HEALTH CAFE DELIVERY IN --AN INUIT SETTLE= : A STUDY OF (ThFLICT AND CCNGRLIENCE IN INUIT ADAPTATICN 1D THE CCSMJPOLITAN MEDICAL SYSTEM A Thesis 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 Anthropology and Archaeology by John D . O'Neil Saskatoon, Saskatchewan c 1979 . J . D . O'NEIL UNIVERSITY OF SASKATCHEWAN PERMISSION TO USE POSTGRADUATE THESES TITLE OF THESIS HPa7th(',:;nn- f, 7iT7Arijin anInuit Settlement ; A.Stndu of 1* .0 - . U . NAME OF AUTHOR John Donald O'Neil DEPARTMENT OR COLLEGE Anthronoloqu and Archaeo7oarz .7 DEGREE ' Master of Arts In presenting this thesis in partial fulfilment of the requirements for a postgraduate degree from the University of Saskatchewan, I agree that the Libraries of this University may make it freely avail- able for inspection . I further agree that permission for extensive copyingof this thesis for scholarly purposes may be granted by the professor or professors who supervised my thesis work or, in their absence, by the Head of the Department or the Dean of the College in which my thesis work was . done . It is understood that any copying or publication or use of this thesis or parts thereof for financial gain shall not be allowed without my written permission . It is also understood that due recognition shall be given to me and to the University of Saskatchewan in any scholarly use which may be made of any material in my thesis . SIGNATURE ADDRESS 31 Avenue E . North Saskatoon,9aSkatr'hF,jyan DATE June 22, 1979 . ABSTRACT This thesis is a descriptive study of health care in the Inuit settle- ment of Gjoa Haven, N.W.T. The purpose of the research was primarily to describe and analyse the interactional networks of health and illness re- lated behaviour that are associated with the Nursing Station . The cultural and organizational background of the administrators and nurses who provide medical services to Inuit are described, as are the attitudes and beliefs held by Inuit about illness and about the health care delivery system . The thesis examines the acculturation of Inuit beliefs and practices related to illness throughout the contact period and focuses particularly on the changing role of the Inuit healer, the anqatquq or shaman . Various influences such as epidemic diseases, missionary activity, and changing economic orientations that have contributed to Inuit dependency patterns and changed beliefs about illness, its causes and cures, are detailed . Theoretically, the thesis is partly a study of the replacement of a traditional medical system by the cosmopolitan medical system and the gradual attenuation of the traditional curer's role . It is also an exami- nation of the manner in which the conflict resulting from differences in attitudes between administrators, nurses and Inuit, affects the delivery and utilization of health services in Gjoa Haven . It demonstrates that where problems occur they are as much a result of conflict between admin- istrators and nurses, as they are due to conflict between nurses and Inuit . The substantive portion of the thesis examines specific domains of interaction such . as health education, agency coordination and native ill participation and points out areas where failure occurs in each of these arenas . Recommendations are included that suggest strategies for improv- ing the effectiveness of health care delivery and ultimately the health levels of the Inuit population . iv ACKNOWLEDGEMEN`.S While the faults of this thesis are entirely my own, its merits are the combined contribution of everyone who has been associated with the study since its inception . I am profoundly grateful for the assistance, inspiration, support and encouragement received from all those involved, and can only hope that the material presented herein justifies everyone's expectations and confidence . First of all I would like to acknowledge the financial assistance of the various funding bodies that made the research possible . A National Health Student Fellowship from the National Health Research and Develop- ment Program of Health and Welfare, Canada provided the major portion of the financial resources necessary to carry out the research . Additional funding from the Institute for Northern Studies and the Department of Anthropology and Archaeology on the University of Saskatchewan campus helped to subsidize the enormous cost of travel, subsistence and employ went of interpreters and research assistants while I was engaged in field- work. My debt collectively to the members of the Department of Anthropology and Archaeology, particularly to the members of my Thesis Committee and specifically to several individuals who have played key roles in my development as an apprentice anthropologist, is enormous . Professor A . M. ':'Sandy" Ervin not only was responsible for the initial inspiration for this entire project but has provided tireless support and encouragement throughout the research process . My approach v to anthropology, research, and life in general has been substantially influenced by our association . Professor