Health care and health care seeking strategies among Puyallup Indians

This study replicated Kleinman's research on family-based popular health care in Taiwan among the Puyallup Indians of Washington. Standardized interviews were conducted among 80 Puyallup families to determine family health practices and beliefs, and the patterns of referral to professional practitioners. Comparisons are made between the Puyallup and Taiwanese family health care practices and health care seeking processes. The author concludes that the relative absence of folk medicine and the availability of free medical care among the Puyallup are the most important factors causing the variance between the rates of family treatment and the patterns of health care seeking behaviors between the Puyallup and the Taiwanese.     

Public versus private care: philosophy,not economics,is shaping the debate

A debate is brewing on the future of private health care within Canada''s medicare system, and even though the federal government professes its intention to defend the existing public system, the growing rightward trend of Canadian voters may mean they are willing to consider more private care. Citizens may continue to express undying support for medicare as an “untouchable” public good, says Charlotte Gray, but they are less and less willing to pay for it through taxes.     

Oral health care in private and small long-term care facilities: a qualitative study

Objective: Elderly people who are institutionalised receive qualified care. Among the services supplied, oral health care has not always been a priority. The aim of this study was to identify the characteristics of oral health care provided to the elderly residents in long‐term care facilities (LTC) in Porto Alegre/RS city. Methods: Twelve private and small‐size LTCs (less than 20 residents) participated in this study. All supervisors and 36 carers were interviewed. The data obtained were organised according to the offer of oral health under the following categories: responsibility for oral care, oral care routines, difficulties carrying out oral care routines. Results: The procedures used most often in order of frequency were tooth brushing, prostheses cleaning, use of mouthwashes, soaking of prostheses and cleaning of the tongue. Among the difficulties mentioned were the high cost of dental assistance, the lack of co‐operation both by family members and by the elderly themselves, the oral and general health status of the elderly and the limited time available for carers to carry out the tasks. Oral care is conducted empirically, and the responsibility is left to the carers. Conclusions: Analysis of the statements given reveals that oral care does not follow any kind of protocol or standardisation. The persistence of this situation could lead to unsatisfactory oral health care in private and small LTC facilities.     

Catawba Indians: morphology, genetics, and history

The Catawba Indians of South Carolina appear to be descendants of the once flourishing Siouan tribe now admixed primarily with Whites of the area. Study of physical traits and blood types was made in 1962 at the time they terminated reservation status. The data permit comparisions with other populations and an estimation of the genetic contribution of presumed parental populations to the hybrid. Skeletal remains of Siouan Indians from archeological sites in the area provide a basis for morphological comparisons. Similar ties of the Catawba to the Indian Knoll people of Kentucky and to the Occaneechi people of early historic times are noted. Results of blood typings of these ancient bones also enable some tentative serological comparisons with the present day Catawba Indians. Certain unusual factors in the history of the present population have affected their isolation and admixture, and this interaction of culture and biology is explored.     

Class,culture, and the Miskito Indians: A historical perspective

Conclusion In this paper I have endeavored to outline a dialectical analysis of the Miskito Indian historical experience of the last 350 years. This history has been divided into three periods, in each of which class processes have been integrally tied to particular ethnic configurations. In the first, pre-contact period, a series of autonomous egalitarian hunting, gathering and horticultural groups, linked in a network of mutual trading and raiding, inhabited the various river basins of the coastal region. In the second period, beginning roughly in the early 17th century, integration as a periphery in the British mercantile empire engendered a political economic transformation in which local headmen emerged as focal points in the articulation of coastal production with British exchange networks. The new level of power over the allocation of social surpluses assumed by these headmen was validated through the symbolic framework of British monarchy. This also served the geopolitical interests of the British. The rise of this incipient tributary mode of production was a central force in the emergence of the Miskito as a new ethnic entity.The decline of mercantilism and the rise of the second phase of the Industrial Revolution saw a shift in British interests in the periphery from commodities to sources of labor and loci for investment. This brought about a second transformation in which the incipient tributary kingship was undermined both from within, by the demise of the slave trade, and from without, by increasing foreign contact coupled with population expansion and the large-scale introduction of wage labor. The Miskito were now integrated fairly uniformly as an underclass in the new coastal class hierarchy. However, wage labor took its place beside kin-ordered production and exchange in a dualistic system, which alternated with continual booms and busts in the local economy. Ethnic groupings now both defined, and were rooted in, class differentiation.As we have seen, due to its theoretically fragmented and inconsistent nature, our received anthropological history of the Miskito also serves us poorly, if we want to develop a critical understanding of the Atlantic coast of Nicaragua and its dilemmas within the revolution. Focusing on the intersection of class and ethnic processes through history gives us a more coherent and analytically convincing picture. It provides us, as well, with a basis for a deeper understanding of the roots of the Miskito/Sandinista conflict. While politics conceived in terms of class or in terms of ethnicity have given rise to ostensibly different social agendas, it is clear that historically the two have never been separate aspects of existence. Miskito culture is an historical creation — evolved in response to the ongoing pressures of integration into a world political economy whose center lay in Europe or the United States and expressive of the class processes set off by these encounters.Yet it is more than just an expression of these processes, for the way in which the Miskito defined and articulated themselves as a cultural unit played a central role in the shaping of those processes themselves. Thus, a Marxist analysis that downplays the importance of ethnic identity in favor of class identity will miss fundamental aspects of what it is to be Miskito, culturally and politically, as well as economically. By the same token, ethnic movements that eschew class analysis in favor of a strictly cultural interpretation will fall into a similar trap, becoming perhaps more vulnerable to acting in ways that go against their own interests. Whatever the outcome of this particular situation, given the size and importance of the indigenous peoples through the Americas, the left's ability to deal with culture as a basis of resistance will have a deep impact on the course of progressive social change throughout the region.Daniel Noveck received his BA degree in anthropology, from the University of Massachusetts, Amherst.     

