This ethnographic study in medical anthropology is a critically interpretative analysis of fieldwork documentation I recorded during field research conducted in the mining city of Mount Isa in the far northwest of Queensland during the 1980s. Eighteen months of participant observation research was undertaken over four fieldtrips (1981-82, 1983, 1985 and 1988) at inter-connected locations: two urban reserves for Aborigines and the people I refer to as the Reserve Dwellers, as well as the local hospital and a group of hospital resident medical officers who I refer to as the Residents. During the field research I found that both Reserve Dwellers and the Residents experienced a difficult relationship during their interactions in medical consultations in the hospital clinics. Now in this dissertation I ask an overarching question of my time-lag field data. It is How can we understand the problematic relationship between indigenous reserve-dwelling help-seekers and biomedical practitioners at their local hospital clinics in the 1980s. To describe this problematic relationship I analyse time-lag data from my diaried participant observation at both the reserves and the hospital; semi-structured interviews with the hospital Residents; case studies and case histories of consenting help-seekers from the Reserves; and illustrative transcriptions of consultations between Residents and Reserve Dwellers that were tape recorded by the Residents during hospital clinics. The contemporary ethnomedical system of the Reserve Dwellers was inclusive of biomedicalized clinics and the Residents as clinicians at this remote hospital in the 1980s. I provide an ethnographic account of a changing contemporary indigenous ethnomedical system and describe the lifeways of the Reserve Dwellers in the 1980s; their pattern of help-seeking at their local hospital including grievous happenings; and their experiences in outpatients clinics and the emergency section of the local non-indigenous hospital. Their lifeways and help-seeking were in many ways defined by the collective sociality of Kalkadunga and other regional indigenous cultures as impoverished, very sick survivors of a genocidal contact history less than 100 years before. This local history is also reconstructed. The Residents view of local indigenous illness, help-seeking, and experiences of biomedicalised hospital clinics further describe the socio-cultural reality of the time. I found that the Residents had an insightful, even predictive assessment of local illness burden. At the same time, they held strong views about a pattern of help-seeking in the outpatients and emergency clinics that was considered disruptive of hospital routines. I also describe how they expressed their difficulties interacting with Aboriginal help-seekers including the taking of biomedical histories. My thesis is that a localized socio-clinical reality was shaped by a synchronic, coeval relationship between Reserve Dwellers enculturated within a changing, contemporary ethnomedical belief system that incorporated biomedicalized hospital clinics, and the Residents as clinicians enculturated within a culture of biomedical science at a remote hospital. I argue that the lifeways and pattern of help-seeking of the Reserve Dwellers, as well as the Residents’ views about sick indigenous help-seekers, formed this particular socio-clinical reality. It was then consistently replicated by problematic socio-clinical interaction and biomedicalized praxis that inhibited investigation and curative outcomes for the Reserve Dwellers and other indigenous help-seekers.

