The legacy of historical trauma continues to plague Indigenous populations throughout the world. This theoretical dissertation describes how biology (neurodevelopment, neurobiology and endocrinology) and culture (inter-generationally learned behaviors) are intricately intertwined in the development of dysfunctional coping behaviors that contribute to stress-related chronic diseases (heart disease, obesity, type II diabetes mellitus, depression, neurodegenerative disorders and memory impairment) in some individuals. The primary impact of the many episodes of historically traumatic genocide has been post-traumatic stress disorder (PTSD) and the onset of dysregulation of the hypothalamic-pituitary-adrenal axis (HPA-axis). PTSD has had a profound impact on relationships and behaviors, while dysregulation of the HPA-axis is associated with pathophysiology. It is well documented that historical trauma has caused a cultural disconnect from traditional wellness and healing practices. Despite incredible resiliency, the result of this legacy has been a genesis of intergenerational, dysfunctional, coping strategies that have become subtly engrained in a viscous cycle of self-perpetuating, self-inflicting, dysfunctional behaviors that have been carried forward into the next generation as "toxic stress" - in the form of childhood abuse, domestic violence, interpersonal violence, and substance abuse. With time, the association to the initial traumatic assault erodes, leaving behind, collectively, a fragmented society that, in many places, has become the basis for a "cultural crisis". The approach presented in this dissertation is founded upon: 1) cultural acquisition theories that describe how existing cultural constructs and traditions are internalized by children and repeated throughout a life-time into the next generation; and 2) understanding the interaction of the autonomic nervous system (specifically, the HPA-axis and its activation by stress) and the neocortex, the basis for higher psychological processes associated with learning and cultural acquisition. This dissertation offers an explanation for the continued impact of historically traumatic events on the contemporary health and wellness of American Indian and Alaska Native people. It is hoped that this approach leads to specific intervention and prevention measures that are culturally relevant in addressing pathophysiology, cognitive-behavioral issues and the collective cultural changes that have ensued as a result of historical trauma.

The purpose of this study was to ascertain the current status of healthcare delivery on American Indian reservations. In particular, the study sought to determine if the Indian Health Service was actually meeting its goals in delivering healthcare to American Indians, and if not, were there alternatives to public medicine for healthcare? The Indian Health Service has not met its own goals in delivering healthcare, and private medicine in the form of private practicing physicians and other medical personnel have filled the void left by the Indian Health Service. The study also discusses the possibility of private medicine being the only realistic alternative in the future for Indian healthcare delivery.

abstract: Due to the history of colonization, disruption of Indigenous life ways, and encroachment of external Western ideals and practices upon tribal peoples in New Mexico, the protection and preservation of tribal customs, values, traditions, and ways of thinking are critical to the continued existence of the tribes. It has taken many years for tribal communities, such as the 19 Pueblos of New Mexico, to get to where they find themselves today: In a paradoxical situation stemming from the fact that Pueblo people are told to pursue the iconic American Dream, which was not actually designed or intended for tribal peoples and that always seems to be just out of reach for many community members. Yet many of them do their best to emulate the capitalistic consumption and the Western way of life. What is troubling about this is that perhaps many of these people are starting to forget that it was the strength of their ancestors and their dreams that allowed Pueblo people to be here today. So, how do Pueblo people address this paradox? How do they begin to give newer generations, such as the youth, the tools to question and to assess future programs and the future of the tribal communities? Furthermore, what does such a process of preserving and reclaiming mean for future governance? Are these communities prepared to accept the outcomes? This compilation seeks to address these issues by examining a) the creation and delivery of Western medicine for American Indians in New Mexico and b) a discussion of Pueblo culture and belief systems. The exploration will include not only discussing health and health care concerns, but it will also engage the future considerations that tribal governments in New Mexico, specifically Pueblo Indian communities, must reflect on to ensure the preservation of the culture and values of Pueblo people. Finally, specific recommendations for action and discussion will be delivered in the form of a policy paper that is designed for tribal leadership and tribal administrative audiences and suggested for implementation. / Dissertation/Thesis / Doctoral Dissertation Social Justice and Human Rights 2015