Focus groups confirm that MDs,public differ on role of private health care

Polls conducted by the CMA in 1995 indicated that most physicians favour more private funding for Canadian health care. However, new information gathered in a series of CMA-sponsored focus groups confirms earlier findings that the public does not yet share these views. In March, a polling expert told the Board of Directors that physicians must be cautious in advocating a position on the issue.     

Problems of care in a private nursing home.

To assess problems of care in a private nursing home an observational study was carried out over two months, during which a research nurse worked as a member of the staff in a home caring for 25 patients aged 62-90. During the second month a consultant physician visited the home weekly to hold case conferences and assess each patient''s functional ability and drug regimen. Various problems in medical, nursing, and bureaucratic matters were identified--for example, staff failed to understand the appropriate response to various medical symptoms; no clear policy existed for managing pressure sores; and one patient''s anticoagulant state could not be assessed when industrial action meant that transport to take him to hospital was not available--and several changes in drug treatments were recommended. The problems that were identified were mainly due to poor communication between the home and general practitioners and hospitals and to the lack of guidance policy on common issues that arise in long term care. Such a policy could be produced by health authority staff, general practitioners, and representatives of nursing homes.     

Dental chipping in Aleuts, Eskimos and Indians

Analysis of dentitions belonging to 324 prehistoric and protohistoric Aleuts, Eskimos and northern Indians, all of whom were regularly meat-eaters, reveals a significant difference between Eskimos and Aleut-Indians for a little known type of tooth wear. This wear is characterized by severe crushing and/or flaking of the crown surface of one or more teeth (termed “pressure-chipping”). It occurs chiefly in dentitions of high arctic Eskimos of Alaska, Canada, and Greenland, and significantly less often in the teeth of Kodiak Island Eskimos, Aleuts and northern Indians. Sex differences do not exist but pressure-chipping occurs significantly more often in adult (21–x years) than in non-adult (0–20 years) Eskimos. The exact mechanism(s) responsible for pressure-chipping is unknown, although ethnographic accounts of Eskimo eating habits suggest that crushing of hard substances such as bone was involved. The severity of this wear could have contributed to the selection for, or preservation of, large and complex crowns in high arctic Eskimos. Pressure-chipping is offered as evidence favoring the view that tooth size (longevity) may have had in the past some adaptive value.     

A novel formulary: collaboration between health care professionals,seniors, private sector and government in Nova Scotia

A novel formulary has been developed in Nova Scotia with the objective of providing quality treatment with needed medications at affordable cost. Creation of the formulary has involved collaboration among health care professionals, seniors, the Department of Health and pharmaceutical companies. This is the first Canadian formulary to use the Anatomic, Therapeutic, Chemical system. Drug listing is comprehensive rather than exclusive. Colour-coded recommendations on use assist physicians with drug choice. Relative costs are indicated within each therapeutic grouping. Listings indicate drugs approved for reimbursement, interchangeable medications, maximum allowable cost, drug identification number and manufacturer code. Treatment summaries provide brief overviews of therapeutic advice. Updates on new products and new or modified treatment summaries are provided every 6 months. The formulary will be the focus of coordinated educational activities on treatment for seniors and health care professionals.