primarily on the
Plains, among the Arapaho, Saulteaux and Dakota tribes .
The concept was also found in the Great Basin region
among the Comanche . According to Wallis and Wallis,
among the Dakota Indians the sinner was not affected by
73
74
his transgression but one of his descendants could be
striken with illness or~be born with a bodily
defect . 302 This concept was also found among the Ojibwa
in a limited sense . It was believed that an individual
who sought too much power could endanger his
descendants . 303 Violation of taboos connected with
ceremonials could also cause illness . 304
As well as personal taboos having to be observed
in order to maintain one's health, a wide range of food
taboos had to be observed, such as abstinance from
certain foods .305 Among the Plains Cree, a man's spirit
helper could impose a food taboo and failure to provide
proper offerings to these spirit powers could result in
harm coming to the individual . 306 Also, a strong taboo
existed among the Plains Cree in regard to the
seclusion of young girls for their first menstruation
for it was believed that if they were to look upon men
the latter could lose their guardian spirits . 307
Confession played a major role in treating
illness resulting from taboo violation in many
societies . 308 La Barre has noted the virtual
pan-American presence of the confession ritual in
aboriginal societies, and argued that the ritual did
not develop from the influence of Jesuit missionaries
as some scholars have suggested . 309 The confession
ritual played a-major role among Dene, 310 Dakota, 311
Saulteaux, 312 and Plains Cree313 groups .
75
Hallowell has concluded that confession as a
treatment for taboo violation was institutionalized
among the Saulteaux .314 Secret sins would also be
confessed by the Saulteaux in order to. cure the illness
afflicting an offspring . La Barre has also emphasized
the Saulteaux's belief that sickness was the result of
sins, particularly sexual ones, which could be cured
only through confession .315 Public recounting of
illicit sexual relations was also very important among
the Plains Cree . A tent would be erected over a buffalo
skull or spirit stone and the men would gather to
confess sexual sins in order that misfortune would not
befall them . 316 The confession ritual was generalized
on the Plains . Apache shamans would elict public
confessions from patients who failed to volunteer the
information . Similarly, the Blackfoot, Iowa and Crow
Indians utilized the public confession ritual . 317
Illness resulting from the sins of the ancestors were
treated by Dakota shamans by diagnosing the sins in a
vision and then stating the sin out loud . 318
3 .4 .7 The Peyote Ritual
An aboriginal ceremony which is still widely
utilized today, especially in the treatment of
alcoholism, is. the peyote ritual . The peyote button
contains nine narcotic alkaloids . 319 La Barre has noted
that in pre-Columbian times the Aztecs and other
76
Mexican tribes would eat dried peyote buttons and dance
around a ritual fire all night in the context of
agricultural and hunting religious ceremonials . 320
According to Troike, peyotism gradually came to replace
the mescal bean medicine society complex which had
spread into the Plains region . 321 The peyote ritual
spread into the Great Basin region after 1870 . 322
Vecsey has suggested that while some Ojibwa
participated in the peyote religion, it was opposed by
the mides (priests) of the Midewiwin and never gained
widespread success .323 In 1983, Kunitz argued that the
peyote ceremony, which lasts only one night and has a
single, standardized ritual which is relatively easy to
learn, was taking the place of the traditional Navajo
healing ceremonials, which could last nine nights . 324
Peyote has many medicinal puposes and among a
number of Indian tribes, such as the Navajo, Delaware
and Comanche, the same word is used for "peyote" and
"medicine ." 325 Anderson has compared the use of peyote
to the use of aspirin in Western culture . In other
words, peyote is used as a general medicine to relieve
pain and facilitate healing . 326 Anderson has noted that
whereas Mexican Indians primarily used peyote to act as
a barrier to protect against witchcraft, American
Indian tribes used peyote after they were ill in the
belief that peyote could purge the body of evil
spirits .327 Aberle has suggested that peyote meetings
77
were traditionally held for virtually all physical and
mental illness, with the road chief of the ceremony
taking the disease of the patient upon himself . 328 In
an extensive discussion of a Comanche medicine woman,
Jones noted that peyote was her most utilized general
medicine . The medicine woman believed that peyote was
the most powerful of all plant medicines and could heal
any human affliction .329 Peyote was also an important
medicine in the therapeutic kits of Potawatomi
shamans . 330 La Barre has commented upon the wide range
of diseases that peyote could traditionally cure,
including goiter, pneumonia, syphilis, tuberculosis,
cancer, skin diseases, malnutrition and insanity . 331
Vomiting of peyote is considered to be punishment for
one's sins and rids the body of its impurities . Peyote
can be used in both "white" and "black" medicine, with
witches utilizing it to make another individual ill . La
Barre has noted that a "father" peyote button was
handled with great reverance and certain buttons were
passed down through the generations . The father peyote
button acted as a fetish which sat upon an alter during
the peyote ritual . Healers would often have a number of
father peyote buttons, with each button having its own
history in terms of the patients it had cured . 332
The role of peyote in alcoholism treatment among
the Indian population has been discussed by Albaugh and
Anderson . They have noted that the use of peyote in the
78
Native American Church may provide a cathartic release
for expression of one's feelings of alienation and
isolation . 333 Clearly, the peyote ritual is one example
of an alcohol treatment matching the philosophy of the
patients . This ritual has been found to be more
successful for Native alcoholics than Western modes of
alcoholism treatment . 334 Theuse of the peyote ritual
in the treatment of alcoholism appears to be quite
widespread, with Roy et al . arguing that the majority
of Indian non-drinkers in Saskatchewan are previous
alcoholics who gave up drinking through participation
in the peyote cult . 335 Researchers such as Bittker 336
and Shore and Fumetti 337 have criticized the alcohol
treatment programs available for Natives ; perhaps
peyote has a real' role to play in the treatment of
Native alcoholics .
Wallace has contrasted the responses to mescaline
intoxication (which is very similar to peyote
intoxication) between Indian and non-Indian subjects .
While non-Indian subjects felt a loss of contact with
reality and a breakdown of social inhibitions, Indian
subjects felt contact with a higher-order reality and
maintained "proper behavior . Wallace concluded that
while the non-Indian gains no therapeutic benefit from
mescaline use, the Indian gains "marked" therapeutic
benefits, especially in terms of a reduction in chronic
anxiety .338 Bergman has also reported a very low rate
of negative reactions to the peyote experience among
the Navajo. He suggested that this was because the
peyote meetings are carefully channelled into an
"ego-strenthening" direction with an emphasis upon the
real, interpersonal world . Further, the "roadmen" in
the meetings are trained to watch people who are
becoming excessively withdrawn after ingesting peyote .
If a person is withdrawing the roadman goes to this
individual and speaks with him in order to draw him
back into reality . 339
Pascarosa and Futterman have compared the roadman
to the Western psychotherapist, for the roadman
utilizes psychotherapeutic techniques and facilitates
group interaction and confession . Further, the roadman
has a profound knowledge of Indian culture and thus can
assume a leadership role . According to Pascarosa and
Futterman, the peyote ritual provides more than just a
cure for alcoholism asit allows self-actualization and
spiritual consciousness for Natives which they argue
are absent from most Western alcoholic treatment
centres . 340 Similarly, Aberle has suggested that the
prayers of the peyotists alleviate the anxiety of
feelings of helplessness . 341
3 .4 .8 The Sweat Lodge
The near universal use of the sweat lodge, or the
steam bath, among North American aboriginal societies
79
80
has been documented . 342 The sweat lodge represents the
vehicle by which Native peoplescan communicate with
greater powers, and the heat and sweating endured is
believed to be a form of suffering for these powers . 343
Vogel has concluded that the sweat bath was a panacea
for virtually all diseases, with immersion in a stream
or lake often following the ritual, and has suggested
that the sweat bath was traditionally also common to
many other cultures . 344 Mandelbaum has provided a good
description of the typical Plains Cree sweat lodge . The
dome-shaped structure was four feet high and six to
eight feet in diameter ; willow withes secured in six
holes dug In a circle were arched over and intertwined
to form the frame . Robes, blankets or tipi covers were
laid over the frame and a circular hole within the
structure was filled with heated stones . The sweat
lodge could only be used once ; however, the frame was
left permanently Intact . 345 The dome-shaped sweat lodge
appears to have been generalized among Eastern tribes
as well . 346 Among other groups, clay was used to cover
the frame, and live coals were also utilized in the
lodge as well as stones . 347
Among the Plains Cree, the sweat bath was part of
virtually all ceremonial activity . Sweats were
undertaken for ritualistic cleansing before
participation in a ceremony, as an offering to a spirit
power, or simply for pleasure . In a typical ceremony,
81
sweetgrass was burned and a pipe was offered around to
all . The lodge was then closed and water was sprinkled
on the hot stones . Four songs were then sung and the
cover of the lodge was lifted slightly to let in some
air . Two or three more songs were sung and the bathers
left the lodge and laid down on the ground to cool
off . 348 Sweats were also central to Dakota healing . 349
Botanical medicines were sometimes placed on live
coals or rocks in the sweat lodge . The Ojibwa would
place white cedar needles on coals, 350 and a number of
Plains groups used red cedar twigs . 351 Tribes of the
Missouri Valley used wild mint in the sweat bath and
also would use purple coneflower to make the heat of
the bath more bearable . 352 The Potawatomi would place
witch hazel in the sweat lodge as a treatment for sore
muscles, while the Menominee utilized hemlock leaves
for this same purpose . 353 Taylor has noted that on the
Northern Plains sweat lodges were often constructed
from a frame of willow or conifer branches . Willow bark
contains salicin, the active ingredient in aspirin, and
acts as an analgesic, while the oil from conifer is a
decongestant . 354
3 .4 .9 . Sweetgrass
Sweetgrass was traditionally widely utilized in
Plains Cree society, being common to most ceremonials .
The grass was gathered when it was long and then was
82
braided . Prior to beginning a ritual, and at frequent
intervals during the ritual, a piece of the braid was
broken off and set on live coals . The smoke was seen as
a purifying agent, and its aroma was believed to please
supernatural spirits . Pipes, drums and virtually all
ceremonial paraphenalla was passed through a sweetgrass
smudge . Those handling sacred bundles would wash their
hands in the smoke and draw it into their bodies before
touching the bundle .355 Sweetgrass smudges played an
important role in the ritual preparations for the sun
dance, with three smudges burning outside the tipi and
one smudge burning in the middle of the singer's
circle . Sweetgrass was also used in the ritual sweat
bath which accompanied the first thunder of the
spring . 356
Sweetgrass was traditionally believed to ensure
good "fortune" and good health . A sweetgrass braid was
dipped in water andthe water was splashed on hot
stones inside the sweat lodge . 357 Sweetgrass is still
commonly burned in Plains Cree and Saulteaux sweat
baths . 358 While traditionally common to the Plains
region, Mandelbaum reported that the use of sweetgrass
was absent among Eastern tribes .359
3.5 Traditional Health Care Systems Today
3 .5 .1 Utilization of Traditional Health Care
Systems
It has been argued by Ragan that globally "the
importance of the traditional practitioner cannot be
underestimated ." 360 Ragan estimates that the number of
people using traditional medical systems worldwide
exceeds that of Western medicine by a factor of 2 to1 .361 Research on the utilization of traditional health
care systems in non-Western and Western countries where
the Western health care system is also in place
demonstrates that indigenous populations still seek out
traditional healers and medicines . 362 Kleinman has
reported that in the major urban centres of Taiwan,
such as Taipei, where the Western health care system is
also prominent, the traditional healer (tang-ki) is
still sought out by many patients . 363 As early as 1959
Press noted the "dual use" of both traditional and
Western medical practitioners in the urban centre of
Bogota, Columbia . 364 Similarly, in a recent article
Ladinsky reported that Vietnamese frequently utilize
both traditional and Western health care systems, with
traditional systems being used more for minor illnesses
and the Western system being used for more serious
diseases .365
83
84
Immigrant populations within North American urban
centres have also been found to utilize traditional
healers . Rappaport and Rappaport have found that
traditional healers are active among Black,
Mexican-American and Hispanic populations in the United
States .366 Ruiz and Langrod have reported on a study at
a community mental health centre in New York which
concluded that at least half of the Puerto Rican
patients were also visiting spiritists (traditional
Puerto Rican healers) . 367 New and Watson discovered
that Chinese patients in St .Catherines, Ontario
utilized traditional healers rather than Western
physicians because Chinese healers could communicate
with them in their particular expression of symptoms,
such as an imbalance of Yin-Yang . 368
As stated previously, research on the utilization
of traditional healers by urban North American Native
populations is very limited . In 1974, Fuchs discovered
that significant numbers of Native Americans living in
San Fransisco utilized traditional healers . 369 In 1975,
Fuchs and Bashshur concluded that traditional Indian
medicine was still being utilized by significant
numbers of Natives living in the San Francisco Bay
area . 370 The only Canadian research to include an
investigation of the utilization of traditional
medicine by an urban Native population was a study by
Mears et al . of the skid row Native population of
85
Vancouver . The researchers found that few people
utilized traditional healers and medicines ; however,
this could reflect the fact that this population is
transient and may lack knowledge of health care
alternatives, such as traditional health care
systems . 371
Non-urban Canadian Native populations are also
utilizing traditional healers . In a recent article,
Gregory and Stewart have reported that many Native
people in Northern Manitoba are now requesting
traditional healers in their health care .372 Similarly,
Speck has suggested that Western medical treatment is
occasionally delayed by Natives in British Columbia
until a traditional healer is consulted . 373 Kennedy has
reported on the manner in which Native patients may
alternate between traditional and Western health care
systems for treatment of the same illness episode . 374
Similarly, Mardiros has commented on the use of both
health care systems by Canadian Natives . 375 Gregory has
suggested that many Native people find it necessary to
utilize both the Western and traditional health care
systems for many illness episodes . 376 Thus while the
information and research is sparse in the area of
utilization of traditional health care systems by both
urban and non-urban Canadian Native populations it
seems that there is a real, perhaps renewed, desire for
access to this system by Native populations .
3 .5 .2 The Integration of Traditional Healers
into the Western Health Care System
Traditional Native healers have not been
integrated into the Western health care system to any
extent ; thus, there is a lack of information in this
area . A few isolated programs and facilities have
integrated traditional healers into the Western health
care system in the United States and Canada . Kahn and
Delk have noted that the mental health clinic on the
Papago reservation utilizes Papago medicine men to
treat psychiatric patients . 377 Similarly, Haven and
Imotichey have discussed the integration of two
traditional healers into the Department of Community
Mental Health and Alcoholism of the Miccosukee tribe of
Florida, and the use of Indian medicine in the mental
health program of the Special Services Department of
the Seminole tribe of Florida . 378 . Guilmet has
commented on the use of traditional healers within the
tribal-run medical clinic of the Puyallup Indians of
Washington State where a permanent sweat lodge is
maintainedd at the alcohol-drug treatment facility of
the clinic . 379 Bergman has outlined a school for
medicine men near the Navajo reservation, funded
through the National Institute of Mental Health . This
program began in 1969 and teaches students traditional
Navajo ceremonial chants .381 In general, however,
traditional healers have not been widely available
86
87
within the Western health care system in the United
States . In a review of forty-five American
reservations, Attneave found that few reservations had
developed any sytematic collaboration between
traditional healers and health programs . 381
Traditional healers have also not been made widely
available to Natives within the Western health care
system in Canada, especially in the urban context .
Gregory has noted that an elder is employed at the
Poundmaker lodge, a Native alcohol treatment centre, in
Edmonton . 382 It should be noted at this point that
elders are regarded as guardians of Native culture who
are endowed with the right of passing on the history,
genealogies, legends, and myths of their peoples
through oral tradition . Elders usually do not practice
traditional medicine ; rather, this role is mainly
confined to traditional healers . Peterson has commented
on a Native healers program in Kenora, Ontario which
was set up to deal with the rampant alcoholism among
the Native population In that area . Initially the
healers worked In the local hospital, but It was found
that this conflicted with the traditional ways of
healings, and the healers began to work through a local
Native organization . 383 Shah and Farkas (1985b) have
noted that "culturally-sensitive" substance-abuse
programs have been developed In Calgary, Edmonton,
Lethbridge, Toronto and Winnipeg although they do not
88
state whether traditional healers or medicines play a
role in these programs . 384
Traditional healers and elders have been
integrated into the Western health care system to a
greater extent on Canadian reserves . Gregory has
reported that elders have been employed by the
Shamattawa band in Northern Manitoba to counsel young
people with solvent abuse problems . 385 According to
Mardiros, traditional healers are now beginning to play
an important role as members of the health care teams
of reserves, along with health care professionals and
auxiliaries . 386
The degree of collaboration between health care
professionals and traditional healers is not very
extensive, however . In an examination of collaboration
between nurses, elders and traditional healers on
Manitoba reserves, Gregory discovered that
collaboration between these groups was very limited and
the majority of nurses interviewed felt that Medical
Services provided them with an inadequate orientation
to Indian culture . 387 Psychiatrists Wolfgang Jilek and
Louise Jilek-Aall are somewhat unique in that they
collaborate with traditional Salish healers in their
practice in British Columbia . They have noted that in
contrast to Western therapists, the traditional healer
works "with and through the patient's extended kinship
and tribal network," and have stressed the need for
89
alternative psychotherapies for some Native
patients .388
Although there is a lack of integration of
traditional healers into the Western health care
system, there have been calls for a recognition of the
importance of traditional healers in Native health and
mental health care. Borunda and Shore have argued that
the most severe emotional impairments are found among
those urban American Indians who have the least access
to traditional health care systems . 389 Similarly, a
1978 Task Force on the Mental Health of Canadian
Natives suggested that in some cases traditional Native
treatment modalities would be much more effective in
the treatment of mental illness among Native patients
than Western modes of treatment . 390 A 1979 Canadian
National Commission recommended a nation-wide program
under Native jurisdiction which would train Native
people in traditional medicine . 391 Segal, in a Medical
Services publication, also stressed the necessity of
training a new generation of traditional healers . 392
Gregory has noted that a 1980 Indian health discussion
paper advocated a "closer working relationship" between
traditional healers and physicians ; however, argued
Gregory, this recommendation has not been acted upon .
Gregory stated :
It would appear that the government acknowledgesthe relevance and utility of traditional healingapproaches within international and nationalpolitical organizations but has not actively nor
90
formally initiated collaborative or interactiveefforts between staff at the field level . . . andmembers of the traditional health caresystem . 393
Recently, in a presentation to the Saskatchewan
Commissions on Directions in Health Care a
representative for the Native Council of Canada spoke
for the need of healers to be part of the health care
system in Native communities . 394
Thus while it appears there is a desire for access
to traditional healers and medicines amongst the Native
population of Canada there really has been very little
attempt made on the part of either the government or
the medicial establishment to provide this access . This
especially seems to be true in urban centres where
little or no commitment to providing access to
traditional health care systems, or for that matter any
type of "culturally-sensitive health care, exists .
Difficulties also arise because traditional healers
themselves often are reluctant to participate in the
Western health care system and prefer to keep
traditional health care systems confined to reserves .
CHAPTER FOUR- RESEARCH METHODOLOGY
4 .1 Research Setting
The Parklands region of Saskatchewan, as
identified by the Federation of Saskatchewan Indian
Nations (F .S .I .N), consists of a broad strip across
central Saskatchewan, including the city of Saskatoon
which presently has a population of 180,000 . Within
this region there are thirty-three Indian bands, the
majority of which are Plains Cree . According to an
estimate by F .S .I .N ., three-quarters of the Treaty
Indians in Saskatchewan are Cree and are concentrated
largely in the Parklands .395 The other major tribal
groups in Saskatchewan, as identified by F .S .I .N ., are
Chipewyan, Saulteaux and Sioux . The Cree tribal
grouping is further divided into Plains, Woodlands and
Swampy Cree . 396
Estimates of the Native populations in urban
centres such as Saskatoon are not precise and often
wide descrepancies exist between estimates . In 1983
Clatworthy and Hull projected the Saskaton Native
population to be approximately 11,000 in 1986 (it was
estimated at 7,600 in 1982) . 34?. Other estimates put the
Saskatoon Native population as high as 23,000 in
1986 . 398 The 1981 census, according to Farkas and Shah,
put the Saskatoon Native population at 4,235,
91
although this figure may represent the status Indian
population only . 399 The influx of Natives to Saskatoon
began in the late 1960s and continued through the mid
1970s . A 1983 F .S .I .N . report suggested that this
off-reserve migration began to slow down in 1976, with
only 3% increases in the Saskatchewan urban population
between 1976-1981 and 1981-1986, as compared to an 11%
increase from 1966-1971 . 400 Clatworthy and Hull
reported that the Saskatoon and North Battleford
districts (as defined by Indian and Northern Affairs
Canada) represent the most common rural origin for the
Saskatoon status Indian population . 401
It must be kept
92
in mind that urban Natives often
live -a "bi-cultural" experience, participating in two
somewhat different cultural milieus, because of
movement between the city and the reserve . Urban
Natives may not live exclusively In the urban cultural
environment with its strong Western orientation, but
may alternate between the urban and reserve
environments . Indian cultures are also present in the
city, especially in a ghettoized area where . there
exists a high concentration of Natives as is the case
in the neighborhoods surrounding the Westside clinic .
One common yet important element of urban Indian
cultures is the bilingualism (a Native language and
English) of the people (over three-quarters of the
respondents in this study could speak at least one
93
Native language) . Thus urban Natives are able to
maintain and experience Indian cultures within the
city, although these may be somewhat different from
that of the reserve .
The age structure of the Saskatchewan status
Indian population is significantly different from that
of the non-Indian population, having a much higher
percentage of young people (0-14 years) and a much
lower percentage of elderly people (65+ years) .
