原住民族部落社區照顧推動歷程與服務設計的文化考量：以台東縣海端鄉為例

Cultural considerations in community care implementation process and service design in Indigenous tribes: The Case of Haiduan Township, Taitung County

隨著原鄉部落青壯人力的外流，現行原住民部落以老人及兒童為主要居住人口，這兩類人口群的自我照顧能力較為有限，甚至是祖父母照顧孫子女的隔代教養方式，衍生出來的老少照顧問題，值得關切。為了解決部落老少照顧問題，政府部門宜以行政體系為主體，建構完整的福利體系。其照顧的方式需在原鄉推動「部落」、「社區」與「家庭」式的福利供給與輸送，並且在過程中要尊重原鄉文化與生活習慣的特殊性，要從原住民的主體性與部落主義思考。這些論點固然正確，但何謂原鄉文化與生活特殊性？何謂原住民的主體性與部落主義思考？迄今仍較缺乏從實踐經驗中加以印證。從2014年開始衛生福利部有鑑於社區照顧的重要性，希望需要被照顧的人口群可以留在自己的社區得到適當的服務，不必遠離家鄉。但偏遠地區資源有限，較難以推動，必須要從實際操作的過程中累積經驗，建立模式，遂開始推動「偏遠地區推動社區照顧試辦計畫」，其中在台東縣選擇海端鄉做為試辦地區逐步建構其社區照顧服務制度。海端鄉係屬台東縣的山地鄉，有90%的原住民人口，以布農族人為主。而該鄉社區照顧服務係由台東縣天主教愛德婦女協會承辦，該協會在海端鄉提供社區關懷據點工作，整合既有各項長照服務資源及社區服務，以偏遠、原住民部落地區的老人與身心障礙者為服務對象，提供生活支持、餐食服務、居家服務轉介、諮詢及交通接送等多元社區照顧服務。本文以海端鄉為研究場域，以深度訪談方式從中瞭解社區照顧模式推動歷程與遭遇的困難，並從族人生活習性中理解服務設計的文化考量，以探討原住民族文化脈絡下社區照顧如何可能？其研究結果可供相關族群推動文化照顧之參考。

A great attention should be paid to the outflow of young peoples in indigenous tribes as it has created ranges of care problems in remote indigenous regions. It was argued that solving such a problem required a comprehensive welfare system to promote an integrated supply service at the levels of tribe, community and family, respect the uniqueness of Indigenous cultures and lifestyles and take subjectivity of indigenous peoples and local tribalism into considerations. However, what is the uniqueness of Indigenous culture and lifestyles? Also what is subjectivity of indigenous peoples and local tribalism? These questions were left no answer since there is a lack of empirical evidence. In 2014, the Ministry of Health and Welfare launched ‘the Remote Areas Community Care Pilot Program’, Haiduan Township in Taitung was selected as one of the pilot townships. 90% of the population in this Township is Bunun people. To work closely with a local agency ‘Taitung County Catholic Charity Women's Association’, the research was designed to employ in-depth interviews for data collection, aiming to understand community care implementation process and difficulties, and how community care becomes possible in diverse cultural contexts.