JUS 530 -DISABILITY IN INDIGENOUS COMMUNITIES

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DISABILITY IN INDIGENOUS COMMUNITIES

1. INTRODUCTION TO DISABILITY IN INDIGENOUS CONTEXTS

There is a like gap in what Indigenous populations experience with regards to disability and how

this is impacted by their cultural, historical, and colonial context. Contrary to the modern western

approach to disability, many indigenous cultures have a more integrated perspective where the

aim is to restore balance in the person rather than checking their deficiency. In traditional

cultures, disabled people have been accorded a support and a place in society through traditional

knowledge systems. Still, the indigenous people had distinct perspectives on impaired

individuals, and today, colonialism has influenced the native people with such Western concepts

as biomedical model that replaced indigenous knowledge. Cultural safety for disabled indigenous

peoples has been criticized as being non-existent, which leads to challenges accessing services,

including healthcare, education, employment, among others. Indigenous people are known to

have a high prevalence of disability, which can be attributed to problems such as poverty, toxic

environment, and absence of early childhood intervention. Therefore, disability studies must be

carried out within indigenous communities to capture the true experiences from the blacks.

Disability, according to some historians, cannot be disassociated from coloniality of power and

its violence on indigenous people and territories. Some authors have observed how colonialism

continues to be present in the overrepresentation of indigenous youth in prisons, child protection

services, and overrepresentation of indigenous youth in disability. Supporters claim for self-

governance because such supports may originate within cultures and hence, be more effective for

those with disabilities. Therefore, disability in indigenous settings has profound layers of

meaning, cultural association, and historical influence rooted in colonialism. It is now necessary

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to address indigenous people for producing more work on disability and work for indigenous

people to change the paradigm of discourse and policy for indigenous people.

a. Defining disability from Indigenous perspectives

A prime quarrel is that Indigenous models of disability are very opposite from those that are

biomedical. Whereas Western frameworks of disability consider it to be a personal flaw and

impairment that needs to be treated or fixed, many Indigenous knowledge systems have more

inclusive ideas about health and ability. From these perspectives, disability cannot exist in

isolation of family, community, spiritual and environmental dimensions. Instead of targeting

mainly the diagnostic, or the physical and mental disabilities, Indigenous definitions are more

inclined to address the holistic interconnectedness of physical, mental, emotional, and spiritual

domains of existence of the person. The view is that the English language does not provide

sufficient language to consider Indigenous ways of viewing disability; indeed, words such as

‘disability’ import categories from outside Indigenous contexts and thus are quite

misleading. These indigenous tribes presuppose various organizational principles of belonging

and differentiation, sharing and fairness in the distribution of power within the community. This

means that every person is important in the organization and everybody has something special to

offer to the organization and there is consideration for those who may have a lesser capacity. For

example, there are elders who cannot provide for their society through hunting due to age or

sickness, but they maintain important knowledge transmission and authority responsibilities.

However, it is also possible to identify certain principles that can be considered universal for

certain Indigenous people. These include much broader views of health; balance between the

relations; and reciprocal responsibilities between oneself, families, and communities as well as

the land. However, there also remain colonial history, loss of territory and diminishing of

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indigenous people’s culture which implies that disability must be also understood within these

ongoing processes. Finally, each tribe, community or nation has its own individual experiences

of disability which are in some ways reflected in their languages, knowledge, economic status,

healing traditions etc. The foreign disability constructions may thus disorient Indigenous peoples

and sever them from their culture and histories.

b. Historical context and colonialism's impact

There are rich indigenous respective traditional ways, knowledge, and practices of difference and

disability that reflects their culture, history and geography. Yet, colonialism had a severe effect

on these frameworks as it began in the 15th century. Colonial policies especially affirmed the

civilizing and Christianizing of the native, which meant colonial regimes sought to change the

mentality of the indigenous people through processes that sought to make them lose their

traditional ways of thinking. Integral was the colonial idea and formation of whitestream

institutions such as residential schools and hospitals. It is estimated that over the course of

several decades, tens of thousands of First Nations children were taken from their homes and

placed in government-funded religious boarding schools only to be sexually abused. At the same

time, indigenous systems of medicine were assaulted; and any form of spiritual and medical

practice was outlawed. These practices were painted by colonial authorities as ‘barbarous,’ and

the ‘civilized’ or ‘modern’ approach was portrayed as the biomedical one. It served in the

disciplining of indigenous bodies and minds and in the severing of a population’s connection to

disability supports historically derived from the land, family and community. Today’s cohorts of

survivors of residential institutions endure multiple disabilities originating from historical

trauma, as well as abuse. Due to the historical experiences of indigenous people, indigenous

languages regarding disability had become highly medicalized in the context of residential

