URBAN ABORIGINAL HEALTH: ISSUES, CULTURALLY APPROPRIATE SOLUTIONS AND THE EMBODIMENT OF SELF-DETERMINATION Ph. D. Thesis – J. Skye; McMaster University – Anthropology. URBAN ABORIGINAL HEALTH: ISSUES, CULTURALLY APPROPRIATE SOLUTIONS AND THE EMBODIMENT OF SELF-DETERMINATION By JAIRUS S. SKYE, B.A., M.A. A Thesis Submitted to the School of Graduate Studies In Partial Fulfillment of the Requirements For the Degree Doctorate of Philosophy McMaster University © Copyright by Jairus S. Skye, October 2012 ii Ph. D. Thesis – J. Skye; McMaster University – Anthropology. McMaster University DOCTORATE OF PHILOSOPHY (2012) Hamilton, Ontario (Anthropology) TITLE: Aboriginal Health Issues And Aboriginal Solutions: Developing A Comprehensive Approach To Health Care And The Embodiment Of Medical Self- Determination In An Urban Aboriginal Community Health Centre AUTHOR: Jairus S. Skye, B.A., M.A. (McMaster University) SUPERVISOR: Professor Wayne Warry NUMBER OF PAGES: viii, 231 iii Ph. D. Thesis – J. Skye; McMaster University – Anthropology. ABSTRACT Urban Aboriginal health and health-related issues are steeped within the sociohistorical, sociocultural, and sociopolitical experiences of Aboriginal peoples since European contact. Thus, urban Aboriginal health issues are very complex in that they consist of aspects associated with collective as well as individual cultural and political life experiences. Therefore, in order to adequately address Aboriginal health issues a comprehensive and multidisciplinary approach is required. This study examines how Anishnawbe Health Toronto, an urban Aboriginal community health centre, addresses the specific healthcare needs of the urban population through a multidisciplinary culturally appropriate healthcare model. As my research evolved, a few themes emerged from the data. First, the health issues experienced by the clientele were inherently complex and simultaneously infused with a culturally collective and individualistic quality. Second, practitioners acknowledged and addressed the complex nature of the clients’ health problems through a unique model of health care created at the centre. Third, the philosophy, infrastructure, and model of health care at Anishnawbe Health Toronto goes beyond the notion of merely offering access to both systems of health care, and instead constitutes an innovative and culturally appropriate system of care which is under Aboriginal control, development and implementation. Therefore, through my analysis of these themes, I conclude that the model of health care developed at the centre is an example of complex solutions designed to address complex Aboriginal health issues and as a result, facilitate the embodiment of self-determination in the area of health care. iv Ph. D. Thesis – J. Skye; McMaster University – Anthropology. ACKNOWLEDGEMENTS Research for this project was made possible through the University of Toronto/McMaster University Indigenous Health Research Development Program Graduate Scholarship, funded by the Canadian Institutes of Health Research-Institute of Aboriginal People’s Health and a Graduate Scholarship from the Anthropology Department at McMaster University. Words cannot express the gratitude and appreciation I have for my supervisor, Dr. Wayne Warry, for all of his guidance, support and patience throughout the duration of this thesis. I would also like to thank the members of my advisory committee, Dr. Dawn Martin-Hill and Dr. Dorothy Pawluch, for their sage advice and contributions to the construction of the thesis. I wish to extend my deepest gratitude to Joe Hester and the staff at Anishnawbe Health Toronto for all of their help and contributions to this research project. I would also like to sincerely thank all of the clients for having the courage to share their healing journeys with me and participate in this project. I would also like to take the opportunity to acknowledge that my research and the completion of the thesis would not have been possible without the love and support of my beautiful wife Aimee and my wonderful daughters Jadelyn, Cheyenne, and Jocelyn. I know at times my graduate work has been very difficult for my family to endure, especially Aimee who had to relocate without me while continuing to support me every step of the way. I will never forget what you have done for me and I promise to do my v Ph. D. Thesis – J. Skye; McMaster University – Anthropology. best to make it up to you. And to my precious daughter Cheyenne who had to go six weeks without her Daddy, the emotional turmoil I had to endure to be separated from my baby girl was excruciating and it still breaks my heart to this day. Words cannot express the emotions I feel as I sit here and reflect on that phase of our lives. As the tears fill my eyes and I become overwhelmed with emotion, all I can say is please hang on babe, I am doing everything I can to make it better and just like I promised Mommy, I will make it up to you, I swear. I am very