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ERIC SMITH Indigenous health research has a tendency to invoke history in narrow and instrumentalist ways and to inadvertently depict Indigenous health, health care, and research as distinct from and as successors to, rather than products of settler colonial history. Work that identifies racism in health care tends to recommend generalized implicit bias and cultural safety training — primarily for health professionals, and most commonly physicians. While training programs are an important step, they tend to focus on Indigenous “culture” and not racism, and in so doing they implicitly re-centre and privilege whiteness as the normative perspective while failing to address the myriad of ways that racism deprives people of opportunities and structures their lives.” Cultural safety is not intentionally detrimental to Indigenous health, but it does leave the door open to focusing on what is “culture” in the outside world rather than how culture influences and is influenced by the “normative” medical infrastructure in North America. Avoiding this open door is the key to progress in culturally appropriate and effective care for Indigenous persons. Therefore, we should consider new ways of encouraging healthcare that safely embraces culture, rather than being content with cultural safety. One reasonable way to approach the concerns of cultural safety is to first allow healthcare to be content with points of “ethnographic refusal”.°® Anthropological study of Indigenous cultures, and the ways in which this study has informed healthcare provision, can only go so far. There are aspects of Indigenous culture that cannot be understood without truly engaging as equals, rather than imbalanced parties with imbalanced interests. Ethnography is an excellent interlocutor in a single direction, but does little to accomplish actual dialogue between institutions and the Indigenous groups it is often fascinated by. Inevitably, the knowledge, not understanding, of an individual’s culture boils down to a sense of, “I am me, I am what you think I am and Iam who this person to the right of me thinks I am and you are all full of shit and then maybe I will tell you to your face”. Cyclical barriers of knowledge production like this are extraordinarily enlightening. They tell us the points at which our anthropological overhead assessments will make no further ground. It is at these points, the point of the Qu’Appelle BCG trial, the point at which we currently stand, the culturally safe point, that we must come to move beyond with the aid of those who can reframe the questions we are asking. Therefore, refusing to allow ethnography to be the sole criterion of culturally effective healthcare allows us to frame healthcare in a way that puts people first. 57 McCallum and Perry, 23. 58 Simpson, On Ethnographic Refusal, 67—80. 5° Simpson, On Ethnographic Refusal, 74. * 260 +