Accordingly, the majority of the urban status Indian
population of Saskatchewan is concentrated in the
younger age groups, with Indian and Northern Affairs
Canada estimating that 43 .1% of this population is
concentrated in the age group of 0-14 years . 402
Similarly, Clatworthy and Hull estimated that 70-75% of
Indian migrants to Saskatoon and Regina from 1978-1982
were children and young adults . 403
Clatworthy and Hull have documented the poverty
that most Native people in Saskatoon face . In 1983 they
found that 73 .8% of the Saskatoon status Indian
population lived at or below the poverty line . 404 The
researchers also discovered that the majority of
Saskatoon's Native population is concentrated in the
older core areas off the downtown area, which includes
the neighborhoods of Riversdale and Pleasant Hill . The
present study was conducted at the Westside Community
Clinic which is located in the heart of this area on
20th st . West . Clinic staff estimate that they have a
85% Native clientele . Part of the study was also
conducted at the Friendship Inn, which is next door to
the clinic 20th st . West .
4 .2 Survey Instrument
The survey instrument utilized in this study was
an interview schedule administered by the researcher .
The interview schedule was developed in cooperation
with Dr . James B . Waldram of the Department of Native
Studies at the University of Saskatchewan as part of a
much larger research project designed to examine the
utilization of the Western and traditional health care
systems by the Saskatoon Native population and barriers
to health care faced by this population . As part of the
overall project, non-native respondents were also
interviewed in order to determine their utilization of
the Western health care system .The interview schedule
itself consisted of one hundred and twenty-three
questions (see Appendix A) and three supplemental forms
(see Appendices B,C,and D) designed to elicit more
detailed information on various aspects of health care
utilization . As can be seen on the interview schedule,
the supplemental forms were utilized when a respondent
had more than one incident of hospitalization,
emergency room visit, or visit to a traditional healer
in the past year . Both open and close-ended questions
94
were utilized in an effort to produce a survey
instrument which would elicit a wide range of data . As
Stoner has argued, the study of the utilization of
health care systems among a population is best achieved
through the use of both qualitative and quantitative
data . 405 The instrument was also designed to elicit a
good deal of information from each respondent .
Respondents signed a consent form at the end of the
interview allowing the researcher to obtain data
regarding the reason for their visit, diagnosis, and
treatment on the day of the interview (see example of
form in Appendix E) .
The resulting survey instrument generally took
between twenty minutes (when no supplemental forms were
completed) to forty minutes (in cases where one or more
supplemental forms were completed) . On the basis of a
pre-test, two questions eliciting little information
from respondents were removed and one question which
caused some comprehension problems was revised . Also,
several questions on the utilization of traditional
health care systems were addedd to elicit more
information in this area . Overall, however, very few
changes were made to the final interview schedule . The
interview schedule proved to be an effective survey
instrument, being both concise yet eliciting a
significant amount of information from each subject .
95
4.3 Testing
A sampling frame for the Native population of
Saskatoon does not exist ; thus a random sampling
technique could not be utilized . The study utilized a
non-random sampling design, using an availability
sampling technique . While a random sampling design is
preferable, it can have one serious drawback as pointed
out by Fuchs and Bashshur in their study on the
utilization of traditional health care systems by an
American Indian population : namely, a high non-response
rate because not all those respondents selected for the
sample can always be interviewed as many may have moved
and can not be located. This, of course, introduces
bias into the final sample . 406 While the present study
utilized a non-random sampling design, virtually every
respondent identified was interviewed thus ensuring a
relatively large sample .
A pre-test was begun on October 13, 1987 at
Saskatoon's main Community Clinic to avoid overlap with
respondents at the Westside Community Clinic . The
pre-test consisted of twelve Native and eight
non-Native interviews (the non-Native interviews were
part of the overall study on native and non-Native
utilization of the western health care system) . The
pre-test was aimed at determining the average length of
the interview, and also whether any problems appeared
to exist with the respondents' comprehension of
96
97
questions . Two other important objectives of the
pre-test were to determine if communication problems
appeared to exist between a non-Native interviewer and
Native respondents, and also whether Native respondents
would discuss traditional medicine with the
interviewer . Fuchs and Bashshur reported negative
reactions by members of the Indian community to their
attempts to elicit information on attitudes toward
traditional health care systems from Native
respondents, with some individuals indicating that
discussing Indian medicine would damage its power . 407
During the pre-test the researcher approached people
directly in the clinic's four waiting rooms,
introducing the project briefly and then allowing them
to read an introductory letter . Patients who were
interested in participating in the study were
interviewed after they had seen the doctor .
Respondents were given three dollars for their
participation in the study . Interviewing took place at
the main Community Clinic from October 13-20, 1987 .
Because of the relatively small percentage of
Nativepatients seen at the main Community Clinic, the
decision was made to shift the pre-test to the Westside
Clinic in order to obtain the remaining Native
interviews . While it would have been preferable to
conduct all of the interviews for the pre-test at the
main Community Clinic, time constraints did not allow
98
this . None of the patients interviewed for the pre-test
were interviewed for the main part of the study .
Interviewing for the pre-test took place at the
Westside Clinic from October 21-29, 1987. The
researcher did not approach the patients directly in
the Westside Clinic's waiting room because the clinic
aide preferred to approach the patients herself and
introduce the study to them . This method worked very
well, with most of the patients coming to the clinic
agreeing to be interviewed . No communication problems
appeared to exist between the researcher and the Native
respondents . Further, all of the Native respondents in
the pre-test were quite willing to discuss their
utilization of and beliefs about traditional health
care systems .
On November 16, 1987, testing for the main part of
the study began at the Westside Clinic . The clinic aide
identified respondents in the clinic's waiting room as
was the case in the pre-test, and she briefly
identified the purpose of the study to them . The
researcher explained the study in more detail to any
respondents who desired more information . A number of
respondents did want more information on the purpose of
the study and under whose auspices it was operating .
Each respondent was paid five dollars for his/her
participation in the study . The interviewing took place
in the clinic's staff/meeting room, which afforded the
99
researcher and respondents both privacy and a
comfortable, Informal atmosphere . Each respondent was
Interviewed alone, except when they had children with
them . Every attempt was made to conduct each interview
in a relaxed manner so that respondents would feel at
ease discussing their beliefs on traditional health
care systems. Before beginning the section of the
Interview schedule which dealt with utilization of
traditional health care systems, a short pre-amble was
read to each of the respondents to indicate why the
researcher was asking them about Indian medicine and
also to reassure them that they would not be asked to
reveal any of the secrets of Indian medicine (see
beginning of Part 3 of interview schedule for
preamble) . As was the case with the pre-test, the
patients freely dicussed their beliefs about and
utilization of traditional health care systems .
It must be made clear that while a relaxed
interview was a major priority, this was not at the
expenseof abandoning the structure of the interview
schedule . Rather, the format of the interview schedule
was followed ; however, If a- respondent wished to
discuss a particular topic further this was done, or if
a respondent began to discuss their beliefs about
traditional medicine before the researcher had reached
this section of the Interview schedule (which happened
occasionally) the researcher moved to this section of
100
the schedule and then returned to the previous
sections . No attempt was ever made to put a time limit
on the interviews and respondents were allowed to
discuss any topic at length because it was felt that
this would yield better qualitative data by
establishing a friendly relationship between the
researcher and the respondents .
Interviewing continued until December 18, 1987 and
then concluded for two weeks over the Christmas period
when, according to the clinic's staff, few patients
come to the clinic . Interviewing resumed again on
January 4, 1988 . It was originally believed that all of
the non-Native interviews could be conducted at the
Westside Clinic . However, because an insufficient
number of non-Native patients came into the clinic to
ensure the necessary sample size for the overall study
of Native and non-Native utilization of the Western
health care system (approximately fifty respondents) it
was necessary to spend several days interviewing
non-Native respondents at the Friendship Inn . This
facility was chosen because it is in the same location
as the clinic and, more importantly, because the
Friendship Inn's clientele is demographically very
similar to that of the clinic in terms of income and
education levels . It also turned out to be necessary to
conduct several Native interviews at the Friendship Inn
because it became increasingly more difficult as the
study progressed to find patients who had not already
been interviewed at the Westside Clinic . Unfortunately
some information was lost when Native subjects were
interviewed at the Friendship Inn : specifically, those
questions relating directly to the respondent's visit
that day to theclinic had to be omitted . It was still
possible to elicit information from these subjects on
their beliefs and utilization of traditional health
care systems, however . The study concluded on January
22, 1988 .
4 .4 Statistical Analyses
The main statistical tests which were utilized in
the data analysis for this study were frequencies, chi
squares (which test randomness of distribution) and
t-tests (which test the difference of means between two
variables) . As was discussed previously, a non-random
sampling design was utilized because of the lack of a
sampling frame for the Native population of Saskatoon .
Nevertheless, it is still appropriate to use tests of
statistical significance such as thechi square and
t-test . 408 Statistical significance - was defined in the
study as p4 .05 . Statistical analyses were performed on
the University of Saskatchewan mainframe system,
utilizing the Statistical Package for the Social
Sciences (SPSSX ) program . A total of 103 Native
interviews were conducted .
101
CHAPTER FIVE : RESULTS
5 .1 Demographics of Sample Native Population
5 .1 .1 Sex
Of a total of 103 interviews conducted, 62 .1% were
with females and 37 .9% of the interviews were with
males . This reflects the fact that the Westside Clinic
has a higher ratio of female to male clients .
5 .1 .2 Age
The mean age of the respondents was 30 .5 years,
ranging from 17 to 61 years . The majority of the
respondents (70 .9%) were concentrated in the age range
from 20 to 39 years, which reflects the age composition
of the Westside Clinic's clientele .
5 .1 .3 Marital Status
The majority of the respondents were single
(43 .7%), while 34 .0% were married (including common-law
marriage), and 22 .3% were divorced/widowed/separated .
5 .1 .4 Dependent Children
Slightly over one-half (55 .3%) of the respondents
reported having dependent children . The mean number of
102
dependent children was 2 .4, with 24 .6% of the
respondents having one dependent child and 40 .4%
reporting having two .
5 .1 .5 Education
The mean level of formal education attained by the
respondents was a grade level of 8 .6 . Some 7 .8% of the
respondents had achieved Grade 12, and only 1 .9% had a
post-secondary education (see Table 1) .
5 .1 .6 Present Employment Status
Virtually all of the respondents in the study were
unemployed (95 .1%) . Only 1 .9% (n=2) were employed
full-time when the interviews were conducted .
Similarly, only 3.9% (n=4) of the respondents were
receiving unemployment insurance, Indicating that few
respondents had been employed In the recent past .
5 .1 .7 Income Level
The mean annual income of the respondents was
$7219 .69 . Some 68 .0% of the respondents reported annual
incomes of $10,000 or less (see Table 2) . The majority
of the respondents (78 .6%) were receiving social
assistance at the time of the interview .
103
104
Table 1 : Education Leve of Respondents
Grade Level N %*
0-6
167-9
4710-12
38Post-secondary
2
15 .545 .636 .9
1 .9
99 .0103
* Percentages are roundedthroughout this chapter .
to one decimal place
Table 2 : Annual Income Level of Respondents
Income- Range U s$ 0-3500 22 21 .43501-6000 24 23 .36001-10,000 24 23 .310,000+ 33 32 .0
103 100 .0
5 .1 .8 Residency
Almost one-third (32 .0%) of the respondents
interviewed lived in the neighborhood of Riversdale
which encompasses the area to the immediate south of
the Westside Clinic . Most of the other respondents
either lived in the neighborhood of Pleasant Hill
(17 .5%) which is immediately to the west of Riversdale,
or Westmount (9 .7%) which is immediately to the north
of Riversdale . Few of the respondents (6 .8%, n=7)
reported living In neighborhoods on the east side of
the Saskatchewan river which bisects the . city .
Two-thirds of the sample either were currently
renting a house (33 .3%) or an apartment (33 .3%), while
only 1 .9% (n=2) reported owning their own house . A
number of respondents (15 .7%) did not have their own
accommodation and were living with friends or family .
The population appears to be somewhat transient within
the city, with over one-half (53 .9%) reporting having
moved within the city two or more times in the past
year . The mean number of different places respondents
had lived in the past year was 2 .3 . About one-fifth
(20 .4%) of the sample had lived in the city of
Saskatoon for less than one year (see Table 3) and over
one-half (52 .5%) had lived in the city for more than
five years. Almost one-quarter (23 .3%) reported their
home community to be other than Saskatoon .
105
Table 3 : Number of Years Resident in Saskatoon
1o6
* Note : Data reflect the total number of years in thecity, not the total consecutive number of years .
Number of Years* N. s0-1 21 20 .42-5 28 27 .26-10 29 28 .211-20 20 19 .421+ 5 4 .9
103 100 .1
5 .1 .9 Native Status and Cultura Background
The maJority of the respondents in this study were
status Indians (68 .9%), 12 .6% were non-status Indians,
and 18 .4% were- Metis. There were no Inuit respondents
in the study . Over one-third of the sample (34 .0%)
stated their cultural background as Plains Cree, 23 .3%
were Saulteaux, 17 .5% were Northern Cree, and 16 .5%
were Metis (see Table 4) . Well over one-half (58 .3%) of
the sample spoke a Native language as their first
language . Three-quarters (75 .7%) reported speaking at
least one Native language today (see Table 5) . Cree was
the most commonly spoken Native language (64 .0%),
followed by Saulteaux (26 .7%) (see Table 6) . A number
of respondents (14 .7%, n=11) reported that they spoke a
Native language "most of the time," with more (24 .0%,
n=18) reporting speaking a Native language "half the
time" (with English spoken half the time) (see Table
7) .
5 .1 .10 Summary
The sample population is culturally and
linguistically diverse, yet is characterized by
extremely high unemployment and a high level of social
assistance . Corresponding to this is a low education
level, a very low percentage of property ownership and
high intra-city mobility .
107
Table 4 : Cultural Background of Respondents
108
Table 5 : Number of Different Native Languages SpokenToday
with a healer for the health problem that had brought
them to the clinic but none had ; however, some of the
respondents (6 .8%) Indicated that they were planning to
see a healer for their current health problem . Some
16 .5% of the respondents had seen both a healer and a
Western physician for the same health problem . About
one in five respondents (20 .4%) had seen a healer only
(and not a Western physician) for a specific health
problem in the past (see Table 10 for breakdown of
types of health problems) .
114
Table 10 : Past Health Problems For Which Only aTraditional Healer Was Consulted
Health Problem
Colds 5 23 .8
Pneumonia 14 .3
Pains in chest/side 3 14 .3
Tuberculosis 2 9 .5
Cannot remember 2 9 .5(taken as child)
Spiritual strength 1 4 .8
Headache 1 4 .8
Diarrhea 1 4 .8
Skin infection 1 4 .8
Refused to answer 1 4 .8
21 100 .2
115
Few of the respondents (3 .9%, n=4)'had participated
in a sweat lodge ceremony in the past year (refer to
Table 8) and in all of these cases the location of the
sweat was outside of Saskatoon and the respondents were
status Indian . It is surprising that so few respondents
had participated in a sweat in the past year, although
many of the respondents indicated that they had
participated in a sweat at an earlier time in their
lives (however specificdata on this was not gathered) .
The impression garnered by this researcher was that
sweats still play an important role in the lives of
many of the respondents . As was noted in the literature
review, traditionally sweats were central to the Plains
Cree not only for curative purposes but also for
ritualistic cleansing .
Many more of the respondents (14 .6%) reported use
of traditional herbs or medicines in the past year,
while even more (33 .9%) reported use of sweetgrass .
Sweetgrass was treated as a traditional medicine in the
study because it is predominately burnt as protection
against evil spirits or to ensure good health and
fortune through prayer . Two medicinal uses of
sweetgrass were also noted by respondents : these being
as a treatment for migraines, and as a treatment for a
sore ear, with sweetgrass smoke being blown into the
ear . As was indicated in the literature review,
sweetgrass traditionally played a major role in Plains
116
Cree life, particularly for ritual cleansing prior to
ceremonial participation . Clearly, sweetgrass still
figures prominently today In the lives of the
respondents . While some herbs and medicines were
obtained from a healer, in many cases they were given
to the respondents by relatives . Quite often the
respondents were not aware of the name of the herb or
medicine, but were able to Identify it in terms of its
purpose. Respondents Indicated that they utilized
specific roots to treat colds,_ for irregular heart
beats and for general preventive health care, while
herbs were noted as being utilized for bladder problems
and kidney infections . Several respondents referred to
"rat root" or "rat food," indicating that this was a
root used for toothaches, colds, sore ears or bad
breath .
None of the respondents made reference to the use
of peyote which, as was discussed in the literature
review, is quite widely utilized today among American
Indian groups . The researcher has heard of the current
use of peyote among specific bands in Saskatchewan but
concrete information on this is not available . It could
be the case that respondents In this study did not
readily think of peyote as a medicine when they were
asked "have you been treated with, or treated yourself
with any Indian medicines or herbs?" because peyote is
virtually exclusively utilized in a ceremonial context
117
and is not self-administered . Also, the peyote ritual
is a very sacred ceremony and if a respondent had
participated in such a ceremony they may not have felt
it proper to indicate this . Further, respondents were
not asked what ceremonies andd rituals they had
participated in other than sweats .
Respondents especially seemed to believe in the
efficacy of traditional health care systems when they,
a friend, or a relative had been successfully treated
by a healer for a serious illness . This particularly
was the case when a healer had enabled the patient to
discontinue taking medication prescribed by a Western
physician . For example, one respondent noted that his
sister had been cured of tuberculosis by a healer . Two
other respondents noted that their sister and cousin
respectively were treated for arthritis and were able
to discontinue their medication, while another
respondent reported that both his uncle and cousin were
successfully treated by a healer for paralysis
affecting one entire side of their bodies . Another
respondent stated that her diabetic aunt no longer had
to have insulin shots after she had consulted with a
healer, and also that her mother was able to
discontinue her heart medication after seeing a healer .
One respondent noted that a friend who "couldn't
think straight" went to a healer and was immediately
cured . Another respondent, who believed strongly in
118
"bad medicine," told of both her mother and father's
experiences with "bad medicine" and their subsequent
curing by a healer :
The respondent's mother had had a recurringproblem with her leg in which the leg wouldswell up above the knee and become very painful .Physicians had been unable to diagnose the causeof this condition and so the respondentaccompanied her mother to a healer . The healerwrapped the woman's leg in a birch bark cast whichhad herbal medicines inside it . After several daysthe healer took the cast off and wrapped the legin a clean white cloth . The next day he removedthe - cloth and revealed the source of her illness :a human hair approximately one foot long hadappeared on the inside of the cloth, having comeout of the woman's leg . The respondent's motherthen fully recovered . The respondent's father hadalso encountered "bad medicine" or, morespecifically, love medicine . Her father hadbeen given_ a beautiful beaded jacket by a woman ;however, whenever he wore the jacket hebecame very disoriented and would keep appearingunexpectedly at this woman's community which wassome distance from his own . The respondent'sfather eventually visited a healer who discoveredthat the woman had sewn love medicine into thejacket's sleeve, which had resulted in the manbeing under this woman's love spell . The jacketwas burned, the man was treated with herbalmedicines, and he recovered soon after [from notestaken by interviewer ; respondent gave permissionto interviewer to use this information] .
As was discussed in the literature review,
disease-obJect intrusion, a form of "bad medicine,"
traditionally was a predominant diseaseetiology on the
Plains .
Other respondents who believed in traditional
medicine told of their own successful experiences with
healers . In another case of "bad medicine," a
respondent noted that a healer had rubbed his hands
over the respondent's leg and removed a hair from
119
inside the leg . The healer then sent the "bad medicine"
back to the person who had sent it . Another respondent,
who had seen a healer within the past year, noted that
the healer had performed a sucking technique on her
right lower abdomen and had removed a rabbit's knee . As
was pointed out in the literature review, the sucking
technique was frequently used in cases of
disease-object intrusion .
One respondent, who had also seen a healer in the
past year for back pain, was diagnosed as suffering
from the pain because her father had broken a taboo .
Her father had fallen from a horse, but his pain was
passed on to his daughter because of the broken taboo .
This is a classic "sins of the father" disease etiology
in which the sin, or punishment for a broken taboo, of
ancestors or parents is passed on to the descendent,
causing illness or disease . As was noted in the
literature review, this disease etiology was also
traditionally found on the Plains . Another respondent
who visited a healer for a pain in his chest was
diagnosed as having an evil spirit in his body . The
healer gave the respondent a decoction and then
exorcised the evil spirit from the respondent's body .
The respondent noted that his chest pains were gone the
next day . Interestingly, the disease etiology of spirit
intrusion was traditionally not found on the Plains,
but rather wass more common among Inuit groups and in
the Plateau region .
5 .3 Access to Traditional Health Care Systems in
the Urban Centre
The second major aim of this research was to
determine if the Native population of Saskatoon wants
access to traditional Indian medicines and healers
within the Western health care system .
Few respondents (5 .8%, n=6) reported knowing of a
practicing healer in the city . For purposes of the
interview schedule, respondents were asked whether they
would like Indian medicines and Indian "doctors"
available at the Westside Clinic (however, respondents
interviewed at the Friendship Inn were simply asked if
they would like access to Indian medicines and/or a
healer within the city) . Traditional healers were
referred to as "Indian doctors" on the interview
schedule because Indian elders consulted during the
construction of the schedule indicated that this was
the most commonly used term among Native people . Well
over one-half (58.9%) of the respondents indicated that
they would like Indian medicines and a healer available
at a clinic . Even more respondents (64 .4%) indicated
that they would actually consult with an Indian doctor
if one were available at a clinic . Of those who wanted
Indian medicines available at a clinic, almost one-half
120
121
(47 .9%) stated that this was because they had a strong
belief in the power of Indian medicine and/or they had
experienced its healing powers firsthand or knew of a
relative or friend who had been cured by a healer (see
Table 11) . .One-third (33 .3%) of the respondents wanted
Indian medicines/healer available because they wantedto
learn about it or wanted the opportunity to experience
it . Some of the respondents (12 .1%) felt it would not
be appropriate for either Indian medicines or a healer
to be available at a clinic because traditional
medicine should be kept confidential and in its own
environment, such as on a reserve (see Table 12) .
