Indigenous Peoples, Traditional Medicine & Healthcare

Since 2015, the United Nations call to action about the goals of the Sustainable Development Goals, including targets related to the health and well-being of populations. Indigenous populations in southern Mexico are the most affected by social inequities, making traditional medicine more accessible and affordable for their treatment. This chapter aims to describe traditional medicine practices in the main illness conditions of Mexican indigenous communities. A case study was carried out in Oaxaca (Mexico) between 2017 and 2019. Surveys were applied to retrieve information on these communities’ knowledge and practices regarding traditional medicine. Several traditional practices were recovered to cure diseases cataloged in international classifications and cultural affiliation syndromes among the main results. 70.3% of the participants used homemade remedies, topically, in preparation of tea, and some compositions of medicinal herbs. Mezcal, the typical alcoholic beverage of the region, has also been reported as one of the most widely used. In addition to the conception of biomedical disease, a total of 40 syndromes of cultural filiation or “cultural diseases” were reported; the most frequent were empacho (indigestion), followed by the mal de ojo (the evil eye), and susto (frighten). This chapter brings us closer to knowing how they cope with illness by using traditional medicine in indigenous communities without the use of health services. Contributing to reach the Sustainable Development Goal 3 (SDG3).

The appropriation of spiritual and medical practices has become a significant topic among scholars and practitioners of Native American religions. Scholars often focus on New Age religion as the primary realm in which the commodification and appropriation of Indigenous religious beliefs, practices, and objects has occurred. Since the 1960s, practitioners of New Age religion have drawn on an eclectic array of spiritual practices, including those originating in Native American communities, for inspiration. Yet the commodification and appropriation of Native American practices began well before the dawning of the New Age. This article examines “Indian medicine companies,” US-based patent medicine companies that developed and marketed Native American-themed medicinal products to the American public in the late nineteenth century. Examining facets of material culture produced by Indian medicine companies reveals the extent to which these business enterprises, in addition to peddling remedies, sold racialized narratives about Native American religion, culture, and history.

Objectives: The study aimed to understand the range of medicinal applications of Erythrina stricta Roxb. (Fabaceae) among the Mizo people of India, and to analyse the pharmacological properties of the bark extract. Methods: Ethnomedicinal investigation was conducted among traditional healers and users. The petroleum ether extract of the bark was analysed for its phytochemical components. Antioxidant property was evaluated by DPPH (2,2- diphenyl-1-picrylhydrazyl) radical scavenging assay. Total antioxidant capacity, flavonoid and total phenolic contents of the plant extract were assessed by using the phosphomolybdate method, Folin-Ciocalteu assay and aluminium chloride assay respectively. Antimicrobial activity was tested on two Gramnegative and four Gram-positive bacteria. Findings: E. stricta was used for the treatment of stomach ulcer, diabetic blisters, intestinal roundworm infection, skin infection, sores and wounds. The plant extract contained phytochemicals like alkaloids, flavonoids, phenols, tannins, amino acids and proteins, phytosterols and triterpenoids. The extract showed concentrationdependent antioxidant activity against DPPH; showing an IC50 value of 3.330.024 mg/ml compared to 0.230.095 mg/ml for the reference butylated hydroxytoluene. The total antioxidant capacity was 12.010.33 mg ascorbic acid equivalent per gram (AAE/g) of the dry extract; the total phenolic content was 3.770.12 mg gallic acid equivalent per gram (GAE/g) of the dry extract; while the total flavonoid content was 7.751.13 mg quercetin equivalent per gram (QE/g) of the dry extract. The extract effectively inhibited the growth of two Gram-positive bacteria, Bacillus cereus and Staphylococcus aureus, and one Gram-negative species, Klebsiella pneumoniae. Novelty: E. stricta was found to have important medicinal applications and pharmacological potential, and needs systematic conservation and propagation. It showed high antioxidant values, and species-specific antibacterial activities.

Objective: The objective of this study is to investigate the perception of traditional medicine use during gestation processes in the Tacueyo Indigenous Reservation. The aim is to understand how indigenous women in the reservation perceive and utilize this resource during pregnancy, childbirth, and postpartum in the period 2021-2022. Theoretical Framework: This study is relevant in a context of high maternal and perinatal morbidity rates, focusing on ancestral practices to improve adherence to prenatal and postpartum care, contributing to the reduction of maternal mortality. Method: The study was guided by qualitative methodology and an ethnographic approach, using semi-structured interviews with 10 women. Results and Discussion: The results revealed the use of medicinal plants, interculturality as a protective factor, and barriers to accessing effective medical care. Research Implications: The implications of this research highlight the need to strengthen collaboration between traditional health practices and local health institutions within the framework of the Indigenous Own and Intercultural Health System (SISPI). Originality/Value: This study contributes to the literature by highlighting its intercultural approach and the integration of ancestral knowledge with modern public health to improve maternal health outcomes in indigenous communities.

