“Being on the Walk Put It Somewhere in My Body”: The Meaning of Place in Health for Indigenous Women

Abstract

Relationship to place is integral to Indigenous health. A qualitative, secondary phenomenological analysis of in-depth interviews with four non-Choctaw Indigenous women participating in an outdoor, experiential tribally-specific Choctaw health leadership study uncovered culturally grounded narratives using thematic analysis as an analytic approach. Results revealed that physically being in historical trauma sites of other Indigenous groups involved a multi-faceted process that facilitated embodied stress by connecting participants with their own historical and contemporary traumas. Participants also experienced embodied resilience through connectedness to place and collective resistance. Implications point to the role of place in developing collective resistance and resilience through culturally and methodologically innovative approaches.

Introduction

Indigenous peoples’ relationship to place is a critical component of health and well-being (Walters, Beltrán, Huh, & Evans-Campbell, 2011). The ongoing loss and destruction of land, along with limited access to healthy environments (Lewis, Hoover, & Mackenzie, 2017) has been a major contributor to stress and negative health outcomes that reflect substantial health disparities between Indigenous and settler colonial populations (Hoover et al., 2012; Walters, Beltran, et al. 2011). A recent review of health intervention literature among Indigenous peoples of North America revealed the limited attention given to the role of connection to place in Indigenous health (Fernandez, 2019). The purpose of this study is to explore how physically walking parts of the Choctaw Trail of Tears in an experiential, place-based pilot study, impacted non-Choctaw Indigenous women’s (NCIW) views on stress and resilience.

Indigenous health is conceptualized holistically across spiritual, emotional, mental, and physical domains and encompassed within familial, communal, and natural environment relationships (Vukic, Gregory, Martin-Misener, & Etowa, 2011). The natural or physical environment is a core protective factor and an important determinant of health and wellbeing, which must be considered in improving Indigenous health (Jennings, Little, & Johnson-Jennings, 2018). Extending beyond land-based, geographic sites, Indigenous notions of place can also be socially constructed (Ramirez, 2007) wherein narratives of both trauma and healing can aid in prevention efforts (Fernandez, 2019). Further, places in which historical trauma events occurred may invoke both positive and negative feelings, as places hold memories of the past that are essential to framing historical and contemporary understandings (Dodge, 2007).

Historical trauma (HT), refers to cumulative and pervasive intergenerational trauma that arises as an outcome of human-made traumatic events targeting a specific community (Sotero, 2006; Walters, Mohammed, et al., 2011), and the aftermath from historically traumatic events is at the root of settler colonial disruptions of Indigenous peoples’ social, cultural, corporeal, and terrestrial relationships with land in the United States (e.g., Walters, Beltran, et al., 2011; Walters & Simoni, 2002). Historical trauma events (HTE) are systematic attempts to destroy spiritual, cultural, and subsistence practices often based on relationships with land (Brave Heart, Chase, Elkins & Altschul, 2011; Evans-Campbell & Walters, 2006), thereby eliminating some of the core protective factors foundational to Indigenous health, and increasing vulnerability to stress and illness. Examples include restrictions on Indigenous agricultural methods and land use, land confiscation, and forced displacement imposed through federal policies (Calloway, 2008), which were designed to increase environmental dispossession of Indigenous people from their lands through limiting access to traditional environments (Richmond & Ross, 2009). Effects of these assaults persist through ongoing environmental hazards related to for profit initiatives such as construction of pipelines and mining projects which threaten tribal sacred sites and water safety (e.g., Cunsolo Willox et al., 2013; Hoover et al., 2012; Lewis et al., 2017).

The contemporary health sequelae of such HTE among Indigenous peoples are evident in their significant health disparities compared to non-Indigenous groups. Resulting disparate health outcomes include alarming rates of obesity, diabetes and heart disease, associated with food insecurity among tribal communities in North America (First Nations Development Institute, 2013). Additionally, climate change—largely the result of human activity—is dramatically reducing sea ice, thereby limiting Arctic Indigenous peoples’ subsistence practices, leading to increased reports of anxiety and depression, and a decreased sense of health and well-being overall (Cunsolo Willox et al., 2013). Such impacts of environmental change on marginalized Indigenous communities increase vulnerability to poor health and mental health outcomes (Billiot, Beltrán, Mitchell, Brown & Fernández, 2019).

