University of Alberta “You need to be double cultured to function here”: Toward an anthropology of Inuit nursing in Greenland and Nunavut by Helle Møller A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Anthropology ©Helle Møller Fall, 2011 Edmonton, Alberta Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission Abstract Working towards an anthropology of nursing, I explore what it means to become and be an Inuit nurse, using as a lens the experiences and voices of Greenlandic and Canadian Inuit nurses and nursing students who are educated and practice in settings developed and governed by Southerners (Danes and EuroCanadians), functioning largely on Southern cultural norms (Danish and EuroCanadian), in Southern languages (Danish and English). I argue that Inuit nurses and students are the Arctic health care systems’ most valuable assets. They offer unique knowledge, qualifications, and spirit to the Arctic health care systems while being affected by health care politics, a lack of permanent health care staff and high turnover rates. These challenges are compounded by Inuit nurses’ and students’ need to negotiate the languages and cultures of the nursing field, the Southern systems and their Southern colleagues, with the languages and cultures of the patients, their families, and the societies from which they come. Inuit nurses’ and students’ success, therefore, hinges on their possessing double cultural and social capital. This includes the ability to communicate in at least two languages and cultures, and in the field of nursing. It also includes the ability to understand, negotiate, and interact, using at least two ways of being in the world, two ways of learning and teaching, and two ways of perceiving the body, health, and disease. I suggest that communication difficulties between Southern and Inuit health care practitioners, as well as between Inuit clients and some Inuit and Southern practitioners, may arise because they possess different cultural capital. This, I maintain, is complicated by the educational and health care systems in the Arctic continuing to be colonial in nature and catering to Southern cultures and habitus, and because some Southern health care practitioners preserve a colonial attitude that creates obstacles to the provision of optimal care to Inuit clients and barriers to equity in workload and professional demands for Inuit and Greenlandic nurses. In order for Inuit nurses’ and students’ knowledge and abilities to have the greatest impact on patient care and recovery they need to be acknowledged, supported and embraced by the Arctic educational and healthcare systems. Acknowledgements First I would like to extend a very big thank you to all the Greenlandic and Canadian Inuit nurses and nursing students who participated in and made this project possible. Your help and participation was invaluable. I would like to thank the University of Alberta, the Social Science and Humanities Research Council of Canada, the Northern Scientific Training Program fund, the Circumpolar/Boreal Alberta Research fund, the Government of Greenland and NUNAMED for significant financial support without which this project would have been very difficult to carry out. At the University of Alberta, I want to thank Dr. Mark Nuttall for being my supervisor and supporting me through the PhD process, for being there and inspiring me when I needed it, and for otherwise trusting in my ability to do the work I needed to do. You had a wonderful ability to be positive while letting me know there were areas in my work that might benefit from further attention. You are an inspiration. I also want to thank Dr. Christopher Fletcher and Dr. Susan Smith for being on my committee, for our good conversations, for your supporting me and providing valuable feedback in my writing process, and for your very valuable questions and comments at the defence. I also want to thank Dr. Helen Valianatos and Dr. Vera Caine for being on my examining committee and for your very valuable questions and comments at the defence. Lastly, I want to thank Graduate Programs Administrator Gail Matthews for all your help and practical assistance. I want to thank Dr. Frank Tester who was the external examiner for my dissertation for your very valuable feedback, comments and insights. I sincerely appreciate your engagement with my dissertation. In Greenland I would like to thank all the staff and students in the previous and current Centre for Health Education and in the Department of Nursing and Health Research at Ilisimatusarfik/University of Greenland, particularly those affiliated with the nursing program, for your welcoming and helping me in many different ways, for your interest, support, good conversations and for being good natured about my presence in classrooms, places of practice, and many other places. I would also like to thank the previous chair of the Centre for Health Education, Ann Birkekjær Kjeldsen, for your support when I initially proposed the project and for your taking time to educate me about the program and its development early on. A particular thank you to chair of the Department of Nursing and Health Research, Suzanne Møller, for your friendship, good conversations, shared meals and help and support in so many different ways – you are an inspiration; to Ruth Lange for our inspirational conversations and for your authoring the very valuable book Når en tanke bliver født (When a thought is born) and co-editing with Liza Ezekiasing an earlier and also valuable book Sana; to Turid Skifte for your friendship, good conversations, shared meals and a place to stay when needed, and last but not least for answering all the questions I have posed in relation to the office of the medical officer of health. I would also like to extend a very heartfelt thank you to MD Gert Mulvad, who initially invited me to give a workshop about cross-cultural health care at the NUNAMED conference in Greenland and has been a support throughout this research project. In Nunavut I want to thank all the staff and students at Nunavut Arctic College - particularly those affiliated with the nursing program - for your welcoming and helping me in many different ways, for your interest, support, good conversations and for being good natured about my presence in classrooms and many other places. I would also like to thank the previous chair of the nursing programme, Ruth Bainbridge, for your support when I initially proposed the project, for our good conversations and for your answering all my questions in relation to the nursing programme and much more. I want to extend a warm and very special thank you to the late Susan Sammons, linguist and director of the Language and Culture program at Nunavut Arctic College. We had many good conversations about many different topics. Susan helped me with Inuktitut terms, suggested literature to me, and was an overall inspiration because of who she was and because of the invaluable work she did at the College and in Nunavut to further Inuit language and culture. All her work has been a tremendous help in my learning about Nunavut and Inuit culture. I miss Susan. Finally I want to thank my family and friends in Denmark and in Canada for your support and trust in my abilities, for listening to my doubts and frustrations, for sharing my joy and happiness, and for accepting my coming and going and still being my friends. A special thank to Maureen Ford with whom I had the first conversations that inspired me to pursue graduate work. You are truly an inspiration. Last, but not least, I want to thank Paul, my beloved, my friend, and the person with whom I have had the most conversations about this work. You have accompanied me physically and mentally in this endeavour like no other. You have given me feedback, discussed and argued with me, shared my joys and frustrations, and helped and supported me in so many ways. Table of contents Clarification of terms Quotations 1. Introduction 1 1.1 Genesis of the Study: The ‘culturedness’ of nursing 1 1.2 The Central Argument of the Thesis 3 1.3 Toward an Anthropology of Nursing 7 1.3.1 Nightingale nurses 7 1.3.2 Nursing and anthropology 9 1.3.3 Colonial nursing 11 1.3.4 Indigenous and Inuit nursing 18 1.3.5 Working towards an anthropology of nursing 21 1.4 Arctic Nursing Matters 25 1.5 Who are the Inuit Nurses and What do They Think? 28 1.6 Theoretical Frameworks 30 1.7 Structure of the Dissertation 41 2. The Field 44 2.1 Inuit Homeland 44 2.1.1 Nunavut 44 2.1.2 Greenland 47 2.2 Histories of Colonization and Roads to Self Determination 50 2.2.1 Greenland 50 2.2.2 Nunavut 58 2.3 Arctic Health Care Past and Present 65 2.3.1 The inseparability of individual and community health 66 2.3.2 The history of Western health care in Greenland 71 2.3.3 The history of Western health care in Nunavut 82 2.3.4 Health care in Greenland today 95 2.3.5 Health care in Nunavut today 99 2.4 Chapter summary 103 3.