R. G. Williamson's rich northern experience has provided many an insight into what otherwise might have remained clouded muddles . My original and sustained interest in the Inuit and the Arctic result from the presence he brings to his teaching. My decision to become a professional anthropologist must be credited to Professor S . P . Sharma and the stimulation and challenge he created in an undergraduate seminar on theory in anthropology . What theoretical sophistication I now possess is due primarily to his example . The opportunity provided by Professor J . F. V. Millar to work as a research assistant is essentially responsible for the development of this entire project. His confidence and encouragement in the developmental stages of the project largely insured its ultimate success . Although previous commitments have made it impossible for Professor F. Silversides to complete his tenure on my Thesis Committee, I am grateful for his advice and support, particularly during the development of the research proposal . I am also grateful to Professor V . Matthews for acting as a replacement on such short notice . Several people outside academe contributed significantly to the de- velopment of the research proposal . Leone Trotter R.N ., Dr . 0. Schaefer, and H . Ferrari R.N., all provided valuable assistance and insight into northern health problems . I would also like to express my thanks to the rest of the Medical Services staff in Edmonton and Yellowknife whose cooperation made the research possible . The students in the Department of Anthropology and Archaeology and in particular, Ian Gray, whose willingness to engage in endless discus- sions on any topic, substantially influenced my anthropological develop- ment and the direction of the research . Individuals associated with the fieldwork in Gjoa Haven are too numer- ous to mention but several people deserve special recognition . The friend- ship of Peter and Simona Akkikungark and Uriash and Lorraine Puqirqnik will always remain one of the most rewarding experiences of my life and is responsible in a major way for the success of the research . Louie Qingnatuq, Peter Ookpik, Raymond Kamookaq and Mark Tootiak also provided much appreciated friendship and information . My debt to the Ullagataq family is irrepayable . Their tolerance and good honour about my presence in their home taught me much . Of those involved in the health care delivery system in Gjoa Haven, Leslie Knight R .N . deserves more gratitude then I can possibly extend . Her constant cooperation and continuing support of a research project that I'm sure she very often felt an intrusion into her personal life, is largely responsible for any success this thesis may have . Agnes Porter, Lynn Hillinrd and Kitty Minor also provided information and ideas during the data-gathering phase and I am grateful to them . To the remainder of the residents of Gjoa Haven I extend my gratitude for their friendship and cooperation and for making my stay in Gjoa Haven a warm, enjoyable and enriching experience . Particularly, I would like to thank the Settlement Council for inviting me to Gjoa Haven in the first place and for supporting the research project throughout . vii Another group of people who deserve mention for their contribution to this thesis are the faculty and participants at the "Lifestyle and Health Workshop" held in Victoria, July 9-23, 1978 . My thanks to Professor Peter K . M. New in particular, who helped to refine my theoretical and mthodological skills and whose encouragement has greatly aided in the production of this thesis . This thesis would never have taken shape without the highly competent secretarial help of T,iz Kennedy and Ann Childs in the Department of Anthropology and Archaeology and Mary Beug who typed and retyped various scraps of paper and endless scribbles into a legible and readable form . To my family and friends in Saskatoon, Toronto and Tisdale I am deeply indebted for their confidence, encouragement and material support . The tents, sleeping bags, letters and home-cooked meals will always be appreciated . Finally I must acknowledge my deepest debt to my closest friend, Kris Robinson R.N ., who has played such a major role in my life, both personally and professionally . It can be very honestly stated that with- out her presence, this research, my conmiLicint to anthropology and the writing of this thesis, would never have materialized . TABLE OF CaqTENIS Page Abstract iii Acknowledgements Table of Contents ix List of Figures xii List of Maps xii List of Photographs xii a=R 1 .0 IN DUCTION 1 1 .1 Purpose and Objectives of Research 1 1 .2 Field Work Methodology 6 CHAPTER 2 .0 THEORETICAL PERSPEU1'1VES CN COMPARATIVE MEDICAL SYSTEMS 15 2 .1 Introduction 15 2 .2 Theoretical Perspectives on Sociocultural Change 16 2 .3 Historical Development of Anthropological Perspectives on Medical Systems 19 2 .4 Concepts, Definitions and Theoretical Approaches to the Comparative Study of Medical Systems 23 2 .5 Traditional Healers and the Cosmopolitan Medical System .