Respondents who indicated they would actually
consult with a healer if one were available- at a clinic
were asked why they would see a healer (see Table 13) .
Two-thirds (66 .6%) of the respondents who indicated
that they would consult with a healer stated a medical
reason, ranging from colds, general bodily aches and
pains, headaches, and fever to diabetes, stomach and
kidney problems, cancers and terminal conditions . Thus
it would seem that many of the respondents see healers
as able to treat a wide range of physical illnesses,
including more serious conditions . A number (21 .1%) of
respondents also indicated that they would consult with
a healer for personal and/or spiritual problems, with
several (12 .3%) indicating that they would see a healer
for all kinds of illnesses .
Table 11 : MaJor Reasons Why Respondents WantedTraditional Medicines/Healer Available
122
* Reflects number of responses, not respondents . Somerespondents could not state a reason why they wantedtraditional medicines/healer available at the clinicand others gavemultiple reasons .
at a Clinic
Reason -a* %
Believe in traditionalmedicine
23 47 .9
Want to learn abouttraditional medicine
16 33 .3
Part of culturalbackground
3 6 .2
New experience 2 4 .2
Would benefit Nativepatients
2 4 .2
To get treatment forspecific health problem
2 4 .2
48 100 .0
123
Table 12 : Major Reasons Why Respondents Did Not WantTraditional Medicines/Healer Available at a
Clinic
Reason,
Do not believe intraditional medicine
Do not know enough abouttraditional medicine
Do not trust healers/traditional medicine evil
"White" medicinesufficient/superior
Not appropriateIn clinic
*Reflects number of responses, not respondents . Somerespondents could not state a reason why they did notwant traditional medicines/healer available at theclinic, and others gave multiple reasons .
hl %s
13 39 .4
7 21 .2
5 15 .2
4 12 .1
4 12 .1
33 100 .0
124
*Reflects number of responses, not respondents ; severalrespondents stated multiple health problems for whichthey would consult a healer .
Table 13 : Proposed Reasons for Consultation With aTraditional Healer at a Clinic
Health Problem 1* aPersonal/spiritualproblems
12 21 .1
Colds, lung problems 8 14 .0
All illnesses 7 12 .3
To learn about traditionalmedicine
8 .8
Terminal conditions/cancers
4 7 .0
Infections 5 .3
Headaches 3 5 .3
Kidney problems 2 3 .5
Bodily aches/arthritis 2 3 .5
Infertility 2 3 .5
Stomach problems 2 3 .5
Other 7 12 .2
57 100 .0
5 .4 Interaction Between the Western and Traditional
Health Care Systems
It appears that use of traditional health care
systems is maintained in addition to utilization of the
Western health care system . Use of traditional health
care systems was not found to detract from use of the
Western health care system, as measured-by such
variables as whether the respondent had a family
doctor, whether therespondent had a regular dentist,
and the last time the respondent visited his family
doctor, (see Table 14 in Appendix F) . In fact, a
significantly higher percentage of those respondents
who had seen a healer at some time in their lives had a
regular dentist (55 .9%) as compared to thosewho had
never seen a healer but had a regular dentist (28 .8%)
(chi sq .=5 .88 ; d .f .=1 ; sign .=0 .01) . Also, a greater
percentage of respondents who had seen both a healer
and a physician for the same health problem had a
regular dentist (58 .8%) compared to those who had not
seen a healer and a physician for a health problem but
had a regular dentist (32 .9%) (chi sq .=2 .97; d .f .=1 ;
sign .=0 .08) .
Well over one-half (61 .1%) of the respondents
stated that they believed that traditional healers
could treat certain health problems better than
Western physicians (see Table 15 for breakdown of types
125
Table 15 : Health Problems Traditional Healers Can Treat
126
*Reflects number of responses, not respondents ; anumber of respondents gave multiple responses andseveral could not give a specific example of a healthproblem .
Better Than Physicians
Health Problem A
Illness from "bad medicine" 17 29 .8
Terminal illness/cancer 9 15 .8
Personal/spiritual problems 6 10 .5
Colds 4 7 .0
Most/all illness 4 7 .0
Heart/liver/kidney/stomach problems
4 7 .0
Diabetes 2 3 .5
Arthritis 2 3 .5
Paralysis 2 3 .5
Other 7 12 .2
57 99 .8
127
of health problems) . More respondents who learned a
Native language as their first language felt that
traditional healers could treat some health problems
better (63 .5%) as compared to English first language
problems . Healers were also seen by a few (10 .5%, n=6)
as being better able to counsel those with personal or
spiritual problems compared to physicians .
Interestingly, several respondents (7 .0%, n=4) felt
that healers could treat most or all illnesses better
than physicians .
Even more respondents (84 .3%) stated that
physicians could treat certain health problems better
than traditional healers (see Table 16 for a breakdown
Table 16 : Health Problems Physicians Can Treat BetterThan Traditional Healers
128
*Reflects number of responses, not respondents ; anumber of respondents gave multiple responses andseveral could not give a specific example of a healthproblem .
Health Problem K* I
Most/all illness 21 29 .2
Terminal illness/cancer . 18 25 .0
Conditions requiringsurgery
14 19 .4
Colds 4- 5 .6
Bone fractures 3 4 .2
Conditions requiringmedication
3 4 .2
Tuberculosis 2 .8
Other 7' 9 .6-
72 100 .0
129
of the types of health problems) . Fewer Native first
language speakers (79 .6%) believed that physicians
could treat certain health problems better than
traditional healers, as compared to English first
language speakers (90 .0%) (chi sq .=1 .10 ; d .f=1 ;
sign .=0 .29) . Also, slightly fewer current Native
language speakers (82 .8%) than non-speakers (88 .0%)
stated that physicans could treat some health problems
better than traditional healers (chi sq .=0 .07 ; d .f .=1 ;
0 .77) . Most of the respondents (29 .2%) indicated that
physicians were superior to healers in treating most or
all illness. One-quarter (25 .0%) of the respondents
stated that physicians could treat terminal illnesses
and cancer better than healers, and a number of
respondents (19 .4%) felt that physicians were superior
to healers in cases requiring surgery . Physicians were
seen as better able to treat several other physical
illnesses and conditions, including colds, bone
fractures and tuberculosis .
Thus traditional healers and physicians are both
seen as being able to treat a wide range of physical
illnesses, Including serious Illnesses . Healers,
however, were seen as being able to treat those with
personal or spiritual problems while physicians were
not noted as being effective in this area .
130
A number of respondents (16 .5%, n=17) reported
that they had utilized both traditional and Western
health care systems for the same illness episode
(see Table 17 for breakdown of types of health
problems) . In most of the cases (76 .5%, n=13) a
traditional healer was consulted after the respondent
had been to a physician but felt that he/she had not
been "cured ." In two cases, respondents had taken their
child to a healer after consulting with a physician
regarding their child's illness . The respondents were
asked how much time had elapsed between their visit to
the physician and the subsequent visit to the healer ;
however, often the respondents could not be specific in
terms of the exact length of time but were able to
indicate if it was within thesame year . In most cases,
(76 .9%) the visit to the physician was followed by a
visit to a healer, and in two cases healers were
consulted within days of the visit to the physician . In
23 .5% (n=4) of the cases where respondents had seen
both a traditional healer and a physician for the same
problem, the healer was consulted first, followed by a
visit to a physician . The majority (64 .7%) of the
consultations with healers (seen either first
after
consultation with a physician) occurred in 1980 or
after, and over
131
Table 17 : Health Problemsl For Which Respondent SawBoth a Traditional Healer and Physician
1 Health problems were usually expressed in terms ofsymptoms and not etiology .
- Health Problem N %
Swollen foot/leg 3 17 .6
Depression/emotionalbreakdown
2 11 .8
Took child (colic ;fever)
2 11 .8
Cold/sore throat 2 11 .8
Diabetes 1 5 .9
Kidney Problems 5 .9
Back pain 1 5 .9
Goiter 1 5 .9
Cut foot 1 5 .9
Hair loss 1 5 .9
Inability to urinate 1 5 .9
Cramps/vomiting 1 5 .9
17 100 .2
132
one-half (52 .9%) of the consultations occurred In 1985
or after, indicating that traditional health care
systems are currently active . As is indicated on Table
16, the respondents' health problems ranged from a
swollen foot or leg, and colds, to more serious health
problems such as diabetes and kidney problems . In two
cases, healers were consulted for psychological
problems after an unsuccessful visit to a physician .
In a number of cases, the respondents were
diagnosed as being victims of "bad medicine . One
respondent reported having consulted with a physician
because his leg would occasionally swell up for no
apparent reason . The physician's diagnosis was
arthritis, and the respondent was given pain killers . A
traditional healer was consulted In the same year, who
diagnosed the condition as being from "bad medicine"
and provided the respondent with a herbal decoction
which helped the condition .
Similarly, another respondent reported seeing a
physician because her foot had become very swollen and
sore while It was In a cast . The physician was unable
to diagnose the cause of the problem and prescribed
pain killers . The foot remained problematic so a healer
was consulted within the same year . The healer
diagnosed the cause of the illness as "bad medicine :"
specifically, the respondent had poison in her blood or
"black blood ." The healer made small Incisions in the
133
respondent's foot and applied medicine to the area
which the respondent said alleviated her condition . As
was discussed In the literature review, traditionally
the use of incisions and the application of medicine
directly to them was another commonly used technique in
cases of disease-object Intrusion .
Another respondent had gone to a physician
complaining of stomach cramps, blurred vision and
vomiting . According to the respondent, the physician
could not determine the cause of her Illness . The same
week she visited a healer who told her that the Illness
had occurred because someone had done "bad stuff" to
her . The healer gave the respondent a small leather
pouch containing medicines to wear under her clothes
against her heart . The respondent reported that she was
better within two days of seeing the healer .
Emotional and psychological problems can also be
diagnosed by healers as being the result of "bad
medicine ." One respondent related her experience : she
had been diagnosed as having suffered an emotional
breakdown and was placed on a psychiatric ward . Later
that same year she visited a healer who diagnosed her
condition as resulting from "bad medicine ." The
respondent was covered with a blanket under which the
healer placed a heated stone annointed with medicine .
This would be similar to the effect obtained by
participation in a sweat : namely, the patient's body
134
and spirit are purified and strengthened . Another
respondent who was diagnosed as suffering from
depression visited a psychologist without success . The
respondent subsequently visited a healer the same month
who diagnosed him as needing to restore the harmony in
his body through a sweat . In both these cases, the
respondents felt that they had received significant
psychological benefits from their encounters with
traditional health care systems .
Two respondents reported a negative experience in
their visit to a healer . The first respondent had seen
a healer for a sore throat and cough and was given a
herbal medicine . She then became quite ill so she
visited a physician within a fewdays of her visit to
the healer . The physician subsequently placed the
respondent in the hospital . The respondent now blames
the healer for not properly diagnosing her illness, and
she has completely rejected traditional health care
systems . The second respondent who reported a negative
experience was a diabetic who was being treated with
insulin and had been placed on a special diet . She saw
a healer later the same year because she had heard that
they could cure diabetes . The healer gave her a
decoction and a dry form of the medicine which she was
to take home and mix with water . The healer also told
her to discontinue her insulin shots, which she did for
one year . She subsequently became very ill and saw a
135
physician who placed her back on insulin treatments .
This respondent now, understandably, feels that Indian
medicine is "dangerous ." Generally, however,
respondents reported their encounters with healers to
be very successful .
5 .5 Hypotheses
In the course of this research project four
hypotheses were tested .
5 .5 .1 Hypothesis One
Socio-cultural variables will be significantlymore important than socio-economic variables inpredicting utilization of traditionalhealth care systems by Native respondents .
A number of soclo-cultural and socio-economic
variables were examined to determine their
relationship, if any, to utilization of traditional
health care systems (see Table 18 In Appendix G) .
Socio-cultural variables examined included the first
language the respondent learned to speak (Native or
English), the language(s) the respondent speaks today,
and the age of the respondent . Age was included as a
socio-cultural variable because it was felt that older
respondents would be more likely than younger
respondents to retain traditional beliefs concerning
health and health care .
136
Language appears to be a somewhat useful predictor
of utilization of traditional health care systems . Some
37 .9% of those respondents whose first spoken language
was a Native one reported seeing a traditional healer
at some point in their life, as compared to 27 .9% who
learned English as their first language (chi sq .=0 .71 ;
d .f .=1 ; sign .=0 .40) . Of those speaking a Native
language today, 39 .7% had seen a healer at some time,
as compared to 17 .9% who spoke only English and who had
seen a healer (chi sq .=3 .41 ; d .f=1 ; sign .=0 .06) . Little
difference existed, however, between those speaking
their Native language today "rarely or never" who
reported seeing a healer at some time (36 .4%) and those
speaking their Native language "most of the time" and
had seen a healer (31 .8%) (chi sq .=1 .01 ; d .f .=3 ;
sign .=0 .79) . It could be concluded that language
retention is more important than actual use of a Native
language when attempting to predict consultations with
a traditional healer .
Similar patterns, although none statistically
significant, were revealed for respondents who reported
seeing a traditional healer only (and not a physician)
for a specific health problem . Of those respondents
speaking a Native language as their first language,
21 .2% had - seen only, a healer, while 17 .5% of English
first language speakers had seen only a healer (chi
sq .=0 .03 ; d .f .=1 ; sign .=0 .86) Of those speaking a
137
Native language today, 22 .2% had seen only a healer,
while 12 .0% of those speaking only English had seen
only a healer (chi sq .=0 .66 ; d .f .=1 ; sign .=0 .41) . More
respondents who reported speaking a Native language
"most of the time" (18 .2%) had seen only a healer,
while 9 .1% of those speaking their Native language
"rarely or never" had seen onlv,a healer (chi sq .=4 .12 ;
d .f .=3 ; sign .=0 .24) .
Some 19 .3% of respondents speaking a Native
language as their first language had seen both a healer
and a physician for the same health problem, as
compared to 15 .0% of those speaking English first (chi
sq .=0 .07 ; d .f .=1 ; sign .=0 .78) . Of those speaking a
Native language today, 19 .4% had seen both a healer and
a physician, as compared to 12 .0% among those who
speak only English . No difference existed between those
who spoke their Native language "most of the time"
(18 .2%) and those speaking their Native language
"rarely or never" (18 .2%) (chi sq .=0 .46 ; d .f .=3 ;
sign .=0 .92) . Thus again it would appear that language
retention is more important than actual language use in
determining utilization of traditional health care
systems .
Slightly fewer respondents who were Native first
language speakers reported use of traditional herbs
(49 .2%) compared to English first language speakers
(51 .2%) who used herbs (chi sq .=0 .00 ; d .f .=1 ;
138
sign .=1 .00) . However, more respondents who spoke a
Native language today reported use of herbs (52 .1%)
compared to English language speakers who used herbs
(44 .4%) (chi sq .=0 .20 ; d .f .=1 ; sign .=0 .65) . More
respondents who spoke their Native language "rarely or
never reported use of herbs (61 .9%) as compared to
those speaking it "most of the time" (45 .5%) (chi
sq .=1 .45 ; d .f .=3 ; sign .= .691) . Again, It can be
surmised that language retention appears to be more
Important than actual language use .
Age was not found to be related to utilization of
traditional health care systems . The mean age of
respondents who had seen a healer at some time was 31 .9
years, while the mean age of those never having seen a
healer was 29 .7 years (T=1 .11 ; d .f .=86 ; prob .=0 .27) .
Virtually no difference existed between the mean age of
those who had used herbs (29.3 years) and those who had
not (29 .7 years) (T=-0 .11 ; d .f .=48 ; prob .=0 .91) . The
mean age of those who had seen only a healer for a
health problem was 32 .3 years, and the mean age of
those who had never seen only a healer for a health
problem was 30 .4 years (T=0 .71 ; d .f .=95 ; prob .=0 .48) .
Similarly, there was only a slight difference between
the mean age of those respondents who had seen both, a
healer and a physician for the same health problem
(32 .6 years) and those who had not (30 .4 years)
(T=0 .81 ; d .f .=95 ; prob .=0 .42) .
139
Several socio-economic variables were also
examined, including mean income and mean education
level . A significant difference existed between the
mean annual incomes of those respondents who had seen a
traditional healer at some time in their life ($8462)
and those who had not ($6607) (T=2 .09 ; d .f .=96 ;
prob .=0 .03) . No significant difference existed between
the annual income . of those respondents who had used
herbs ($7056) and those who had not ($7535) (T=-0 .55 ;
d .f .=94 ; prob .=0 .58) . Also, no significant difference
existed between respondents who had seen only a healer
for a health problem ($8266) and those who had not
($7015) (T=1 .16 ; d .f .=93 ; prob 0 .24), or between those
who had seen both a healer and a. physician for the same
health problem ($8717) and those who had not ($6949)
(T=1 .58 ; d .f .=93 ; prob .=0 .12) . A significant difference
almost existed between the mean grade level of those
respondents who had seen a healer at some time in their
life (9 .3 years) and those who had never seen a healer
(8 .3 years) (T=1 .90 ; d .f .=49 ; prob .=0 .06) . No
difference existed between the grade level of those
respondents who reported use of herbs (8 .7 years) and
those who had not (8 .5 years) tT=-0 .34 ; d .f .=98 ;
prob .=0 .74) . Likewise, no significant difference
existed between the mean education level of those
respondents who had seen both a healer and a physician
for the same health problem (8 .8 years) and. those who
had not (8 .5 years) (T=0 .59 ; d .f .=95 ; prob .=0 .56) .
However, a significant difference did exist between the
mean education level of those who had seen only a
healer for a health problem (9 .7 years) and those who
had not (8 .3 years) (T=2 .33 ; d .f .=95 ; prob .=0 .02) .
In conclusion, it would appear that language is a
moderately good predictor of utilization of traditional
health care systems . This was found to exist both in
terms of Native first language speakers and current
Native language speakers, although it does appear that
the actual use of a Native language is not related to
use of traditional health care systems . Rather,
language retention (the ability to speak a Native
language) appears to be somewhat related to the
respondents' utilization of traditional health care
systems . The last socio-cultural variable, that of mean
age, was not found to be related to utilization,
although the respondents who utilized traditional
health care systems were generally slightly older than
those not utilizing these systems . The socio-economic
variables of annual income and education level were
found to be significantly related to utilization,
although it must be emphasized that the income level of
respondents was basically very low for all the
respondents as was the mean education level achieved .
Generally, both the income and education level was
higher for those respondents utilizing traditional
140
health care systems . In conclusion, hypothesis one must
be rejected because socio-cultural variables were not
found to be more important than socio-economic
variables in utilization of traditional health care
systems .
5 .5 .2 Hypothesis Two
Those respondents with Indian status will besignificantly more likely than those withoutIndian status to utilize traditional healthcare systems .
This hypothesis is based upon the assumption that
because of their connection with a reserve, status
Indian respondents would have greater knowledge of and
access to traditional health care systems than
respondents without Indian status (non-status Indian
and Metis) .
A significant difference was found to exist
between those respondents with Indian status and those
without Indian status in terms of the use of medicinal
herbs (see Table 19 In Appendix H) . While 57 .1% of the
respondents with Indian status reporteduse of herbs,
33 .3% of those without Indian status reported use of
herbs (chi sq .=3 .85 ; d .f .=1 ; sign .=0 .04) . No other
significant differences existed between respondents
with Indian status and those without Indian status on
the other measures of utilization of traditional health
care systems .
141
142
Also, when each group was examined individually,
differences were apparent . Interestingly, the category
reporting the largest proportion of respondents having
seen a traditional healer at some time was that of
non-status Indian (61 .5%), with approximately one-third
(33 .8%) of status Indians reporting having seen a
healer ; and slightly over 10% (11 .8%) of Metis
reporting seeing a healer . These inter-group
differences were found to be statistically significant
particularly good predictor of utilization behavior ;
thus, hypothesis two must be rejected . This may be due
largely to the inappropriateness of the legal
distinction between status and non-status Indians in a
cultural analysis of this type . In other words, some
non-status Indian respondents may have strong cultural
ties to traditional Indian culture while others may not
identify with this culture, and some status Indian
respondents may have close ties to traditional culture
while others may not .
5 .5 .3 Hypothesis Three-
Respondents who have experienced difficultyutilizing the Western health care system will besignificantly more likely to utilize traditionalhealth care, systems than respondents who have notexperienced this difficulty .
A number of variables were used to measure
difficulty utilizing the Western health care system,
including language, cultural and economic barriers (see
Table 20 in Appendix I) . Variables measuring language
and cultural problems were as follows : difficulty
finding a doctor (or nurse) or making an appointment
with a doctor ; difficulty explaining a health problem
to a doctor (or nurse) ; difficulty understanding the
language used by the doctor (or nurse), or
understanding a doctor's Instructions concerning a
health problem, or difficulty understanding the
doctor's directions for taking prescribed medication .
Respondentswere also asked If they had ever been
treated by a doctor (or nurse) In a way that made them
"feel bad," or If they had ever been denied medical
care by health care providers . Variables measuring
economic problems Included difficulty travelling to see
a doctor or nurse, difficulty paying for a babysitter
so they could visit a doctor, difficulty paying for
144
145
prescription drugs, or difficulty paying for
non-prescription drugs and other medicines .