Doctor of Philosophy(PhD) / Indigenous health is one of the most pressing issues confronting contemporary Australian society. In recent years government officials, medical practitioners, and media commentators have repeatedly drawn attention to the vast discrepancies in health outcomes between Indigenous and non-Indigenous Australians. However a comprehensive discussion of Aboriginal health is often hampered by a lack of historical analysis. Accordingly this thesis is a historical response to the current Aboriginal health crisis and examines the impact of colonisation on Aboriginal bodies in Queensland during the early to mid twentieth century. Drawing upon a wide range of archival sources, including government correspondence, medical records, personal diaries and letters, maps and photographs, I examine how the exclusion of Aboriginal people from white society contributed to the creation of racially segregated medical institutions. I examine four such government-run institutions, which catered for Aboriginal health and disease during the period 1900-1970. The four institutions I examine – Barambah Aboriginal Settlement, Peel Island Lazaret, Fantome Island lock hospital and Fantome Island leprosarium – constituted the essence of the Queensland Government’s Aboriginal health policies throughout this time period. The Queensland Government’s health policies and procedures signified more than a benevolent interest in Aboriginal health, and were linked with Aboriginal (racial) management strategies. Popular perceptions of Aborigines as immoral and diseased directly affected the nature and focus of government health services to Aboriginal people. In particular the Chief Protector of Aboriginals Office’s uneven allocation of resources to medical segregation facilities and disease controls, at the expense of other more pressing health issues, specifically nutrition, sanitation, and maternal and child health, materially contributed to Aboriginal ill health. This thesis explores the purpose and rationales, which informed the provision of health services to Aboriginal people. The Queensland Government officials responsible for Aboriginal health, unlike the medical authorities involved in the management of white health, did not labour under the task of ensuring the liberty of their subjects but rather were empowered to employ coercive technologies long since abandoned in the wider medical culture. This particularly evident in the Queensland Government’s unwillingness to relinquish or lessen its control over diseased Aboriginal bodies and the continuation of its Aboriginal-only medical isolation facilities in the second half of the twentieth century. At a time when medical professionals and government officials throughout Australia were almost universally renouncing institutional medical solutions in favour of more community-based approaches to ill health and diseases, the Queensland Government was pushing for the creation of new, and the continuation of existing, medical segregation facilities for Aboriginal patients. In Queensland the management of health involved inherently spatialised and racialised practices. However spaces of Aboriginal segregation did not arise out of an uncomplicated or consistent rationale of racial segregation. Rather the micro-histories of Fantome Island leprosarium, Peel Island Lazaret, Fantome Island lock hospital and Barambah Aboriginal Settlement demonstrate that competing logics of disease quarantine, reform, punishment and race management all influenced the ways in which the Government chose to categorise, situate and manage Aboriginal people (their bodies, health and diseases). Evidence that the enterprise of public health was, and still is, closely aligned with the governance of populations.

The life expectancy (LE) gap experienced by Aboriginal and Torres Strait Islander peoples in one of Australians most enduring health divides. Whilst there are many likely reasons, cardiovascular diseases (CVD) stand as the primary contributor. In particular, it is the almost ten-fold higher mortality from CVD at young ages that distinguishes this epidemic. The reasons for this disparity remain incompletely understood. Current research has focused on the likely contribution of traditional risk factor burdens in Aboriginal people, who demonstrate higher levels of smoking, obesity, hypertension and dyslipidaemia. Less attention has focused on the potential contribution of disadvantage and its interplay with psychosocial factors. Research on the psychosocial determinants of health, particularly in relation to CVD, has a long pedigree. Social context, particularly inequality between individuals, has assumed its rightful place at the forefront of our understandings of population levels of disease. Among them, socioeconomic position [SEP] and depression are the most robust, and most widely researched. They have not been adequately explored in the context of Aboriginal Australians, nor has the manner in which culture shapes, sustains or transforms disadvantage and psychosocial stress been outlined. The objective of the Men Hearts and Minds (MHM) Study was to identify the possible ways in which social disadvantage may lead to CVD in Aboriginal men in Central Australia and consider the role of psychosocial factors in modifying or mediating this relationship. This required a detailed and multi-disciplinary plan of research, covering the epidemiology of mental illness and chronic diseases, biomedical science, ethnographic field work and qualitative methodologies. Stage I required the development of measurement tools for exploring depression, stress, resilience, mastery and socioeconomic indicators that were valid and robust for use with Aboriginal men within Central Australia. This involved multi-stage qualitative techniques, engaging Aboriginal men, traditional healers (Ngangkari Tjuta) and mental health experts, to define the expressions and construction of mental illness in Aboriginal men. Depression existed, was recognizable, common, and had profound impacts on the social, emotional and physical well-being of Aboriginal men. ‘Worry’ was the most recognisable element, and the principle contributor to depression in Aboriginal men. Much of this was focused on the increasingly heavy and cumulative social and cultural burdens experienced throughout Aboriginal men’s lives, and manifest as a sense of inner turmoil and questioning of self, and of feelings of disconnectedness from all the things of critical importance within their lives. Kurunpa [spirit] was seen as the foundation of vitality and was critical to the physical, emotional and spiritual well-being of Aboriginal people. These findings were then used to interrogate existing psychological testing tools and develop novel measures to explore the interplay of SEP, stress and depression. These tools were then used in a community dwelling sample of Aboriginal men in Central Australia to explore the interaction of SEP, stress and depression and their potential contribution to CVD risk. In total 186 Aboriginal men across urban and remote community settings were assessed. Almost 40% of the sample had elevated depressive symptoms. Depression was highly correlated with standard measures of distress and inversely with mastery. Newly created measures, assessing Chronic Stress, the ‘Sense of Injury’ and deprivation, were highly correlated, reliable and fulfilled many validity criteria. There was a high level of cardiovascular risk, which was related to a number of psychosocial factors, particularly depression. Major depression was over 9 times as common in individuals with prevalent CVD. Cardiovascular risk was patterned across social strata, but not evident with the use of routine measures of SEP. Psychosocial factors modified the observed social gradient. In those with high chronic stress, the social gradient in CVD risk gradient was amplified. This pattern was mirrored in those who had been removed or had family forcible removed. Depression was correlated with a number of atherogenic pathways. Smokers were more likely to be depressed, and depression was strongly related to obesity. Individual with high depression scores were more than 20 times more likely to have a Body Mass Index >30. The interplay between the Autonomic Nervous System (ANS) (estimated with measures of Heart Rate Variability) and the Hypothalamic Pituitary Adrenal (HPA) axis (as measured according to obesity) highlights the interconnections across atherogenic pathways and may frame the cardiometabolic risk and psychosocial pathways to cardiovascular disease in this sample. The phenomenology of cumulative stress, distress and depression within the narratives of Aboriginal men constructed illness as a consequence of the ongoing fight to maintain balance - physically, emotionally and spiritually. From both a social and biological perspective, the construction of depression and heart disease as a consequence of cumulative chronic stress among Aboriginal men was supported in the findings of this work.

