Tribal Sovereignty
There are over 560 Federally recognized AI/AN tribes in the United States and almost 245 non-Federally recognized tribes. The non-Federally recognized tribes are typically recognized by their states and are seeking to be Federally-recognized. The relationship between the Federal government and Indian tribes is a unique legal and political one. Because a tribe is considered a sovereign nation, Tribal governments have a right to hold elections, determine their own citizenship, and to consult with the U.S. government on policy, regulations, legislation, and funding. State laws cannot be applied where they interfere with the right of a tribe to make its own laws with the interest of the health and welfare of its citizens or if it would interfere with any Federal interest. The Indian Self-Determination Act (Public Law 93-638) gives authority to Tribal governments to contract programs carried out by the Federal government.
Cultural Differences
Before European contact, AI/AN communities lived all throughout various areas of North America. Voluntary and forced relocations happened throughout the tribes, after Federal policies were in place, from their familiar territories to current day reservations. On reservations, some tribes were forced to co-exist together on the same reservation. Some of these tribes were related culturally and linguistically, but some were not. Some historic enemies were even forced to live on the same reservation. Many of the repercussions from this can still be felt today in those communities with political and cultural tension. Differences in cultural groups are related to regional differences. Language or spiritual belief systems may help to distinguish a tribe. The differences are also a result of homeland diversity as well as Tribe migration patterns. Cultures developed in adaptation to their natural environment and are influenced by trade and interactions with non-Indians and other AI/AN groups.
Cultural Customs
A group or individual’s preferred ways of meeting their basic human needs and conducting daily activities as passed from generation to generation are considered to be cultural customs. Specific cultural customs may vary greatly from among AI/AN groups. There are multiple factors that influence customs. Different factors include origin, ethnicity/spiritual beliefs, gender, sexual orientation, age, marital status, socioeconomic status, ancestry, history, gender identity, geography, etc. Cultural customs can be seen evidently through material culture like food, dress, dance, ceremony, drumming, stories, symbols, and other visual characteristics of culture. Outward reflections of cultural customs are often more a reflection of an ingrained and implicit culture that cannot be seen visually or verbalized. A Tribe’s decision-making process and how they conduct ways of doing things within their tribe, family, community, or clan can represent the thoughts, core values, and beliefs of a group or individual. Questions respectfully made about a Tribe’s cultural customs are generally welcome but not always answered directly. Questions about culture should be directly for the purpose of increasing understanding so as to better improve the quality of service given to a patient.
Health & Wellness
The definition of health and wellness can be broad across the board. It’s generally defined as living in a harmonious balance with all elements, as well as balance and harmony of spirit, mind, body, and the environment. AI/ANs define what health and wellness is to them, which can be very different from the Western definition, especially within the medical field. Many health issues are not unique to AI/AN communities, but are statistically higher than the general population. In most AI/AN communities, many health disparities exist with limited access to culturally appropriate healthcare. Service providers must take great care in the assessment process when working with this community to consider cultural differences with a cultural gap between the different health concepts. Especially when drawing conclusions about specific problems or diagnosing. Efforts should be made to consult with local cultural advisors about symptomology and treatment options.
Historic Distrust
Establishing trust with members of an AI/AN community may be difficult. This is due to a long history of Tribal communities being destroyed when exposed to infections and European illnesses and being mistreated by European colonists. Treaties were also made by the U.S. Government with Tribal nations that were ultimately broken. It is important to consider historical trauma, ethnocide, and genocide, as well as the government breaking many of their promises, when working with the AI/AN community. Policies such as “kill the Indian, save the child” in the 1800s started a movement that forcibly removed children from their families and placed them in boarding schools where abuse was rampant and children died from infectious disease. The result was generations of physical and emotional trauma, making it important to adopt sensitivity.
Spirituality
There is a strong respect for spirituality found in AI/AN communities. Whether it be traditional (prior to European contact), Christian (resulting from European contact), or both, spirituality forms a sense of group unity. Many communities have a strong church community and integrate organized religion into their culture and day-to- day living. For AI/AN populations who are spiritual, this usually manifests in a community oriented belief rather than an individual practice. The specific practices and protocols of ceremonies will very greatly among AI/AN communities. Mainstream faiths may also coexist. It is best to inquire about an individual’s faith before making assumptions. Also be aware that many AI/AN spiritual beliefs are considered sacred and are not to be shared publicly.
Cultural Identity
It is important to understand that each person has experienced their cultural connection in a unique way. An individual’s personal and family history are what will shape their cultural identity and practices, Some view himself or herself as “traditional” and live their traditional culture daily and some view themselves as “Indian” or “Native” and yet have little knowledge or interest in their background or traditional cultural practice. Many families are multicultural and adapt to surrounding culture. When asked “Where are you from?” most AI/AN people identify their name of their tribe or village. They also may mention their traditional family homeland. These are important keys to self identity. Age is also an important factor in cultural identity. Elders typically identify as more traditional while younger generations are multicultural or non-traditional. There are also younger members who eagerly practice traditions.
Communication Styles
There are a few communication styles to keep in mind when working AI/AN communities. Only a few will be highlighted here, but they are worth noting.
Nonverbal Messages – A great deal of communication among AI/AN people involves non-verbal gestures. Use careful observation to avoid miscommunication.
Humor – AI/AN people may convey hard truths or difficult messages through humor. Great pain may be covered with smiles and jokes. Listen closely to humor and keep in mind it might be covering an internal struggle.
Indirect Communication – Openly criticizing each other within the AI/AN community is generally frowned upon. When children or youth are asked to speak out or testify against another person, it is important to understand that they may consider doing so disloyal.
Storytelling – Whether through traditional teachings or personal stories, it is very common to get messages across through telling a story which can take time.
Etiquette
Learn how a community refers to itself as a group of people. Listen and observe more than you speak and learn to be comfortable with silence in long conversations. It is acceptable to admit to limited knowledge of an AI/AN culture and invite people to educate you about specific cultural protocols within their community. Respect confidentiality and the right of the tribe to control information, data, and public information about services that were provided to the tribe. Do not touch sacred items such as jewelry, medicine bags, etc. Always ask permission before taking any pictures. Examine your own belief system and be respectful of the differences in the belief system of the AI/AN community.