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schools, which deprived indigenous people from knowledge of disability based on their cultural

contexts. Medical apartheid has instilled deep-seated mistrust in the disabled community towards

hospital settings leading to cases of being given substandard care or being denied altogether. The

residential school system eradicating the learning networks of the disabled individuals and

youths from the elders. Essential to recovery, fishing rights were diminished or lost; extensive

relocation from ancestral territories to distant reserves also impacted the availability of

traditional little and medicinal foods utilized for prevention and for treatment purposes. If

colonial oppression has posed a challenge to indigenous health, culture and disability knowledge,

therefore indigenous people still look to their historical cultural framework to reclaim their

cultural practices, language and ways of living. This resurgence has supported other indigenous

modes of thinking about disabled beyond colonial perimeters.

c. Intersectionality of disability and Indigenous identity

Disability is not a homogenous category, but an aspect that intertwines with Indigenous identity

and experience. Many of the disability affecting indigenous people today like FASD, psychiatric

disability, chronic health issues and intergenerational trauma are as a result of the colonial

regimes policies and actions on indigenous individuals and communities including residential

schools, the Sixties scoop, and continued racism and Indigenous people’s access to health

services. The disabling effects cannot be divorced from the Indigenous peoples and contradict

the understanding of disability as a personal or a medical condition – instead, disability is within

the Indigenous people due to structural vulnerability. The traditional indigenous models of

disability also vary significantly from the WBMM. whereas western paradigms have dominantly

colonially diagnoseable indigenous epistemologies and ontologies, Indigenous cultures

conversely support difference in mind and body as part of existence and living organically in

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community-based relations and self-identifications. However, colonization has negatively

impacted most of these cultural supports for many Indigenous people with disabilities in the

present-day. As for the limit of accessibility for disabled people, it is extremely high for the

residents of remote communities especially due to the disability services and support systems

which are urbanized and do not respect Indigenous peoples’ self-determination and ways of life.

Disability activism and academe has also done a fairly poor job of addressing Indigenous

people’s experiences and perspectives until quite recently, but First Nations self-advocates are

now meaningfully re/staking Indigenous claims to disability discourse. Effects of Indigenous

disability, culture, and equity considerably differ based on colonialism’s enduring ramifications

on Indigenous peoples regarding their identities, geographies, policies, and support systems.

Solutions entail disrupting and mobilizing resistance against systemic ableism and racism at one

and the same time by centering Indigenous persons with disabilities who get to speak for

themselves, tell their own narratives, and detail their experiences, needs, and aspirations for

change.

d. Cultural beliefs and traditional healing practices

Just as any other society, indigenous people possess some implicit beliefs that influence the way

people with disabilities are treated and other issues concerning them. Research supports the

argument that in a number of indigenous cultures, disability is not seen as a pathological state as

it is in the medical model; rather, it is one among other forms of human variation. In some

cultures, people with disabilities are viewed as being punished for their sins as perceived by the

spirits or as being bestowed with a cross to bear due to their disabilities. These beliefs can

enhance the lifestyle and structured care in the social inclusion and community care sectors than

in medical model of interventions. However, in some cases, spiritual beliefs about disability help

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to create a stigma condition if the disability has offended and, therefore, requires punishment.

Also, spiritual, medicinal or shamanic indigenous practices such as plant healing, spiritualism,

energy healing, may also be used to cure disability or offer healing and counseling to disabled

persons and their families from the spirit world. Their integration with the conventional medical

practice is considered; however, it remains controversial; there is a lack of sufficient evidence to

support cultural healing practices, the increased knowledge of indigenous views on disability can

improve the environment and approach to the support of disabled people for everyone involved.

