省思文化照顧在原鄉部落社區照顧服務之實踐──南投縣三個族群部落的經驗

Reflection on the Practice of the Cultural Care in Indigenous Community Care Service: Experiences of Three Ethnic Groups in Nantou County

長期照顧政策公共化的實施，如何既要能夠在普遍公平的原則架構上，又可以保留及突顯原住民族原有的文化價值與生活模式，這是推動原鄉部落長期照顧服務的一大考驗。本研究從Madeleine Leininger所提出的「文化照顧理論」觀點出發，採用質性研究方法，以南投縣三個不同族群（泰雅族、布農族、邵族）的部落文化健康站為研究對象，以深度訪談法做為資料蒐集方法，據以瞭解原鄉部落社區照顧服務的圖像，探索部落在推動社區照顧服務時所遭遇的問題與威脅。研究結果顯示，原鄉部落對於社區照顧服務的圖像，並不是強調醫療健康的照顧，反而認為部落文化健康站可以再現及傳承部落文化傳統知識與技藝，重拾長者在部落的價值地位，進而達到文化傳承與產業發展的目標。然而，現行的部落社區照顧運作仍遭遇到許多的問題與威脅，需要部落與各界共同面對與解決。依據研究發現，本文提出以下討論與建議：（1）深入理解原住民族「照顧」的實質意涵，以「傳統部落文化資產」突破「現行社區照顧服務的想像」；（2）尊重部落自主能力，建構「以部落為主體、以長者為核心」的部落社區照顧內涵；（3）正視部落族群的「同」與「不同」，突破既有的「原漢雙元思維」，開啟實際的「多元族群部落視角」；（4）重視部落文健站的文化與經濟功能，整合相關部會資源，共同致力部落文化與產業的發展；（5）簡化行政措施，並鼓勵部落年輕族人參與照顧服務，落實「族人照顧族人，在地安養」的目標；（6）避免過度依賴昭顧服務資源，匯差用剑落互助優勢，維持部落傳統價值。本研究的論述期可做為政策、制度與實務之參考與反思，進一步累積原鄉部落社區照顧服務的經驗與知識。

How the publicity of long-term care policy is implemented to keep and highlight the indigenous culture and life mode of indigenous people in the principle of universality and fairness is a great challenge in promoting the long-term care service in indigenous tribes. Based on Madeleine Leininger's “Cultural Care Theory,” this study uses qualitative research method to study the tribal cultural health stations of three ethnic groups (Atayal, Bunun and Thao) in Nantou County. With in-depth interview as the data collection method, this study aims at understanding the images of the community care service in indigenous tribes, and discusses the problems and threats encountered by the tribes in promoting the community care service. The results show that, in terms of the images of the community care service, indigenous tribes regard that the tribal culture health stations can reproduce and inherit the traditional knowledge and skills of the indigenous culture as well as regain the value and role of the elders in the tribes for the goal of cultural heritage and industrial development rather than emphasizing the medical and health care. However, many problems and threats exist in current tribal community care, making the tribes and all walks of life must work together to solve. Based on the findings, this paper puts forward the following discussions and suggestions: (1) to have an in-depth understanding of the core of “care” of indigenous people and to break through the “imagination of current community care service” with the “traditional tribal cultural assets;” (2) to respect the autonomy of tribes and to construct the connotation of the tribal community care with “taking the tribe as the main body and the elderly as the center;” (3) to face up to the“similarity” and“difference” between the ethnic groups and to break through the existing “Binary Thinking of indigenous and Han peoples” to inspire the actual outlook on “diversified ethnic groups and tribes;” (4) to attach importance to the cultural and economic functions of the tribal culture and health stations, integrate the relevant resources, and work together to develop tribal culture and industry; (5) to simplify administrative measures, encourage indigenous youths to involve in care services and to achieve the objectives of “mutual help among indigenous people and aging in place;” (6) to avoid over-reliance on care services resources and to make good use of the collaboration within tribe for maintaining traditional indigenous values. The discussion of this study is expected to serve as a reference and reflection of policies, systems and practices to further accumulate the experience and knowledge of the community care services in indigenous tribes.