Understanding traditional medicine - ICT

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Health industry struggles to define traditional medicine as its use increases among tribal communities

• Author: Renae Ditmer
• Publish date: Oct 25, 2022

Graduate students at the University of Wisconsin-Green Bay spend time in an outdoor classroom with 90-year-old Ojibwe elder, Dan Pine from Garden River, Ontario, in an herbal medicine workshop. (Photo courtesy of Kathleen Ratteree/FILE PHOTO)

Health industry struggles to define traditional medicine as its use increases among tribal communities

Renae D. Ditmer, Ph.D.
Sault Tribe of Chippewa Indians

Whatever else you believe about traditional medicine, know that no one can agree on its definition.

Type the terms "traditional medicine" into any search engine and out spits a plethora of definitions (and I use that term loosely).

The National Institute of Health defines it as "…health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being."

Not to be outdone, The World Health Organization states that, "It is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences Indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the preventions, diagnosis, improvement or treatment of physical and mental illness," and inexplicably lumps it in with "complementary medicine" and "herbal medicine".

Johns Hopkins sees it as largely "herbal medicine" as do many other medical schools and universities that also glom on "alternative medicine," yoga, naturopathy, homeopathy, and the kitchen sink just in case they're feeling left out.

Add to that the not-so-subtle lectures aimed at traditional medicine users about depleting increasingly scarce or endangered flora and fauna that fuel a search for a cure for something that ails you, Indigenous or not, and you get the picture.

Almost all agree, however, that traditional medicine is somehow connected to Indigenous or cultural practices passed down through generations, however undefined those are. And though providers don't acknowledge it out loud, anything Indigenous is a hot ticket item on the medical market menu right now, and many are glad to offer whatever it is in addition to modern medical protocols to line their pockets.

What is true in the Indigenous community is that traditional medicine, however defined, is making a comeback in Indian health clinics as well. But it's complicated.

Many Indian Health Clinics now provide underserved, non-Indigenous communities healthcare as well, thanks to policies that have allowed our clinics to accept much-needed, third-party payments from Medicare, Medicaid, Veterans benefits, and other state or federally sponsored programs.

While the additional money has underwritten improvements in Native healthcare, what muddles things is that those underserved communities have their own culturally based medical practices.

This has left urban Indian Health Centers scrambling to define and provide traditional medicine that fits all groups' expectations.

First traditional medicine clinic

In its earliest and purest form in Indian Country, the definition of traditional medicine wasn't quite as squishy when the Sault Tribe of Chippewa Indians stood up the first traditional medicine clinic in the United States in Sault Ste. Marie, Michigan in 1995.

The clinic introduced the traditional medicine program when the tribe moved into its then-new clinic in the mid-1990s, according to Anthony Abramson Sr., the clinic manager from 1995-2019, and Laura Collins-Downwind, the Sault Tribe behavioral health manager.

After amendments to Public Law 93-638 in 1994 that gave tribes the authority to contract with the federal government to operate services for their citizens, the tribe's program manager, Theodore Holappa, and traditional healer Adam Lusier were able to bring their vision for Indian Country to life when they integrated the program using funds carved out of the tribe's block health grant and burgeoning casino funding.

Like most Natives involved in traditional medicine, practitioners and consumers believe the Creator provides all that the people need in the region from which they originate, and that traditional medicine is a spiritual practice.

Consequently, in 1994, the dream was to integrate into clinic offerings everything deemed "traditional" from across Anishinabek territory that was already being practiced by healers living in the region on both the U.S. and Canadian sides of the border.

As critical to Holappa and Lusier was the need to legitimize traditional practices by bringing them into the modern health clinic setting. They wanted their people to have access to anything that benefitted them in a single point of service.

But it was challenging given the size of traditional Anishinabek territory. Abramson said both men struggled to get that knowledge from reluctant traditional healers. They then faced the challenge of collecting and harvesting plants - a large part of traditional medicine -and cataloging what they were and how they were used. Non-Anish medicines were not incorporated, although some practices, such as sweats, from the Plains Indians, were incorporated.

The purism of Sault Tribe traditional medicine has continued. While other tribes have expanded their definition of "traditional" to include practices from other cultures, the tribe continues to push back at the notion - especially the inclusion of cannabis - and doesn't offer herbs that don't grow in the area.

That said, the Sault Tribe welcomes non-Natives from the region to participate based on the belief that Creator provides medicine for all originating in the same region.

'A piece of who we are'

None of the Michigan medical schools has traditional medicine programs, and tribal elders prefer it that way.

Abramson and Collins-Downwind agree that for traditional medicine to become a standard inclusion in those schools, standards for its practice need to be developed. They're not there yet, but those seeking traditional healing are growing in number. The pressure is on for medical schools to adapt.