In terms of possible language and cultural
problems which could act as barriers to maximum
utilization of the Western health care system, 17 .5% of
the respondents reported difficulty finding a doctor at
some time in their life, 21 .6% reported difficulty
making an appointment with a doctor at some time, while
26 .2% reported difficulty explaining their health
problem to a doctor at some time . While 9 .6% of those
who reported difficulty explaining a health problem to
a doctor spoke a Native language today, 4 .8% of those
reporting this difficulty spoke only English (chi
sq .=0 .04 ; d .f .=1 ; sign .=0 .83) . Almost half of the
respondents (46 .1%) reported having, difficulty at some
time understanding a doctor's language . Little
difference existed between respondents who reported
difficulty understanding a doctor's language and spoke
a Native language today (47 .3%), and those respondents
who experienced this difficulty but spoke only English
(42 .9%) (chi sq .=0 .03 ; d .f .=1 ; sign .=0 .85) . Over
one-quarter of the respondents (26 .2%) experienced
difficulty at some time understanding a doctor's
instructions concerning a health problem . Slightly
fewer of those reporting this difficulty were current
Native language speakers (25 .7%) as compared to those
reporting this difficulty and speaking only English
146
(27 .6%) (chi sq .=0 .00 d .f .=1 ; sign .=1 .00) . Some 15 .5%
of the respondents had difficulty at some time
understanding a doctor's directions for taking
prescribed medication . While 14 .9% of those respondents
reporting difficulty understanding a doctor's
directions spoke a Native language today, 17 .2%
reporting this difficulty spoke only English (chi
sq .=0 .00 ; d .f .=1 ; sign .=1 .00) .
Some 7 .9% (N=8) of the sample reported being turned
away from medical care at some time . Little difference
existed between respondents who reported being turned
away from medical care and who were current Native
language speakers (8 .2%) and those who were turned away
but were English-only speakers (7 .1%)(chi sq .=0 .00 ;
d .f .=1 ; sign .=1 .00) . Some 22 .9% of the respondents
reported having been treated at some time by a doctor
or nurse in a manner which made them "feel bad ." Fewer
respondents who were made to "feel bad" at some time
were current Native language speakers (18 .8%), as
compared to those reporting this difficulty but
speaking only English (33 .3%) (chi sq .=1 .55 ; d .f .=1 ;
sign .=0 .21) . When respondents were asked why they felt
the doctor or nurse had treated them in this manner
many felt that it was because of the personality of the
health care provider : "He (doctor) was a grouch ;" "She
(nurse) was bitchy to everyone ; "She (nurse) was maybe
in a bad mood . A number of the respondents blamed
147
themselves for the incident : "I was drinking . It was my
fault ;" "I was on medication for asthma and was
cranky ;" "I missed the appointment so I guess I
deserved it ." Only three respondents (7 .3% of those
who reported being treated In a way that made them
"feel bad") suggested that the Incident was the direct
result of racism on the part of the health care
provider : "Nurses don't like Indians ;" "Because I'm
Native ;" "She (nurse) seemed prejudiced ."
Difficulties finding a doctor or making an
appointment with a doctor were not found to be related
toutilization of traditional health care systems . For
example, of the respondents who reported difficulty at
some time finding a doctor, 27 .8% had seen a healer at
some time, as compared to 34 .9% not experiencing this
difficulty but having seen a healer (chi sq .=0 .09 ;
d .f .=1 ; sign .=0 .75) . Similarly, difficulty explaining a
health problem to a-doctor was not related to
utilization of traditional health care systems, with
26 .9% of those who experienced this difficulty having
seen a healer as compared to 36 .0% not experiencing
this difficulty but having seen a healer (chi sq .=0 .36 ;
d .f .=1 ; sign .=0 .54) . Difficulty understanding a
doctor's Instructions concerning a health problem was
found to be'related to whether a respondent had seen
only a healer for a health problem, with 34 .6% of
respondents who indicated they had experienced problems
148
understanding a doctor's instructions also reporting
having seen only a healer for a health problem as
compared to 14 .1% who reported no problems and had seen
only a healer (chi sq .=3 .87 ; d .f .=1 ; sign .=0 .04) .
Difficulty understanding a doctor's instructions was
not found to be related to any other variables
measuring utilization of traditional health care
systems, however . Respondents who had experienced
difficulty understanding a doctor's directions for
taking prescribed medication were also more likely to
have seen only a healer for a health problem, with
40 .0% of those reporting such difficulties having seen
only a healer compared to 15 .9% of those reporting no
difficulties but having seen a healer (chi sq .=3 .28 ;
d .f .=1 ; sign .=0 .06) .
The last two variables measuring language and
cultural barriers, being treated in a way that made the
respondent "feel bad" or having ever been turned away
from receiving medical care, were not found to be
related to utilization of traditional health care
systems . For example, 36 .4% of those who reported being
made to "feel bad" had also seen a healer at some time,
as compared to 30 .1% who had never been made to "feel
bad" but had seen a healer (chi sq .=0 .08 ; d .f .=1 ;
sign .=0 .77) ; and 25.0% of those reporting having been
turned away from medical care had seen a healer at some
time, compared to 34 .1% who had never been turned away
149
but had seen a healer (chi sq .=0 .01 ; d .f .=1 ;
sign .=0 .89) .
There is evidence that some of the respondents in
the study suffered economic problems when attempting to
utilize the Western health care system . Many of the
respondents (41 .7%) reported that they occasionally had
financial difficulty travelling to see a doctor at some
time, especially when they had to travel across the
city . This Is also supported by the finding that 39 .1%
of the respondents stated that they had come to the
Westside Clinic on the day they were Interviewed
because it was close to where they lived, and also that
64 .1% of the respondents reported having walked to the
clinic that day . Some 22 .2% of the sample reported
difficulty paying for a babys.itter so that they could
visit a doctor or take another of their children to a
doctor . About one-fifth ( .21 .4%) reported difficulty
paying for prescription drugs ; however, if one deletes
status Indians from the analysis (who do not pay for
prescription drugs) this figure Increases : 53 .8% of
non-status and 52 .6% of Metis respondents reported
difficulty paying for prescription drugs . Over
one-third of the respondents (37 .9%) reported
difficulty paying for non-prescription drugs ; status
Indians are not covered for these .
Some significant differences were found to exist
between variables measuring socio-economic barriers and
utilization of traditional health care systems . Of
those reporting having difficulty paying for
prescription drugs, 40 .0% had seen only a healer (and
not a physician) for a health problem at some time in
their life, as compared to 14 .3% who had not
experienced such difficulties but had seen a only a
Interestingly, significantly fewer respondents who
reported difficulty travelling to a doctor had seen a
healer at some time in their life (20 .9%) as compared
to those who had not experienced this difficulty but
had seen a healer (43 .1%) (chi sq .=4 .48 ; d .f .=1 ;
sign .=0 .03) .
It appears that the respondents in this study do
face real language, cultural and economic barriers In
utilizing the Western health care system . While several
of these variables are related to utilization of
traditional health care systems, most are not ; thus,
hypothesis three is be rejected .
5 .5 .4 Hypothesis Four
Respondents who are more "traditional" will besignificantly more likely than "non-traditionalrespondents to desire urban access totraditional health care systems
"Traditionality" was measured In this research
through a number of socio-cultural variables, including
Native status (status Indian or non-status
150
151
Indian/Metis), first language spoken, language(s)
spoken today, and age (see Table 21 in Appendix J) .
Respondents were asked two questions to determine
whether they wanted urban access to traditional health
care systems : firstly, did they want traditional
medicines and a healer available at a city clinic
(emphasis was upon the Westside Clinic) ; secondly,
would they actually consult with a healer in a clinic
if one were available . As was noted earlier, 58 .9% of
the respondents indicated they would like access to
traditional medicines and a healer in a city clinic,
and 64 .4% indicated they would actually consult with a
healer if one were available in -a clinic . A significant
difference did not exist between those respondents with
Indian status (62 .5%) and those without (50 .0%) in
terms of desired access to traditional medicines and a
healer at a clinic (chi sq .=0 .73 ; d .f .=1 ; sign .=0 .39) .
Also, no significant difference existed between status
Indian respondents (67 .2%) and respondents without
status (57 .7%) in terms of the likelihood of actual
consultation with a healer at a clinic (chi sq .=0 .37 ;
d .f .=1 ; sign .=0 .54) . However, more status Indian
(62 .5%) respondents wanted access to traditional
medicines and a healer at a clinic as compared to
non-status Indians (46 .2%) or Metis (53 .8%) respondents
respondents want urban access to traditional medicines
and healers in order that they can learn about
traditional health care systems . As was noted in the
discussion of hypothesis one, It was found that those
respondents utilizing traditional health care systems
generally had a mean age : slightly higher than those not
utilizing these systems . Alternatively, it could be the
case that the younger respondents had more recently
come from a reserve or rural area where they had
encounters with traditional systems . This supposition
is supported by the finding that those respondents
desiring access to traditional medicines and a healer
at the clinic had lived in Saskatoon fewer mean years
(5 .8 years) as compared to those who did not desire
this access (11 .0 years) (T=-1 .82 ; d .f .=40 ;
prob .=0 .07) . Similarly, those respondents who stated
that they would actually consult with a healer at a
clinic had lived In Saskatoon fewer mean years (6 .4
years) compared to those who wouldd not consult with a
155
healer (10 .3 years) (T=-1 .23 ; d .f .=36 ; prob .=0 .22) . A
significant relationship did not exist, however,
between the respondents' ages and the number of years
they had lived in the city (r= .137 ; sign .=0 .08) .
In conclusion, a significant difference was not
found to exist between those respondents with Indian
status and those without Indian status in terms of
desired access to traditional health care systems . A
significant difference did exist between respondents
who were Native first language speakers and those who
were English first language speakers in terms of
whether they would actually consult with a healer at a
clinic . A significant difference also existed between
respondents speaking a Native language today and those
speaking only English and desired access to a healer
and traditional medicines at a clinic, and also whether
a healer would actually be consulted at a clinic .
However, as was the case with hypothesis one, language
retention was a more important predictor than the
actual use of a Native language . While a significant
difference existed between age and desired access to
traditional medicines and a healer at a clinic and
whether a healer would actually be consulted, this was
contrary to the hypothesis which assumed that older,
and hence more "traditional," respondents would be more
likely to desire this access . In conclusion, some
support was found for this hypothesis as there does
156
appear to be a relationship between language and
desired access to traditional medicines and a healer,
as well as proposed consultations with a healer at a
clinic ; thus hypothesis four is accepted .
CHAPTER SIX: DISCUSSION
6.1 Summary of Results
The data presented here suggests that traditional
health care systems continue to play an important role
in the health care of urban Native respondents .
One-third of those interviewed had seen a healer at
some time, and almost one-half (48 .5%) of the sample
had used traditional herbs and/or sweetgrass in the
past year . While few people had participated in a sweat
in the past year this likely relates to the fact that
sweats largely occur in rural areas and on reserves,
and financial constraints can make travel difficult .
Use of traditional health care systems was not
found to be related to Indian status ; rather,
utilization was generalized among status Indian,
non-status Indian respondents, with Metis respondents
showing less utilization than the other two groups .
Utilization of traditional health care systems was
found to be related to the ability to speak a Native
language . This parallels the findings of Fuchs and
Bashshur's study of the use of traditional medicine
among Native Americans in the San Francisco Bay area
which also discovered that Native Americans who speak
their Native language were significantly more likely to
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158
use traditional medicine .410 A relationship was also
found to exist between both education and income level
and utilization, with those utilizing traditional
health care systems having a significantly higher
education and Income level . This contrasts with Fuchs
and Bashshur's findings which pointed to no
relationship between education or Income level and use
of traditional medicine . 411 Use of traditional health
care systems was not, found to be related to
difficulties receiving health care In the Western
health care system . Again this contrasts with Fuchs and
Bashshur's study which discovered that respondents who
experienced difficulty receiving Anglo medical care
tended to resort to use of traditional medicine . Use of
traditional health care systems was not found to
detract from use of the Western health care system,
which parallels Fuchs and Bashshur's findings . 412
It is clear that many of the respondents in this
study want access to traditional medicines and a healer
within the city (58 .9%), while even more stated that
they would actually consult with a healer If one were
available at the Westside Clinic or a similar facility
(64 .4%) . Again, the ability to speak a Native language
was found to be significantly related to whether
respondents wanted traditional medicines and a healer
available, and also whether respondents would consult
with a healer at Westside Clinic . The number of years
159
respondents had lived in the city was also found to be
related to desired access to traditional medicines and
a healer, with those desiring access living in the city
significantly fewer years than those not desiring this
access . It appears that traditional healers are not
widely available in the city as only 6 .0% of the sample
knew of a healer in Saskatoon .
It would appear from this study that traditional
medicine and related beliefs are still an important
part of Native culture . Further, many respondents
(33 .3%) stated that they wanted to have a chance to
learn about traditional medicine . This is supported by
the fact that those who wanted traditional medicines or
a healer available In the city and stated that they
would consult with a healer were significantly younger
than those who did not desire the availability of
traditional medicines/healer or would not consult with
a healer . It seems that young Native people have a
strong desire to learn about traditional medicine
because It is a part of their heritage . But is it at
all feasible to propose - that traditional health care
systems be brought more formally into the urban centre?
Some of the issues and concerns related to such a
proposal, prefaced by a discussion of the state of
Western medicine and the relevance of traditional
medicine today, will now be discussed .
6 .2 The Western Health Care System and the Role of
Traditional Medicine Today
Much has been written about the insensitivity of
physicians and their inability to relate to their
patients as fellow human beings . While some in the
medical establishment have accused medical
anthropologists and medical sociologists of
"doctor-bashing," In fact some important issues have
been brought to the forefront . As Dossey has argued,
Western medicine, while making great technological
strides, appears to have degenerated to a remote and
dehumanzing experience for the patient . 413 This
attitude seems to be widely held by lay-people: one
only need speak to someone who has recently been in a
teaching hospital to hear stories of how they were
subjected to poking and proding by medical students on
rounds, followed by the inevitable discussion of "the
case" with complete disregard for the presence of the
patient . The patient can become completely dissociated
from his/her body ; "the body" can be put through a
series of sometimes painful tests, often with no regard
for the fears of the patient . At times the tests are
not adequately explained beforehand, and it does not
help the matter that each type of specialized test is
performed by another technician . Often the technicians
are physically isolated from the patient as they
operate the machines from a separate room, and the
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161
patient is left to endure the testing alone . Thus the
patient is not able to develop a rapport with the
people Involved in his/her health care, but rather "the
body" Is shifted from site to site within the hospital
for testing. Clearly, this can be a dehumanizing and
frightening experience for the patient who is likely
already disquieted because of his/her illness .
This sense of allentation from one's health care
providers Is not limited to teaching hospitals,
however, but exists in non-teaching hospitals, and even
in small clinics and physician's offices . Virtually
everyone has had the experience of visiting a physician
for an illness only to have the physician elicit one's
symptoms in the most expedient manner possible,
scribble down a prescription, and then make It clear
that the visit has concluded . Many physicians appear to
have no interest In knowing about You and your thoughts
on what might be contributing to or causing your
illness (i .e . your explanatory model of the illness) ;
rather, their concern is "the body" and correcting the
body's problem or controlling the body's symptoms .
Mehl argues that modern biomedicine "arose in
virtual contempt" of traditional medicines, and that
religion and medicine began to separate during the
Renaissance . 414 The prevailing paradigm of medicine
came to be that of the body as a mechanical device,
encapsulated In the 17th century Cartesian philosophy
162
of Descartes which asserted the, distinction between
mind and body known as Cartesian dualism .415 The
reductionism of biomedicine has continued to the
present, with researchers such as Good and Good arguing
that this reductionism has led to the "Impoverishment
of the caring function of medicine ." 416
If the "caring function" of the Western health care
system has been lost, what are the implications of this
for the Native patient where a different culture and,
occasionally, a different language from that of the
health care providers can be factors complicating the
health care encounter? Hanson has argued that while
many Canadian urban Native people may have
"superficially adopted the Canadian urban lifestyle,"
misunderstandings and communication problems between
Native patients and non-Native health care providers
are still very common .`I 17 From her experiences working
at both a street-level social service liaison unit and
in a community-based health centre- in the Inner city of
Edmonton, Hanson cites three areas in which problems
occur in the delivery of health care services to
Natives in the inner city : firstly, the attitudes and
values of the professional health care providers ;
secondly, the communication process between the health
care providers and Native patients ; and thirdly, the
problem-solving methods employed by the health care
providers . She notes how physicians are trained to
163
observe, assess and act In as efficient a manner as
possible . 418 It can be extremely difficult for the
Native patient to relate a concise list of symptoms to
a physician both because the physician is likely a
stranger and because of the underlying belief in Native
culture that illness is multi-faceted, with many
components and causes . Thus prescriptions may not be
filled or if they are the pills may not be taken . Also,
to the consternation of health care providers,
appointments for x-rays or other tests or appointments
with medical specialists may not be kept . This can seem
irresponsible to health care providers, but may be
perfectly logical to the Native patient who knows
his/her illness cannot be "cured simply through
medication or tests .
In contrast to Western physicians, notes Hanson,
the traditional Native healer approaches the initial
encounter with the patient In a much different manner .
The encounter is unhurried with a good deal of eye
contact ; even more important, there is a "shared
understanding" between the healer and patient that the
patient's illness may stem from any number of things in
the patient's life . There Is also a shared
understanding of the role spirituality plays in health
and illness . Rituals involved in the treatment of the
patient bring the patient and healer closer together
and also encircle the patient in his/her culture . There.
164
is a real sense of personal caring in the health care
encounter between the healer and patient, which clearly
is often lacking in the health care encounter between
physician and patient (Native or non-Native) . 419
One of the most important roles traditional health
care systems could potentially come to play is in the
alleviation of alcohol and drug abuse . As was throughly
discussed in section 3 .2 .1 ., alcohol and drug abuse is
a very serious problem among some Native populations
and often leads to accidental and violent deaths . It is
naive to assume that encouraging people to participate
in the traditional elements of their culture, such as
traditional health care systems, is going to result in
an immediate solution for such a serious problem which
is clearly tied to the socio-economic status of Native
peoples and their marginalization within Western
society . However, what traditional health care systems
can do is to provide help for some individuals
suffering through alcohol and drug abuse . Traditional
Native teachings stress that one must have respect for
one's body and that a harmony must be achieved between
the mind, body and spirit which, of course, isJ
antithetical to the physical abuse of one's body with
alcohol or drugs (obviously this does not include
traditional "drugs such as peyote) . Further,
traditional teachings stress the importance of a
spiritual life within oneself which provides one with
165
inner strength . When an individual is a member of a
group which Is marginalized within society anything
that provides a positive source of strength (whether it
is termed "psychological" or "spiritual") is of great
importance In terms of one's survival .
As has been discussed In the literature review, the
peyote ritual has gained success in the United States
In the treatment of alcoholism among Native groups .
Also, the traditional Spirit Dance of the Salish has
been documented by Jilek to be very beneficial in the
treatment of alcoholism among these people . Elements of
traditional medicine and ceremonials do seem to have a
very important role to play In the treatment of alcohol
and drug abuse among Native peoples . However, such
traditional treatment modalities can only treat the
symptoms causing alcohol and drug abuse . To get at the
true cause of these problems one must acknowledge the
lack of an economic base for Native peoples today and,
in fact, how this same scenario of alcoholism and drug
abuse and concomitant accidental and violent deaths
exists among aboriginal populations aroundthe world
who have also been marginalized and have had their
traditional economies destroyed . It is believed,
however, that while one must recognize the structural
constraints which keep Native people In a marginalized
position one must also be realistic In recognizing that
these constraints are not going to disappear overnight,
if ever . Thus it is believed that something must be
done n2j, if even on a small scale, to try to prevent
the waste of so many human lives .
6 .3 Traditional Health Care Systems in the Urban
Centre
It is clear, both from the present research and
other research, that Native patients still desire
treatment from traditional healers . 420 Formalization of
traditional medicine through the Western health care
system is problematic, however . Firstly, there could be
extreme reluctance on the part of Western health care
providers, particularly physicians, to accept healers
within the Western health care system because healers
are not "scientifically" trained in medicine .
Obviously, there could be conflicting treatment
modalities if a patient is seeing both a traditional
healer and a physician (for example, see the case of
the diabetic patient in Chapter Five) . Occasionally a
healer will inform his/her patient that "Indian" and
"white" medicines cannot be combined and thus the
patient is advised to discontinue any medications
prescribed by a physician . 421 Indeed, in interviews
with healers, Gregory discovered that the majority felt
strongly that Indian and white medicines could not be
combined . 422
166
167
The issue of the legal implications of traditional
healing practices has to be considered, as well . Could
a traditional healer who advises a patient to
discontinue prescribed medication and/or prescribes a
herbal medicine be sued for malpractice if the patient
subsequently becomes III or dies? Robb has noted that
there are many unresolved legal issues in the area of
traditional medicine . For example, could traditional
healers be subject to criminal liability and would
healers be able to obtain liability Insurance?423
Obviously the legalities of traditional healing
practices would have to be examined in detail .
It must also be kept in mind that while there is
reluctance on the part of Western physicians in regard
to collaboration between the Western and traditional
health care systems, there is also reluctance on the
part of many healers who feel that traditional medicine
must be protected and must remain separate from Western
medicine . Again, this is a very important issue which
would have to be examined further .
While a growing body of research is demonstrating
the efficacy of some traditional treatments for
particular illnesses and conditions which Western
treatment modalities are unsuccessful In treating, 424
(also see Chapter Five for a discussion of "bad
medicine,") attempts to "scientifically" document the
efficacy of these treatment can face methodological
168
problems .425 Until the western medical establishment
can be given unequivocal proof of the efficacy of
traditional treatments it likely will continue to be
skeptical of traditional healers .
