打開vuvu的智慧寶庫： 文化照顧在森永文健站的實踐與反思

Abstract

依據既有的研究指出我國社會福利政策對原住民族是制度性介入，且背後帶有文化霸權和殖民之態度，不但限縮了族群文化自主性，進而忽視了原住民族群間的文化特殊性。基於上述的背景，本研究主要係以部落文化健康站為研究對象，研究目的在於探討原鄉長照依附在主流政策的規劃下，當面對原住民族文化與族群間的差異時，部落工作者如何透過文化轉譯的方式，實踐具有文化底蘊的照顧方案；同時在提供服務過程中遭遇到哪些工作日常的斷裂經驗，以上皆是本研究欲探討的議題。

本研究採用質性研究中的田野調查法，以台東排灣族森永部落文化健康站為研究場域，資料蒐集方面透過「參與式觀察法」與「深度訪談法」大約四個月左右的時間內完成；而後續在資料分析方面則係以「主題式分析法」，並藉由文化照顧理論的視角與詮釋學典範探討原鄉部落照顧實踐的具體樣貌。

研究發現包括以下四個部分：其一，當代族人對於部落照顧的想像由於經歷過殖民政權以及宗教信仰之影響，在年輕一輩的照服員身上，以及部落長者的回應當中看見跨世代的差異，前者對於照顧的價值觀來自於主流知識教育以及宗教信仰影響甚重：而後者闡述了排灣族既有的共享、互惠之集體照顧的社會結構，其照顧精神鑲嵌於文化當中。其二，透過長者現身自述，了解他們參與文健站的動機，亦感受到長者在部落裡的生活慣習是多元面向的，展現出老年生活是積極且活躍之圖像。其三，由於新公共管理的影響，照服員面對文健站的諸多規定以及繁雜的業務，時常因為標準化的工作規範、固定流程方式等因素，在進行照顧服務中常出現工作與日常生活的斷裂經驗。最後，在面對主流政策的影響之下，看見工作者如何透過族群之「語言」、「認知」、「行為」和「物質創造」等，轉譯成對部落長者有意義的實踐模式，這其中則是藉由族群中的「文化」元素，來回應族人日常生活的方式。值得一提的是，工作者透過做中學、學中做之方式，試圖修正自己正受到主流社會價值觀的想法，最後將照顧服務場域由站內走入部落每個角落，並重新詮釋與解構照顧的關係、時空、空間、以及角色等層面，從中看見主流知識與在地知識間的抗衡。

綜上所述，本研究結果與文化照顧理論相互呼應，強調照顧的意涵，不僅關注長者身體健康，也同等重視其心理和靈性等需求。從部落的觀點來看，照顧的概念根源於長者的日常生活，緊密聯繫著他們的生活習慣，在部落中文化與生活密不可分，並以血緣和地緣關係為基礎形成一個互助的文化系統。

Purpose: According to past research, Taiwan's social welfare policy is an institutional intervention on indigenous peoples, behind which is a kind of cultural hegemony and colonial attitude, which not only limits the cultural autonomy of ethnic groups, but also ignores the particularity of indigenous cultures. Based on the aforementioned background, this study primarily focuses on cultural health stations as the research subject. How workers implement culturally aware care programs through cultural translation; at the same time, what kind of daily disjuncture of experiences they encounter in the process of providing services are the topics to be explored in this study.

Methods: This study adopts the field investigation method in qualitative research, and takes the Taitung Senyong cultural health station as the research field, where the Paiwan people is the main population. Data collection was conducted over a period of approximately four months using "observer-as-participant" and "in-depth interviews"; In the follow-up data analysis, the thematic analysis method was used, and the specific appearance of the indigenous tribe's care practice was explored through the perspective of cultural care theory and hermeneutics paradigm.

Results: The research findings can be summarized into the following four parts: First, due to the influence of the colonial regime and religious beliefs in the contemporary tribe's imagination of tribal care, there are inter-generational differences in the response of the younger generation of attendants and the responses of tribal elders. The former’s value of care comes from mainstream knowledge and education and the influence of religious beliefs; while the latter expounds the existing social structure of shared and mutual-help collective care of the Paiwan people, and points out that these care spirits are embedded in cultural norms. Second, through the self-reports of the elders, we can understand their motivations for participating in the cultural health station, and also feel that the living habits of the elders in the tribe are multifaceted, showing a positive image of the life of the elderly. Third, due to the influence of the new public management, the care workers face many regulations and complicated business of the cultural health station, often because of the standardized work specifications and fixed workflow, which often lead to the experience of encountering difficulties in the care work during the care service. Fourth, under the influence of mainstream policies, we can see how workers integrate cultural elements such as "language", "cognition", "behavior" and "material creation" into meaningful ways of caring for the elderly. Through the way of learning by doing, workers are trying to correct their thoughts that they are being influenced by mainstream social values. It is worth mentioning that the field of care is moved from the cultural health station to every corner of the tribe, and the relationship, time and space, and roles in the care service are re-deconstructed, so that we can see the confrontation between mainstream knowledge and local tribal knowledge.

Conclusions: In summary, the findings of this study align with the theory of cultural care. The study emphasizes the substantial importance of tribal care, which not only focuses on the physical health of the elderly but also addresses their psychological and spiritual well-being. Care must originate from the tribe's perspective since the concept of care is deeply intertwined with the elders' daily lives and their unique living habits. In the tribe, culture is life, and the tribal care system is built upon blood and geographical relationships.