Made available in DSpace on 2015-04-22T21:56:07Z (GMT). No. of bitstreams: 1 DISSERTACAO NOELI.pdf: 358119 bytes, checksum: 8be74b1b1bad6956d31b96b03baffc18 (MD5) Previous issue date: 2008-07-21 / Fundação de Amparo à Pesquisa do Estado do Amazonas / The present study aims to know the Social Representations of the 8 th period students of the graduation course in Nursing of a Federal, State and Particular educational institution of the city of Manaus AM, in the year 2007. The collection of data con sisted on the accomplishment of interviews, using half -structuralized questions applied on 57 students and inquiry of the curricular structure of the graduation course of the 03 educational institutions that had participated of the research. For the questi ons most subjective the data had been analyzed by multidimensional statistical methods (SSA) based on the Facet Theory, whereas the questions most objective the data had been presented and argued through graphs and tables. The results had displayed that th is group of students has a stigmatized representation in relation to the indigenous, at the same time it did not relate the Nursing Assistance Systematization - SAE as work methodology to be used by the nursing team of the hospitalized indigenous. This st udy, through a bigger understanding of the students concerning the indigenous, makes possible to think about new perspectives of formation, searching to create spaces so that the differences are democratically dialogued both in the academic circle as in the surrounding social field. / O presente estudo tem por finalidade conhecer as representações Sociais sobre os povos indígenas dos alunos do 8º período do curso de gra duação em enfermagem de instituições de ensino Federal, Estadual e Particular da cidade de Manaus AM. A coleta dos dados consistiu na realização de entrevistas, utilizando questões semi -estruturadas com 57 alunos e na investigação da estrutura curricular do curso de graduação das 03 instituições de ensino que participaram da pesquisa. Para as questões mais subjetivas os dados foram analisados por métodos estatísticos multidimensionais (SSA) baseados na Teoria das Facetas, enquanto que para as questões mais objetivas os dados foram apresentados e discutidos através de gráficos e tabelas. Os resultados apontaram que este grupo de alunos possui uma representação estigmatizada em relação ao índio, ao mesmo tempo em que não relacionou a Sistematização da Assistência de Enfermagem SAE como metodologia de trabalho a ser utilizada pela equipe de enfermagem ao indígena hospitalizado. Este estudo, através de uma maior compreensão dos alunos acerca dos povos indígenas, possibilita pensar em novas perspectivas de formação, buscando criar espaços para que as diferenças sejam democraticamente dialogadas tanto no meio acadêmico quanto nos demais ambientes sociais.