Another problem inherent In attempting to develop a
formal relationship between the Western and traditional
health care systems is that the traditional healer is
being placed In an alien environment . Rappaport and
Rappaport have suggested that this can lead to the
"demystification" of the healer because the symbolic
"props" which play an important role in the healer's
image may have been neutralized . If the expected image
is not conveyed, the patient may not feel secure in the
health care encounter in terms of the ability of the
healer to cure him/her . 426 Moerman has stressed the
importance of "healing metaphors" In any medical
treatment, 427 but practical problems can arise when the
healer attempts to utilize his/her "healing metaphors
in the urban centre . O'Neil has noted how many Native
healing ceremonies and rituals can Interfere with the
routine of a hospital, and also how the sweetgrass
ceremony can be impossible in a hospital room because
the burning sweetgrass sets off smoke detectors . 428
Morse et al . have also discussed the problems in
accommodating a healer in a health care setting because
of the traditional menstrual taboo which can require
that menstruating women be absent from the building in
1 69.
which the healer is practicing . 429 Healers themselves
can feel uncomfortable in the alien environment of a
health care setting which may render their medicine
less effective . 430
Because of the obstacles involved in bringing the
traditional healer directly into the hospital, O'Neil
argues that traditional health care systems cannot be
integrated Into the Western system at this point in
time . Rather, O'Neil suggests that Native medical
interpreters should come to play a greater role In the
health care of Native patients .431 The interpreters
would act as a vital link to Native society and would
consult withlocal elders in the city and maintain
links to traditional healers . The interpreters would
bring the healers to the hospital at a pre-determined
locale In which sweetgrass could be burned and where
the healer's treatment would not interfere with
hospital regulations . 432
Unfortunately an examination of theexperiences of
Native medical interpreters in Winnipeg found that the
interpreters were not readily accepted by the
physicians . Conflict was found to occur when
Interpreters "over-stepped" their authority and began
to advocate for the needs of the patients rather than
acting only as language Interpreters . Conflicts also
arose between the interpreters and the physicians when
the interpreters were not expedient enough in obtaining
170
responses from patients . Instead, an interpreter would
often attempt to establish some rapport with a patient
before asking a physician's questions, or an
interpreter would delay asking a physician's questions
while he/she attempted to find a culturally-appropriate
manner in which to explain a medical concept .433
Translating medical terminology into a Native language
can be problematic ; however, the Saskatchewan Indian
Languages Institute has produced a preliminary list of
medical terminology translated into Cree . 434 While
Native medical interpreters could come to play a
greater role in the health care of urban Natives they
may continue to be viewed by physicians as playing a
relatively unimportant role in the health care system .
Traditional healers likely could not be integrated
into the hospital environment at this time . However,
healers perhaps could be situated at an alternative
health care setting such as a clinic located in an core
urban area with a high Native clientele, such as the
Westside Community Clinic . At a clinic a healer could
provide consultations for patients with treatment, if
required, occuring in another location such as on a
reserve .
Alternatively, a healer could practice out of an
Indian organization, . such as an Indian-Met is Friendship
Centre . Both clinics in core urban areas and Friendship
Centres could likely offer environments appropriate to
171
the practice of traditional medicine . This, of course,
is predicated on the assumption that the staff of the
facilities were committed to bringing traditional
medicine to their clientele . This is necessary so that
some of the difficulties already outlined, such as
having menstruating women absent from the building if
necessary or providing a room without a smoke detector
or where a detector can be temporarily disconnected for
the burning of sweetgrass, could be met . Further, the
staffs' attitudes toward the healer are paramount . I
the case of a clinic, conflict could arise between the
physicians and a healer unless the physicians believed
that the healer had an important role to play in the
health care of the clinic's patients . Thisunderscores
the need for cross-cultural education in health care
beliefs and practices in medical schools . It should be
noted that the Medical Services Branch of Health and
Welfare Canada has published a cross-cultural
orientation manuel for Saskatchewan health care
professionals which discusses traditional medicine and
healers, cultural values and conflicts which can arise
between Native patients and non-Native health care
providers, as well as providing cultural backgrounds on
the major Native groups in Saskatchewan . 435
If a healer was located at a clinic with a
predominately Native clientele, such as the Westside
Clinic, physicians could refer patients to the healer
172
if they felt the patient had a culturally-determined
illness, such as illness resulting from "bad medicine ."
Physicians could also refer patients to the healer in
cases of what can broadly be referred to as spiritual
problems (i .e . alcohol and/or drug abuse ; depression)
if they felt that the patients would benefit more from
traditional treatments than Western modes of therapy .
If a healer was located at a Friendship Centre, the
centre could promotethe healer through posters,
pamphlets, and by word of mouth . Further, physicians
from core urban clinics could refer patients to a
healer at a Friendship Centre .
Organizations such as the Saskatoon Tribal Council
play an important role in the health care of Native
people coming to Saskatoon from northern areas by
providing hotel accommodation and taxi services . They
could expand this role by making these patients aware
of the healer(s) In the city . It could be comforting
for a Native patient unaccustomed to the urban centre
to be able to visit a traditional healer, even if the
purpose of the visit was solely for emotional support .
Other organizations such as Native Alcohol Centres and
local alcohol treatment facilities could refer Native
clients to a healer for counselling in alcohol and drug
abuse . As has been discussed in the literature review,
it has been argued by some researchers that traditional
Native psychotherapeutic treatment strategies are at
least as, if not more, effective than Western therapies
in treating alcohol and drug abuse among Natives .
Probably the most difficult Issue In proposing to
bring traditional healers Into the urban centre is
determining exactly what role the healers should play
In the health care of Native patients . In other words,
should the healers treat organic Illnesses or should
their domain be strictly spiritual and emotional
counselling (including treatment of supernaturally-
caused illnesses). If healers are treating organic
illnesses the difficulty arises in determing if they
should treat ..11. types of organic Illnesses or treat
only less serious organic illnesses .
Obviously, in arguing for healers in the urban
centre It would be irresponsible to reject the role of
Western medicine in the health care of Native patients .
It would be more appropriate to accept that both the
Western and traditional health care systems have their
own area of expertise : physicians are likely superior
in the treatment of many types of organic illnesses,
while healers are likely superior In the treatment of
supernaturally-caused illnesses and in some cases of
spiritual and emotional counselling . Thus a healer
would have to be willing to refer a patient to a
physician for treatment when the patient's illness was
out of the healer's domain of expertise ; however, the
healer could still play an Important role in the
173
174
patient's health care by providing emotional support,
particularly in cases of serious Illness, by helping to
"make sense" of the illness for the patient .
Healers could also play an important role in the
treatment of some chronic conditions which Western
medicine can do little for, such as arthritis and
rheumatism . This is especially so because these
conditions tend to afflict the elderly and elderly
Natives could gain great emotional support from a
traditional healer who represents a link to the
patient's culture . Indeed this could be the healer's
greatest role : namely, the link he/she represents to
Native culture because the healer is the embodiment of
Native culture .
It could be the case, however, that actual
treatment by a healer might be best suited to a
reserve . Perhaps patients could have contact with
healers within the urban setting for emotional and
spiritual counselling . Robb has suggested that pursuant
to s . 81 of the Indian Act bands have the power to pass
health by-laws . Thus, assuming these by-laws were not
disallowed by the Minister of Indian Affairs,
traditional Indian medicine clinics could be set up on
reserves . Further, notes Robb, such by-laws would allow
the clinic freedom In terms of not being bound by the
Medical Profession Act ; this act makes it an offense
for anyone but a registered physician to practice
175
medicine, which obviously could prove problematic for a
traditional healer . 436 Perhaps some type of "registry"
of traditional healers would have to be 5developed to
avoid the problem of charlatans . While a reserve could
"validate its own healer(s), an urban clinic may need
to have some type of formal validation that a
particular individual is recognized by at least one
Indian community as a healer . If actual healing took
place on reserves, urban clinics and physicians could
play a role by referring Native patients to a healer if
it was felt that a patient would benefit from treatment
by a healer .
6 .4 Recommendations
The following recommendations address not only the
role traditional medicine has to play in the health
care of Native patients, but also attempt to address
Native health care and health needs in Saskatoon and
across Canada .
1 . A traditional healer(s) should be made available
to provide counselling to Native patients and Native
clientele of health-related organizations either at a
health care facility, such as the Westside Clinic, or
at an Indian organization, such as the Indian-Metis
Friendship Centre . If only one healer could be made
available he/she should be of Plains Cree background as
176
the maJority of respondents in this study were Plains
Cree . Clearly, future examination into the legalities
of traditional medicine must take place . As has already
been discussed, the issue of whether traditional
healers could be sued and whether they should carry
liability insurance must be resolved .
2 . The Medical Services branch of Health and Welfare
Canada must begin to accept responsibility for the
health care of urban Natives . While Medical Services
has traditionally limited its role to the health care
of non-urban Natives, it must begin to expand this role
to include urban Natives who can "fall between the
cracks" in terms of the Western health care system
because their health care is no longer a federal
responsibility .
Traditionally, a healer receives only a ritual
payment, such as tobacco and a square of cloth from
his/her patients ; thus, a healer would not be able to
earn a living from the payments of patients . This is
where Medical Services could play a vital role by
providing some type of funding for an urban traditional
healer and could also more actively promote the
importance of traditional health care systems in its
publications . Medical Services could also provide funds
for the establishment and maintenance of a permanent
sweat lodge either within the city (eg . on the
riverbank, which would involve negotiations with the
177
Saskatoon Meewasin Valley Authority) or in a rural
setting close to the city (eg . the Moose Woods
reserve) . The healer would then be able to utilize the
sweat lodge in the treatment of his/her patients .
3 .- Links should be set up between the city's
hospitals (University, City and St . Pauls), the
Westside Community Clinic, the Saskatoon Tribal Council
and the Indian-Metis Friendship Centre to promote
Native health care . If a healer(s) were made available
in the city, these organizations and facilities would
have to work together to make the availability of
traditional health care services known to Native
patients .
4 . The present research found that some
communication problems exist between Native patients
and Western health care providers . The majority of
Native patients in the study (75 .7%) spoke a Native
language as well as English which could be a factor
contributing to these communication problems . As was
previously noted, a proposal for a Native medical
interpreters program was made a number of years ago by
the Saskatoon Joint Hospital Committee due to a
recognition by the committee of the special health care
needs of Native people in Saskatoon . Unfortunately
this proposal was not acted upon . The present research
again underscores the need for such a program .
178
Related to this is the need for cross-cultural
education for medical students in terms of the
traditional health care beliefs of Native patients .
Healers could come to play - an important .role in the
education of medical students and practicing physicians
by providing seminars in which traditional health care
belief and treatment modalities were discussed .
Clearly, the only way in which physicians will come to
respect traditional health care systems and realize all
they have to offer is through first-hand knowledge of
these systems . Increased cross-cultural training for
nurses employed by Medical Services is also needed .
Perhaps systematic study into the efficacy of
traditional medical treatments, perhaps initially in
terms of treatment of alcohol and drug abuse, is needed
in order to demonstrate their utility to Western health
care providers .
It is sincerely hoped that the present research
will act as a vehicle for further research into the
health status and health needs of urban Native
populations. More research is needed into the health
care utilization patterns of Native people in
Saskatoon . While the present research has identified
some socio-cultural and socio-economic barriers among
the Native population, further research is needed to
more fully examine the extent to which such barriers
are interfering with utilization of the Western health
care system by the Native population . It could be the
case that while the overall project examining the
Native utilization patterns of the Western health care
system at the Westside Community Clinic found a high
level of utilization, this was precisely because of the
nature of the clinic Itself . The "non-threatening" and
friendly atmosphere of the Westside clinic may be
responsible for this high level of utilization and thus
may make Saskatoon somewhat unique . Certainly, more
research is needed in urban centres across Canada, and
within Saskatchewan (such as in the cities of Prince
Albert and Regina) . Following_ the lead from this study,
assessments should also be made of the utilization of
traditional health care systems among urban Natives in
other centres and whether these populations also desire
access to these systems in the urban context .
The overall project examining utilization of the
Western health care system found little difference
between the utilization patterns of Natives and
non-Natives . Obviously non-Natives using the Westside
clinic were as economically disadvantaged as the Native
clientele ; thus, research is needed to examine the
utilization patterns of middle and upper-class
non-Natives and Natives in order to be able to make
some determination as to whether the utilization of the
Western health care system by poor urban Natives (i .e .
the Westside sample)is optimum or even adequate .
179
180
It must again be stressed that there are inherent
limitations in this study and the overall project
because of theuse of a non-random sampling technique .
Thus the findings speak for a specific population in a
specific geographic location within Saskatoon . The
extent to which these findings can be generalized to
Natives of a higher socio-economic status is not known,
nor is it known the extent to which these findings
represent other Canadian urban Native populations .
Nevertheless, this study represents probably the first
extensive examination of the role of traditional health
care systems among urban Canadian Native populations,
and the overall project examining utilization of the
Western health care system by urban Natives is also
unique . More such research is urgently needed ;
researchers have, to this point, largely ignored the
health issues of urban Native populations and without
concrete research findings little can be done in the
way of benefiting these populations . It is gratifying
that the Westside Community Clinic has recently been
provided with funding to hire a Native health worker to
act as a liason between the Native community and
medical and social organizations as well as to develop
programs for Native clientele at the clinic . This small
step is certainly a step in the right direction . It is
hoped that this study and future research can work for
the real benefit of Native peoples, and if this study
has contributed in even the smallest way to this end
then it has served its purpose .
181
Notes
1 . Chandrakant P . Shah and Carol Spindell Farkas,Canadian Indians : An Urban Health Challenge . Departmentof Preventive Medicine and Blostatistics, University ofToronto, 1985 : 1 .
2 . Carol Farkas and Chandrakant Shah, "PublicHealth Departments and Native Health Care in UrbanCentres," Canadian Journal of Public Health 77 (1986) :274
3 . Shah and Farkas (1985a) : 11 .
4 . Michael Fuchs and Rashid Bashshur, "Use ofTraditional Indian Medicine Among Urban NativeAmericans," Medical Care 13 (1975) : 915-917 .
5 . David Michael Gregory, "Nurses and HumanResources in Indian Communities : Nurses' Perceptions ofFactors Affecting Collaboration with Elders and Contactwith Traditional Healers on Indian Reserves," M .A .Thesis, University of Manitoba, 1986 :23 .
6 . James B . Waldram and Mellisa M . Layman, "HealthCare in Saskatoon's Inner City : Report of the WestsideClinic-Friendship Inn Health Care Research Project,"Department of Native Studies, University ofSaskatchewan, 1988 .
7 . See : Bronwen Mears, Karen Pals, K . Kuczerpa,Maureen Tallio and E . Alan Morinis, Illness andTreatment Strategies of Native Indians in DowntownVancouver : A Studv of the Skid Row Population . NationalHealth and Welfare Canada,- 1981 : 86-87 ;
MellisaLayman, "Native Health and the Present Health Status ofHealth Care in Saskatoon," Department of NativeStudies, University of Saskatchewan, 1986 ; 50-51 ; Shahand Farkas (1985a) : 6-8 .
8 . Gregory : 75 .
9 . Gregory : 23 .
10 . M . Peterson, "Native Healers Program," i0.Canadian Psychiatric Association Native Mental Health1982 : 26-27 ; M .W Kahn and John L . Delk, "Developing aCommunity Mental . Health Clinic on an IndianReservation," International Journal of SocialPsvchiatrv 19 (1973) : 299 ; 305 .
182
11 . Arthur Kleinman, "Concepts and a Model for theComparison of Medical Systems as Cultural Systems,Social Science and Medicine 12 (1978) : 86-87 .
12 . Irwin Press, "Problems in the Definition andClassification of Medical Systems," Social Science andMedicine 14B (1980) : 48 .
13 . Press : 48 .
14 . George Foster, "Disease Etiologies InNon-Western Medical Systems," American Anthropologist78 (1976) : 775 .
15 . Arthur Kleinman, "What Kind of Model for theAnthropology of Medical Systems," American,Anthropologist 80 (1978) : 664 .
16 . Edward F . Foulks, "Comment on Fosters DiseaseEtiologies in Non-Western Medical Systems," American,Anthropologist 80 (1978) : 661 .
17 . Peter Worsley, "Non-Western Medical Systems,Annual Reviews of Anthropoloay 11 (1982) : 315 .
18 . See : Herbert Rappaport and Margaret Rappaport,"The Integration of Scientific and Traditional Healing :A Proposed Model," American Psvcholoaist 36 .7 (1981) :774-781 ; Marilyn Mardiros, "Primary Health Care andCanada's Indigenous People," Canadian Nurse, Sept .1987 : 24 ; Ronald Frankenberg, "Medical Anthrology andDevelopment : A Theoretical Perspective," Social Scienceand Medicine 14B (1980) : 197 ; Kleinman (1978) : 86 .
19 . Kleinman (1978) : 86 .
20 . See : Rappaport : 774; Morgan Martin, "NativeAmerican Medicine : Thoughts for Post-TraditionalHealers," Journal of the American Medical Association245 .2 (1981) : 141 ;
David Gregory and Pat Stewart,"Nurses and Traditional Healers : Now Is the Time ToSpeak," Canadian Nurse Sept . 1987 : 26 ; Maridos : 24 ;Frankenberg: 197 .
21 . Martin (1981) : 774 .
22 . George M . Foster and Barbara GallatinAnderson . Medical Anthropology New York : John Wiley &Sons, 1978 : 101 .
23 . Kleinman (1978) : 86 .
183
24 . Arthur Kleinman, Patients and He-lers in theContext of Culture Berkeley : University of CaliforniaPress, 1980 : 105 .
29 . Fuchs amd Bashshur : 85 .
30 . Allan Young, "The Anthropologies of Illnessand Sickness," Annual Reviews of Anthroaoloav,11(1982) : 269-270 .
31 . Frankenberg : 197 .
32 . Vincente Navarro, "Social Class, PoliticalPower and the State and the Implications in Medicine,"Social Science and Medicine 10 (1976) : 448 .
33 . Hans A . Baer, Merrill Singer and John H .Johnsen, "Toward a Critical Medical Anthropology,"Social Science and Medicine 23 (1986) : 95 .
34 . Navarro : 449-449 .
35 . Kleinman (1978) : 85 .
36 . Baer et al . : 96 .
37 . Wesley R . Hurt, "The Urbanization of theYankton Indians," Human Organization, 20 .4 (1961-62) :226 ;231 ; John Price, "The Migration and Adaption ofAmerican Indians to Los Angeles," Human Organization, 27(1968) : 168 ; Harry W . Martin, "Correlates ofAdjustment Among American Indians in an UrbanEnvironment," Human Organization 23 .4 (1964) : 294 ;Joan Ablon, "Relocated American Indians in the SanFrancisco Bay Area : Social Interaction and IndianIdentity," Human Organization 23 .4 (1964) : 303 ; JoanAblon, "Cultural Conflicts in Urban Indians," MentalHvalene 55 .2 (1971) : 199-205 .
38 . Dol -ores Gold, "Psychological ChangesAssociated With Acculturation of Saskatchewan Indians,"The Journal of Social Psvcholoav ., 71 (1967) : 182 .
184
25 . Kleinman (1980) : 106-107 .
26 . Kleinman (1980) : 106 .
27 . Kleinman (1980) : 10.7-108 .
28 ., Kleinman (1978) : 85 .
185
39 . North Dakota State Department of Health, NorthDakota : Off-Reservation Indian Health Survey,, 1972 : 32 ;Bhopinder S. Bolaria, Health Care . Health and IllnessBehavior of American Indians in the State of Maine .Maine's Regional Medical Program, Research MonographSeries 2, 1971 : 138-140 . -
40 . Micheal Fuchs, "Health Care Patterns ofUrbanized Native Americans," Diss ., University ofMichigan, 1974 : 114 .
41 .-John Price, "The Urban Integration of CanadianNative People," Western Canadian Journal of,Anthropoloay, 4 .2 (1974) : 29-47 .
42 . James S . Frideres, Canada's Indians :Contemporary Conflicts . Scarborough : Prentice-Hall, .1974 : 87-98 .
43 . Mark Nagler, Indians in the City : A Study ofthe Urbanization of Indians in Toronto Ottawa : CanadianResearch Centre for Anthropology, 1970 : 5 .
44 . W .T . Stanbury, "The State of Indian Health : AStatistical Profile," in Success and Failure in UrbanSociety Vancouver : University of British Columbia,1975 : 130-154 .
45 . Stewart J . Clatworthy and Jonathon P . Gunn,Economic Circumstances of Native People in Selected,Metropolitan Centres In Western Canada . Winnipeg :Institute of Urban Studies, 1981 : 31 ; 77 .
46 . . Arthur K . Davis, "Toward Mainstream," in A_Northern Dilemma : Reference Papers Vol .II Bellingham,Washington : Western Washington State College, 1965-67 :519 .
47 . Edgar J . Dolman, Indians : The Urban DilemmaToronto : McClelland and Stewart Ltd ., 1972 : 157 .
48 . Hugh Brody, Indians on Skid Row Ottawa:Department of. Indian Affairs and Northern Development,1971 : 1 .
49 . Stewart J . Clatworthy and Jeremy Hull, NativeEconomic Conditions in Regina and Saskatoon Winnipeg :Institute of Urban Studies, 1983 : 97 .
50 . V . Matthews and D . Hart, "Native Health Careand the Saskatoon Hospitals," A Position Paper Preparedfor the Joint Saskatoon Hospital Planning Group, 1982 :12 .
51 . Mears et al . : 2 .
