與台灣原住民族健康專家共同探索社群療癒方案

Abstract

臺灣的原住民族經歷了數百年的殖民統治，和其他原住民族一樣，面臨因剝奪而產生的健康問題。以多民族代表性民主作為國家認同，臺灣也開始了與原住民族和解的進程。其中，補償工作的一部分集中在恢復原住民族的健康上，但臺灣尚未正式採用北美洲、大洋洲和拉丁美洲推動的原住民族參與式方法，來改善原住民族的健康。於此，本研究從Web of Science資料庫中搜尋英文科學研究進行廣泛文獻回顧，了解上述地區如何運用原住民族認識論，解決剝奪的方式，於本研究中稱為「社區療癒策略」。而後，藉由與十位臺灣原住民族健康領域的專家進行訪談，探討在臺灣實施社區療癒策略的情況和面臨的挑戰。在這個過程中，作者也努力使自己去殖民化。 在文獻回顧中，作者分析了48篇文章，發現大多數或所有社區療癒策略都有社區、儀式、自然和知識保護者這四個主要方面。這48篇文章也記錄了幾種療癒效果，包括賦權和韌性等心理效果，飲食和體能改善等行為效果，以及重新與土地與心靈產生連結等情感效果。實施社區療癒策略的主要挑戰則再於如何協調資金需求，這往往會形成艱難的權力動態（power dynamics）情境，有時還需採取不適合其文化的措施以達到療癒目標。本研究之訪談結果則反映了與文獻回顧類似的敘述。傳統知識、語言和家庭凝聚力的喪失在訪談中被描述為殖民的後果，但本次受訪者並不總是將上述情形視為健康問題。部分受訪者則描述了臺灣政府以「缺失為基礎的方法」（deficits-based approach）處理原住民族健康議題。雖然受訪者未必熟悉「社區療癒策略」這個術語，但他們意識到需要解決剝奪，並描述了一些旨在解決剝奪的計畫工作。儘管很難確定這些案例是否符合本研究所定義的社區療癒策略，但從這些計畫概述中，可知其著重於群體合作以達療癒之目的，於此本研究認為這些案例應屬於社區療癒策略之一。 訪談中討論的社區療癒策略包括當地食物復振、沉浸式族語環境、歷史遊程的重新體驗、文化技能的傳遞和與長者的故事分享等。文化安全雖是恢復原住民族的健康正確地一步，但不足以達到「療癒」效果，因此社區療癒策略仍存在必要性。目前臺灣的文化健康站和部落健康營造中心則為潛在社區療癒策略現成的實踐場域，而其他社區療癒策略則仰賴原住民族組織持續發展。現今各原住民族所關注的原住民族健康預算的分配權仍掌握在衛生福利部手中，維持著新殖民（neo-colonial）的情況，並且在文化上不適當。受訪者也強調與政府機關合作的難處，並需要將其計劃調整為衛生福利部或文化部所認為的「合適」方案。綜合文獻回顧和訪談結果，本研究提供了關於原住民族健康最新進展的資訊，也為臺灣原住民族健康提供可能的發展方向。

The Indigenous peoples of Taiwan have faced centuries of colonization, and, like other Indigenous peoples, face health issues arising from a history of settler colonialism. As Taiwan embraces its national identity as a multi-ethnic, representative democracy, it began a process of reconciliation with its Indigenous peoples. Part of its efforts to make amends focus on restoring Indigenous peoples' health, but Taiwan has not yet formally adopted the Indigenous and participatory methodologies towards Indigenous peoples' health, as advanced in North America, Oceania, and Latin America. The author conducted an extensive literature review in the Web of Science database on the ways Indigenous peoples in English-speaking parts of the world addressed the dispossession of settler colonialism through Indigenous epistemologies, which the author calls "community-healing strategies." Then, through interviews with ten experts in Taiwanese Indigenous health, the author explores the implementations of and challenges facing community-healing strategies in Taiwan. Throughout this process, the author also worked to decolonize herself. From the literature review, the author analyzed 48 reports to find four major aspects of community, ceremony, nature, and teaching guiding most or all of the community-healing strategies. Several healing effects were also documented by these 48 reports, including psychological effects such as empowerment and resilience, behavioral effects such as improvements in diet and fitness, and emotional effects such as reconnecting to land. The main challenge that emerged in implementing community-healing strategies was reconciling the funding requirements, which created difficult power dynamics and sometimes required culturally inappropriate measures, with the healing objectives. The interviews reflected a similar narrative to that of the literature review. Loss of traditional knowledge, language, and family cohesion were all described as consequences of colonization in the interviews, though these experiences of dispossession were not always construed as health issues by the experts. Several interviewees described issues with the Taiwanese government's deficits-based approach to Indigenous health. While the interviewees were unfamiliar with the term "community-healing strategy," they were able to recognize the need to address dispossession and described several initiatives that worked to resolve this sense of dispossession. While it may be difficult to determine where these examples are community-healing strategies as defined in this thesis, their Indigenous leadership precludes the author to believe they are most likely community-healing strategies. The community-healing initiatives discussed in the interviews were examples of local food revitalization, language nests, re-experiences of historical journeys, transfer of cultural skills, and story-telling with Elders. Cultural safety, though a step in the right direction, was insufficient to create "healing,” so there was still a need for community-healing strategies. Cultural Health Stations and Tribal Health Promotion Centers emerged as natural centers for potential community-healing strategies, while other community-healing strategies were developed by Indigenous organizations. Budget allocation for Indigenous health, originally an inter-Indigenous concern, maintains the neo-colonial status quo in the hands of the Ministry of Health and Welfare and is culturally inappropriate. Interviewees highlighted the difficulty of working with government agencies and the need to tailor their initiatives into "appropriate" projects for the Ministry of Health and Welfare or the Ministry of Culture. Combining the literature review and interviews, this research can inform readers interested in current advances in Indigenous health, as well as possibilities for Taiwanese Indigenous health.