Despite the development of an Aboriginal Healing and Wellness Strategy (AHWS), which implemented Aboriginal Health Access Centres (AHACs) to provide integrated healthcare including both mainstream and traditional services, health inequalities persist among the urban Aboriginal population in Ontario. There are multiple social determinants of health (SDOH) besides access to healthcare that affect Aboriginal health. The objectives of this study were to describe the past and current policy strategies to address Aboriginal health in Ontario, and to investigate the ways that service providers perceive health inequalities, demonstrating whether the SDOH are considered in service provision to urban Aboriginal clients. In addition to a document review, interviews were held with representatives from three provincial ministries involved with the AHWS. Through a community engagement research strategy, nine semi-structured interviews were conducted with service providers from various departments within an urban AHAC. Interviews were analyzed using a modified grounded theory, which was guided by the SDOH framework. In understanding policy development, themes included: collaboration with Aboriginal communities and improving access to holistic care. In approaching service provision, themes included: perceived health inequalities and their determinants, what is being done and what must be done to address health inequalities and the use of the SDOH framework in practice. Findings suggest that service providers accurately identify the health needs of their clients, and utilize the SDOH to understand the causes of inequalities, however the SDOH cannot be fully addressed at the service provision level. The SDOH framework must be utilized at the policy level, in order to effectively address the wider determinants of health through intersectoral collaboration between provincial ministries and Aboriginal communities. / Thesis / Master of Arts (MA)

Background: Aboriginal peoples face disproportionate health inequalities in comparison to non-Aboriginal Canadians, especially in regards to cardiovascular disease risk factors. Evidence illustrates that the propensity to develop these chronic diseases happens during the perinatal period. Related to this are maternal health behaviours—which are influenced by grandmothers’ advice. Very few studies have explored Aboriginal grandmothers’ beliefs around perinatal health or how they translate into maternal health behaviours. Objectives: The objectives of this thesis were to: 1) Qualitatively explore the beliefs and cultural perceptions around prenatal and postnatal health behaviours from the accounts of Grandmothers from the Six Nations reserve; 2) Incorporate the emergent themes to develop a theoretical framework; 3) Design and apply culturally-respectful avenues for knowledge translation. Methods: Qualitative, semi-structured individual interviews and focus groups were conducted with grandmothers from the Six Nations reserve. Sampling of participants used non-probabilistic methods. Recruitment was achieved through the leadership of community members and continued until saturation. All interviews were audio-recorded, transcribed verbatim, and underwent thematic analysis. A Six Nations community member was involved with the coding process and additional interviews were conducted to ensure member-checking. Results: Six Nations grandmothers identified three primary perinatal beliefs: 1) Pregnancy is a natural phase of the life course that is not an illness nor a “comfort zone”; 2) Pregnancy is a sacred period where balance is key; 3) Optimal perinatal health is achieved through immunity, security, comfort, social development, and parental responsibility. This knowledge is shared via storytelling and observational teaching. In addition, the grandmothers identified local community responsibilities required to uphold optimal health. Consultation with the community resulted in an integrated knowledge translation component (short film) for key stakeholders. Conclusion: Building resilience and strength through culturally-generated interventions will guide the future of community-based programs and policies that aim to reduce cardiometabolic risk factors in this Aboriginal community. / Thesis / Master of Science (MSc)

<p>The purpose of this dissertation is to discuss and evaluate processes and institutional structures that influence relationships between Aboriginal communities and government in the development, implementation, and evaluation of health policy. It explores the changing nature of Aboriginal health policy and politics in Canada and examines the shift to self-determination that has transpired in Canada’s Aboriginal health policies focusing on their application to Aboriginal peoples. This dissertation examines two Aboriginal health policies in Canada: the federal health transfer policy and Ontario’s Aboriginal Healing and Wellness Strategy. Both policies are intended to improve health at the community level by supporting the development of community-based and culturally appropriate health programs. Thus, using community-based research methods, this dissertation maps some of the key political stakeholders in Aboriginal health policy, from local level community members and health representatives to peak provincial and federal Aboriginal organizations, to the offices of ministers in Canadian parliament. I reflect upon the processes and institutional structures that shape relationships between the Aboriginal community-controlled health sector and government.</p> <p>I examine several First Nations communities in northern Ontario involving both federal and provincially supported initiatives to illustrate the strengths, weaknesses and paradoxes that surface from the implementation of locally controlled health programs. I contrast these efforts with a second First Nations community in Manitoba that operates solely under the federal health transfer policy. I juxtapose these two communities to assess whether additional layers of community-controlled initiatives make tangible differences to community wellness; particularly for Aboriginal peoples living off reserve. This dissertation is being written under the theoretical assumption that governance and community wellness are intrinsically linked. Arguably, there is a definitive correlation between self-determination and community well-being; self-determination may be a determining factor in improving conditions for Aboriginal peoples and understanding resiliency.</p> <p>This dissertation is about a long lasting colonial legacy of social inequalities in Aboriginal health but also about the incredible successes in Aboriginal health. It is also about the many challenges of Aboriginal representation and self-determination in the context of contemporary Canadian society.</p> / Doctor of Philosophy (PhD)