52 . City of Calgary, Social Services Department,Native Needs Assessment 1984 : 80 1 .
53 . Native Counselling Services of Alberta andNative Affairs Secretariat, DemographicsCharacteristics of Natives in Edmonton, 1985 : 19 .
54 . Shah and Farkas (1985a) : 1-13 ;* Chandrakant P .Shah and Carol Spindell Farkas, "The Health of Indiansin Canadian Cities : A Challenge to the Health CareSystem," Canadian Medical Association Journal 133(1985) : 859-863 .
55 . Farkas and Shah : 274-277 .
56 . Matthews and Hart : 13-15 .
57 . Layman : 38-56 .
58 . Task Force on Canadian Native Peoples' MentalHealth, "Mental Health : Recommendations Urge NativeInvolvement in Mental Health Imperative," NativePerspective 2 .8 (1978) : 34 .
59 . Department of National Health and Welfare, .Vital Statistics for the Recistered In-Ian Populationof Saskatchewan,, 1984 .
60 . Michael Ogden, Mozart I . Spector and CharlesA . Hill, "Suicides and Homicides Among Indians ." PublicHealth Reports 85 .1 (1970) : 75-78 ; Robert J .Havinghurst, "The Extent and Significance of SuicideAmong American Indians Today," Mental Hvaiene 55 .2(1971) : 174 .
61 . Helen M . Wallace, "The Health of AmericanIndian Children," American Journal of Disease inChildren 125, (1973) : 451 .
62 . Chris Brown, "The Epidemiology of AccidentsAmong the Navajo Indians, Public Health Reports 85(1970) :- 881 ; Stephen J . Kunitz, Disease Change and theRole of Medicine : The Nava.lo Experience, Berkeley :University of California Press, 1983 : 102 ; Sheldon I .Miller and Lawrence S . Schoenfeld, "Suicide AttemptPatterns Among the Navajo Indians," InternationalJournal of Social Psychiatry 17 (1971) : 189-191 .
186
187
63 . Donald D . Stull, "Victims of Modernization :Accident Rates and Papago Indian Adjustment," HumanOrganization 31 (1972) : 238-239 ; Robert A . Hackenbergand Mary M . Gallagher, "The Cost of Cultural Change :Accidental Injury and Modernization Among the PapagoIndians," Human Ora-nization 31 .2 (1972) : 213; 224 ;Rex D. Conrad and Martin W . Kahn, "An EpidemiologicalStudy of Suicide among Attempted Suicide Among thePapago Indians, American Journal of Psychiatry 131(1974) : 69-70 ; James H . Shore, John G . Bopp, Thelma R .Wailer and James B . Dawes, "A Suicide Prevention Centeron an Indian Reservation," American Journal ofPsychiatry 128 .9 (1972) : 76 .
64 . Larry H . Dlzmang, Jane Watson, Philip A . May,and John Bopp, "Adolescent Suicide At An IndianReservation," American Journal of Orthonsvchlatrv 44(1974) : 43-46 ; Shore et al . (1972) : 78-79 ; James H .Shore, "American Indian Suicide : Fact and Fantasy,"Psychiatry 38 (1975) : 87 ; James H . Shore, "Suicide andSuicides Attempts Among American Indians of the PacificNorthwest," International Journal of Social Psychiatry18 (1972) : 96 ; Laurence French and Jim Hornbuckle,"Indian Stress and Violence : A Psycho-CulturalPerspective," Journal of Alcohol and Drua Education 25(1979) : 37 . ; A. Pambrum, "Suicide Among the BlackfeetIndians ." Bulletin of Suicidoloav 7 (1970) : 42-44 ;Joseph Westermeyer, "Violent Death and Alcohol UseAmong the Chippewa in Minnesota ." Minnesota Medicine 55(1972) : 749; Everett R . Rhoades, Melody Marshall,Carolyn Attneave, Marlene Echohawk, John Bjorck andMorton Beiser, "Impact of Mental Disorders Upon ElderlyAmerican Indians As Reflected in Visits to AmbulatoryCare Facilities," Journal of the American GeriatricsSociety 28 .1 (1980a) : 37 .
65 . Andrew J . Siggner, An Overview of Demographic ..Social and Economic Conditions Amona Canada's,Registered Indian Population Department of IndianAffairs and Northern Development (Inuit AffairsProgram) Ottawa : DIAND,-1979 : 22-26 .
66 . Department of Indian Affairs and NorthernDevelopment, Indian Conditions . DIAND : Ottawa, 1980 :15-20 .
67 . N . Schmitt, L .W . Hole and W .S . Barclay,"Accidental Deaths Among British Columbia Indians, :Canadian Medical Association Journal, 94 (1966) :228-234 .
68 . T . Gregory Hislop, William J . Threlfall,Richard P . Gallanger and Pierre R . Band, "Accidentaland Intentional Violent Deaths Among British ColumbiaNative Indians ." Canadian Journal of Pu •l ic Health 78(1987) : 271 .
69 : Grand Council Treaty No . 3, While PeopleSleep: Sudden Deaths in the Kenora Area, 1973 : 1-32 .
70 . T . Kue Young, "Mortality Patterns of IsolatedIndians in Northwestern Ontario : A 10-Year Review,"Public Health Reports 98 .5 (1983) : 467-475 .
71 . J .A . Ward and J . Fox, "A Suicide Epidemic onan Indian Reserve," Canadian Psychiatric AssociationJournal,22 (1977) : 425 .
72 . Prince Albert-Daily Herald . "Suicide AmongNative Teens," 16 August 1987, 14 .
73 . George K .Jarvis and Menno Boldt, "Death StylesAmong Canada's Indians," Social Science and Medicine 16(1982) : 1347 .
74 . Jarvis and Boldt : 1347-1349 .
75 . Rae Corelli, "A Canadian Tragedy," Maclean's99 .28 (1986) : 12 .
76 . Yang Mao, Howard Morrison, Robert Semenciw andDonald Wigle, "Mortality on Canadian Indian Reserves,1977-1982," Canadian Journal of Public Health 77(1986) : 269 .
77 . H .I . Morrison, R .M . Semenciw, Y . Mao, and D .T .Wigle, "Infant Mortality on Canadian Indian Reserves,1976-1983," Canadian Journal of Public Health 77(1986) : 269-273 .
78 . Susan E . Evers and Charles G . Rand, "Morbidityin Canadian Indian Children in the First Year of Life,"Canadian Medical Association Journal ., 126 (1982) : 250 .
79 . Susan E . Evers, and Charles G . Rand,"Morbidity in Canadian Indian and Non-Indian Childrenin the Second Year," Cana-Ian Journal of Public Health .74 (1983) : 192 .
80 . Department of National Health and Welfare,Vital Statistics for the Registered Indian Populationof Saskatchewan, 1972-1984 ; Saskatchewan Department ofPublic Health, Vital Statistics, 1972-1984 .
188
189
81 . Saskatchewan Department of Public Health,Vital Statistics, 1960-1969 ; Department of NationalHealth and Welfare, Vital Statistics for the RegisteredIndian Population of Saskatchewan, 1972-1984..
82 . St . Paul's Hospital, "Saskatoon Native IndianMorbidity and Mortality," 1985 :4 .
83 . Saskatchewan Department of Public Health,Vital Statistics, 1972-1984 ; Department of NationalHealth and Welfare, Vit-l Statistics for the RegisteredIndian Population of Saskatchewan . 1978-1984
84 . Saskatchewan Alcohol and Drug AbuseCommission, "Suicide : The Alcohol and Drug Connection :Natives in Saskatchewan, 1985-86," 1988 .
85 . Federation of Saskatchewan Indian Nations,"Suicides, Violent and Accidental Death Among TreatyIndians in Saskatchewan." FSIN, 1986 : 100-103 .
86 . Saskatoon Star Phoenix, "Native Suicide RateLinked to White Society," 9 July 1987 : B11 .
87 . James 0 . Whittaker, "Alcohol and the StandingRock Sioux Tribe," Part II Quarterly Journal of tudieson Alcoholism 24 (1964) : 80, 89 ; Richard T .Curley,"Drinking Patterns of the Mescalero Apache," Quarterly,Journal of Studies on Alcoholism 28 (1967) : 129-130 ;Robert E . Kuttner, and Albert B . Lorincz, "Alcoholismand Addiction in Urbanized Sioux Indians," MentalHygiene 4 (1967) : 531, 540 ; James A . Kline and ArthurC . Roberts, "A Residential Alcoholism Treatment Programfor American Indians," Quarterly Journal of Studies ofAlcoholism 34 (1973) : 860
Thomas M . Brod, "Alcoholismas a Mental Health Problem of Native Americans,"Archives of General Psychiatry 32 (1975) : 1390 ; EdwardP . Dozier, "Problem Drinking Among American Indians,"Quarterly Journal of Studies on Alcoholism 27 (1966) :85 .
88 . Edwin M . Lemert, "The Use of Alcohol in ThreeSalish Indian Tribes," Quarterly Journal of Studies onAlcohol 19 (1958) : 90 ; 10 ; L. Jilek-Aall,"Psychosocial Aspects of Drinking Among Coast SalishIndians," Canadian Psychiatric Association Journal 19 .4(1974) : 357-361 ; Ronald M . Wintrob and Sharon Diamen,"The Impact of Culture Change on Mistassini CreeYouth," Canadian Psychiatric Association Journ-1 19(1974) : 336-340 .
190
89 . J .L . Strimbu et al . cited in : Duane C . McBrideand J . Bryan Page, "Adolescent Indian Substance Abuse :Ecological and Sociocultural Factors," Youth andSociety 11 .4 (1980) : 480 ; D .D . Chitwood et al . citedin : McBride and Page : 480 ; Fred Streit and Mark J .Nicolich, "Myths Versus Data on American Indian DrugAbuse," Journal of Drua Education 7 .2 (1977) : 117-120 .
90 . McBride and Page : 480 ; Frances NorthendFerguson, "Navaho Drinking : Some Tentative Hypotheses,"Human Oraanization 27 .2 (1968) : 159,167 ; Bernard J .Albaugh and Patricia Albaugh, "Alcoholism and SubstanceSniffing Among the Cheyenne and Arapaho Indians ofOklahoma," International Journal of the Addicitions14 .7 (1979) : 1002-1003 ; Michael R. Phillips and ThomasS . Inui, "The Interaction of Mental Illness, CriminalBehavior and Culture : Native Alaskan Mentally IIICriminal Offenders," Culture . Medicine and Psychiatry10 (1986) : 123 ; 131 .
91 . Federation of Saskatchewan Indian Nations,"Alcohol and Drug Abuse Among Treaty Indians inSaskatchewan," FSIN, 1984 : 62-63 ; 75 .
92 . Gerald Littman, "Alcoholism, Illness andSocial Pathology Among American Indians In Transition,American Journal of Public Health 60 (1970) : 1772 ;1784 .
93 . Joseph Westermeyer, "Chippewa and MajorityAlcoholism in the Twin Cities : A Comparison," Journalof Nervous and Mental Disease 155 .5 (1972) : 322-327 .
94 . Thomas W . Hill, "Lifestyles and DrinkingPatterns of Urban Indians, Journal of Drua Issues 10 .2(1980) : 257 ; 267 .
95 . Schmitt et al : 223 .
96 . Standing Committee on Indian Affairs andNorthern Development, "Indian Mortality," No .2, 1969 :2 .
97 . Grand Council Treaty Number 3 : 7-8 .
98 . Jarvis and Boldt : 1349
99 . C . Adrian Heindenreich, "Alcohol and Drug Useand Abuse Among Indian-American : A Review of Issues andSources, Journal of Drua Issues 6 .3 (1976) : 261 .
100 . Booz-Allen & Hamilton Canada Ltd . Departmentof National Health and Welfare, Study of HealthServices for Canadian Indian, 1969 : 46 .
191
101 . Connie Kirchner, "Registration for HealthCare in City Clinics," HumanOrbanization 27 .3 (1968) :250 ;259 .
102 . Fuchs : 88 ; 114 .
103 . Nancy Brown Miller, "Social Work Services toUrban Indians, in James W . Green, ed . CulturalAwareness in the Human Services Englewood Cliffs, N .J . :Prentice-Hall Inc ., 1982 : 174-175 .
104 . Saskatoon Hospital Planning Group : 13-14 .
105 . E . Nemetz cited in : Shah and Farkas(1985a) : 6 .
106 . Shah and Farkas : 9 .
107 . Donald McCaskill, "The Urbanization ofCanadian Indians in Winnipeg, Toronto, Edmonton andVancouver : A Comparative Analysis," Diss ., YorkUniversity, 1979 : 114 .
108 . City of Calgary, Native Needs Assessment,Social Services Department, 1984 : 80 .
109 . Native Counselling. Services of Alberta andNative Affairs Secretariat, Demographic Characteristicsof Natives in Edmonton, 1985 : 19 .
110 . Waldram and Layman : 48 ; 65-68 .
111 . G . Graham-Cumming, "Pre-Natal Care and InfantMortality Among Canadian Indians," Canadian Nurse 63(1967) : 30 .
112 . Gerald Littman, "Alcoholism, Illness andSocial Pathology Among American Indians in Transition,"American Journal of Public Health 60 (1970) : 1773 .
113 . City of Calgary : 102 .
114 . Eleanor Glor, "Impacts of a Prenatal Programfor Native Women ." Canadian Journal of Public Health 78(1987) : 249 .
115 . Layman : 39 .
116 . F .C . Redlich, A .B . Hollingshead and ElizabethBellis, "Social Class and Attitudes Toward Psychiatry,"American Journal of Orthopsvchlatrv 25 (1955) : 60 ;Norman Q . Brill and Hugh A . Storrow, "Social Class andPsychiatric Treatment," Archives of General Psychiatry .3 (1960) : 343 .
117 . Joe Yamamoto, Ouinton C . James and NormanPalley, "Cultural Problems in Psychiatric Therapy,"Archives of General Psvchiatrv 19 (1968) : 49; A . Vail,"Factors Influencing Lower-Class Black Patients'Remaining in Treatment," Journal of Consultina andClinical Psvcholoav 46 (1978) : 341 ; S .W . Vernon andR .E . Roberts, "Prevalence of Treated and UntreatedPsychiatric Disorders in Three Ethnic Groups," SocialScience and Medicine 16 (1982) : 1575; S.J . William,"Mental Health Services : Utilization By Low IncomeEnrollees in a Prepared Group Practice Plan," MedicalCare 17 (1979) : 139; Stanley Sue, "Community MentalHealth Services to Minority Groups : Some Optimism, SomePessimism," American Psvcholoaist, 32 (1977) : 616 .
118 . E .R . Barter and J . Barter, "Urban Indians andMental Health Problems," Psychiatric Annals 4 (1974) :42 .
119 . Stanley Sue, David B . Allen and LindaConaway, "The Responsiveness and Equality of MentalHealth Care to Chicanos and Native Americans," AmericanJournal of Community Psvcholoav,6 .2 (1978) : 137-146 .
120 . Patrick Borunda and James H . Shore,"Neglected Minority : Urban Indians and Mental Health,"International Journal of Social Psvchiatrv, 24 (1978) :222 .
121 . I-Hsin Wu and Charles Windle, "EthnicSpecificity in The Relative Minority Use and Staffingof Community Mental Health Centres, Community MentalHealth Journal 16 .2 (1980) : 156-159 .
122 . Rhoades et al . (1980b) : 332 .
123 . Hugh C .Hendrie and Diane Hanson, "AComparative Study of the Psychiatric Care of Indian andMetis," American Journal of Orthopsvshiatrv, . 42 (1972) :489 .
124 . Wayne,Fritz and Carl D'Arcy, "Comparisons :Indian and non-Indian Use of Psychiatric Services," 1nPeter S . Li and B . Singh Bolarla (eds .) RacialMinorities in Multicultural Canada Toronto : GaramondPress, 1983 : 63 ; 83 .
125 . Charles Kadushin, "Social Distance BetweenClient and Professional," American Journal of Socioloav67 (1961-62) : 517 .
126 . Shah and Farkas (1985a) : 7; Mary B . Black,"Ojibwa Ouestionning Etiquette and Use of Ambiguity,"Studies in Linauistics . 23 (1973) : 13 .
192
193
134 . Byron Good and Mary-Jo Delvecchio Good, "TheMeaning of Symptoms : A Cultural Hermeneutic Model forClinical Practice," in L. Eisenberg and A . Kleinman(eds .) The Relevance of Social Science for MedicineDortecht : D . Reidel Publishing Co ., 1980 : 175 .
135 . McBride and Page : 489 ; Lawrence S .Schoenfeld, R . Jeannine Lyerly and Sheldon I . Miller,"We Like Us : The Attitudes of the Mental Health StaffToward Other Agencies on the Navajo Reservation,"Mental Hvaiene 55 .2 (1971) : 171-173 .
136 . Thomas E . Bittker, "Dilemmas of Mental HealthService Delivery to Off-Reservation Indians,"
141 . E .J . Carlson, "Counselling in NativeContext," Canada's Mental Health 23 .1 (1975) : 8 .
142 . E .R . Barter and J . Barter, "Urban Indians andMental Health Problems," Psychiatric Annals 4 (1974) :42 .
143 . Task Force on Native Peoples' Mental Health(1978) : 34-35 .
144 . Ibid .
.145 . Task Force Committee on the Mental HealthServices in Saskatchewan, "A Report on 'The ForgottenConstituents' To the Mental Health Association inSaskatchewan", 1983 : 122 .
Anthroaoloaical Quarterly . 46 (1973) : 180 .
137 . Shah and Farkas (1985a) : 5 .
138 . Shah and Farkas (1985b) : 860 .
139 . Farkas and Shah : 275 .
140 . Shah and Farkas (1985a) : 5 .
127 . Shah and Farkas (1985a) : 7 .
128 . Mears et al . : 78 ; 86-87
129 . Farkas and Shah :274-276 .
130 . Layman : 57-58 .
131 . Matthews and Hart : 14 .
132 . St . Paula Hospital : 1-2 .
133 . Kleinman (1980) : 106-107 .
146 . Jilek-Aall : 354-356 .
147 . Eduardo Duran, Archetypal Consultation : AService Delivery Model for Native Americans New York :Peter Lang, 1984 : 130-131 .
148 . John A . Grim, The Shaman : Patterns ofSiberian and O.iibwav Healinq Norman : University ofOklahoma Press, 1983 : 15 .
149 . Joan Halifax, The Wounded Healer New York :Cross Road Publishing Co ., 1982 : 5 .
150 . Frederick Johnson, "Notes on MicmacShamanism," Primitive Man 16 (1943) : 55 .
151 . William Z Park, Shamanism in Western NorthAmerica Evanston : Norwestern University Studies in theSocial Sciences No . 2, 1938 : 109 .
152 . Grim : 172 .
153 . Halifax : 16 .
154 . Ruth Fulton Benedict, "The Vision Quest inPlains Culture," American Anthroooloaist 24 .1 (1922) :10-11 .
155 . David Mandelbaum, The Plains Cree Regina :Canadian Plains Research Centre, 1979 : 159-162 .
156 . Robert Lowie, The Assiniboine AnthropologicalPapers of the American Museum of National History 4,Part 1, 1909 : 47 .
157 . Lowie : 47 .
158 . A .H . Gayton, "Yokuts-Mono Chiefs andShamans," University of California Publications in,American Archaeloav and Ethnoloav 24 (1930) : 389 .
159 . Benedict : 10-11 .
160 . Ibid .
161 . William Thomas Corlett, The Medicine-Man ofthe American Indian and Cultural Background .Springfield, Ill . : Charles C . Thomas, 1935 : 120 .
162 . Corlett : 87-88 ; 91 ; 142 .
194
195
163 . David E . Jones, Sanaaia : Comanche MedicineWoman Prospect Point (Ill .) Waveland Press, Inc ., 1972 :27-28 ; Corlett : 142; William Morgan, "Navaho Treatmentof Sickness : Diagnosticians," American Anthropologist33 (1931) : 390 .
164 . Don Taylor, "A Survey of Shamanistic and .Other Traditional Curing Roles," NA'F-,12 12 (1982) : 20 .
165 . Laurie Lacey, Micmac Indian Medicine : ATraditional Wav of Health Antigonish, N .S . : FormacLimited, 1977 : 17 ; Elizabeth Macdonald, "IndianMedicine in New Brunswick," Canadian MedicalAssociation Journal 80 .3 (1959) : 221 ; Park : 88 .
166 . Mandelbaum : 160-162 .
167 . Park : 88 ; Corlett : 67-68 .
168 . Robert Ritzenthaler, "Primitive TherapeuticPractices Among the Wisconsin Chippewa in Iago Galdston(ed .) Man's Imaae in Medicine and Anthropoloav NewYork : International Universities Press Inc ., 1963 :321-322 .
169 . Morgan : 390 ;- Kunitz : 130 .
170 . Lacey : 11 ; Johnson (1943) : 57 .
171 . Lowie : 42-43 .
172 . Benedict : 10-11 .
173 . Park : 100 .
174 . Dara Culhane- Speck, An Error in Judgement :,The Politics of Medical Care in an Indian/WhiteCommunity Vancouver : Tal - onbooks, 1987 : 69-70 .
175 . Grim : 65 ; 105 ; 111-112 ; 140-150 .
176 . John Lame Deer and Richard Erdoes, Lame Deer :Seeker of Visions New York : Simon and Schuster, 1972 :163-165 ; Luis S . Kemnitzer, "Structure, Content, andCultural Meaning of Yuwipi : A Modern Lakota HealingRitual," American Ethnologist 3 .2 (1976) : 265 .
177 . Mandelbaum : 162 .
178 . Virgil J . Vogel, American Indian MedicineNorman : University of Oklahoma Press, 1970 : 27-28 ;Jones : 48-64 ; Ritzenhaler : 328-332 .
