I’ll never forget being in my doctoral program one day when one of the faculty for the course referred to me as exotic. I politely but swiftly corrected her and said, actually I was the only non-exotic person in the room. This set off quite a discussion and the 2 faculty members apparently fact-checked me after class (no hand-held Google back then). They had all thought exotic to mean ‘different’ or ‘rare’ etc. They were shocked to find that exotic was defined as ‘not native’ and or ‘introduced from abroad’, and that it fit the class to a ‘T’, myself excluded. My class (including the faculty for the course) was comprised of: An African American; a citizen of the British Isles; 4 Caucasians and; myself. As an indigenous person, I was ‘native’ to the continent, and ergo the only non-exotic in the school room.
Now, other than being mildly amusing on some front, I thought, if THESE people don’t get it understand the differences, what hope is there for the larger community? And the health care community in particular…What does any of this have to do with policy and politics? The short answer is that sovereignty is arguably the number one issue in Indian Country. Inherent sovereignty or the sovereignty that nations enjoyed pre-contact, although retained in spirit has now been redefined and reassigned.
American Indians are often lumped in to the ‘minority health’ realm. The lumping does 2 things: 1) It effectively knocks them out of sight due to small numbers (the other 1 %), and 2) fails to apply historical and geopolitical concerns that must be known and figured into care, i.e. what difference does exotic vs. indigenous make? For one, they are the only people in American to have had the following in their history: (forgive the abbreviated nature of this)-
- The Removal Era (including the Trail of Tears) conceived of by President Jefferson (with words such as ‘extermination’ bandied about) and notoriously carried out By President Jackson (the people’s president, father of the democratic party- just sayin’…);
- The Reservation Era where American Indian people were forced to live in many cases far from their traditional lands and way of life, or as in my tribe’s case with other tribes, related or not. And usually, in areas that were difficult under even the best of circumstances.
- Allotment and Assimilation Era where plots of land were assigned in the hopes of them becoming so divided through passage by one to many after death that it would essentially end American Indian holding of any territory. And of Indian Boarding Schools where indigenous language, culture, roles, religion, dress etc. were literally beaten out of the children. Families often never saw the children again, many children died. Many were traumatized and the effects have been passed on to today’s Natives through historical trauma.
- The Termination Era where the federal government un-recognized 100 tribes effectively cutting any further responsibility for them.
- And American Indians were among the last group to gain –widely- US Citizenship in 1924.
If health care providers were to understand these histories, or if US citizens and residents were to understand all that has happened in a few short hundred years, versus the ten thousand or more that American Indians held inherent sovereignty over this land, they would be hard pressed to see them as ‘exotic’, or as lump-able. They would understand that American Indians deal not only with historical trauma (trauma to their ancestors) but increased individual trauma. This complication lead can lead to depression, loss of identity, roles, shame and all the attendant behaviors. The environment, whether reservation or city has contributed to some of the lowest years of expected average life span or available health care.
Admittedly, the ‘exotics’ have their own stories, but all were ‘introduced from abroad’ and they do not have the sorrows or the joys over this land in quite the same way. They do not know where the medicine is, or where the spirits are…Indigenous medicine, people, and spirits.
For citations on these ideas please see my article: Margaret P. Moss, American Indian Health Disparities: By the Sufferance of Congress? Hamline Journal of Public Law and Policy, V32, No.1, 2010, p.59-81