Background: Strengths-based and culturally sensitive approaches to Indigenous healthcare are much needed within the Canadian healthcare system. This is where allyship comes in. Allyship is loosely defined as the actions of an individual who strives to advance the interests of marginalized groups in which they are not a member. This study investigated the concept of allyship with healthcare providers who were community-identified allies providing care for Indigenous patients. Methods: Qualitative description methodology was utilized, and data was generated through semi-structured interviews with allies in and around the Edmonton area, in Canada. The interviews were conducted online, transcribed verbatim and then coded using thematic analysis. Results: Interviews were conducted with 13 allies (eight physicians, four allied health professionals and one nurse). The results were captured into three main themes. The meaning of allyship demonstrated how allyship must be determined by the community, and encapsulates authentic action and advocacy, as well as working to create positive healthcare experiences. The experience of being an ally included commitment to the allyship journey, embracing emotions, and facing and disrupting systemic barriers. Finally, cultivating allyship in healthcare necessitated building and maintaining meaningful relationships with Indigenous people, and ongoing training and education. Conclusion: The study results enabled a better understanding of how allies interact with their Indigenous patients within the confines of the healthcare system and could inform learning opportunities for those who seek to practice in a culturally humble way. In particular, transcending passive education and training modalities to include opportunities for real life interactions and the development of reciprocal relationships with Indigenous patients.

Background Patient-reported outcome measures (PROMs) provide clinicians and consumers a platform to inform and improve healthcare planning and management. Aboriginal people experience disproportionately high rates of chronic diseases, including type 2 diabetes. Treatment and management require holistic approaches that draw on culturally relevant resources and assessment tools. This study explored perceptions of Aboriginal people about two diabetes management-related PROMs (PROMIS-29, PAID Scale). Methods Twenty-nine Aboriginal people living with diabetes in the Shoalhaven discussed two PROMs in one of four focus groups or at an individual interview. Preliminary data coding was conducted by clinician researchers, with thematic analysis overseen by Aboriginal co-researchers. Subsequent individual interviews with participants were undertaken to seek further feedback and articulate what is needed to improve methods of evaluating Aboriginal people’s self-reported quality of life and diabetes management. Results The PROMs did not capture information or knowledge that Aboriginal people considered relevant to their diabetes-related health care. Participants’ recommendations included adapting survey materials to be more culturally sensitive; for example, by improving the alignment of measures with common day-to-day activities. This study also describes a genuine collaborative, Aboriginal community-guided approach to evaluate ‘fit-for-purpose’ diabetes management tools. Conclusions Appropriate evaluation methods are paramount to address the disproportionate burden of diabetes experienced by Aboriginal peoples and overcome inverse diabetes care. Our learnings will contribute to development of tools, resources or methods that capture culturally tailored outcome measures. Study findings are relevant to clinicians and researchers using and/or developing Patient Reported Measures, particularly in relation to the practicality of tools for First Nations peoples.

Biologics are becoming an increasingly important part of patient care across Canada. Recent studies from the USA show that Black patients are less likely than White patients to receive biologic treatment for several medical conditions. The relative lack of race-based data in Canada makes it difficult to replicate such studies in Canada. As a result, there is a paucity of literature that explores the association between biologic usage and race in Canada. Our review aims to explore the factors that might be driving racial treatment disparity in Canada that likely parallels the inequalities found in the USA. We provide a summary of the available literature on the factors that contribute to biologic treatment hesitancy among Black and Indigenous populations in Canada. We highlight several solutions that have been proposed in the literature to address biologic treatment hesitancy. Our review found that biologic treatment decision at the individual level can be very complex as patient's decisions are influenced by social inputs from family and trusted community members, biologic-related factors (negative injection experience, fear of needles, formulation, and unfamiliarity), cultural tenets (beliefs, values, perception of illness), and historical and systemic factors (past research injustices, socioeconomic status, patient-physician relationship, clinical trial representation). Some proposed solutions to address biologic treatment hesitancy among Black and Indigenous populations include increasing the number of Black and Indigenous researchers involved in and leading clinical trials, formally training physicians and healthcare workers to deliver culturally competent care, and eliminating financial barriers to accessing medications. Further research is needed to characterize and address race-based new treatment inequalities and hesitancy in Canada.

Background Indigenous populations globally have significantly high rates of type 2 diabetes compared to their non-Indigenous counterparts. This study aims to implement and evaluate the effectiveness of a culturally and contextually informed Aboriginal Diabetes Workforce Training Program on Aboriginal primary health care workforce knowledge, attitude, confidence, skill and practice relating to diabetes care. Methods A Cluster Randomised Crossover Control Trial with two arms (Group A and Group B) will be conducted with Aboriginal primary health care services in South Australia. These services primarily provide primary health care to Aboriginal and Torres Strait Islander people. All healthcare service sites will be randomised into groups A and B to receive the training program. The training program consists of three components: 1) Peer support network, 2) E-Learning modules and 3) onsite support. Aboriginal Health Workers of participating sites will be invited to participate in the monthly online peer support network and all chronic disease staff are eligible to participate in the E-Learning modules and onsite support. The Peer Support Network runs for the entirety of the study, 17 months. Training components 2 and 3 occur simultaneously and are 2.5 months in length, with a six-month washout period between the two randomised groups undertaking the training. All primary outcomes of the study relate to diabetes management in a primary health care settings and measure participants’ knowledge, attitude, confidence, practice and skills. These will be collected at seven time points across the entire study. Secondary outcomes measure satisfaction of the peer support network using a survey, interviews to understand enablers and barriers to participation, health service systems characteristics through focus groups, and medical record review to ascertain diabetes patients’ care received and their clinical outcomes up to 12 months post training intervention. Discussion The findings will explore the effectiveness of the training program on Aboriginal primary health care provider knowledge, attitude, confidence, skill and practice relating to diabetes care. The final findings will be published in 2027.