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Indigenous Health Systems: An Emergent Yaqui- Centered Framework for Public Health Practice Item Type text; Electronic Dissertation Authors Oré de Boehm, Christina E. Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 05/10/2021 19:49:53 Link to Item http://hdl.handle.net/10150/627745 INDIGENOUS HEALTH SYSTEMS: AN EMERGENT YAQUI-CENTERED FRAMEWORK FOR PUBLIC HEALTH PRACTICE by Christina E. Oré de Boehm ______________________________________ Copyright © Christina E. Oré de Boehm 2018 A Dissertation Submitted to the Faculty of the MEL AND ENID ZUCKERMAN COLLEGE OF PUBLIC HEALTH In Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PUBLIC HEALTH In the Graduate College THE UNIVERSITY OF ARIZONA 2018 STATEMENT BY AUTHOR This dissertation has been submitted in partial fulfillment of the requirements for an advanced degree at the University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this dissertation are allowable without special permission, provided that an accurate acknowledgement of the source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the copyright holder. SIGNED: Christina E. Oré de Boehm - 3 - ACKNOWLEDGEMENTS I would like to acknowledge the Traditional Authorities of the 1st and 2nd Cabeceras for the eight Yaqui pueblos who approved this study and my presence in the Yaqui communities. I am grateful to the people and families who shared their knowledge and experience. May this contribute to your continued work for the health and wellbeing of Yoeme communities. This study would have remained an aspiration if it weren’t for the unconditional, deep- rooted support given by my friend, Margarita, her daughters, and my mother, Jennepher. Thank you for exemplifying respect and reciprocity, talking -story at the kitchen table, laughing along bumpy roads, making good food, and caring for your grandchildren. This gratitude extends to the Leyva, Gonzales, and Valenzuela families who opened their homes to my husband, children, and family in Vicam estación, Sonora. I am grateful for my husband, Joe, who accompanied me to visit the pueblos during Semana Santa, helped with logistics for the CEDIS public health workshop, and stood by me through the thick and thin of completing the doctoral program. I acknowledge my family who, despite the sudden loss of our mother, encouraged completion of this dissertation. My father, Horacio, and children, Munai and Tenzin, for their love; brothers, Omar and Eamon, for their teasing support; and Rachel and Octavio for coming into our lives. My Tia Ruthie who drove with me through monsoon rains to watch Munai and Tenzin so that I could return to the pueblos. Cesar, Estela, Ludmilla, Julio, Raul, and Sarina, and the Colio family in Hermosillo, estoy muy agradecida. Love to my uncles, aunts, and cousins in Peru, Mexico, and U.S. for their family support -given, always without hesitation! Love and gratitude to my extended family. My hermanamiga, Aleena M. Kawe, for her passion and commitment to Indigenous community wellness. She understood the essence of this work, believed in its potential, and always reminded me that the “path was illuminated.” Leslie Silko, talking with you on a cool fall morning, after a rain, is a good memory. I’ve heard the teachings in our conversations and pray this dissertation honors them. Stephanie and Olivier, thank you for remembering our mother and taking our little ones under your wings after school. I would like to thank Reuben T. Howard, Raquel Aviles and all my co-workers from the Pascua Yaqui Health Services Division (PYHSD) for their continued, long-standing support. Since 1999, PYHSD has inspired me through their innovative, creative, and community-based work. This gratitude extends to my language teacher. I would like to acknowledge Leonie Pihama, Sarah-Jane Tiakiwai, Linda Smith, Amohia Boulton and Glenis Mark for their kindness, generosity, and inspirational kōrero. Thank you for sharing your scholarship and creating nurturing spaces for us to gather strength for our life’s work. Thank you to all my DrPH compañeras. Carmella and Sofia, we did it! You are amazing women, sister scholar. I look forward to working together into the future, for the future. I would like to acknowledge the L.F. Marshall Foundation, Hispanic Women’s Corporation, Victoria Foundation, Zuckerman Family Foundation, Dr. C. Rosales, and Programa de Investigación en Migración y Salud (PIMSA) for their fellowship and scholarships, which supported research and dissertation writing. Finally, I’d like to thank my dissertation chair and committee members, Cecilia Rosales, Nicolette Teufel-Shone, Stephanie C. Rainie, Anne Marie Hall, and James Hopkins, for their support, commitment, and service to Indigenous public health practice. Anne Marie Hall, we recognize the spirit and beauty of our reconnection at this time and place. Thank you all for your steadfast support for indigeneity, equity, and public health. - 4 - DEDICATION ______________________________________________________________________________ For Nani (b. 1944 – d. 2015) & Infinite Possibilities… - 5 - TABLE OF CONTENTS LIST OF FIGURE ………………………………………………...