abstract: American Indian literature is replete with language that refers to broken or hollow promises the US government has made to American Indians, one of the most prominent being that the US government has not kept its promises regarding health services for American Indians/Alaska Natives (AI/AN). Some commenters refer to treaties between tribes and the US government as the origin of the promise for health services to AI/AN. Others point to the trust relationship between the sovereign nations of American Indian tribes and the US government, while still others assert that the Snyder Act of 1921 or the Indian Health Care Improvement Act (IHCIA) contained the promise for health care. While the US has provided some form of health care for AI/AN since the country was in its infancy, and continues to do so through the Indian Health Service, the promise of health services for AI/AN is not explicit. Philosophers have articulated that a promise contains a moral obligation to fulfill it because of others’ expectations created by that promise. As the US government made its first promises in early treaties with AI/AN tribes and subsequently made promises in the years since, it is morally obligated to fulfill those promises, be they lying promises or not, because of resulting expectations. Yet, the US government has historically acted to restrict the rights of AI/AN—rights that include access to health services—through assimilation, separation, or termination policies. Further, the policies of the US government have kept the AI/AN populations socioeconomically impoverished, dependent on the US government for basic needs, and susceptible to health-compromising conditions. Using case studies, this dissertation looks not only at the policies and events that directly affected health services and health status, but also at how those policies and events contributed to health outcomes and the expectations of AI/AN. Given the history of the US government in fulfilling (or not fulfilling) its promises, this dissertation examines the expectations of AI/AN for their own future health outcomes under the policy of self-governance. / Dissertation/Thesis / Doctoral Dissertation Biology 2016

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este trabalho é um estudo sobre os usos de bebidas alcoólicas pelos Yawari, subgrupo Yanomami, moradores da região do rio Ajarani, Roraima, Brasil, buscando situá-lo no contexto histórico e na dinâmica sociocultural das relações interétnicas. O referencial teórico metodológico para entendimento do tema baseou-se na proposta integradora que articula três linhas conceituais: dependência, processo de alcoolização e problemas relacionados ao uso do álcool. Para aplicação da pesquisa optou-se pelo método qualitativo privilegiando a observação e entrevista em profundidade, tendo como referência trabalhos de autores da antropologia (etnografia Yanomami), saúde coletiva e epidemiologia. Foram realizadas pesquisa bibliográfica e consultas a sites de organizações governamentais e não governamentais. As entrevistas foram aplicadas a lideranças, indígenas e outras pessoas que conviveram ou trabalharam ao longo dos anos com os Yanomami. A partir desse estudo foi possível identificar os fatores associados ao consumo, estratégias para conseguir a bebida e para conter o abuso, substâncias consumidas, as circunstâncias, motivações e sentidos atribuídos ao uso de bebidas alcoólicas pelos indígenas. Dentre as três linhas conceituais: não se identificou Yawari com sintomas de Síndrome de Dependência ao uso do Álcool; como resultado dos problemas relacionados ao uso, verificou-se agravantes de saúde (física e psicológica) dos indivíduos. Identificou-se, ainda, aspectos positivos e negativos do uso de bebidas relacionados a comportamentos e normas internas. Conclui-se que o abuso de álcool na comunidade pesquisada é fenômeno coletivo e heterogêneo, que desempenha função construtiva e socializadora, mas está relacionado também à identidade negativa, ao preconceito da sociedade envolvente, à desagregação social, cultural e econômica da comunidade. / This work is a study about the use of alcoholic beverages by the Yawari, Yanomami sub-group, inhabitants of the Ajarani River region, Roraima, Brasil, seeking to frame them on the historic context, social and cultural dynamics of the interethnic relationships. The methodological theoretical referential to understand the theme was based on the integrative proposal, which link three conceptual lines: dependence, alcoholization process and problems related to the use of alcoholic beverages. In applying this search it was chosen the qualitative method, privileging the observation and deep interview questions, based in reference works of authors in anthropology (Yanomamis ethnography) collective health and epidemiology. Bibliographic research and consultations on websites of governmental organizations and non governmental organizations were undertaken. The interviews were applied to local leaders, indians and other people who lived or worked for many years with the Yanomami. From this study, it was possible to identify the associate factors of consumption, strategies to get the beverages and to refrain the abuse of alcohol, the consumed substances, the circumstances, motivations and senses attributed to use of alcoholic beverages by indians. Among the three conceptual lines, the Yawari were not identified with dependence syndrome to the use of alcohol; as a result of the problems related with excessive use of alcohol aggravating of health (physical and psychological) of individuals were verified. It was also identified some positive and negative views that were related to the use of alcoholic beverages associated to behaviour and internal rules. The misuse of alcohol in the researched community is a heterogeneous and collective phenomenon that play a constructive and socializing function, but it was also related to the negative identity, to the prejudice of the surrounding society, to the social, cultural and economic degradation of the community.

