A Trail of Transformation: The Meaning of Place in Health for Indigenous Women

Background and Purpose:  American Indians (AI) are more likely to experience obesity-related chronic diseases such as diabetes, and to experience high rates of substance abuse relative to other races.  In response, Choctaw leaders and AI researchers developed the Yappalli: Choctaw Road to Health Study, Pilot Phase I, an innovative, culturally-focused, outdoor experiential health leadership intervention focused on obesity, and substance abuse risk prevention among Choctaw women.  Participants re-traced parts of the Trail of Tears while re-committing to their ancestors’ vision of health.  For AI overall, health means balance and connectedness to all members of the ecological world as family members. The aim of this study is to develop an understanding of the role of place in Indigenous women’s health through analyzing the experiences of Indigenous allies who supported Choctaw participants on the walk, whose perspectives have not been previously explored.

Methods:  This pilot study used a purposive sampling strategy, consisting of 21 eligible volunteer participants who were female-identified, 18 years of age or older, self-identifying as Choctaw (n=12), other tribal affiliation (n=5), or non-Indigenous (n=4), and who agreed to participate in the walk.  Participants ranged in age from 21-49.  To examine the experience of Indigenous participants, this study focused on a subset of four Indigenous allies (one could not complete the interview) of diverse nationalities with graduate level education in health-related fields.  Data were collected in person using a semi-structured interview guide with focus groups during the walk, and through in-depth interviews at pre-walk and post-walk.  Post-walk transcripts were selected for this analysis due to their explicit inclusion of questions related to experiences of place.  Using Dedoose qualitative software, an inductive, thematic approach guided the analysis.

Results:  The findings discuss the two major themes of stress embodied and resilience embodied.  In the first theme, participants embody stress through memory of historical traumas and experience of contemporary traumas triggered by walking on the Trail of Tears.  In the second theme, participants embody resilience through connectedness to others and the environment as well as through maintaining cultural and spiritual traditions related to place as a form of resistance to colonial oppressions.  Indigenous allies viewed the walk as transformative, and embodied both the trauma of the Trail of Tears and that of their own tribal histories, as well as the resilience and resistance of Choctaw and other Indigenous ancestors.  They claimed the walk as an opportunity for healing, hope and renewal. Findings illustrate how place relationships link past, present and future generations in a common vision for health and resilience.

Conclusion and Implications:  Results of the study advance the literature on the role of place in Indigenous health promotion through exemplifying the transformational role place plays in the health of Indigenous women.  This study’s focus on Indigenous allies’ experiences offers cultural perspectives that cut across tribal specificity, a critical aspect for identifying common components that could be built into other Indigenous outdoor experiential health strategies.