lucky to have my wife and kids in my life and I cannot thank them enough for their love and for always being my greatest source of motivation and inspiration. I also would like to thank my sister Shawnee for being the best sister a guy could ever have. Many, many thanks for all of your help with transcription and for loaning me your car in times of need. I also want to thank my family for all of their love and support: Ray, Wilma, Mike, Pat-C, Terri, Shawnee, Brandon, Ruth, Edgar, Mary Lee, Warren, Norine and Brad. I would also like to express my gratitude to my beautiful nieces and nephew for their love and support: Karly, Erica, Emily, Bryce, Sydney and Aidan. vi Ph. D. Thesis – J. Skye; McMaster University – Anthropology. TABLE OF CONTENTS Descriptive Note iii Abstract iv Acknowledgements v 1. Introduction 1 1.1 Theoretical Orientation 4 1.2 Situating the Research 7 1.3 The Western Biomedical System 9 1.4 Complementary and Alternative Medicine 14 1.5 Issues with Defining Complementary and Alternative Medicine 16 1.6 Who is using CAM and Why? 20 1.7 Traditional Indigenous Healing 23 1.8 Anishnawbe Health Toronto 29 1.9 Contextualizing the Urban Aboriginal 31 1.10 Methodology 33 1.11 Ethical Considerations 39 1.12 Structure of the Thesis 40 1.13 The Healers 43 1.14 Notes on Ceremonies 43 1.15 Contextualizing Quotes 45 1.16 Notes on Terminology 45 Chapter 1 Notes 47 2. The Role of Contact and Colonialism on Aboriginal Health Issues 48 2.1 Aboriginal Pre-contact Health and Disease 49 2.2 The Impact of the Fur Trade: Cultural Change and Disease 52 2.3 Shifts in Disease 60 2.4 Conclusions 64 Chapter 2 Notes 66 3. The Embodiment of Medical Self-Determination 67 3.1 A Culturally Appropriate Approach to Urban Aboriginal Mental Health 67 3.2 Traditional Indigenous Healing within the Context of AHT 74 3.3 Practitioners, Patients, and the Pluralistic Approach 81 3.4 Challenges: The Co-existence of Two Approaches 90 3.5 Maintaining a Traditional Approach Through the Embodiment of Medical Self-Determination 101 3.6 Conclusions 107 Chapter 3 Notes 111 vii Ph. D. Thesis – J. Skye; McMaster University – Anthropology. 4. Aboriginal Mental Health: Issues and a Culturally Appropriate Approach 112 4.1 The Clientele: Mental Health 113 4.2 Concurrent Disorders 128 4.3 Discussion and Conclusions 130 Chapter 4 Notes 132 5. Ceremony and Spirituality: Healing the Spirit, Mind, and Emotions 133 5.1 Smudging: Sacred Smoke 133 5.2 The Smudging Ceremony 135 5.3 Traditional Healers: Smudging and its Purpose 136 5.4 The Clientele: Smudging and Mental Cleansing 139 5.5 Traditional Counselors and Mental Health Workers: Smudging and Mental Health 143 5.6 Biomedical Practitioners: Incorporating Smudging 145 5.7 External Interviews: Incorporating Cultural Beliefs and Practices 150 5.8 The Sweat Lodge 153 5.9 Traditional Healers and the Sweat Lodge 155 5.10 The Clientele and the Sweat Lodge 159 5.11 The Shake Tent or Conjuring Lodge 165 5.12 The Yuwipi or Tie Up Ceremony 167 5.13 Personal Experiences and Observations 168 5.14 Conclusions 175 Chapter 5 Notes 179 6. Conclusions 180 Bibliography 191 Appendices Appendix A: Programs and Services offered at Anishnawbe 206 Health Toronto Appendix B: Research Participant Recruitment Poster 213 Appendix C: Research Participant Intake Questionnaires 214 Appendix D: Client Demographic Data 218 viii Ph. D. Thesis – J. Skye; McMaster University – Anthropology. 1. Introduction The conception and rationale for this project evolved in part from my previous research experience at Anishnawbe Health Toronto (AHT). In 2004-05, I conducted research at the centre as a requirement for my Master of Arts degree at McMaster University. The research for my M.A. thesis focused on how cultural identity affects the overall health and well-being of individuals. My examination illustrated that for the majority of clients, the affirmation or establishment of an Aboriginal identity enhanced their ability to effectively address their particular health issues by creating a cultural foundation through which they utilize a culturally appropriate approach to their health care. In addition, my research demonstrated that urban Aboriginal health and related issues are mired in the sociohistorical, sociocultural, and sociopolitical experiences of Aboriginal peoples since European contact. From its inception, AHT has continued to refine and develop its multidisciplinary healthcare model and implement a growing number of services in various areas of health care to adequately address the needs of the urban Aboriginal population in Toronto. For my PhD project, I wanted to examine how various aspects of Western biomedical and traditional Indigenous healing systems are utilized within a medical pluralistic approach for urban Aboriginal health and well-being. However, I also realized that given the sheer volume of health related services offered at the centre, an all-inclusive investigation was far beyond the scope of a PhD project.