179 . Corlett : 98-99 .
180 . Mandelbaum : 165 ; 170-171 .
181 . Corlett : 95 .
182 . Park : 134 .
183 . Ake Hultkrantz, "Ecological andPhenomenological Aspects of Shamanism," in V . Dioszegiand M . Hoppal, (eds .) Shamanism in Siberia Budapest :Akademlai Kiado, 1978 : 101 .
184 . Mandelbaum : 162 .
185 . Ibid .
186 . Corlett : 92 ; Hultkrantz : 100 .
187 . Hultkrantz : 100 .
188 . Johnson ( 1943) : 69 .
189 . Lowle : 163 .
190 . E . Ackerknecht, "Natural Disease and RationalTreatment in Primitive Medicine," Bulletin of theHistory of Medicine 19 (1.946) : 481 .
191 . W .R . Holland and R . Tharp, "Highland MayaPsychotherapy," American Anthroaoloaist 66 (1964) : 41 .
192 . K .M . Calestro, "Psychotherapy, Faith Healingand Suggestion," International Journal of Psychiatry 1,0(1972) : 83 .
193 . J . Frank, "The Medical Power of Faith," HumanNature 1 (1979) : 45-46 .
194 . J . McCreery, "Potential and Effective Meaningin Therapeutic Ritual," Culture . Medicine andPsvchiatrv 3 (1979) : 69 .
195 . 0 . Pfister, "Instinctive PsychoanalysisAmong the Navahos," Journal of Nervous and MentalDisease 76 (1932) : 234 .
196 . A . Leighton and D . Leighton, "Elements ofPsychotherapy in Navaho Religion," Psychiatry 4 (1941) :521 .
197 . D . Sandner, " Navaho Medicine," Human Nature 1(1979) : 60-61 .
196
198 . George Devereux, MohaveEthnopsvchlatrv :ThepsychicDisturbances of an Indian Tribe Washington :Smithsonian Institution, 1969 : 485 .
199 . Jane Monning Atkinson, "The Effectiveness ofShamans in an Indonesian Ritual," AmericanAnthropolosaist 89 .2 (1987) : 353 .
200 . Ake Hultkrantz, "Spirit Lodge, A NorthAmerican Shamanistic Seance," 1.1#. Christopher Vecsey(ed .) Belief and Worship in Native North AmericaSyracuse : Syracuse University Press, 1981 : 75 .
201 . R . Bell, "The 'Medicine Man' or Indian andEskimo Notions of Medicine," Can-da Medical andSurgical Journal 14 (1886) : 460 .
202 . Hultkrantz (1981) : 84-89 .
203 . Ibid .
204 . Christopher Vecsey, Traditional 0.iibwaReligion, Philadelphia : The American PhilosophicalSociety, 1983 : 103 .
211 . Forrest E . Clements, "Primitive Concepts ofDisease," University of California Publications inAmerican Archaeology and Ethnology 32 .2 (1932) :219-224 .
212 . George Murdock, Theories of Illness : A WorldSurvey Pittsburgh : University of Pittsburgh Press,1980 : 20
213 . Paul Fejos, "Magic, Witchcraft and MedicalTheory," in Iago Galdstone (ed .) Man's Imave inMedicine and Anthropologv New York : InternationalUniversities Press, 1963 : 52 .
197
214 . Hugh Dempsey, Indian Tribes of AlbertaCalgary : Glenbow Museum, 1979 : 59 .
282 . R . Landes, "The Abnormal Among the OjibwaIndians," Journal of Abnormal and Social Psychiatry 33(1938) : 25 .
215 . John L . Honigmann, Personality in Culture NewYork : Harper & Row, 1967: 184; James G .E . Smith citedin : Lou Marano, "Windigo Psychosis : The Anatomy of anEmic-Etic Confusion ." Current Anthrovoloov 23 .4 (1982) :393 ; David H . Turner, "Windigo Mythology and theAnalysis of Cree Social Structure," Anthropolooica,19(1977) : 73 .
216 . Cornelia Schuh, "Jubilee on the NorthernFrontier : Early Murder Trials of Native Accused,"Criminal Law Quarterly 22 .1 1979 : 76-81 .
217 . Robin Ridington, "Wechuge and Windigo : AComparison of Cannibal Belief Among Boreal ForestAthapaskans and Algonkians," Athropoloaica 18 .2 (1976) :108-114 .
218 . George H . Fathauer, "The Mohave 'GhostDoctor'," American Anthropoloaist,53 (1951) : 605 .
219 . M .E . Opler, "Some Points of Comparison andContrast Between Treatment of Functional Disorders byApache Shamans and Modern Psychiatric Practice," IbgAmerican Journal of Psychiatry 92 (1936) : 1386 .
220 . Jones : 68-71 .
221 . James Mooney and Frans M . Olbrechts, TheSwimmer Manuscript : Cherokee Sacred Formulas andMedicinal Prescriptions Smithsonian Institution Bureauof American Ethnology Bulletin 99, 1932 : 24-28 ; 48 .
222 . Karl W . Luckert, Covotewav : A Navajo HolvwavHealina Ceremonial Tuscon : University of Arizona Press,1979 : 8-9 .
223 . Mandelbaum : 158 .
224 . Wolfgang G . Jilek, Indian Healinq Surrey :Hancock House Publishers Ltd ., 1982 : 40-42 .
225 . H .K . Haeberlin, "sbEtEtda'a, a ShamanisticPerformance of the Coast Salish," AmericanAnthropologist 20 (1918) : 249-250 .
226 . Jilek (1985) : 42-47 .
198
227 . Jilek (1985) : 59-105 .
228 . Park : 86 .
229 . Johnson (1943) : 72 .
230 . T . Kue Young, "Sweat Baths and the Indians,"Canadian Medical Association Journal 119 .5 (1978) :406-407 ; Fejos : 53 .
231 . Macdonald : 220-221 .
232 . Vecsey : 150-151 .
233 . Vogel : 19 ; Fejos : 89 .
234 . Murdock : 19 .
235 . Clements : 190 .
236 . Arthur J . Rubel and Harriet J . Kupferer ."Perspectives on the Atomistic-Type Society :Introduction," Human Organization 27 .3 (1968) : 189-190 .
237 . Clements : 231 .
238 . Clements : 193-195 ; 228 .
239 . Park : 41 .
240 . Vecsey : 146 .
241 . R .A . Hahn, "Aboriginal American PsychiatricTheories," Transcultural Psychiatric Research 15(1978) : 44 .
242 . Clements : 233-234 .
243 . A . Irving Hallowell, "Psychic Stresses andCulture Patterns," American Journal of Psychiatry 92(1936) : 1302 .
244 . Clements : 232-233 .
245 . Elmendorf : 108 .
246 . Vogel : 19-20 .
247 . Balikci : 392 .
248 . Corlett : 84 .
249 . Clements : 233-234 .
199
250 . Kunitz : 123 .
251 . Clements : 232-233 .
252 . Hultkrantz : 89 .
253 . Marilyn E . Johnson, "My Apprenticeship with aModern OJibwa Shaman : A Personal and ComparativeAnalysis of Shamanic Flight," M .A . Thesis, YorkUniversity, 1983 : 54-69 ; 117 .
254 . Corlett : 130 .
255 . Corlett : 93 .
256 . Murdock : 21 ; Jones : 68 ; 92-95 .
257 . Clements : 193-195 .
258 . Vecsey : 146 .
259 . Corlett : 84 .
260 . Clyde Kluckhohn, Navaho Witchcraft Cambridge,Mass . : Papers of the Peabody Museum of AmericanArchaeology and Ethnology, Harvard University Vol . 22No . 2, 1944 : 20 ; Vogel : 16 .
261 . Corlett : 116 .
262 . Clements : 212 .
263 . Hultkrantz : 90 .
264 . Murdock : 65-67 .
265 . Kluckhohn : 15 .
266 . S .A . Barrett, "Porno Bear Doctors," Universityof California Publications in American Archaeology andEthnology 12 .11 (1965) : 443 ; 452-454 .
267 . Ibid .
268 . Lame Deer and Erdoes : 164 .
269 . Vecsey : 148 .
270 . Mooney and Olbrechts : 29-30 .
271 . Barbeau : 66 .
272 . Jones : 68 ; 92-95 .
273 . Mandelbaum : .163 .
200
274 . Mandelbaum : 163-165 .
275 . Mandelbaum : 164 .
276 . Kluckhohn : 18 .
277 . Johnson (1943) : 73 .
278 . Vecsey : 147-148 .
279 . Dorothy Kennedy, "The Quest For a Cure : ACase Study in the Use of Health Care Alternatives,"Culture 4 .2 (1984) : 22 .
280 . Vogel : 16 ; Clements : 193-195 ; 213 .
281 . Hultkrantz : 88-89 .
282 . Vogel : 17 ; Jones : 49 .
283 . George E . Darby, "Indian Medicine in BritishColumbia," Canadian Medical Association Journal 28 .4(1933) : 437 .
284 . Vecsey : 152 .
285 . Mandelbaum : 163 .
286 . Ritzenhaler: 325-326 .
287 . Jones : 96 .
288 . Corlett : 144 .
289 . F . Andros, "The Medicine and Surgery of theWinnebago and Dakota Indians," Journal of the AmericanMedical Association,1 .4 (1883) : 118 .
290 . Clements : 216 .
291 . Mandelbaum : 169 .
292 . Kluckhohn : 28-29 .
293 . James H . Howard, Oklahoma Seminoles :,Medcines . Manic and Religion Norman : University ofOklahoma Press, 1984 : 101 .
294 . Barbeau : 66 .
295 . Clements : 204-205 .
201
202
296 . John Adair, "Physicians, Medicine Men andTheir Navaho Patients," in Iago Galdston (ed .) Man'sImaae in Me •i cine and Anthropoloav New York :International Universities Press Inc ., 1963 : 248 .
297 . Clements : 205 .
298 . Wallis and Wallis : 431-435 .
299 . Mandelbaum : 161 .
300 . Corlett : 145-146 ; Park : 37 ;- Jones : 32-34 ;Balikci : 392 .
301 . Irving Hallowell, "Ojibwa World View andDisease," j Iago Galdston (ed .) Man's Image inMedicine and Anthropology New York : InternationalUniversities Press, 1963 : 292-293 ; Vecsey : 123 .
302 . Ruth S . Wallis and Wilson D . Wallis, "TheSins of the Fathers : Concept of Disease Among theCanadian Dakota," Southwestern Journal of Anthropoloav9.4 (1953) :- 431-435 .
303 . Vecsey : 149 .
304 . Gladys Tantaquidgeon, . A Study of Delaware,Medicine Practice and Folk Beliefs Harrisburg :Pennsylvania Historical Commission, 1942 : 13-14 ;
C .A .Westlager, Magic Medicines of The Indians Somerset,N .J . : The Middle Atlantic Press, 1973 : 40-42 ; 56; RuthUnderhill, Papaao Indian Religion New York : Ams PressInc ., 1969 : 284-285 ; Corlett : 115; Adair : 243-244 ;Kunitz : 128 .
305 . Franz Boas, Tsimshian Mvtholoav Thirty-firstAnnual Report of the U .S . Bureau of Ethnology to theSecretary of the Smithsonian Institution, 1916 :462-463 ; Frederick W . Turner, The Portable NorthAmerican Indian Re-der Kingsport : Viking Press, 1973 :172 ; Vecsey :-109 .
306 . Mandelbaum : 145-146 .
307 . Mandelbaum : 161 .
308 . Vecsey : 153 ; Balikci : 394 .
309 . W . La Barre, "Primitive Psychotherapy inNative American Cultures : Peyotism and Confession ."Journal of Abnormal and Social Psvcholoav 42 (1947) :302 ; 307 .
310 . Clements : 205 .
311 . Wallis and Wallis : 432 .
312 . Hallowell (1936) : 1299-1301 .
313 . Joseph F . Dion, My Tribe . The Crees Calgary :Glenbow Museum, 1979 : 56 .
321 . Rudolph C .Troike, "The Origins of PlainsMescalism," American Anthropologist 64 (1962) : 960 .
322 . La Barre : 294 .
323 . Vecsey : 196 .
324 . Kunitz : 121 .
325 . Edward F . Anderson, Peyote : The Divine CactusTucson : The University of Arizona Press, 1980 : 91 .
326 . Anderson : 91 .
327 . Anderson : 93 .
328 . David F . Aberle, The Peyote Reltalon Amonathe Navaho New York : Viking Fund Publication inAnthropology 42, 1966 : 125 ; 137 .
329 . Jones : 62-63 .
330 . Robert L . Bee, "Potawatomi Peyptism : TheInfluence of Traditional Patterns," SouthwesternJournal of Anthroploav 22 (1976) : 194 .
331 . La Barre : 297 .
332 . Ibid .
333 . Bittker : 172 .
203
314 . Hallowell (1936) : 1299-1301 .
315 . La Barre : 305 .
316 . Ibid .
317 . La Barre : 304-306 .
318 . Wallis and Wallis 432 .
319 . La Barre : 294 .
320 . Ibid .
204
334 . James H . Shore and Billee Von Fumetti, "ThreeAlcohol Programs for American Indians," American,Journal of Psvchiatrv 128.11 (1972) : 138
335 . B .J . Albaugh and P .O . Anderson., "Peyote inthe Treatment of Alcoholism Among American Indians,"American Journal of Psychiatry 134 (1974) : 1249 .
336 . R .L . Bergman "NavaJo Peyote Use : ItsApparent Safety,"' American Journal of Psychiatry 128 .6(1971) : 698 .
337 . Chunilal' Roy;, "Indian Peyotists and Alcohol,"American Journal' of Psvchiatry,130 (1973) : 330 .
338 . Anthony F .C . Wallace, "Cultural Determinantsof Response to Hallucinatory Experience,," Archives ofGeneral Psychiatry 6 (1959) : 63 ..
339 . Bergman (1,971) : 697-698 .
340 . Paul Pascarosa and Sanford Futterman,"Ethno-psychodeiic - Therapy for Alcoholics : Observationsof the Peyote Ritual of the Native- American. Church,"
Saskatoon Star Phoenix Sunday Accent,, "Sweat LodgeCeremony Indian's- Link With God," 16 : April 1988 : 5-6 .
354 . John F . Taylor, "Sociocultural Effects ofEpidemics on the Northern Plains," Western CanadianJournal of Anthropoloav," 7 .4 (1977) : 58 .
355 . Mandelbaum : 145 ; 153 ; 211 ; 234-235 .
356 . Mandelbaum : 185 .
357 . Mandelbaum : 223 .
358 . Koozma Tarasoff, Persistent Ceremonialism :The Plains Cree and Saulteaux,National Museum of ManMercury Series . Canadian Ethnology Service Paper No .69, 1980 : 16 .
359 . Mandelbaum : 312 .
360 . E .J . Ragan, "The Role of TraditionalMedicine," in Selected Readings in Support of Indianand Inuit Health Consultation Vol .I . National Healthand Welfare, Medical Services Branch, 1980 : 40 .
361 . Ibid .
362 . Ragan : 43 .
363 . Kleinman (1985) : 1-7 .
364 . Press : 215 .
365 . Judith L . Ladinsky, Nancy D . Volk andMargaret Robinson, "The Influence of TraditionalMedicine in Shaping Medical Care Practices in VietnamToday," Social Scienceand Medicine 25 .10 (1987) :1108-1109 .
366 . Rappaport and Rappaport : 774 .
367 . Pedro Ruiz and John Langrod, "Psychiatristsand Spiritual Healers : Partners in Community MentalHealth," ja Joseph Westermeyer (ed .) Anthropoloav andMental Health (The Hague, Paris : Mouton Publishers,1976) : 77-80 .
368 . Peter Kong-ming New and Walter Watson,"Pathways to Health Care Among Chinese-Canadians : AnExploration," in Peter S . Li and B . Singh Bolaria(eds .) Racial Minorities in Multicultural CanadaToronto : Garamond Press, 1983 : 58 .
369 . Fuchs : 82-84 .
370 . Fuchs and Bashshur : 926 .
205
371 . Mears et al . : 74 .
372 . Gregory and Stewart : 27 .
373 . Speck : 101 .
374 . Kennedy : 29 .
375 . Mardiros : 24 .
376 . Gregory : 180 .
377 . M .W . Kahn and John L . Delk, "Developing aCommunity Mental Health Clinic on an IndianReservation," International Journal of SocialPsychiatry 19 (1973) : 299 ; 305 .
378 . George A . Haven and Paul J . Imotichey,"Mental Health Services for American Indians : The USETProgram," White Cloud Journal 1 .3 (1979) :4 .
379 . George M . Guilmet, "Health Care and HealthCare Seeking Strategies Among Puyallup Indians,"Culture . Medicine and Psychiatry 8 (1984) : 350-354 .
380 . R .L . Bergman, "A School for Medicine Men,"American Journal of Psychiatry 130 (1973) : 664 .
381. . Carolyn L . Attneave, "Medicine Men andPsychiatrists in the Indian Health Services,"Psychiatric Annals, 4 .9 (1974) : 49 .
382 . Gregory : 1-5 .
383 . Peterson : 26-27 .
384 . Shah and Farkas (1985b) : 862 .
385 . Gregory : 1-5 .
386 . Mardiros : 24 .
387 . Gregory and Stewart : 26-27 .
388 . W . Jilek and L . Jilek-Aall, "The Psychiatristand His Shaman Colleague : Cross-Cultural Collaborationwith Traditional Amerindian Therapists," Journal ofOperational Psychiatry . 9 (1978) : 38 .
389 . Borunda : 223 . .
390 . Task Force on Canadian Native Peoples' MentalHealth (1978) : 34-35 .
206
391 . National Commission Inquiry on Indian Health,"Priorities for Indian Health Care," 1979 : 15 .
392 . Sydney Segal, "Health Care Training of NativePeople," in Selected Readings In Support of Indian andInuit Health Consultation Vol .I, National Health andWelfare, Medical Services Branch, 1980 : 41 .
393 . Gregory : 24 ; 158-159 .
394 . Dave Yanko, "Elders Said Vital Component ofNative Health Care," Saskatoon Star Phoenix 3 March1989 : A8 .
395 . Federation of Saskatchewan Indian Nations(1984) : 37-39 .
396 . Federation of Saskatchewan Indian Nations(1984) : 38 .
397 . Earl Fowler, "City's Native Population 11,000Plus," in "A People Apart : Natives in Saskatoon,"Special Report by the Saskatoon Star Phoenix ,7 October1986 ; Clatworthy and Hull : 36 .
398 . Ibid .
399 . Farkas and Shah : 275 .
400 . Ibid .
401 . Fowler : 3 ; Clatworthy and Hull : 43-47 .
402 . Federation of Saskatchewan Indian Nations(1984) : 23 .
403 . Fowler : 3 .
404 . Clatworthy and Hull : 97 .
405 . Bradley P . Stoner, "Formal Modelling ofHealth Care Decisions : Some Applications andLimitations," Medical Anthropoloav 16 .2 (1985) : 45 .
406 . Fuchs and Bashshur : 916 .
407 . Fuchs and Bashshur : 917 .
408 . Robert F . Winch and Donald T . Campbell,"Proof? No . Evidence? Yes . The Significance of Tests ofSignificance," American Sociologist 4 .2 (1969) : 143 .
207
409 . James B . Waidram, "Ethnostatus Distinctionsin the Western Canadian Subarctic : Implications forInter-Ethnic and Interpersonal Relations," Culture 7 .1(1987) : 36 .
410 . Fuchs and Bashshur : 922 .
411 . Fuchs and Bashshur : 922 .
412 . Fuchs and Bashshur : 920-921 .
413 . Larry Dossey, "The Inner Life of the HealerThe Importance of Shamanism for Modern Medicine," inGary Doore (ed..) Shaman's Path Boston : Shambhala, 1988 :91 .
414 . Lewis E . Mehl . "Modern Shamanism :Intergration of Biomedicine with Traditional WorldViews," In Gary Doore (ed .) Shaman's Path Boston :Shambhala, 1988 : 127 .
415 . Rene Descartes, "Meditations on the FirstPhilosophy in Which the Existence of God and theDistinction Between Mind and Body are Demonstrated," inSteven M . Cahn (ed .) Classics of Western PhilosophyIndianapolis : Hackett Publishing Co ., 1977 : 309-313 .
416 . Good and Good : 170 .
417 . Alice Hanson, "Problems Involved in TreatingNative Patients in a Western Health Care' Clinic," iDavid E . Young (ed .) JIealth Care Issues In the CanadianNorth Edmonton : Boreal Institute for Northern Studies,1988 : 25 .
418 . Hanson: 26 .
419 . Hanson : 27 .
420 . John D . O'Neil, "Referrals to TraditionalHealers : The Role of Medical Interpreters," in David E .Young (ed .) Health Care Issues in the Canadian North,Edmonton : Boreal Institute for Northern Studies, 198832 .
421 . O'Neil : 32 .
208
422 . Gregory : 75 .
209
423 . O'Neil : 32-33 ; David E . Young, Lise Swartzand Grant Ingram, "The Psoriasis Research Project : AnOverview," In David E . Young (ed .) Health Care Issues,in the Canadian North Edmonton : Boreal Institute forNorthern Studies, 1988 : 82-88 ; Lise Swartz, "HealingProperties of the Sweat lodge Ceremony," in David E .Young (ed .) Health Care Issues in th? Canadian NorthEdmonton : Boreal Institute for Northern Studies, 1988 :102-106 ; Frank Lawlis, "Shamanic Approaches in aHospital Pain Clinic," in. Gary Doore (ed .) Shaman'sPath Boston : Shambhala, 1988 : 143 .