A prevalência de patógenos intestinais foi estudada entre os índios da etnia Tapirapé, da Amazônia mato-grossense, por meio de técnicas coproparasitológicas, imunológicas e moleculares. Do total de 1526 amostras, 83,35% apresentaram ao menos um parasito intestinal e 65% tinham mais de um parasito (poliparasitismo). Entamoeba coli foi o mais prevalente (827/1526 - 54,19%). Entamoeba histolytica/dispar (581/1526 - 38,07%), Giardia intestinalis (287/1526 - 18,81%), Blastocystis spp. (257/1526 - 16,84%) e Ancylostoma spp. (293/1526 - 19,20%) também foram freqüentes. Cistos de Giardia intestinalis foram seqüenciados utilizando os genes <font face=\"Symbol\">b-Giardina e gdh. Apenas os assemblages A e B foram encontrados, sendo que o assemblage A foi o mais prevalente. Análise molecular de Blastocystis spp. demonstrou que, por meio do gene SSU-rNA, o subtipo 1 foi o mais dominante entre os Tapirapé, seguido pelos subtipos 2 e 3. Com base nisso, G. intestinalis e Blastocystis spp. são potencialmente zoonóticos. Os resultados corroboram com outros estudos realizados na Amazônia brasileira. / The prevalence of intestinal pathogens was studied in indigenous of the Tapirapé ethnic from Amazon region of Mato Grosso State, using the coproparasitological, immunological and molecular. Of the total 1,526 fecal samples 83.35% had at least one intestinal parasite and 65% had more than one parasite (poliparasitism). The most prevalent parasite was Entamoeba coli (827/1526 - 54.19%). Entamoeba histolytica/dispar (581/1526 - 38, 07%), Giardia intestinalis (287/1526 - 18.81%), Blastocystis spp. (257/1526 - 16.84%) and Ancylostoma spp. (293/1526 -19.20%) were found too. Cysts of G. intestinalis were sequence by <font face=\"Symbol\">b-Giardina and GDH gene. Only assemblages A and B were found and assemblage A was the most prevalent. The molecular characterization of Blastocystis spp. by SSU-rRNA demonstrated that subtype 1 was dominant followed by subtypes 2 and 3. So, G. intestinalis and Blastocystis spp. are potentially zoonotic. The results are in agreement with previous studies conducted in the Brazilian Amazon.

Na última década ocorreram transformações positivas na saúde indígena brasileira. A saúde bucal é um dos temas relevantes da saúde indígena e carece de informações na literatura. O objetivo deste trabalho foi descrever o perfil de saúde bucal e sociodemográfico da população indígena Guarani do Rio Grande do Sul. Este é um estudo de prevalência com levantamento epidemiológico de saúde bucal e variáveis demográficas. Um total de 203 sujeitos em diferentes idades e faixas etárias e em 19 aldeias foram examinados. As crianças Guarani de cinco anos de idade apresentaram um índice de cárie (ceo-d) 2,8 com 37,7% destas crianças livres de cárie. Os adolescentes de 12 anos e de 15 a 19 apresentaram um CPO-D, respectivamente, de 1,31 e 3,39, sendo o maior percentual do índice aos 12 anos o componente cariado (C) com 54,3%; entre adolescentes de 15 a 19 anos é o obturado (O) com 49,4%. Entre os adultos na faixa etária de 35 a 44 anos o CPO-D médio foi de 11,55, sendo que o componente perdido (P) foi responsável por 69,3% do índice. Entre os idosos, faixa etária de 65 a 74 anos, o CPO-D médio foi de 18,58. Os dados desta investigação demonstram que a média do CPO-D nas diferentes idades e faixas etárias é mais baixa na população indígena Guarani indicando uma menor experiência de cárie dental do que a população em geral. Acesso ao creme dental fluoretado e uma política de saúde indígena diferenciada podem estar relacionados com estes resultados. No entanto é necessário mais pesquisa acercada influência de hábitos culturais sobre o processo saúde doença bucal destas populações. / Over the past decade, positive