Traditional Indian Medicine (TIM) 
Breakout Session
CAM Workshop, November 2008
  Terry Maresca, MD
Polly Olsen

FACTOIDS

MNEUMONICS

RESOURCES

Take Home Message:

1. Most traditional healers are willing to work with Western-trained doctors if approached in a respectful collegial manner, especially if they are not called in at the last minute. They want what is best for their patients too.
2. Expand your ICM 2 mediciation/herbal and CAM history to include this aspect of care: "Do you also see tribal or Indian doctors for your condition?".
3. Get comfortable asking about spiritual practices during social histories with your patients.
4. It's OK for you to ask diplomatically about TIM, but also OK for the patient to refuse to discuss this sensitive area until trust is firmly established.

1. 24% of the nation's American Indians/Alaskan Natives live in our WWAMI region.
2. TIM use, definitions, and practitioners vary widely among the over 200 Alaska Native villages and 41 tribes in our WWAMI states, but spirit and community are core common elements.
3. Urban natives use TIM, although it appears to be more common in reservation settings, among elders, those that retain their Native language, and those with strong cultural connections to their tribe.
4. From 1887 until the American Indian Religious Freedom Act of 1978 (PL95-341), it was illegal for Native Americans to openly practice TIM.
5. American Indians have a long history of having been discriminated against, including denied opportunities to practice their cultural beliefs. These historic facts have led to a certain level of distrust of Western medicine.
6. Divulging TIM practices assumes a high level of trust between patient and doctor and often a "need to know" situation.
7. Patients may use traditional or sacred tobacco but deny this in a medical history that questions only smoking or chew practices (there is a distinction between this & commercial products).
   
8. The community decides who its healers are, not a Federal or State licensing body.
9. Tribal doctors have a long and rigorous training process, with many similarities to yours. They are typically modest, and may downplay their reputation or importance of their work.
   
10. Traditional healer advice is generally seen as more valuable than that of physicians for those who seek both services [Marbella et al, Arch Fam Med, 1998].
11. The Veteran's Administration system has a formal agreement with certain tribes (e.g. Navajo Nation) to pay Medicine Men for certain ceremonies done for veterans.
12. The Medicine Wheel concept (mental, physical, spiritual, emotional) has been widely adapted by many Native and non-Indian communities to promote wellness.

HOPE
Sources of Hope, Organized religion, Personal spirituality, Effect on medical care and end of life issues.
[Anandarajah G, Hight E, Am Fam Physician 2001]

SPIRIT
Spiritual beliefs, Personal beliefs, Integration with spiritual community, Rituals, Implications for care, and Terminal care.
[Maugans TA, Arch Fam Med 1996]

South Central Traditional Healing Program (Anchorage, AK)
http://www.scf.cc/tradhealing.cfm
907-729-4958

Indian Health Service Primary Care Dialog on Traditional Healing 2007
http://www.ihs.gov/MedicalPrograms/MCH/F/PCdiscForumMod.cfm

Beck, P, Walters AW, Francisco, N. The Sacred: Ways of Knowledge, Sources of Life. Flagstaff: Northland Publishing Co., 1990.

Bruchac, J.  The Native American Sweat Lodge: History and Legends. Berkeley: Crossing Press, 1993.