Power and personhood: Health care decision-making in a Plains Indian community.

Abstract

This study employs a critical-interpretive approach to investigate health-care decision-making and the practice of medical pluralism in a Plains Indian community. Data are from a four-year ethnographic experience, community-based focus group discussions and individual interviews. An analysis of the community's discourse of health shows that their health-related discourse is shaped by four major themes: the conceptualization of the human life cycle as cyclical, intra-family responsibilities, bounded cross-gender relationships, and a quadpartite worldview. Health-related dialogue, then, serves as a medium for verbalizing, mediating, and at times, manipulating the illness experience and its perceived outcome to conform with community-specific cultural understandings. Members of the community view the various medical traditions as separate and non-competitive domains where the boundaries are fluid and are constantly being negotiated and re-negotiated through dialogue. Paramount to their practice of medical pluralism is that both indigenous etiologies and biomedical perspectives, the available resources, decisions, and treatments form a dynamic and interrelated system that empowers both the individual and the collective group. Thus, the community's discourse of health and their practice of medical pluralism is not just about the re-making or re-constituting of the self (associated with an illness experience) as it is a transformative process that restores the individual within his or her physical, psychological, and socio-political worlds of experience.