…….…………….…...........10 LIST OF TABLES ………………..…………………………………………………….……….11 ABSTRACT………………………………………………………………………………...........12 CHAPTER 1 INTRODUCTION ………………………………………………………...……...13 ¿De quién eres? ¿Con quién andas? Situating the Author………………………………13 Tipping Point for Yaqui Health Development……………………………………...........16 Study Overview………………………………………………………………………….17 Purpose and Specific Aims……..………………………………………………..17 Research Questions and Potential Impact………………………..…………..…..18 Dissertation Parameters……………………………………………………….…………19 Terms and Definitions………………………………………………….…..........19 Assumptions……………………………………………………………...............22 Delimitations…………………………………………………………...………...23 Audience………………………………………………………………………….……...26 Dissertation Outline……………………………………………………………………...26 CHAPTER 2 DEVELOPING A YAQUI HEALTH SYSTEMS STUDY………………………28 Context for Yaqui Health Development……………………………………...………….28 Socio-Political and Environmental Determinants……………………...…...........31 Environmental, Health and Safety Impact……………………………….………34 Yaqui - Indigenous Strengths………….………….…………………….…….….35 Yaqui Health Development, ‘by and for’ the Yaqui Tribe…………….………...36 From Practice to Research ………………………………………………………............37 - 6 - Feasibility of Conducting a Community Health Assessment……………………38 Reframing Efforts to Strengthen the Yaqui Health System……………………...42 Systems for Health, Equity, Indigeneity…………………………………………………44 Mexico and Indigenous Communities ….……………………………………….45 American Indian and Alaska Native Health Systems in the U.S. ……………….48 Yaqui Tribe, Health Systems in U.S. and Mexico……………………………….50 Indigenous Peoples’ Health Development……………………………………….53 Tipping Point – Summary of Challenge and Opportunity……………………………….56 CHAPTER 3 CONCEPTUAL AND THEORETICAL FRAMEWORKS……………………...58 World Health Organizations (WHO) - Health Systems Strengthening………………….58 “Six Building Blocks” Health Systems Framework, WHO……………….……..61 Social Determinants of Health and Health Inequity Framework, WHO………...62 U.S. Public Health System Performance Improvement………………………………….66 Public Health System Framework to Measure Performance, U.S….…………....66 Public Health Accreditation Board (PHAB) Tribal Standards and Measures.......68 Indigenous Health System Performance…………………………………………………69 Aboriginal and Torres Strait Islander Health Performance Framework, AUS…...71 Confluence for Health Equity – Address Omission and Step into Opportunity………....74 CHAPTER 4 RESEARCH STRATEGY “WAYS OF KNOWING AND WAYS OF DOING”.77 Yaqui - Centered Methodology …………………………………………….…………….....77 1. (Re)connecting & (Re)membering –Worldviews, Perspectives and Paradigms…..80 2. Encanto – Strategy, Approach, and Design……………………………………….84 3. Tu Camino está Iluminado – Ethical - Spiritual Connections………………….91 - 7 - 4. Allewame - Affirmation of Strategy…. ………………………………………….100 5. Lios Está Contigo – Approvals……………………………………………...…...104 6. Visitas and Etehoi – Sharing, Listening and Learning……….………………….110 7. Lutu ‘uria – Meaning-Making …………………………………………….…….120 8. Cumplir Siempre – Responsibilities and Obligations………………...….………135 9. Always Connected - Giving and Planning………….………………...………….137 Guiding Principles of a Yaqui-Centered Methodology…......………...………………..139 CHAPTER 5 SHARED MEANING MAKING – A HEALING LANDSCAPE………………142 Traditional Healing and Its Interface.…………………………….……………….........142 Traditional Healers – Hitevi and Hittoareo…………………………………….142 The Traditional Healer’s Experience – Themes…………………………….….147 Community Health and Its Interface………………….………………….......................172 Community Lay Health Workers – Auxiliares and Promotoras………….……173 The Lay Health Worker’s Experience – Themes……………………………….175 Perspectives on Health, Healing, and Being Well ………………………………….….194 Healing Source and Way…………………………………………………….…195 Hiak Bwia/Yoem Bwiara, Yoeme Homeland and Environment………….……..198 Cadenita De Los De Antes, Knowledge Transmission…………...….…………201 A Yaqui