Background: Food nourishes us, sustains us, and has the potential to both heal us and make us sick. Among many Indigenous cultures, traditional activities, ceremonies, events and practices often involve or use food, grounding Indigenous peoples within the context of their local, natural surroundings. This suggests that food is important not only for physical health, but also emotional, mental and spiritual health. The relationships that Indigenous peoples have with food can help us to understand the health of individuals, and the communities in which they live. Purpose: The following qualitative study explores how three generations of adults who live in one Labrador Inuit-Metis community experience and understand their relationships to food in a context of global change. Theoretical Orientation: The research is guided by Two-Eyed Seeing. Two-Eyed Seeing acknowledges that there are many different ways of seeing and understanding the world, some of which can be encompassed through a Western eye and some through an Indigenous eye. If we learn to see through both eyes, we can gain a perspective that looks very different than if we only view the world through a single lens. Methods: For the study, twenty-four people from the south-eastern Labrador community of St. Lewis participated in individual and joint story-telling sessions. A group story-telling session also took place where community members could share their stories with one another. During many of the story-telling sessions, participants shared photographs, which helped to illustrate their relationships to food. Findings/Discussion: Historically, the people of St. Lewis relied almost entirely upon their own wherewithal for food, with few, if any, government services available and very little assistance from the market economy. This fostered and upheld an Inuit-Metis culture that promoted sharing, reciprocity and respect for the natural world. Currently, greater access to government services and the market economy has led to the creation of certain policies and programs that undermine or ignore established social and cultural norms in the community. Conclusions: Existing Inuit-Metis knowledge should work alongside non-Indigenous approaches to policy and program development. This would serve to protect and promote the health of both individuals and communities.

Background: Food nourishes us, sustains us, and has the potential to both heal us and make us sick. Among many Indigenous cultures, traditional activities, ceremonies, events and practices often involve or use food, grounding Indigenous peoples within the context of their local, natural surroundings. This suggests that food is important not only for physical health, but also emotional, mental and spiritual health. The relationships that Indigenous peoples have with food can help us to understand the health of individuals, and the communities in which they live. Purpose: The following qualitative study explores how three generations of adults who live in one Labrador Inuit-Metis community experience and understand their relationships to food in a context of global change. Theoretical Orientation: The research is guided by Two-Eyed Seeing. Two-Eyed Seeing acknowledges that there are many different ways of seeing and understanding the world, some of which can be encompassed through a ‘Western eye’ and some through an ‘Indigenous eye.’ If we learn to see through both eyes, we can gain a perspective that looks very different than if we only view the world through a single lens. Methods: For the study, twenty-four people from the south-eastern Labrador community of St. Lewis participated in individual and joint story-telling sessions. A group story-telling session also took place where community members could share their stories with one another. During many of the story-telling sessions, participants shared photographs, which helped to illustrate their relationships to food. Findings/Discussion: Historically, the people of St. Lewis relied almost entirely upon their own wherewithal for food, with few, if any, government services available and very little assistance from the market economy. This fostered and upheld an Inuit-Metis culture that promoted sharing, reciprocity and respect for the natural world. Currently, greater access to government services and the market economy has led to the creation of certain policies and programs that undermine or ignore established social and cultural norms in the community. Conclusions: Existing Inuit-Metis knowledge should work alongside non-Indigenous approaches to policy and program development. This would serve to protect and promote the health of both individuals and communities.

Thesis (Ph.D.)--Yale University, 2004. / Presented to the Faculty of the Graduate School of Yale University in candidacy for the degree of Doctor of Philosophy. Includes bibliography. Preview available online at: http://proquest.umi.com/pqdlink?did=765029031&Fmt=7&clientId%20=43258&RQT=309&VName=PQD.