Stress and resilience related to Indigenous relationships to place can be embodied. Embodiment refers to how societal and ecological circumstances become biologically incorporated, and can manifest in health outcomes across generations (Krieger, 2005). Indigenous scholars have incorporated this concept into their framing of the relationship between place and health (Beltran et al., 2018; Schultz, Walters, Beltrán, Stroud & Johnson-Jennings, 2016). Indigenous peoples’ concept of connectedness, defined as “the interrelated welfare of the individual, one’s family, one’s community, and the natural environment” (Mohatt, Fok, Burket, Henry & Allen, 2011, p. 444), provides a culturally specific context in which these embodied relationships can be understood. Importantly, place-related stress can manifest in the embodiment of both the memory and contemporary manifestations of HTE. This embodied stress, coupled with a reduction in protective factors, results in negative, intergenerational health consequences (Krieger & Davey Smith, 2004; Walters, Mohammed, et al., 2011). For example, Indigenous peoples today across tribal nations experience loss and grief surrounding widely shared historical trauma events such as displacement or boarding school abuses, even if they or their ancestors did not directly experience these traumas (Whitbeck, Adams, Hoyt & Chen, 2004).

Despite hundreds of years of settler colonial attempts to sever Indigenous relationships to place, Indigenous bodies, minds, and spirits continue to be sites of resilience. Indigenous resilience is a multi-level, evolving, transformative, and adaptive social and psychological process, characterized by positive outcomes at the personal, familial, community and larger social group levels (Kirmayer, Dandeneau, Marshall, Phillips & Williamson, 2011). Simultaneously, Indigenous peoples’ resistance is a crucial part of their resilience. The opposition of oppression through actively upholding Indigenous identities, lifeways, and ontologies can be viewed as coping mechanisms (e.g., Alfred & Corntassel, 2005). Such coping mechanisms can be reinforced within relationships between strong families and communities, and with language, storytelling, spirituality and engaging with land through cultural, spiritual and subsistence practices (Alfred & Corntassel, 2005). These efforts can also be conceptualized as “survivance,” which emphasizes Indigenous peoples’ active presence (including ties to homelands) through continuation of stories that renounce Indigenous erasure and victimization (Vizenor, 2008).

Over the past several decades, Indigenous scholars have contributed to the ongoing work of communities and practitioners to transform the adverse impacts of historical trauma through innovative theory, research and interventions. Indeed, research on the role of place and settings in Indigenous health interventions is steadily growing (Beltrán et al., 2018; Fernandez, 2019; Jennings et al., 2018; Schultz et al., 2016; Walters, Beltran, et al., 2011). One widely used model, the Indigenist stress-coping model (ISCM; Walters & Simoni, 2002), posits that cultural and spiritual buffers moderate the relationship between traumatic stressors and poor health outcomes in Indigenous populations. Within the ISCM, the Indigenous connection to place is an integral context and consequence of events and activities in both the “trauma” domain (e.g., historical trauma via displacement), as well as of the “cultural buffers” domain (e.g., traditional health practices) identified in the model. This informs our proposed conceptualization of place engagement as both a stressor as well as a protective factor in the prevention of illness. The Tribal Health Sovereignty model also calls for health researchers to center place and environment as health within Indigenous obesity prevention efforts (Jennings et al., 2018). In fact, culturally grounded, strengths-based interventions that center on local Indigenous knowledge, are effective at improving health and often, more accepted within communities (Fiedeldey-Van Djik et al., 2017; Jennings et al., 2018; King, 2011; Rowan et al., 2014; Walters et al., 2018). Such interventions focus on positive tenets of both traditional and contemporary Indigenous cultures including connectedness through relationships with people and places (Fiedeldey-Van Djik et al., 2017; Jennings et al., 2018; Mohatt et al., 2011).

This article focuses on relationship to place among NCIW who participated in Yappalli: Choctaw Road to Health, an experiential, land-based intervention that involved walking the physical path of the Choctaw Trail of Tears (Walters et al., 2018). The “Trail of Tears” is a major HTE that involved forced removal of five tribal nations under a federally mandated Indian removal policy in the 1830s. On the Choctaw Trail of Tears, over 12,500 Choctaw people were forced to walk 500 miles from their traditional homelands or face losing their tribal sovereignty (Barnett, 2012). An estimated 2,500–6,000 people died from disease, starvation, and exposure (Akers, 2004; DeRosier, 1970; Foreman, 1932; Wright, 1928). This initial pilot study demonstrated how physically being in places where HTE occurred—even for NCIW as people from tribal communities other than the one in which the HTE occurred—was a multi-faceted process that illuminated experiences of both stress and resilience. While Choctaw women’s physical experiences of re-walking the Trail of Tears have initially been analyzed and discussed (Schultz et al., 2016), the experiences of NCIW in the pilot study have remained unexamined. Physically walking the Choctaw Trail of Tears helped the NCIW connect with the trauma of their own tribal histories, and simultaneously develop transformative narratives of resilience.