Language barriers, racism, poverty, and isolation from rural areas are some of the challenges that

hampers access to disability services in indigenous population. Developing anti-culturally

solutions for problems of disable origin in indigenous populations is thus far a dynamic and

sensitive process of discussion among the indigenous people, leaders and advocates as well as

those policy makers, medical, social and spiritual specialists.

e. Contemporary challenges and opportunities

There are a wide range or barriers that indigenous peoples with disability are likely to encounter

in their fight to access health care, education, job or any other facilities that would enable them

to fully participate in the society. Potential barriers of a systemic nature include limited

availability of culturally safe services, division of powers between the federal and

provincial/territorial governments, isolation of the communities and insufficient funding across

the programs, there are also possibilities for transforming supports and services in order to create

more positive conditions for Indigenous peoples with the disabilities on the basis of

reconciliation principles. Over the past decades, Indigenous communities and organizations have

started to create new, culturally safe programs and practices based on Indigenous knowledge, for

example, Thunderbird Partnership Foundation’s Indigenous Youth Leadership program

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incorporates traditional approaches such as land-based healing and peer support for First Nations

youth with disabilities to regain their confidence and leadership skills. Concurrently, the Neil

Squire Society, an organization that supports the creation of technologies that reflect Indigenous

culture and ways of knowing, has a program called “Teaching Each Other” whereby Indigenous

knowledge holders educate technologists so that when such devices are designed, they already

have Indigenous safety in mind. Policy makers are slow but nevertheless realizing that

Indigenous persons with disabilities require meaningful consultation and engagement in policy

development. It is important to note that the 2019 Accessible Canada Act contains a requirement

that is to address the issues of First Nations, Métis, and Inuit peoples’ accessibility. Discussions

must persist with Indigenous disability organizations with federal/provincial/territorial

governments to mitigate program and service deficiencies encompassing healthcare, education,

employment, transportation, and housing, and disaster response. These sources should

proportionally reflect the need indicated by demographic data, in terms of funding. By adopting

visionary thinking, advocating, and continual action, it becomes possible to dismantle the

obstacles and ensure Indigenous persons with disabilities in their rightful opportunity to be self-

reliant and productive to their families and communities. In totality, there remains deeply

institutionalized problems that hinder the quality of Indigenous persons with disability lives, but

the growing Indigenous disability rights movement suggests that the future holds positive

progressive changes brought about by future policy advancements and Indigenous led ground up

efforts.

2. LEGAL AND POLICY FRAMEWORKS

Indigenous people who have disabilities are doubly oppressed and restricted from getting

assistance because the social oppressions of racism, colonialism, and ableism that exist in many

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legal and policy systems comprise the interactions. In particular, the culturally safe and

accessible disability services remain severely underdeveloped and implemented by or for

Aboriginal and Torres Strait Islander people. The indigenous peoples have also accused various

governments for not honoring their responsibilities and pledges towards the indigenous peoples’

rights in line with treaties, agreements, declarations, and conventions. It is argued that existing

disability frameworks are inadequate in understanding and acknowledging the complexity and

richness of Aboriginal and Torres Strait Islander disability, health and well-being frameworks,

which are founded on social/cultural and spiritual relationships. Indigenous peoples with

disability will remain powerless and marginalized as long as communities cannot organize and

lead interventions themselves with adequate resources to draw on. Hoping for the adoption of

more relevant and a cohesive policy/legislation that could potentially be co-designed through

shared power relations, there is a possibility of meeting unfulfilled needs or correcting for

persistent policy and legislative deficiencies. This could include; fluid funding sources,

indigenous government organizations, increased equal opportunity for people with disability,

culturally sensitive staff, healing lodges, diverse health care teams and so on. Solutions must be

place-based which acknowledges the untapped strength, capacity, and knowledge available

within each First Nations community to nurture members with disability leading a good life in

the community. The essence of identity, culture, power and kinship demands enabling structures

that recognize Indigenous people’s agency to define disability for themselves.

a. Indigenous rights and disability rights

Research has shown that Indigenous peoples who have disabilities experience multiple layers of

marginalization and multidimensional prejudice arising from their Indigenous status and

disability status, it is crucial to highlight that the indigenous peoples’ construction of disability

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diverges from the construct of disability influenced by medical models and the concept of

impairment. It is also important to understand the Indigenous peoples’ perspectives of the rights

for disabled Indigenous peoples, and for the Indigenous peoples’ needs to be met within

structures that create vulnerability. The UN Declaration on rights of Indigenous peoples and the