424 . James C . Robb, "Legal ImpedAments toTraditional Indian Medicine," In. David E . Young (ed .)Health Care Issues in the Canadian North Edmonton :Boreal Institute for Northern Studies, 1988 : 136-137 .
425 . Janice M . Morse, Ruth McConnell and David E .Young, "Documenting the Practice of a TraditionalHealer : Methodological Problems and Issues," i_-n DavidE. Young (ed .) Health Care Issues in the Canadian North,Edmonton : Boreal Institute for Northern Studies, 1988 :89-93 .776 ; 779 .
426 . Rappaport and Rappaport : 776 ; 779 .
427 . Daniel Moerman, "Anthropology of SymbolicHealing," Current Anthroaoloav 20 .1 (1979) : 61 .
428 . O'Neil : 32 .
429 . Morse et al . : 91 .
430 . Young et al . : 86 .
431 . O'Neil : 37 .
432 . O'Neil : 35-37 .
433 . Joseph M . Kaufert and William W . Koolage,"Role Conflict Among 'Culture Brokers' : The Experienceof Native Canadian Medical Interpreters," Social,Science and Medicine 18 .3 (1984) : 285-286 .
434 . Saskatchewan Indian Languages Institute,"Preliminary Checklist of Plains Cree Medical Terms,"Freda Ahenakew (ed .), 1987 .
435 . Health and Welfare Canada, Medical ServicesBranch, "The Sacred Circle : A Cross-CulturalOrientation Manuel for the Health Care Professional inSaskatchewan," Health Education Medical Services BranchSaskatchewan Region, 1986 .
436 . Robb : 136-137 .
210
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233
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234
235
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236
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237
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242
Appendix A : Interview Schedule
2 .
Sex :[
J
1 .[ ]
2 .
West Side Clinic Health Survey - 1987
1 .
I .D . NUMBER :
DATE :
PART 1 : DEMOGRAPHIC AND SOCIOLOGICAL DATA
malefemale
3 . How old are you ?years
4 . What is your marital status :
[
]
1 .[ ]
2 .
[ ]
3 .
singlemarried (including common-law) and livingwith spousedivorced, widowed, or separated
5 .
Do you have any children who are presently dependent uponyou for support ?
[ ]
1 . Yes
[GO TO Q .6][ ]
2 . No
[GO TO Q .8]
6 .
How many dependent children do you have ?
7 .
What are their ages ?
8 . Which of the following would best describe your ethnic orNative status? [READ LIST]
I am a status Indian (with or without treaty)I am a non-status IndianI am an Inuk (Eskimo)I am a MetisI am a Caucasian ("White")I am an OrientalNone of these . I am
[IF 1, GO TO Q .9][IF 2 THRU 7, GO TO Q .10]
9 .
If you are a status Indian, have you recently become astatus Indian as a result of the changes to the Indian Act'
[ ]
1 . Yes[ J
2 . No
244
-------------------------------
[IF 1 THRU 7, GO TO Q . 11][IF 8 THRU 10, GO TO 4 .12][IF 11, GO TO EITHER 11 OR 12 AS APPROPRIATE]
11 . Have you ever been married to a non-Native or livedwith a non-Native in a marriage relationship ?
[ )
1 . Yes[ ]
2 . No
GO TO 4 .13
12 . Have you ever been married to a Native person or livedwith a Native person in a marriage relationship ?
[ )
1 . Yes[ ]
2 . No
13 . What was the first language you learned to speak ?
[IF RESPONDENT IS NATIVE GO TO 4 .14][IF RESPONDENT IS NON-NATIVE GO TO 4 .16]
10 . Which term would best describe your cultural background ?(READ LIST]
[
) 1 . I am a northern Cree Indian[
] 2 . I am a Plains Cree Indian[
] 3 . I am a Chipeywan or Dene Indian[
] 4 . I am a Dakota Indian[
) 5 . I am a Saulteaux Indian[
] 6 . I am a Blackfoot Indian[
} 7 . I am a Metis(
] 8. I am of Western European descent[
] 9 . I am of Eastern European descent(
] 1.0 . I am of Asian descent[
] 11 . None of these . I am a
(
J 1 . Cree[
] 2 . Chipeyw.an or Dene[
] 3 . Saulteaux[ } 4 . Dakota[
] 5 . Blackfoot[
] 6 . Michif(
) 7 . English[
] 8 . French[
] 9 . Other
14 . Are you able to speak any Indian languages today ?
[
J
1 .f
)
2 .[ ]
3 .L )
4 .L 1
5 .[ ]
6 .[ )
7 .( )
8 .
CreeChipewyan or DeneSaulteauxDakotaBlackfootMichifOtherNone
[IF 1 THRU 7, GO TO Q .15 .][IF 8, GO TO Q . 161
15 . How often do you speak this language ? [READ LIST]
most of the timeabout half the timeonly occasionallyrarely or never
16 . What is the highest grade you have completed at school ?-------------
Which of the following situations bestpresent living arrangements ? [READ LIST]
describes your
[ ] 1 . I rent an apartment[ ] 2... I rent a house[ ] 3 . I own (or am buying) -a housej ] 4 . I live with some friends or members of my family[ ] 5 . I do not have a place to live at this time[ ] 6 . Other -----------------------------------------------
24 . How many years in total have you lived in Saskatoon ?
25 . What do you feel is your home community ?
(
][
]1 . Saskatoon2 . Other (name)
(IF 1, GO TO 9 .27][IF 2, GO TO 9 .26]
26 . How often do you return to this community [READ LIST]
[
] 1 . once a year or less[
] 2 . two or three times a year[
] 3 . four or more times a year
PART 2 : HEALTH CARE PATTERNS
27 . If you wanted medical treatment in Saskatoon for somethingthat you felt was not an emergency, where would you probablygo first ?
[ J 1 .[ ] 2 .
West Side ClinicSt . Paul's Hospital
29 . Do you have a regular or family doctor ?
[ 1
r .[ J
2 .Yes
[GO TO 0_301No
(GO To Q .32]
30 . What is his or her name ?
[ ]
1 .[ J
2 .NameCan't remember or don't know
31 . When was the last time you went to see this doctor
[GO TO 0 .331
32 . Why don't you have a regular or family doctor ?------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------33 . Do you feel it is important to have a regular or family
doctor ?
( ]
1 . Yes[ ]
2. No
246
(
] 1 . Within the last month[
] 2 . Within the last three months[
] 3 . Within the last year(
] 4 . More than a year ago
(
][
J[
]
3 .4 .5 .
Medi-Clinic or drop-in medical clinicPrivate physicians officeOther (name) : ---------------------------------------
28 . If you wanted medical treatment in Saskatoon for somethingthat you felt was an emergency, where would you probably gofirst?
[
J 1 . West Side Clinic[
J 2 . St Paul's Hospital[ ] 3 . Medi-clinic or drop-in medical clinic[ ] 4 . Private physicians office[
] 5 . City Hospital( ] 6 . University Hospital[ ] 7 . Other (name) : _________________
34 . When
was the last time you' had a complete physicalexamination by a doctor ?
Within the last yearWithin the last three yearsMore than three years agoCan't rememberI have never had a physical examination
35 . Have you been admitted to a hospital in the last year ?
[ j
1 . Yes[ ]
2 . No(GO TO Q .36](GO TO Q .41)
36 . How many times ? _[If more than once, use Supplementary FormA]
37 . Why were you hospitalized ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
40 . Why did you pick this particular hospital to go to ?------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------T----------------------------------------------------------------41 . In the last year, have you voluntarily gone to an emergency
room at a Saskatoon hospital for medical care ?
( ]
1 . Yes[ j
2 . No[GO TO Q .42}[GO TO Q .49]
38 . To which hospital were you admitted ?
[
] 1 . University[
] 2 . St . Paul's[
] 3 . City[ ] 4 . Other ----------------------------------------
39 . Did you pick the hospital to go to, .or were you sentthere by a doctor or taken there by an ambulance ?
[
] 1 . Picked [GO TO Q .40][ ] 2 . Referred or taken [GO TO 0 .41]
24.7
42 . How many times ?
[If more than once, use
SupplementaryForm B]
43 . Which hospital did you go o ?
[
]
1 .[ J
2 .[ ]
3 .
[)[
J
UniversitySt . Paul'sCity
44 . Why did you go to this particular hospital ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
to the emergency room ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------47 . At the time did you feel that your medical problem required
the immediate attention of a doctor?
[ ) 1 . Yes[ ] 2 . No
48 . Were you admitted to the hospital, or treated and released ?
[ ] 1 . Admitted[ ] 2 . Treated and released
49 . Have you gone to a Medi-Clinic or drop-in medical clinic(not including this clinic) in the last year
1 . Yes [GO TO Q .50]2 . No [GO TO Q .51]
50 . How many times have you gone to a Medi-Clinic or drop-inclinic in the last year?
45 . What time of the day was it when you went to this emergencyroom ?
[
] 1 . Daytime (6 :00 a .m . to 6 :00 p .m .)[
] 2 . Evening (6 :01 p .m . to midnight)[
] 3 . Nightime (12 :01 a .m to 5 :59 a .m .)
46 .
What was the particular medical problem which brought you
Within the last two yearsMore than two years agoCan't rememberI have never had an eye examination .
55 . Have you ever been turned away from medical care by aclinic, doctor's office, or hospital ?
[ ] 1 . Yes
[GO TO Q .56][ ] 2 . No
[GO TO Q .58]
56 . Where were you turned away--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
57 . Why were you turned away ?-----------------------------------------------------------------
87 . Did you have any trouble explaining your health problem tothe doctor or nurse ?
[ ] 1 . Yes [GO TO Q .88][ ] 2 . No [GO TO Q .89]
88 . What was the trouble ?---------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------
89 . Why did you decide to come here and not to any other healthfacility ?
[ ] 1 . To see a particular doctor[ ] 2 . Atmosphere (the people are friendly ; like the place)[ ] 3 . The clinic is close[ ] 4 . Other health facilities are not open[ ] 5 . Other
90 . In the future, do you think that you will return to thisclinic for your health needs ?
[ ]
1 . Yes [.GO TO Q .91][ ]
2. No
[GO TO Q .92]
91 . Why will you return here?
[ ] 1 . To see a particular doctor[ ] 2 . Atmosphere (the people are friendly ; like the place)[ ] 3 . The clinic is close[ ] 4 . Other
GO TO Q .93
85 . Is this your first visit to a medical doctor or nurse for thisproblem ?
[ J 1 . Yes[ ] 2 . No
86 . Have you done anything yourself to correct the problem ?
92 . Why won't you return here ?-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------93 .
Is there anything the clinic might do to improve itsservices to patients ?
-----------------------------------------------------------------=-----------------------------------------------------------------94 . How did you first learn about the clinic ?
250
96 . Why or why not ?
[[
] 1 . Yes] 2 . No
Happened to see it one dayWas told about it by a friend or member of my familyWas told about it by someone elseWas referred to it by another health professionalOther (explain)
PART 3 : TRADITIONAL MEDICINE (NATIVE RESPONDENTS ONLY)
Some Native people believe strongly in Indian medicine, andwill visit an Indian doctor or medicine man for certainhealth problems . Other Native people either do not believe inIndian medicine or choose, for other reasons, not to consultwith Indian doctors . It is important that we learn theextent to which Native patients are consulting with Indiandoctors, because we feel that Indian medicine is important .We have a few questions we would like to ask you about this,and would hope that you would answer them as honestly as youhave all our other questions . We will not ask you to revealany of the secrets of Indian medicine .
95 . Would you like to see some of the Indian medicine waysavailable in this clinic?
[ ]
1 . Yes[ J
2 . No
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------97 . If an Indian doctor or medicine man were available in this
clinic, do you think you would come to see him or her ?
98 . For what kinds of problems would you come to see him or her?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------99 . Have you been to see an Indian doctor about the health
problem that brought you here today ?
[][]
1 . Yes
[GO TO Q .100]2 . No
(Go TO Q .103]
100 . What did this Indian doctor say was your problem-----------------------------------------------------------------
101 . What did this Indian doctor do to treat you ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------102 . Do you think this treatment worked ?
[ ] 1 . Yes( ] 2 . No
[GO TO Q .105]
103 . Are you planning on seeing an Indian doctor about the healthproblem that brought you here today ?
[
]
1 .( ]
2 .
104 . In the last year, have you gone to see an Indian doctor ?
[
]
1 .[ ]
2 .
105 . Thinking of the last time you went to an Indian doctor,where did you go to see him or her?
1 . Saskatoon2 . Other community or reserve (name)
[][]
YesNo
Yes [GO TO Q .105]No [GO TO Q .110]
106 . In this case, why did you decide to go to an Indian doctorand not a white doctor ?
What did this Indian doctor say was your problem ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------108 . What did this Indian doctor do to treat you ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------109 . Do you think this treatment worked
[ ] 1 . Yes[ -] 2 . No
[GO TO Q .112]
110 . Have you ever gone to see an Indian doctor for a healthproblem ?
[ ]
1 . Yes [GO TO Q .112][ ]
2 . No [GO TO Q .111]
If not, why not ?
You don't believe in Indian medicine .Indian medicine frightens youYou don't know how to find an Indian doctorThere are no Indian doctors in SaskatoonYou don't know enough about Indian medicineSome other reason
112 . Do you think there are certain kinds of problems that Indiandoctors can handle better than white doctors ?
[ ] 1 . Yes [GO TO Q .113][ ] 2 . No [GO TO Q .114]
113 . Which kinds of problems?-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
114 . Do you think there are certain kinds of problems that whitedoctors can handle better that Indian doctors ?
[ ] 1 . Yes [GO TO Q .115][ ] 2 . No [ GO TO Q .116]
251
115 . Which kinds of problems ?-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------116 . In the last year, have you participated in a sweat ?
( ]
1 . Yes[ ]
2 . No
117 . Where did you go to have this sweat ?
[
]
1 .[ ] 2 . Other community or reserve (name)
118 . In the last year, have you been treated with, or treatedyourself with any Indian medicines or herbs ?
[
]
1 .[
]
2 .
119 . Have you ever gone to see only an Indian doctor for a healthproblem ?
[ ]
1 .[ ] 2 .
Saskatoon
YesNo
YesNo
[GO TO Q .117][GO TO Q .118]
120 . What was the health problem ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
121 . Have you ever gone to see both a White doctor or nurse and anIndian doctor for the same health problem ?
[
]
1 .[ ]
2 .Yes [GO TO SUPPLEMENTARY FORM C]No [GO TO Q .122]
122 . Do you know an Indian doctor in Saskatoon whom you wouldconsider seeing for a health problem ?
[ ] 1 . Yes
[END INTERVIEW][ J 2 . No
[GO TO Q .123J
123 . Do you think you could find an Indian doctor in the city ifyou wanted one ?
[ ] 1 . Yes[ J 2 . No
Appendix B : Supplemental Form "A" (Hospital Visits)
SUPPLEMENTARY FORM A
Second Hospitalization
124 . Why were you hospitalized ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
128 . Why were you hospitalized---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
130 . Did you pick the hospital to go to, or were you sentthere by a doctor or taken there by an ambulance ?
[ ]
1 . Picked
(GO TO Q .131][ ] 2 . Referred or taken
125 . To which hospital were you admitted ?
[
] 1 . University[
J 2 . St . Paul's[
] 3 . City[
] 4 . Other
126 . Did you pick the hospital to go to, or were you sentthere by a doctor or taken there by an ambulance ?
[
] 1 . Picked [GO TO Q .127)[
) 2 . Referred or taken
127 . Why did you pick this particular hospital to go to ?
129 . To which hospital were you admitted ?
[
] 1 . University[
] 2 . St . Paul's[
] 3 . City[
] 4 . Other
131 . Why did you pick this particular hospital to go to ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
[GO TO Q .41]
Appendix C : Supplemental Form "B" (Emergency Room Visits)
SUPPLEMENTARY FORM B
SECOND EMERGENCY ROOM VISIT
132 . Which hospital did you go to ?
[ J
1 . University[ )
2 . St . Paul's[ ]
3 . City
133 . Why did you go to this particular hospital---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
134 . What time of the day was it when you went to this emergencyroom ?
135 . What was the particular medical problem which brought youto the emergency room ?
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------136 . At the time did you feel that your medical problem required
the immediate attention of a doctor ?
[ ] 1 . Yes[ ] 2 . No
137 . Were you admitted to the hospital, or treated and released ?
[ ]
1 . Admitted[ ] 2 . Treated and released
[RETURN TO Q .49, OR CONTINUE IF NECESSARY]
THIRD EMERGENCY ROOM VISIT
138 . Which hospital did you go to
( ]
1 . University[ ]
2 . St . Paul's[ ]
3 . City
ID
255
[
J 1 . Daytime (6 :00 a .m . to 6 :00 p .m .)[
] 2 . Evening (6 :01 p .m . to midnight)[
] 3 . Nightime (12 :01 a .m to 5 :59 a .m .)
139 . Why did you go to this particular hospital ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
140 . What time of the day was it when you went to this emergencyroom ?
141 . What was the particular medical problem which brought youto the emergency room ?
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------142 . At the time did you feel that your medical problem required
the immediate attention of a doctor?
[ J 1 . Yes[ ] 2 . No
143 . Were you admitted to the hospital, or treated and released
[ ]
1 . Admitted[ ] 2 . Treated and released
[GO TO Q .49J
?
[] 1 . Daytime (6 :00 a .m . to 6 :00 p .m .)[] 2 . Evening (6 :01 p .m . to midnight)[] 3 . Nightime (12 :01 a .m . to 5 :59 a .m .)
Appendix D : Supplemental Form "C" (Utilization ofTraditional and Western Health CareSystems for Same Illness Episode)
144 . At that time what did you feel was your health problem ?----------------------------------------------------------------------------------------------------------------------------------=-----------------------------------------------------------------
First Encounter-----145 . Which doctor or nurse did you see first ?
146 . Approximately when did you see him or her ?----------------------------------------------------------------------------------------------------------------------------------147 . What did they say was your health problem ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------148 . What treatment did they suggest to restore your health ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------149 . Did you follow their instructions ?
[ J
1 . Yes[ J
2 . No
150 . Did you get better as a result of seeing this person
[ J
1 . Yes[ ]
2 . No
[RETURN TO Q .122, OR CONTINUE IF NECESSARY]
Second Encounter
151 . Who did you then go see ?
257
SUPPLEMENTARY FORM C
ID
?
[
] 1 . White Doctor[
] 2 . White Nurse[
] 3 . Indian Doctor
[
J 1 . White Doctor[
] 2 . White Nurse[J 3 . Indian Doctor
152 . Approximately when did you see him or her ?----------------------------------------------------------------------------------------------------------------------------------
153 . At that time what did you feel was .your health problem ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
154 . What did they say was your health problem ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=155. What treatment did they suggest to restore your health ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------156 . Did you follow their instructions ?
[ ]
1 .[ ]
2 .
157 . Did you get better as a result of seeing this doctor ?
[ )
1 .[ )
2 .
[RETURN TO Q .122, OR CONTINUE IF NECESSARY]
Third Encounter-----158 . After seeing this person, did you then go to see another
YesNo
YesNo
159 . Approximately when did you see him or her ?
one ? Who was this ?
[
] 1 . Same White Doctor[
J 2 . Different White Doctor[
] 3 . Same White Nurse[
] 4 . Different White Nurse[
] 5 . Same Indian Doctor[
] 6 . Different Indian Doctor
258
160 . At that time what did you feel was your health problem ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------161 . What did they say was your health problem ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------162 . What treatment did they suggest to restore your-health ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------163 . Did you follow their instructions ?
166 . Approximately when did you see him or her ?----------------------------------------------------------------------------------------------------------------------------------
167 . At that time what did you feel was your health problem ?---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------168 . What did they say was your health problem ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
[
][
]1 . Yes2 No
164 . Did you get better as a result of seeing this doctor ?
[ ]
1 . Yes[ ]
2 . No
[RETURN TO Q .122, OR CONTINUE IF NECESSARY]
Fourth Encounter
165 . Afterone ?
seeing this person,Who was this ?
did you then go to see another
[
] 1 . Same White Doctor (Episode[
j
f
J
2 .3 .
Different White DoctorSame White Nurse (Episode
[
] 4 . Different White. Nurse[
] 5 . Same Indian Doctor (Episode[
] 6. Different Indian Doctor
169 . What treatment did they suggest to restore your health ?
170 . Did you follow their instructions ?
[[
[
]
1 .[ ]
2 .
YesNo
YesNo
171 . Did you get better as a result of seeing this doctor
[RETURN TO Q . 122, OR CONTINUE IF NECESSARY]
Fifth Encounter
172 . After seeing this person, did you then go to see another oneWho was this ?
173 . Approximately when did you see him or her ?-----------------------------------------------------------------174 . At that time what did you feel was your health problem?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------175 . What did they say was your health problem--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------176 . What treatment did they suggest to restore your health ?--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
[] 1 . Same White Doctor (Episode ___)[] 2 . Different White Doctor[] 3 . Same White Nurse (Episode[] 4 . Different White Nurse[] 5 . Same Indian Doctor (Episode[] 6 . Different Indian Doctor
177 . Did you follow their instructions ?
[ ]
1 . Yes[ ]
2 . No
178 . Did you get better as a result of seeing this doctor ?
[ )
1 . Yes]
2 . NoRETURN TO Q .122
Appendix E : Consent Form for Respondents
May I have your permission to obtain information from yourmedical record regarding your visit to the clinic today?
Yes --------------------------Print Name
Sign Name
----------------Date
261
Appendix F : Use of Traditional Health Care Systems BySelected Indicators of Use of Western
Health Care System
Table 14 : Use of Traditional Health Care Systemsl BySelected Indicators of Use of Western Health