changes have occurred to Brazilian indigenous health. Oral health is one of the relevant issues of indigenous health, but there is a lack of information about it in literature. The aim of this paper is to describe the oral health and sociodemographic profile of the Guarani indigenous population in Rio Grande do Sul. This is a prevalence study using an epidemiological survey on oral health and demographic variables. A total of 203 subjects in 19 villages at different ages and in different age groups were examined. Five-year-old Guarani children showed a dental caries index (DEF) of 2.8, with 37.7% of these children being free of caries. Teenagers aged 12 and from 15 to 19 years showed a DMF index of 1.31 and 3.39, respectively, the highest rate at age 12 was for the decayed component (D), 54.3%; and among teenagers from 15 to 19 years, the filled component (F) had the highest rate, 49.4%. Among adults in the age group of 35 to 44 years, the mean DMF index was 11.55, and the missing component (M) accounted for 69.3%. Among the elderly, in the age group of 65 to 74 years, the mean DMF index was 18.58. The data from this investigation demonstrated that the mean DMF index at different ages and in different age groups was lower in the Guarani indigenous population, indicating a lower presence of dental caries than in the general population. Access to fluoridated dental cream and a specific indigenous health policy may be associated with these results. However, further studies on the influence of cultural habits on the process of oral health and disease among these populations are necessary.

A prevalência de patógenos intestinais foi estudada entre os índios da etnia Tapirapé, da Amazônia mato-grossense, por meio de técnicas coproparasitológicas, imunológicas e moleculares. Do total de 1526 amostras, 83,35% apresentaram ao menos um parasito intestinal e 65% tinham mais de um parasito (poliparasitismo). Entamoeba coli foi o mais prevalente (827/1526 - 54,19%). Entamoeba histolytica/dispar (581/1526 - 38,07%), Giardia intestinalis (287/1526 - 18,81%), Blastocystis spp. (257/1526 - 16,84%) e Ancylostoma spp. (293/1526 - 19,20%) também foram freqüentes. Cistos de Giardia intestinalis foram seqüenciados utilizando os genes <font face=\"Symbol\">b-Giardina e gdh. Apenas os assemblages A e B foram encontrados, sendo que o assemblage A foi o mais prevalente. Análise molecular de Blastocystis spp. demonstrou que, por meio do gene SSU-rNA, o subtipo 1 foi o mais dominante entre os Tapirapé, seguido pelos subtipos 2 e 3. Com base nisso, G. intestinalis e Blastocystis spp. são potencialmente zoonóticos. Os resultados corroboram com outros estudos realizados na Amazônia brasileira. / The prevalence of intestinal pathogens was studied in indigenous of the Tapirapé ethnic from Amazon region of Mato Grosso State, using the coproparasitological, immunological and molecular. Of the total 1,526 fecal samples 83.35% had at least one intestinal parasite and 65% had more than one parasite (poliparasitism). The most prevalent parasite was Entamoeba coli (827/1526 - 54.19%). Entamoeba histolytica/dispar (581/1526 - 38, 07%), Giardia intestinalis (287/1526 - 18.81%), Blastocystis spp. (257/1526 - 16.84%) and Ancylostoma spp. (293/1526 -19.20%) were found too. Cysts of G. intestinalis were sequence by <font face=\"Symbol\">b-Giardina and GDH gene. Only assemblages A and B were found and assemblage A was the most prevalent. The molecular characterization of Blastocystis spp. by SSU-rRNA demonstrated that subtype 1 was dominant followed by subtypes 2 and 3. So, G. intestinalis and Blastocystis spp. are potentially zoonotic. The results are in agreement with previous studies conducted in the Brazilian Amazon.