Convention on Rights of persons with Disabilities are established frameworks of protection of

rights of Indigenous peoples with disabilities. However, there are still considerable discrepancies

between what rights have been formulated in the international level instruments and what has

been adopted in the domestic legislation and policies, it is time to remove restrictions and

barriers and strive for culturally safe, community-centered, and self-directed approaches that are

opposed to mainstream ableism. Indigenist mainstream service provision remains to be

ineffective in addressing cultural and language, regional, and other forms of diversity that

prevent Indigenous people with disabilities from availing themselves of services. Colonization is

also perpetually felt in the present, and substantially compounds socioeconomic inferiority,

which is why self-determination of disability supports and services is vital, in addition to

structural alterations that target intergenerational trauma, poverty, substandard housing, and other

variables that amplify the disabling consequences of impairment. In sum, to ensure the rights and

address the needs of Indigenous peoples with disabilities, these conflicts need to be reconciled,

oppression and marginalization based on ability and race deconstructed and the work needs to be

done within an Indigenous framework that challenges hegemonic power and provides culturally

appropriate community-based solutions that are not limited by the restrictive legalistic and

medical models of disability.

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b. International conventions and declarations

There are several international conventions and declaration that have legal and policy backing in

relation to indigenous communities and disability, most significant among these is the United

Nations Declaration on the Rights of Indigenous Peoples that was passed in 2007. It is

imperative to note that UNDRIP contains the individual and collective claims of indigenous

people, it does not outline the rights to persons with disability but it states on the rights to

equality and non-discrimination, it offers an inspirational model and call for action to the states

to establish a legal and policy regime embracing indigenous people with disability in the sectors

such as health, education, employment and justice. Some of the other pivotal instruments include

the United Nations Convention on the Rights of Persons with Disabilities (CRPD) 2006 which

recognizes and seeks to protect equal rights of all persons with disability and Indigenous and

Tribal Peoples Convention 1989 (No. 169 by International Labor Organization which covers

indigenous rights to demand equal participation in decisions affecting policies and programs that

affect them. While not specifically dealing with disability, they promote the idea of access,

accommodation and diversity. Efforts are also made in the international arena to come up with

better framed documents related to indigenous people and disability, for example, the UN

Permanent Forum on Indigenous Issues – Draft Guidelines on the Promotion and Protection of

the Rights of Indigenous Persons with Disabilities. However, the use of all these instruments

depends on the domestication of such into national legal systems. Hence while the global

conventions and declarations offer the call and standards for the protection of rights of

indigenous persons with disability, further efforts are required to ensure that these translate into

effective and suitable policies and services for indigenous people within their communities in

terms of coverage and cultural sensitivity and funding.

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c. National policies and their implementation

If indigenous people with disabilities are to receive adequate and timely attention, there is a need

for understanding how these national disability policies have contributed to the compounded

barriers resulting from the intersection of cultural and ability status. Disability policy in

indigenous contexts is a significant issue as its creation and deployment significantly affects

indigenous people but seldom meets their frameworks of thinking, values, and priorities. For

instance, the National Disability Strategy 2010-2020 focused on developing strategic foundations

for enhancing the quality of life for Australians with disability, families, and carers. While the

strategy did accurately acknowledge that Aboriginal and Torres Strait Islander people with

disability are doubly disadvantaged, it has been pointed out that there was little true consultation

with indigenous peoples and no policy pledges made to fix the situation. When it comes to policy

implementation, serious and specific attention and funding must have to be provided at national,

state and local level. Nonetheless, most aboriginal services remain underfunded, functioning with

precarious budgets and temporary funding, which hampers their work. Many indigenous people

experience difficulty in getting access to the National Disability Insurance Scheme because of

language, communication, and poor cultural sensitivity, and procedural complexities, and equal

handling of the application. Hence, indigenous Australians remain disadvantaged and are less

employed; less educated; have poor health standards; and high mortality compared to the non-

indigenous Australians. In this case, culturally appropriate disability policies and support

services that are developed and implemented by indigenous people have high chances of success.

It may involve indigenous health services being responsible for delivering culturally grounded

and locally situated health care services or indigenous First Nations agencies engaging in direct

lobbying of the state institutions over some policies affecting their respective communities.