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Collins-Downwind said it's important to bring keep traditional medicine available.

"Traditional medicine is a piece of who we are, and when we lose the knowledge of traditional medicine, we're going to lose the dynamic of how to treat our people," Collins-Downwind said. "Our job to seek it out and bring it back."

The University of Minnesota's Center of American Indian and Minority Health, however, has been up and running in its medical school for the past 50 years, according to the center's director, Dr. Mary J. Owen, Tlingit.

A graduate of the school who completed her residency at the North Memorial Family Practice before returning to Duluth in 2014 to head the center, she has developed and manages programs to grow the ranks of American Indian/Alaska Natives attending medical schools in all fields, as well as keeping them in fields serving those communities.

The Minnesota center was originally launched in 1957 to address rural healthcare and Native suffering in Minnesota, despite an absence of legislative backing and funding. Since 1987, it has been a recognized center in the excellence of Native healthcare education. Today, it has the second-highest number of Native graduates of any medical school in the U.S. with more than 200 having finished the program so far.

All medical students have been required to participate in the Native curriculum at the center since 2014, when it was devised under Dr. Melissa Louis. The curriculum includes the history since Wounded Knee, the Indian Health System, trust responsibility, treaties, and sovereignty. It also deals with historical trauma and its complexity, although students and patients alike have, in her estimation, difficulty grasping its impact on physical and mental health.

Owen didn't think about traditional medicine until that point. Admittedly "very White educated," Western medicine was her core. It wasn't until later that she recognized the powers of Indigenous healing ways - traditions and cultures, not simply herbs.

She sees traditional medicine as embracing more than people ingest — it's how foods are cultivated and harvested, putting community above ourselves, living and evolving language, our core values, trade knowledge. The list goes on. She believes in selecting the good from all things and integrating it into traditional medicine.

"We are evolving, so traditional medicine is evolving," she said. "The more that there's a community dedicated to wellness and helping each other, the more likely we are to understand our physical and mental problems and to be able to address them."

Sage LaPena, Nomtipon Wintu, the only certified medical herbalist in California, an ethnobotanist, and the Healing Ways Practitioner at the Sacramento Native American Health Center, expands on Owen's view.

Her journey in traditional medicine started early in her youth when she participated in a traditional healing ceremony with the northern central California Tribes. And though she is certified in both western and traditional herbalism and her philosophy remains embedded in traditional herbalism, she focuses on the problems plaguing Native communities that food items can address, with herbs addressing more discrete health problems.

Hypertension, diabetes, cardio-vascular issues, obesity — basically diseases associated with metabolic syndrome and a sedentary lifestyle — constitute the core of her practice because herbs can't correct what is rooted in diet.

"Diabetes didn't become a problem post contact until we were put on reservations and dependent on the commodities program," she said.

Moreover, it affected unincorporated areas more than it did urban areas because the rules for the program were different, offering more diversity to urban Natives.

"Insulin drivers comprise the mainstay of the program while we remain surrounded in California by healthy food from local farmers which ends up in local landfills," she said. "When complicated by the obstacles that most Natives are no longer trained in incorporating and preparing healthy food, you end up with a community health crisis."

LaPena laments the many Indigenous societies that are not agricultural and where many elders no longer have basic food knowledge to pass down, and the sheer number of Indigenous people who no longer enjoy vegetables for lack of access.

The food sovereignty programs are a sign of hope, but can't come fast enough.

"How do I get individuals to come to the garden?" she asked. Good question, especially in drought-plagued California.

She thought the Sacramento center was onto something when it sponsored Produce for All, a program that offered imperfect food gathered from the Valley once a month to anyone who needed it. COVID ended that, when telemedicine forced patients out of the clinic into virtual reality.

Beyond bringing back real food to the community, LaPena would prefer to work less as a clinical herbalist and more as a traditional herbalist, someone who could address an individual's habits, life rhythm, personality, and stressors in a broader circle group-type of setting. She believes it would produce changes in outcomes, her ultimate goal, regardless of the patient's community of origin.

At the end of the day, like many things across Indian Country, there is a common theme that runs through traditional medicine even if the definition isn't static. To sum it up, we are all part of a much larger reality yet intrinsically related, and it will take that whole reality to return us to health. Yes, indeed.

Renae Ditmer, Ph.D., is the chief administrative officer for the Tuolumne Band of Me-Wuk Indians, and an expert in tribal sovereignty and governance. She founded STRATCON LLC in 2007 to provide research and management expertise to both the federal government and tribes and has written for Indian Country Today, now ICT, since 2016. She has a doctorate in government from Georgetown University and a master's in strategic studies and international economics from the Johns Hopkins Paul H. Nitze School of Advanced International Studies. Renae is a citizen of the Sault Tribe of Chippewa Indians.