herbs. In anchoring this chapter on current issues, information from a
Saqamaw (chief) of a Canadian aboriginal reserve is noted in a number of
places (the reserve is the Conne River Reserve [the Miawpukek First Nation]
in Newfoundland, Canada); however, it reflects the efforts among many
aboriginal peoples to revitalise traditions and values, while situating them in
the development of modern communities.^3 Any approach to aboriginal health-
care needs to understand the revival of interest in recent decades in traditional
customs and practices.
In considering topics that healthcare providers in the USA and Canada face
with aboriginal patients, this chapter is directed primarily at practitioners who
are generally unfamiliar with native concerns and practices.^4 The focus is also
on questions from aboriginal patients living off reserves, commonly in urban
locations, rather than on the medical services on reserves.^5 One reason for this
is that, since the 1960s to 1970s, aboriginal people living off as well as on
reserves have been taking increasing interest in their traditional ways of
healing that embraced magico-religious/spiritual ceremonies, herbs and
lifestyles. Today’s rediscovery of many traditions and values only minimally
rebalances a long history of aboriginal acculturation driven by North
American governments, church policies and broad social changes.^6
The reinvigoration of aboriginal traditions, alongside continuing social
hardships for many aboriginal people in North America, has coincided with
a new focus – albeit not consistent – on educating health professionals
about multicultural issues and cultural sensitivity.^7 Unfortunately, however,
cultural sensitivity does not necessarily lead to easy, non-judgemental deci-
sion-making. Dilemmas can arise for healthcare practitioners when non-
conventional practices fail to meet the standards of efficacy and safety
acceptable to ‘evidence-based medicine’ (EBM), which, since the 1990s, has
been commonly accepted as a new era in healthcare. Although the thrust of
the chapter is directed at practitioners of conventional healthcare – in a
doctor’s surgery, hospital ward, pharmacy, etc. – it also applies to the
growing numbers of practitioners of complementary and alternative medi-
cine (CAM) who increasingly face the challenges of EBM and meet the same
cultural issues as other practitioners.
There is no doubt that EBM, with critical and systematic approaches to
evaluating clinical practice and research, has sharpened opinions that much
of traditional medicine (and of CAM) is merely anecdotal and at best
placebo. As a result of this, conventional practitioners are known to side-
step discussion with patients on any ‘unproven’, ‘alternative’ or ‘unscien-
tific’ practice by peremptorily dismissing it as being outside the scope of
their practice. Other practitioners, however, in being ‘pragmatic’, tell a
patient (unless safety concerns are obvious): ‘If it helps, it’s OK with me.’
Unfortunately, this response, often as a result of ‘sitting on the fence’, can
appear glib and dismissive to a patient.
Aboriginal/traditional medicine in North America | 45