However, further systemic change is still possible if resources are secured and if these are

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sustainable and equal partnership between indigenous people and governments. It will similarly

fail indigenous peoples with disabilities as the gap between policy ambitions and the real world

remains persistently wide.

d. Tribal sovereignty and disability legislation

Indigenous tribes possess the power to govern their territories and their people however, they

share legal structures with both the federal government and state governments. This complicates

disability policy for tribes because it makes the decision-making process regarding disability

among tribes more complex. Despite the Americans with Disabilities Act seeking to bar

discrimination on basis of disability, tribes are shielded by the over arching sovereign immunity.

Given the lack of the clause ‘as applied’, standards for accessibility, reasonable accommodations,

and non-discrimination do not extend, by default, to tribal programs, services, or facilities. It also

relates to a tribe’s status in determining who is qualified for federal disability benefits and

services that tribes might wish to offer for its people. Some services differ in requirements for the

different programs, for instance, the vocational rehabilitation must be negotiated through a joint

agreement between a tribe and state government agency. They stress that lack of clear

jurisdiction and unclear roles and responsibilities can lead to service gaps and people with

disabilities not getting the support they require. For instance, a tribal citizen whose income

complies with state-level Medicaid eligibility may not be eligible for IHS. Proponents have

contended that the practice of honoring the tribes’ self-governance in policy matters concerning

disability also reflects sovereignty. However, tribes have depicted less funding that other

governments possess to fund disability schemes. Although the federal government contributes

grants, these grants only partially address the requirement. Discrimination laws for persons with

disabilities enable such individuals to have legal ways of forcing governments to eliminate

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barriers. Even where tribes have established laws that relate to disability, they do not contain

provisions that would require citizens with disabilities to be afforded full opportunity to be active

members of their communities.

e. Case studies of successful policy interventions

One potential real-world example of an approach for policy intervention in disability matters

involving indigenous people could be examined in the context of the Aboriginal Head Start

program in Canada. Established in 1995, AHS finances community services, which give

culturally sensitive early childhood education to FNIM children with disabilities and up to the

age of 6. The program evaluations have revealed benefits in relation to child development,

culture and language, and parental and family links. For instance, in the evaluation of programs

in British Colombia, it was reported that nearly a third of the children participating had disability

or developmental delay. Parents and community members highlighted that AHS programs

operating in their communities were easier to access and made them feel more comfortable

because the programs were also implemented by indigenous people. In the process of developing

the cultural programming, elders also had a significant input based on what cultural teachings

there were in relation to child development and support. An example of policy success is

observed through the accomplishments of Disabled Peoples International Asia-Pacific, an

indigenous people organization for disability rights and government accountabilities. DPI and

indigenous leaders have been actively defending indigenous peoples’ rights engaging in policy

analysis, lobbying, and activism for over three decades and were key in the adoption of the

United Nations Declaration on the Rights of Indigenous Peoples that directly addresses the state

obligations of indigenous peoples on disability. They also played a big role in Australia in

developing 2009 National Indigenous Disability Framework at federal and state or territory

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arenas. New partnerships and funding arrangements, improved service delivery, data and

information systems and other arrangements to increase accessibility of services for ATSI people

with disability had to be established under the framework. Grass root monitoring conducted

continuously by the DPI regional bodies has been vital in place pressure on governments to

honor framework pledges, this contributes to the understanding that alongside activism, policy

work can create sustained change supporting indigenous community access, self-determination

and cultural safety.

3. HEALTHCARE ACCESS AND DISPARITIES

Indigenous people experience tremendously higher difficulty of access to healthcare and heath

inequity as compared to the non-Indigenous people as it relates to disability. Challenges such as

geographical barrier, inadequate culturally sensitive first level of care, Indigenous people

discrimination and health social determinants affect the health of Indigenous communities. For

instance, about 18. 4% of American Indians and Alaska natives below the age of 65 years have a

disability; this is almost double the rate of disability within the US all population. Nevertheless,

because of limited service provisions in the first place in tribal settings, Indigenous peoples with

disabilities are limited to the option of either moving away or forgoing life-saving care services.