Na última década ocorreram transformações positivas na saúde indígena brasileira. A saúde bucal é um dos temas relevantes da saúde indígena e carece de informações na literatura. O objetivo deste trabalho foi descrever o perfil de saúde bucal e sociodemográfico da população indígena Guarani do Rio Grande do Sul. Este é um estudo de prevalência com levantamento epidemiológico de saúde bucal e variáveis demográficas. Um total de 203 sujeitos em diferentes idades e faixas etárias e em 19 aldeias foram examinados. As crianças Guarani de cinco anos de idade apresentaram um índice de cárie (ceo-d) 2,8 com 37,7% destas crianças livres de cárie. Os adolescentes de 12 anos e de 15 a 19 apresentaram um CPO-D, respectivamente, de 1,31 e 3,39, sendo o maior percentual do índice aos 12 anos o componente cariado (C) com 54,3%; entre adolescentes de 15 a 19 anos é o obturado (O) com 49,4%. Entre os adultos na faixa etária de 35 a 44 anos o CPO-D médio foi de 11,55, sendo que o componente perdido (P) foi responsável por 69,3% do índice. Entre os idosos, faixa etária de 65 a 74 anos, o CPO-D médio foi de 18,58. Os dados desta investigação demonstram que a média do CPO-D nas diferentes idades e faixas etárias é mais baixa na população indígena Guarani indicando uma menor experiência de cárie dental do que a população em geral. Acesso ao creme dental fluoretado e uma política de saúde indígena diferenciada podem estar relacionados com estes resultados. No entanto é necessário mais pesquisa acercada influência de hábitos culturais sobre o processo saúde doença bucal destas populações. / Over the past decade, positive changes have occurred to Brazilian indigenous health. Oral health is one of the relevant issues of indigenous health, but there is a lack of information about it in literature. The aim of this paper is to describe the oral health and sociodemographic profile of the Guarani indigenous population in Rio Grande do Sul. This is a prevalence study using an epidemiological survey on oral health and demographic variables. A total of 203 subjects in 19 villages at different ages and in different age groups were examined. Five-year-old Guarani children showed a dental caries index (DEF) of 2.8, with 37.7% of these children being free of caries. Teenagers aged 12 and from 15 to 19 years showed a DMF index of 1.31 and 3.39, respectively, the highest rate at age 12 was for the decayed component (D), 54.3%; and among teenagers from 15 to 19 years, the filled component (F) had the highest rate, 49.4%. Among adults in the age group of 35 to 44 years, the mean DMF index was 11.55, and the missing component (M) accounted for 69.3%. Among the elderly, in the age group of 65 to 74 years, the mean DMF index was 18.58. The data from this investigation demonstrated that the mean DMF index at different ages and in different age groups was lower in the Guarani indigenous population, indicating a lower presence of dental caries than in the general population. Access to fluoridated dental cream and a specific indigenous health policy may be associated with these results. However, further studies on the influence of cultural habits on the process of oral health and disease among these populations are necessary.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Nesta dissertação são analisadas, a partir de uma situação social específica, as articulações entre práticas de cura e relações de gênero entre grupos Maxakali população indígena que reside no Vale do Mucuri, Minas Gerais, Brasil. Trata-se de uma abordagem antropológica sobre uma situação social na qual grupos Maxakali e a equipe de atendimento sanitário da Fundação Nacional de Saúde (FUNASA) enfrentaram uma epidemia de diarréia infantil. O estudo etnográfico aborda a maneira como os diferentes sujeitos em interação lidaram com a perturbação buscando o restabelecimento da condição de saúde, a partir de dois referenciais de conhecimento: a concepção Maxakali e a medicina ocidental. De acordo com a perspectiva de entendimento sobre a perturbação, distintos recursos de cura foram utilizados, demonstrando a interdependência entre os sujeitos e percepções nesta situação social específica. / This thesis analyzes, from a specific social situation, the articulation between the healing practices and the relations of gender in Maxakali groups indigenous people from the Valley do Mucuri, Minas Gerais, Brazil. It is an anthropological take on a social situation where Maxakali groups and the team of sanitary service of the National Heath Foundation (FUNASA) faced an epidemic childrens diarrhea. From the knowledge frameworks of both the Maxakali conceptions and those of Western medicine, the ethnographic study shows how the different subjects have dealt with the problem trying to achieve the improvement of the health condition of the population. Depending on the perspective assumed to understand the disturbances, it was observed that different resources for healing were used, showing the reciprocal dependence among the subjects and perceptions involved in this specific social situation.