Volume 1 Number 3
May 1962

The success or failure of the Indian Health Program depends, to a great extent, on our ability to work with the Indian beneficiaries. The acceptance or rejection of our services, contrary to popular belief, is not determined by the excellence of the professional skills of our staff—unless the ability to relate to our Indian beneficiaries is identified as one of these professional skills. Unfortunately, few, if any, of us have had the opportunity to develop the ability to relate to Indians through our normal educational processes. Our education commences when we first meet the Indian patients or reservation residents with whom we will be associated during the period of time we will be in the program. The experiences we will have during this association will depend entirely on the relations we develop.

The purpose of this Tribal Relations paper is to assist you, the new employee, to adjust to this new environment and to suggest ways and methods that will insure good tribal relations. Your experience in this program can be one of the most satisfying experiences you will ever have, or else it can be the opposite. It will depend on you.

Individuals who choose to work with underprivileged, sick, uneducated, and socially depressed groups of people are motivated toward this work for a variety of reasons. The majority of us choose to identify our motives as altruistic. Few of us care to explore beneath the surface of our altruistic motivation. Is our so-called altruism unselfish, or are we answering basic selfish needs and cloaking them with this aura of altruism?

Most, if not all, of the problems that occur in our relations with Indian beneficiaries stems from a basic conflict of values found in both cultures. With few exceptions, we, as members of the dominant culture, conform to and strongly support accepted middle class values. Conversely, we tend to suppress, discourage, and even destroy values that oppose ours. We get along best with members of certain minority groups who "think like we do," i.e. have accepted our way of life and conform to most of the same values that we do.

It is not the intent of this outline to suggest that we change our values or that we change the values of the Indian people to conform to ours. It is the intent to present objective information about these different values, to promote understanding and, we hope, respect.

Indian values that conflict with ours:

The following description by Robert A. Roessel, Jr. (see Note 1) of the basic conflict of values between Indians and non-Indians is, in the opinion of the author, one of the best descriptions found:

Cooperation—The Indian believes in working together and sharing with one another. Competition—We non-Indians believe this is the foundation stone in the growth of our nation.

Giving—The respected Indian is not one who keeps, but one who gives ,and shares with others, no one starves unless all starve.

Saving—We believe that one must save today so he can enjoy tomorrow.

Lack of time consciousness—The Indian is not a slave to time. He has all the time he needs and is in no hurry. "Indian time" means an 8 o'clock meeting may not start until 10.

Time consciousness—We are clock and calendar watchers; everything we do is controlled by time.

The present—The Indian takes no thought for the future, so he rarely feels anxious. He lives moment by moment.

The future—Many of our actions are based on hopes for the future. We work hard now so we can enjoy a vacation later.

Harmony with nature—The Indian believes one must live in harmony with nature to be healthy or to have successful crops. Disastrous events result when the harmony is destroyed. Conquest over nature—We believe we can and should control nature. We seed the clouds, build dams, unlock the atom. We are masters of our fate.

The problem of understanding different ways of life is world wide, and today we are constantly being made aware of these conflicts in values. As a nation we have been trying to understand the American Indian for nearly 300 years, and with a singular lack of success. I submit that an important reason for failure lies in our unwillingness to discover and respect the Indian's set of values.

Indian values that are similar to ours:

There are many similar values that most Indians and non-Indians have, An awareness of the similarity is important in that we will be more readily accepted by the Indian people if we reinforce these values in our every day relationships with Indian beneficiaries.

In addition, the Indian is honest, loyal, courageous, patient, and generous, all values found in our middle class society.

Respect comes with understanding. The more contacts we have with our Indian beneficiaries, in both social and professional activities, the greater the development of understanding and respect. When we become aware of the beautiful philosophy that most Indian people have, it is difficult to understand why so few of us really respect the Indian people with whom we work. If we placed ourselves in a similar environment, having identical problems that most Indian beneficiaries face daily, how many of us would survive?

Probably the greatest, single, most important need found in all humans is that of identification. All of us need to be recognized, to be identified by our peers and superiors. As children this need is so great that we seek attention even though it means punishment for us. It is basic that if this need is not satisfied in a positive fashion, e.g. to be identified as worthwhile, contributing members of society, we will accept a negative identification instead; the delinquent, anti-social, criminal element in our society falls into this category.

A feeling of confidence is usually developed as the result of successful experiences. Individuals who have had little opportunity to participate in successful, meaningful activities have, of necessity, built up defenses against repeated failures. The Indian protects himself by withdrawing. If an Indian is told by authorities that something can't be done, if he is refused service in a clinic or hospital, if he is told to come back later, he doesn't ask "why"? he just passively accepts the refusal and withdraws. Tribal leaders who question, who challenge authoritative sources, are the exception rather than the rule. When this problem of passive acceptance of refusal by authorities is discussed with tribal leaders and individuals, it is apparent that this fatalistic attitude developed as a result of innumerable experiences of refusal by authorities.

When we are able to communicate to the Indians with whom we have contact that we have confidence in their ability to do the things we are suggesting, that we respect them, that we have developed an understanding and an interest in them as worthwhile human beings, the progress that is possible under these circumstances is remarkable. Conversely, the status quo can be easily maintained if we don't provide these opportunities for the Indian to actively participate in our programs.

Probably one of the greatest problems faced by newcomers to Indian Health results from their immediate cognition of the multitude of problems faced by the Indian people with whom they will work. Also, because of past experiences, most new staff have well developed concepts of how to resolve many, if not most, of these problems. As most new staff are strongly motivated to help an obviously depressed group of people, considerable energy is directed toward this objective. Great frustrations are developed through the apparent rejection of these offers of assistance by the Indian people and, frequently, staff who have worked long with Indians. Most newcomers to Indian health are appalled by the laissez faire attitude adopted by most Indian residents. With the rejection of these new ideas by the Indians with whom they work, it is relatively easy to build up defenses as to why these proposals fail. Unfortunately, file Indian resident frequently gets the blame.

When we, the members of the dominant culture, attempt to initiate new programs aimed at resolving problems that frequently are of hundreds of years' duration, we assume that because the problem is so obvious to us that it must be as obvious to the people with whom we work. We fail to recognize that most of the tribal groups with whom we work have, until very recently, existed in a primitive physical environment that has been relatively unchanged since the initial contact with non-Indians four hundred years previously. Even more important, we fail to recognize that our so-called civilized environment did not emerge overnight, that a process of evolution lasting hundreds of years was needed to initiate even minor changes.

Change is occurring. The Indian people are most responsive to many of the recommendations, suggestions, and demonstrations that public health staff are providing. However, we must recognize that we live in a democratic society that the choice of acceptance or rejection is that of the Indian, that we can't legislate attitude change; it is an educational process. For this reason progress is, and will continue to be, slow.

It is extremely difficult to evaluate attitude change. Most of our evaluative measurements are quantitative rather than qualitative. How much weight can we give to a smile? A nod of recognition? Conversely, how do we evaluate a scowl? A sullen, hostile response?

The variables that are present in the Indian Health program are great, and in order to document good tribal relations we are faced with a multitude of variables that we cannot ignore. The increased budget and staff, improved facilities and better housing are all factors that have had an impact on the increased utilization of services and greater acceptance of the program by the Indian people.

However, the staff in the program are quick to indicate that the socio-cultural and emotional needs of the Indian beneficiaries must be resolved before the health status of the Indian people can approach the level of the non-Indian population.

There is no question that the emotional climate found at facilities where good tribal relations exist is much improved over that found at facilities where tribal relations are poor. The response, acceptance and interest shown by the reservation residents is a good indicator of this.