However, even when care is reachable, clinicians do not give Indigenous people the disability

services that could encompass their cultural realities and practices. As a result, Native American

communities have inadequately addressed healthcare needs that include preventable secondary

conditions. Other causes of Indigenous disability gaps beyond the delivery of health care are

oppression and intergeneration trauma. Boarding schools and other assimilation attempts have

maladjusted psychosocial trauma passed from generation and poverty, poor education, a breeding

ground for poor health. Of course, the existing government policies do not even begin to address

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these structural injustices for tribes in the present. In conclusion, further financial support, tribal

self-governance over the health systems, the availability of the facilities in the rural areas,

culturally competent staff and program, trauma-informed culturally-appropriate wellness

programs designed by the members of the community are needed to overcome the disability-

related disparities in care for Indigenous peoples. Nevertheless, the road to health equity is still

far from being achieved, especially without addressing the past injustices and bent on healing.

a. Traditional vs. Western medicine approaches

Cultural barriers include limited access to transportation, geographic isolation, inability to take

time off from work, racism and other ethnic disparities within healthcare organizations and

systems, and other socio-economic factors. Most of them rely solely or in part on indigenous

system of medicine and wellness, with consideration to spirituality, herbal medicine and

communal relationship. However, indigenous traditional medicine itself can be problematic and

lack of transmission of knowledge from one generation to the next due to colonial and

assimilationist policies that obliterated indigenous languages, practices, and knowledge systems.

Thirdly, loss of traditional lands also contributes to the denial of plant medicinal use due to

restricted access. This relationship affects access to healthcare by disabled indigenous persons in

a given context. Western medical model is an individualistic model that is pathology and

technical biomedical model of ‘repairing’ the defective body while traditional medical model is

cultural and indigenous model that situates disability in a clan, family, and community

relationship, metaphysical, and spiritual balance of the body. Disabled indigenous people may

have restricted access both to the systems because of discrimination and inadequacy of Western

doctors’ cultural sensitivity, coupled with possible loss of indigenous knowledge regarding

healing. This calls for recognition of indigenous peoples’ sovereignty and self-governance to

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promote traditional healer’s access to indigenous communities, enhancing cultural sensitivity of

Western trained doctors who practice in indigenous nations’ reservation clinics or urban Indian

health centers to be aware of new urban Indians and indigenous people constitutionality, ensuring

that clinics are physically accessible and availability of medical transportation if necessary. In the

end, it is required to state that both western technical interventions and traditional healing

approaches are necessary to ensure an adequate level of patient treatment.

b. Barriers to healthcare in Indigenous communities

Indigenous peoples with disabilities are again disadvantageously positioned when it comes to the

healthcare services and support. Stake 4: The geographical location presents a barrier because

many Indigenous population groups reside in the rural, remote or isolated areas, which implies

that the availability and accessibility of HC providers and facilities is severely restricted.

Transport barriers compound this, because lack of appropriate transport means to get to distant

health services results in people not accessing them. There are also financial factors though;

travel expenses and time off work to get medical care in another community can be expensive as

well. First Nation individuals also struggle with an absence of cultural and communication

compatibility within predominantly Anglo-American medical facilities that lack cultural

sensitivity, security, and education. Indigenous people with disability are discriminated and

experience racism in the health care facilities available for their treatment. This means that due to

past experiences and the subsequent intergenerational trauma, there is a lack of trust in the

systems such as health care, resulting in the reluctance to seek treatment. Disputes of sovereignty

between federal, provincial/territorial, and Indigenous governments lead to an unclear and

contradictory administrative labyrinth that hinders individuals from obtaining the care they need.

The lack of local human capital willing to practice in remote regions also contributes to limited

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availability of these services locally. Hence disability needs are unmet in instances where health

care providers do not have awareness of the disability. Indigenous people with disability

experience multiple intersects of disadvantage along geography, economic, cultural, social,

political and health systems in a way that contributes to the significantly reduced access to health

care than their non-Indigenous disabled, or Indigenous non-disabled counterparts. To address and

hence eliminate these inequities it becomes necessary to systematically deal with this multitudes

of barriers at multiple levels.

c. Mental health and disability

Self-identified Indigenous peoples encounter numerous systemic and structural challenges and

inequities in accessing healthcare services and products, especially in the mental health and

disability sectors. Research has indicated that indigenous people suffer high degrees of common

psychological disorders, suicides and mental health issues as a result of colonization and racism,

however, people with mental illness or disability continue to have limited access to adequate

services within many indigenous communities. Some of the challenges include absence of

funding and policy focus on mental health, inadequate supply of indigenous health care workers,

overlapping of authority between federal and provincial levels of health ministries, indigenous

people’s prejudicial treatment in the health care setting and lack of culturally sensitive care.

