Author: Chloe Hemm/ Master Student of Global Health Program, National Taiwan University

The opportunity to develop my passion for cross-cultural healthcare drew me to study in Taiwan. In January 2022, I signed up for the course, “Cultural Competence in Global Health,” looking forward to firsthand insight into Taiwanese culture in Hualien. My experiences in Hualien, thanks to the professors, students, and indigenous educators, opened my eyes to the richness of diversity within Taiwanese society and deepened the way I approach cultural competence as a whole.

        During this trip, we visited the Hualien Indigenous Wild Herb School, where we learned from various members of the Amis (Pangcah) tribe. Here, I saw, smelled, and tasted a variety of plants grown as part of the community’s revitalized traditional practices and connection to the modern-day Slow Food movement. The intentionality and care involved in nurturing and harvesting each crop spoke to the connection between many indigenous groups and the land. I learned that many Amis people view their culture of gathering and interactions with nature simply as a “way of knowing.”

        I saw how Amis people’s ways of knowing have extended to the preparation and enjoyment of food. From traditional uses of seawater to ferment vegetables, to the labor-intensive process of harvesting and preparing rattan cane, community experts shared the cultural significance attached to many products of the environment. I witnessed how the health of the land is intertwined with the health of the people. From there, I was able to appreciate this cultural pillar more profoundly.

At the Amis Tafalong ancestral house, Kakita’an, we listened to community members’ oral storytelling and observed corresponding wooden carvings. One of the Pangcah origin stories involved a flood. A brother and sister were the sole survivors, and because they were relatives, their offspring were cursed turtles, snakes, and other creatures. With the help of the gods and engaging in prayer rituals, these creatures became the human ancestors of the Pangcah people. Associated rituals, including the use of rice wine, are continued in Pangcah spiritual practices today. Rice wine and betel nut in particular, are substances important to Pangcah culture which I had previously only contextualized from a public health perspective.

According to many oral accounts, indigenous ancestors have been said to come from stone, other animals, and many natural sources. The tradition of life tied to the earth, existing merely as permutations of different forms reflects the relationships of dignity and interdependence between all nature and people. In my coursework from GHP, I had been learning about the One Health approach to combine aspects of environmental, human, and animal health. Despite being promoted as a modern movement in global health improvement, such principles have always been central to many indigenous cultures—in Taiwan and around the world. I found it unjustly ironic that many of those who have been practicing One Health for centuries are often faced with health disparities in the present day.

A common theme throughout my cultural encounters in Hualien was unfortunately the injustices many indigenous peoples face. Propagated with each wave of colonization in Taiwan, indigenous people have been marginalized in many governmental and health policies. I learned that disrespect for cultural sovereignty is even reflected in the name, “Guangfu Township,” where many Amis people live. The name signifies the reclamation of the territory by the Chinese government following Japanese rule. For the indigenous people living there, this “reclamation” overlooks their own historical inhabitation of the land. The land was not to be claimed in the first place.

Overlooking indigenous relationships with the land easily translates to overlooked disparities in health. In the classroom, I had learned about the documented higher mortality rates in indigenous populations as well as disproportionate barriers to healthcare. During the trip, I began gaining a clearer picture of the relationships between power, indigenous reclamation, and barriers to clinical effectiveness.

Dr. Jian Yang. from the Fengbin Aboriginal Branch of Hualien Hospital expounded on some of these dynamics from an indigenous practitioner’s perspective. One point that particularly stuck with me was his advocacy for recruiting and retaining indigenous practitioners for local healthcare delivery. Relationships of trust between providers and patients are crucial for quality healthcare, he explained. Patients’ feelings of safety must be prioritized. From a strength-based approach, local community members can best serve their populations. This counters the deficit-based approaches that (often unintentionally) victimize indigenous populations by imposing outside sources of care that are not culturally informed.

As I consolidated my learning from the trip, I contemplated the development of health disparities, the implication of majority colonizing groups, and positionality of marginalized peoples. Overcoming inequities in health, in any context, requires not only cultural competence but also the realization of a concept I learned through the course: cultural safety. While I am grateful to have learned about many traditions and customs of some indigenous Taiwanese cultures, I also recognize that it is not the lack of awareness about “other” cultures alone that drives inequity. Rather, more focus should be given to understanding the processes through which social environments shape cultural and individual identities. These processes and inevitable power imbalances contribute to the “othering” which harms disadvantaged groups.

As I continue pursuing my work on intercultural healthcare in Taiwan, I hoped to draw connections between the U.S. and Taiwan.I have been challenged to expand my understanding of Taiwan’s people–a social and cultural group I previously viewed as a single “other” to my own cultural group and identity. Through my learning, I have a new appreciation for the diverse experiences of personhood on this island and hope to apply my learning by navigating cultural engagement in the health and healthcare spheres.