The story illustrates a tenet of Native belief about health: All four components — spiritual, mental, emotional, and physical — must be in balance, much like the holistic paradigm that nurses are taught in their curricula.
“One elder recently told me at a conference, ‘You have to think of the four domains of a person like a car with four wheels. If one is flat, you’re going to have a very bumpy ride,’” Moss says.
This expression proved to be applicable to Moss, who witnessed family members struggle with alcoholism and self-medication while growing up in a suburb of Washington, D.C., suffering from what she describes as “the vestiges of historical trauma.”
“There was a lot of prejudice in the mid-’60s. We were probably the only Indians in our town,” she says.
Witnessing the early deaths of several of her family members from liver failure, HIV/AIDS, and complications from diabetes made Moss want to study a healthcare system whose failures disproportionately affect Native Americans. According to the National Congress of American Indians, Native Americans live an average of six years less than other ethnic groups and have higher rates of diabetes, heart disease, and substance abuse than any other group.
“All these factors intertwine,” Moss says. “There’s more to the person than the physical. My siblings had every physical thing taken care of, but they had three ‘deflated tires.’ The emotional and mental weren’t working.”
Part of the difficulty in assessing cultural needs, she says, is that healthcare providers may not know that someone is Native American and are afraid to ask for fear of offending them.
“In the East, everyone thinks I’m white; west of the Mississippi, everyone knows I’m Indian. In the Southwest, people think I’m Spanish,” she says. “I’ve had four kids, and no one’s ever asked me what I was. How do you propose to give culturally competent care?”
Moss’ hope for the book is to raise awareness of the needs of the Native community, for whom federal healthcare funds are often lacking.
“Before there was nothing; it did something. I have no idea if people will use it but at least it’s out there,” she says.
From the August/September 2018 issue Cowboys and Indians.
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O’Leary, C. (2020). Use of exemplars: Identification of best practices in cancer prevention and screening. Clinical Journal of Oncology Nursing, 24(5, Suppl. 2), 45–48. https://doi.org/10.1188/20.CJON.S2.45-48
Watson, J. (2020). Advocacy and collaboration: Advancing cancer prevention and screening. Clinical Journal of Oncology Nursing, 24(5, Suppl. 2), 39–44. https://doi.org/ 10.1188/20.CJON.S2.39-44
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