[ 摘要 ]

台灣原住民的健康問題自八Ｏ年代以來，一直是政府與學術界關注的焦點，然而受限於研究與學術資源的分配，具有最大的發聲與傳播能力的，反而是對原住民群體了解最淺薄的漢公衛學者，而漢公衛學者與被研究者的疏離，某一層面上是其他相關領域研究的短缺所造成，不論是原住民健康的族群差異、文化、或社會層面，目前都缺乏細緻的一手質性研究。

漢公衛學者在進行原住民健康問題的探討時，他們不僅不了解原住民的傳統文化與習慣，對於原住民的社會條件限制也非常陌生，往往以漢人現況為標準去評價原住民群體，生產了許多「去歷史、自然化」的論述，甚至影響了本應客觀的公衛研究的設計、以及結果。而另一群同樣也非常關心原住民健康的人──原住民醫者，雖然能夠體諒一般民眾的社會條件限制，且對於傳統文化習慣並不陌生，卻仍然經常將健康問題歸咎於一般民眾的「被動」，雖然較漢公衛學者更貼近被論述對象，但是還是與一般民眾還是有著某種程度的隔閡。

而西方醫學專業訓練的背景，使得漢公衛學者與原住民醫者觀看方式都以西方現代科學（modern science）為圭臬，且對傳統知識體系完全排斥。受到專業訓練的影響，原住民醫者缺乏以傳統認知方式認知傳統的能力，成為一個「半他者」。而這種對西方生物醫學的熱切與深信，使他們認為原住民尋求傳統醫療是因為知識不足所導致，而無法覺察一般民眾在非西醫治療上的需求，形成了解主要醫療健康問題的阻礙。

反觀擁有豐厚的適應能力的原住民一般民眾，總是利用他們所能迄及的所有資源來面對疾病問題，這是受到西方現代科學框限的醫者所不具有的才華，他們並不是一群缺乏西醫知識而盲目的群眾，其主體價值、需求與觀點，都是以西醫和自我為本位，從事研究與論述的漢公衛學者難以覺察的。

雖然原住民醫療健康論述受限於論述者和被論述者間的疏離，失去原本應有的客觀與公正，但是以西方醫療體系、甚至漢人的視角進行研究的確有其必要，透過不同視角發現的差異與問題，能夠提供該群體缺乏的思考。不論是研究者或是被研究者的主體，都不能偏廢，在異文化的研究過程中，要先認識差異、接納差異並與以尊重，而不是一昧地尋求絕對的標準，進行對或錯的評斷、甚至否定被研究對象的本質，如此才能跨越疏離。容許「雙主體」的存在，才能夠創造更高的研究價值。



[ 英文摘要 ]

The government and academia have fellow Taiwan aboriginal health problems closely since 80’s. However, Han sanitarians, the most powerful discourse makers, were alienated from the aboriginal society. And this alienation is formed by lack of innovate qualitative research about diversity of race, culturology and sociology of Taiwan aborigine.

Han sanitarian can’t perceive aborigine’s tradition and custom while they investigate aboriginal health problems. They are also unconscious of aborigine’s social conditionality, and judge them by the standard of Han. Therefore, they made a lot of essentialized and naturalized discourse. The stereotype of Taiwan aborigine even influences the design and result of research, which must be objective originally. The aborigines in medical profession are more aware of aborigine’s social conditionality and familiar with tradition and custom, but they blame on aborigine’s passive attitude to health, which was essence as well. Although they are more intimate with aborigine populace than Han sanitarian, there is still a gap between them.

The professional training of Western medicine makes Han sanitarian and the aborigines in medical profession value modern science as the only knowledge system. They are convinced that aboriginal knowledge system is non-rational. The enthusiasm to biological medicine makes them believe that people seeking for traditional medicine just because of their ignorance. They can’t figure out that might because Western medicine is not able to satisfy all people needs. And this thought becomes a bug for them to investigate the main problem of aboriginal health. Furthermore, aborigines in medical profession can’t comprehend traditional medical system with aboriginal knowledge system. They become the “half others”.

On the other hand, aborigine populace, with great adaptability, is able to use every resource to cure illness. They are not ignorant but never limited by belief in modern science.

It’s hard for self-centered Han sanitarians to know the subjective values and needs of aborigine populace. Through the research in different culture, researchers have to know the difference and accept it, respect it. It is incorrect to judge everything by one highest standard. The essence of everyone is sacred and inviolable.

However, except for the alienation, it is still necessary to investigate aboriginal health problems from the view of otherness, since biological medicine and Han culture can provide a key perspective which aborigine subject can not provide. Objectivity is as important as subjectivity in different-culture research.