23 Introduction

Bente Norbye

When working in the rural and remote areas of the Circumpolar North, some of the challenges health professionals face in today’s environment is a mismatch in the knowledge they have received through health care education, and the contextual knowledge of their patients. We are all part of a culture, and its values, its people, its practices and material manifestations. There are many different definitions concerning the understanding of culture, but in this context we will support an understanding of culture as a combination of: a) the world view, values and norms that are dominant for a group of people; b) the attitude, actions and practices dominant for the same group of people; and c) their material manifestation (Gule 2008).

As health professionals we are also members of a professional culture with particular language, knowledge, values, artefacts, and ways of performing in health care practices (Markauskaite & Goodyear 2017). Further, as professionals we have a public agenda and/or work obligation with standards for professional conduct. The knowledge we use in treatment and care needs to be valid and based on research evidence relevant to that professional conduct. Our own values might influence the way we, as health personnel, carry out treatment and care, and it can be challenging to provide treatment and care if the cultural norms, values and contexts are different and unknown to us. We need to be aware concerning values and norms different to our own and explore how treatment and care can be carried out in respect for the patients and the families we care for.

Understanding different cultures and values specific to place is critically important for health personnel. Both our own background and our profession might influence the way we see patients with their families and see value in different ways of living. Professional conduct and context-specific treatment and care are not necessarily in conflict, but when it happens, it is our responsibility to identify the conflict and see if there are other ways or means to achieve the health goal. The importance is understanding what the conflict might be and the reason behind it. We need to rethink what kind of knowledge we need and how it can be used and in relation to the patients and family concerned.

For people in communities with a high proportion of Indigenous people, Western ways of treatment and care might collide with traditional ways of attending to an issue, that might be based on aspects other than scholarly research based findings. Since no cultures are static or without change, it is important to understand peoples’ background and the values of how they have lived and survived in the North, and include this with our professional knowledge. Colonial influences have altered traditional ways of living, often in detrimental ways. There have been numerous, well-meaning initiatives taken from “the outside world” to solve northern health issues, but with limited knowledge and cooperation of the people involved. This has caused distrust between those who are experiencing health issues and those trying to solve it. The recommended course of action to solve different kinds of challenges have often been drawn from an outside point of view and with an outside perspective of valid actions (Bjerregaard et al. 2004). Over generations this has created a gap between different ways of thinking, different values and knowledge systems. How can we ensure this gap becomes smaller in the future? How do we construct a bridge to combine different ways of thinking and ensure cultural safety for patients?

The chapters in this theme are covering themes from the Circumpolar North, and show how different knowledge influence how health care is received. They also demonstrate how important it is to relate and contribute to trusting relationships and discuss culturally safe approaches that reflect traditional knowledge in a modern context.

From the Northwest Territories in Canada, elderly women share their stories and knowledge through Sharing Circles. The article Infant Feeding Teachings from Indigenous Grandmothers, by Pertice Moffitt, Sabrina Lakhani, and Sheila Cruz, describes how families have supported and contributed to the feeding of infants historically. The Grandmothers hope to share their knowledge with new mothers as they can connect the past with the future and support new mothers. Elders hold an important place in many northern communities and cultures and storytelling empowers them as an important source of traditional knowledge.

Siv Kvernmo assesses The Impact of Cultural Determinants on Indigenous Sami Adolescents’ Well-Being and Mental Health. Although Sami adolescents have as good mental health and well-being as their non-Indigenous peers, Kvernmo finds significant variation in mental health across groups of young Sami. In Sami-dominated contexts, where there are stronger ethnic supports, cultural practice in daily life, and cultural safety, youth had better health outcomes than those in majority mixed and Norwegian dominated contexts, which often expose the Indigenous youngsters to prejudice and racism. Kvernmo concludes that the concept of ethnic identity and ethnic discrimination are particularly relevant cultural determinants which should be addressed in interventions and studies of mental health in Indigenous youngsters.

In Northern and Indigenous Ethical Imperative for Working with Communities Julie Bull describes an important dimension of research in northern communities and with Indigenous peoples. The paper describes the need to evolve research strategies from what to do to how to do research. It is important to involve patients, families and communities, and form mutual relationships between researchers and Indigenous communities. This relationship should facilitate the development of methodologies, conceptual frameworks and meaningful recruitment strategies that relate to the communities and the theme that is being researched. The paper shows that individual ethical consent might be inadequate when conducting research related to a community as a whole.

The Norwegian paper Establishing Trustful Relationships between Marginalized Indigenous People and Researchers/Health Workers by Snefrid Møllersen and Tonje Haanæs-Rensberg discusses how important it is to establish trustful relationships between marginalized peoples and researchers through a partnership model in research. This model shifts the emphasis from passive to active participation in research where participants’ competence and expertise are recognized and taken seriously. The inclusion of reindeer herders’ knowledge in this case was essential and both parties understood that the research findings were rooted in trusting relationships. This model can be useful for others who seek a more ethical conduct of research.

Both culture and health are interrelated, essential elements of the human experience. Hopefully, we can accept and learn from each other’s ways of living and better understand what is valued by individuals, families and communities, and thus ensure that the highest professional standards are achieved.

References

Bjerregaard, P., Kue Young T., Dewailly, E., and Ebbesson, S. O. E. (2004). Indigenous Health in the Arctic: An Overview of the Circumpolar Inuit Population. Scand J Public Health, 32: 390–395

Gule, L. (2017) Profesjon og flerkulturalitet (Profession and Multiculturalism). In Anders Molander and Lars Inge Lerum (eds). Profesjonsstudier (Studies of Professions) (pp. 233 – 250). Oslo Universitetesforlaget. In Norwegian

Markauskaite, L., and Goodyear, P. (2017). Epistemic Fluency and Professional Education.  Innovation, Knowledgeable Action and Actionable Knowledge. Dordrecht: Springer.