Methods

Secondary qualitative data belonging to the four non-Choctaw Indigenous women was drawn from Yappalli: Choctaw Road to Health, a community-based, participatory pilot study (n=12; Walters, Principal Investigator (PI) and Johnson-Jennings, Co-PI) conducted in 2012. In response to high rates of obesity and related adverse health outcomes among members of the Choctaw Nation of Oklahoma (CNO), Choctaw women researchers, community and academic, developed a pilot project incorporating culturally generative activities deeply rooted in relationship to place in order to develop an initial Choctaw health framework (see Walters et al., 2018). While Choctaw participants were recruited, non-Choctaw Indigenous volunteers were also recruited to provide support on the Trail and serve as witnesses. The non-Choctaw volunteers joined in re-walking the Choctaw Trail of Tears and participated in the curriculum regarding the place-based trauma and Choctaw ancestral teachings of hope and resilience.

Four Indigenous researchers, including the PI and co-PI Choctaw tribal members, took part in the trail experience as both participants and data collectors. They conducted semi-structured, in-depth, English-language interviews and two focus groups among all Choctaw and Indigenous participants. All 12 Indigenous participants were recruited using convenience sampling, yielding a primarily female-identified sample for the pilot study. Utilizing a semi-structured interview guide that assessed new insights and reflections on health behaviors and attitudes within the context of experiences on the Trail, researchers collected data through in-depth interviews at pre-walk and post-walk, and focus groups conducted during the walk. This article analyzes the three months post-walk interviews from the total of four adult NCIW volunteers (one of whom was both an NCIW interviewer and participant). The post-walk interview guide included explicit questions related to experiences of place, which were the focus of this analysis. Additionally, any references to the place and health relationship within the entire transcripts were also analyzed. The specific place-related questions consisted of the following: 1) Were there any moments on the trail you felt connected to place? What was that like? Where did it happen? 2) If at all, how did the trail affect your sense of home? How did you feel that in your body? An example of open-ended health-related questions is: 1) What does health and being healthy mean for you as a Native or Indigenous person, especially now that you have walked the trail? The study received Institutional Review Board approval from both the University of Washington and the CNO to ensure protection of human subjects. Schultz et al. (2016) and Walters et al. (2018) provide a more detailed description of the pilot study.

The NCIW in this sample were in their 20s and 30s, represented four distinct Indigenous nations of binational (U.S. and another country) origin, had graduate-level educations, and were working in health research. With phenomenology as our guiding methodology, we used an inductive, thematic analytic approach to capturing NCIW’s embodied, lived experiences (Guest, MacQueen & Namey, 2012; Smith, Flowers & Larkin, 2009; Starks & Brown Trinidad, 2007). A sample size of four is within the typical range for phenomenological studies (Starks & Brown Trinidad, 2007), which aim to find a relatively homogenous sample in order to capture detailed, nuanced experiences (Smith et al., 2009). The metatheoretical assumptions of the ISCM (Walters, Simoni & Evans-Campbell, 2002)—the theoretical model that guides this study—are predicated upon Indigenous worldviews, which emphasize a relational worldview of interconnectedness, respect, and interdependence of both animate and inanimate things/beings. Additionally, the relational worldview recognizes one’s role in maintaining balance and harmony in relationship with the natural environment and corresponding ancestral obligations (i.e., past and future generations) tied to the natural world, sacred sites, and original territories. Such relational worldviews are holistic and emphasize application to daily living in mutuality, respect and mindfulness. Phenomenology guides the generation of themes and categories from NCIW narratives in order to illuminate individual and collective meanings of the NCIW experiences on the Trail, through embodied perception (Guest et al., 2012; Smith et al., 2009; Starks & Brown Trinidad, 2007).

