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專任助理蔡紅慈

屏東縣三地門鄉部落健康營造中心

   衛生福利部為落實原住民族部落及社區「健康生活化、生活健康化」的目標,自2000年起以「因地制宜」、「建立機制」、「永續經營」三大原則,推動「原住民部落及離島社區健康營造計畫」,營造部落優質的生活條件,達到促進原住民族健康的目的。台灣原住民醫學學會於2016年獲衛生福利部委託成立專業輔導團隊,協助縣市衛生局及部落健康營造中心發展具「文化敏感度」及永續經營的策略,並透過會議的召開讓原民朋友分享並了解健康的重要。

   台灣原住民醫學學會透過全國輔導委員共識營、工作坊、辦理原住民健康促進論壇及實地訪視與輔導工作,發展具當地特色之推動模式,建立部落相互評比之評核機制,並維護原住民部落健康營造網站,發行原住民部落健康營造季刊,以建立完善的輔導網絡。衛生福利部為活化並提升原住民族及離島地區部落及社區健康狀態,鼓勵成立營造中心,結合地方資源推動「部落社區健康營造」計畫,藉由民眾的學習與參與,建立健康的支持環境,共同營造健康之部落及社區。

主流文化對健康管理的重視與影響

   對於欠缺核心價值,而主流文化又陷入“窮到只剩下錢”的台灣社會,要形塑健康行為的支持性環境,確實不易。在部落工作不是件容易的事,因為部落重視「共識」。一件事情的傳達,需要連續不斷地宣導,直到大家都認同與明瞭執行才會有效益。

   原住民長年來平均餘命皆少於一般國民約10歲,經調查發現屏東縣原住民菸酒檳行為、不運動比例、肥胖率皆偏高,這些不健康的生活型態都是癌症、心血管疾病及慢性病的高危險因子,為改善部落民眾健康生活習慣,各部落健康營造中心透過部落推動委員會的運作,每年制定專屬部落民眾關心的健康議題加以營造及推動。不論中央或地方原住民的健康一直備受矚目,因為寶島國家的真正寶物就是原住民,但原住民在健康維護與自主管理上總不甚在意,需要部落健康營造積極提供陪伴關懷與支持。

原民福利需求與輸送的均衡考量

   筆者自小在平地社區長大,看見許多居住平地的原住民有許多福利是看的到,但無法享受到,原因是戶籍不在原鄉。一般對原住民的印象,總認為原鄉地屬偏遠、資源缺乏、人力外移、部落老化。但反觀,因到平地鄉移居或謀生的原住民除了位置不偏遠外,其他問題一樣反應在居住的環境與村莊。原民會提供的福利與台灣原住民醫學學會的服務也應重視居住平地的原民同胞,提供適切的想要與需要服務。

社區的人才留用與專業教育的抉擇

   筆者有這機會參與到衛生福利部正在推動的「預防及延緩失能照護計畫」,這份計畫的啟動目的在銜接長照1.0,預防失智、失能的增加,也期望藉由社區人才的資源使在地高齡者能延緩老化、預防失智。但反觀,自行政院推動社區照顧關懷據點至今,許多政府部門、民間單位、醫療院所相繼開設許多關於活動帶領、認識老化、照顧服務等的課程。開設的目的在培訓在地人才,如今將近20年載,培訓的人才留用在據點了嗎?據點的課程是否仍以社區培訓之人才授課呢?大致上沒有,因為據點課程邀請之講師仍以專業為主,如醫師、護理師、職能治療師、政府單位提供的講師群等,據點的講師鐘點費多數仍留給〝專業〞的講師群。如今配合長照2.0推動的「預防及延緩失能照護計畫」在社區的運作,落實引領退休者及新世代投入社區自助、互助與共助之預防照護產業發展之目標。讓社區有心參與培訓課程的人才,藉由服務社區提升自我價值、提升成為社區師資群,並讓計畫的美意跟推動的目的〝三〞思而後確實執行。

   在「2025無齡世代-迎接你我的超高齡社會」(陳恭亮、楊惠君。2015)書中提到,高齡階段首重的就是「健康」,但現階段醫療體系看重的是疾病診斷、醫療成效,但與高齡者息息相關的是生活品質,出院後的照護銜接計畫更是首要的需求。如何維護健康、延緩退化並且健康在地老化,是各領域共同達成的最終目標。

   部落健康營造中心的執行理念是由下(部落)對上(政府部門)發出期望的意象,共同推動健康議題讓部落全民動起來,健康迎向我。但長久來,受文化理念、職場環境、同儕影響,使部落健康議題的執行仍是有限。如今平均餘命的增加,政府也大量植入國民健康維護的觀念,期望原鄉也能盡快重視自我健康品質的維護,讓原民文化加入健康元素,建立獨特的原創健康新概念。

   飲酒文化需要提升至如何正確的節酒,是部落也是部落健康營造的重要課題,當在原民部落推動“節制飲酒”迄今,仍有人保持不樂觀的態度,但如今有越來越多部落願意堅守健康議題,在宴會活動上拒絕提供菸、酒、檳榔,提升這樣的信念是第一線部落健康營造中心的績效,也是本所與本部落健康營造中心長久以來辛勞推動,換來全國冠軍榮耀的殊榮。

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