Decolonizing Care at Diagnosis: Culture, History, and Family at an Urban Inter‐tribal Clinic

Abstract

The decolonization framework in medical anthropology is slowly reframing tropes of cultural competency toward decolonizing health care. For decolonization of health care to occur, both colonial histories and continuing postcolonial inequities must be recognized from the first diagnostic moment. We report on qualitative research into the role of culture, history, and family experience in person‐specific reactions to receipt of a diagnosis. A collaborative approach at an urban inter‐tribal clinic was used to interview patients with a recent (within six months) diagnosis of diabetes or related condition. Interviews revealed ways that the Relocation Act eventuated in isolation, poverty, and diabetes among now‐urban Native Americans. We discuss how patients may or may not have the ability to (re)connect with their heritage and may simultaneously perceive only recent family contexts as influential in their diabetes. We conclude by acknowledging how postcolonial harms are not captured in diagnoses but should not be left out of diagnostic discussions.

Civic leadership, emotions and social change: decolonial ethnographic research on an American Indian non-profit organisation

“…Since the colonisers arrived in what today is the US, American Indians have suffered from acculturation and violence that have resulted in emotional wounding and health issues over their lifespan and across generations (Yellow Horse Brave Heart, 2003;Walters et al, 2011;Smith-Morris et al, 2021). Being aware of the accumulation of emotional psychological wounds that many Native American experience today, this non-profit organisation has been developing leadership work to transform the constraints of negative emotions into an asset and a resource for social change.…”

“…As a result of this context of historical injustice, American Indians have experienced intergenerational trauma or a 'soul wound', understood as the cumulative emotional and psychological wounding over their lifespan and across generations (Yellow Horse Brave Heart, 2003). Additionally, because of the disruption of colonialism in the ways of life of Native American communities, each generation has kept transmitting different health issues to the following generation (Walters et al, 2011;Smith-Morris et al, 2021). Notwithstanding, despite the accumulation of emotional and psychological wounds, many American Indian non-profit organisations have transformed the constraints of negative emotions into an asset or a resource for social change.…”

Healthcare needs and infrastructure obstacles for a state‐recognised Indigenous tribe in the United States

“…Family members of Indigenous people tend to serve as supportive figures who encourage healthy eating habits (Smith‐Morris et al, 2021). Additionally, researchers find that aligning with the concept of cultural safety in the healthcare setting, wherein non‐Indigenous health professionals receive more education about Indigenous practices, clinical settings are altered to allow for culturally relevant practices, and Indigenous health professionals are integrated into the mainstream workforce, leads to improved health outcomes and healthcare experiences (Tremblay et al, 2020).…”

“…The tribe in this study is not recognised by the federal government despite being recognised by the state government because of a host of political and historical factors (Fitzgerald, 2015;Fletcher, 2006;National Conference on State Legislatures, 2016;Salazar, 2016). Although being recognised at the state level is an important act, when tribes are not recognised by the federal government, they have restricted access to needed resources and the right to tribal sovereignty, defined as tribal independence over their own sovereign nation.…”

Introduction: Diagnostics, Medical Testing, and Value in Medical Anthropology

“…By narrowing the epidemiological imagination of the scale and nature of disease in Senegal, this absence of diagnosis also inhibits global health investment in effective measures of disease detection and control.A similar set of disjunctures animates Vernooij's descriptions of the improvisation work performed by laboratory technicians to stabilise unstable equipment in the clinical laboratory of a Sierra Leonean hospital. Here, we see how the 'diagnostic moment'(Jutel 2015;Smith-Morris et al 2021; Bunkley, this issue) is attenuated by infrastructural instabilities: the unstable supply chains, electrical outages, malfunctioning equipment, and poorly paid laboratory staff. In Vernooij's article and in the Field Note co-authored by Bah, Vernooij, and Street, diagnosis is a considerable achievement, made possible by investment of 'entrepreneurial staff' who privately procure materials to fill in the gaps, a charge which they offset by covertly charging patients for results.…”