Culturally unsafe care can be defined as services that do not acknowledge or fail to have an

appreciation of indigenous peoples’ cultural practices, past, and present. Therefore, indigenous

peoples with mental health problems or other disabilities get a woefully inadequate measure of

initial consultation, guidance, community, and home-based care, and targeted, comprehensive

treatment. Patients who do not have access to services receive poorer levels of care, have worse

mental health, and are less likely to have the chance to improve their health and well-being. As a

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result, lobbyist for increased funding believe that there is an urgent need to train many more

indigenous mental health workers, involve indigenous healers and cultural models into the

treatment systems, develop facilities that are culturally suitable to offer treatment to indigenous

people, improve mental health services to distant areas, and incorporate cultural safety training

for all health care personnel serving indigenous communities, as well as having indigenous

control on the mental health and disability services. To tackle the persistent issues of inaccessible

healthcare and inequality, it is necessary to merge and transform indigenous and the colonial

views on mental health and disability in a comprehensive postcolonial model of care that

respects indigenous peoples’ rights, promotes their strengths, and addresses their health needs.

d. Culturally appropriate healthcare services

The native population of countries worldwide is plagued with significant limitations to access

healthcare and suffer from resulting disparities. These stem partly from colonial history and from

structural racism that is inherent and persists even in modern societies that intrinsically

disadvantage indigenous peoples. One vital element that has to be taken into consideration as a

way of improving the health of the indigenous communities involves the use of appropriate

services which are in the health sector. This requires recognizing of the Indigenous ontology of

health and welfare that is more comprehensive and has mental, physical, spiritual, emotional, and

communal dimension of health. Modern conventional disease-oriented models often have a

mind-body split and a mechanistic perspective toward disease and the human body. This has led

to the prevalence of western biomedicine with many current and previous healthcare providers

being inexperienced in issues to do with indigenous cultures, thereby leading to indigenous

peoples’ skepticism about the health systems. The previous literature also argues that if

healthcare services are to cultivate trusting provider-patient relationships then such services need

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to respect, value and incorporate indigenous healing practices, supports, languages and

idiosyncrasies associated with health and illness. To support local requirements and concerns,

healthcare centres on indigenous territories that are developed in partnership with tribal

authorities assist in serving indigenous communities. As a result, providers need to acknowledge

that intergenerational and place-based trauma that results from the erasure of Indigenous

epistemologies and ontologies are still present. Cultural humility involves a process that aims at

eliminating disparities of power that lead to stigmatization and discourage Indigenous people

from seeking treatment. Transportation, appointment flexibility, elders, traditional foods, as well

as applications for support access initiatives are also important for service uptake. At its core,

culturally relevant care brings self-governance of indigenous peoples over their own well-being

and supports the ability of communities to address the legacies of injustice.

e. Telemedicine and remote healthcare solutions

HMAHSES has highlighted the restricted access to health care services experienced by

Indigenous communities because of geographical remoteness, poor access to transport, and

shortage of health care workforce in rural settings. Telemedicine and remote healthcare solutions

are thought of as tools that can widen access and decrease disparities. In particular, telemedicine

is the acquisition and use of information and communication technologies to deliver clinical

health care without the physical proximity of the patient and the clinician. This can encompass

video telephony, remote patient monitor, image transfer, telehealth including patient self-service

interfaces, and so on. Applying these technologies can bring the indigenous people of one area,

who have no access to doctors or any other professional, to the physicians in another province or

city. For instance, instead of traveling long distances to get a face-to-face appointment with a

specialist, a patient could engage in a video consultation to get advice and a diagnosis. Wearable

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devices in remote patient monitoring may help the health workers to monitor the patient with

chronic diseases such as diabetes and track the patients’ conditions and intervene whenever

necessary. Store-and-forward technologies enable sending images and data to the doctor for later

assessment. In general, they enable patients and doctors to treat the former and monitor their

condition, being connected through communication technologies while being geographically

apart. This comes with several benefits concerning time, costs and other factors for patients who

otherwise would have to travel in order to access health facilities. In particular for indigenous

people who have limited physical mobility and often lack access to enough doctors or nurses,

telemedicine can significantly enhance the availability, quality, and continuity of the health care

being delivered. It has been opined that, there are opportunities of minimizing some of the health

inequities for remote and marginalized populations such as aboriginal population or disabled

population by extending some of the telemedicine solutions.

4. EDUCATION AND EMPLOYMENT