This qualitative, thematic analytic approach included several steps that involved de-contextualization and re-contextualization within and across cases to narrow down the data to representative categories, and organize it into clusters of representative meaning (Ayres, Kavanaugh & Knafl, 2003). The lead author conducted all of the data analysis, with review and input by research study PIs, staff and faculty. Initial coding began with data immersion through multiple readings of each transcript, followed by an analysis of individual transcripts and identification of key words, phrases, sentences, and paragraphs that mention place, health, and the relationship between place and health. Next, intermediate coding involved a deeper analysis of the relationships between codes, leading to the generation of categories to create a codebook, which helped organize the data (Guest et al., 2012; Saldaña, 2009). Further coding occurred in Dedoose, a qualitative analytics software, in order to generate a coherent, engaging story that illuminates deep understanding of participant experiences with health and place as contextually grounded (Ayres et al., 2003).

To ensure rigor and trustworthiness, the lead author acknowledged their insider/outsider status as a NCIW who participated as a volunteer in a sequential NIH funded randomized control trial for a Yappalli health intervention, several years after the pilot study analyzed in this article was conducted. The lead author also worked with some participants and members of the research team on different projects before and after the pilot study. Thus, even with de-identified data there were instances where the lead author recognized participants based on their narratives. However, those relationships with participants and members of the research team enabled the lead author to triangulate the data and engage in member checking. The lead author engaged in memo-writing and consultation with the research staff and faculty in order to bracket personal biases and perspectives (Corbin Dwyer & Buckle, 2009). Furthermore, all of the co-authors except for the second author participated in the Yappalli pilot study.

Results

Two main themes emerged from the analysis, each with two sub-themes. First, the NCIW experienced stress embodied which reflected the visceral connection to the Choctaw Trail of Tears as well as subthemes of feeling connected to ancestral trauma and the recognition of its impact on contemporary health disparities. Second, resilience embodied reflected the NCIW’s reconstructed narratives of the transformation of trauma to health, through subthemes of connectedness to place, and through forging a collective path of resistance for future generations.

Stress Embodied: “Being on the Walk Put it Somewhere in My Body”

Drawing on concepts of historical trauma and its manifestation in contemporary health adversities, NCIW connected specific HTEs that resulted in or from environmental dispossession—including forced relocations, compulsory attendance of boarding schools, and loss of traditional knowledge—to contemporary health disparities, disconnection from identity and land, and violence. NCIW narratives revealed the physical and emotional stress they experienced as they reflected on the intergenerational impacts of such HTEs. One NCIW related her own family’s premature deaths from chronic disease, with an understanding now on a corporeal level:

Every single year, at least one of my relatives has died of these things, so going through that as a relative has been hard and arduous and painful. Being on the walk put it somewhere in my body, an understanding that is now in my cells.

Another NCIW described her visceral reaction as she recognized the connection between historical trauma and contemporary health outcomes on the Trail:

A lot of the traumas that were experienced 100…200 years ago, are still happening…It makes me feel sick. It takes away energy. It feels really heavy…it’s historically situated, but it extends into the present moment, like a spider web…the reasons that our people are getting sick and dying, they’re the same reasons as they were.

Historical trauma: “It’s historically situated.”

Although NCIW recognized differences in HTE across the Choctaw and their own tribal nations, they also saw numerous connections. NCIW shared their own experiences of pain and grief surrounding the trauma of the Choctaw Trail of Tears. One NCIW described how walking with Choctaw participants on the Trail deepened her own connection to historical trauma: “There’s sort of this peripheral awareness of the atrocities that were committed against Choctaws and against native communities….to really have to face it in a tangible way made me really have to connect to that trauma differently.”

The clear physical impact of thousands of Indigenous footsteps on the Choctaw Trail of Tears was striking, and evoked visceral reactions in NCIW. One portion of the Trail in what is now known as Village Creek State Park, Arkansas, was sunken six to ten feet below ground level by the thousands of Indigenous people forced to walk the Trail of Tears. One NCIW recounted her reaction to this site: “I really feel pain in my heart….I feel shock….We hurt…I hurt.”

This NCIW’s description is an example of how the impact of trauma from a place is more than symbolic—the sunken path was a powerful, physical reminder of the thousands of men, women, and children whose footsteps literally shaped the Choctaw Trail of Tears. She recollected her own tribal history of politically imposed violence, and highlighted the connectedness of Indigenous experiences across the globe:

Even though it is not in my history, this happened in different ways in different parts of the world. We also experienced violence policies like relocation. I feel like we are very similar so I would like to join. …I believe that other Indigenous people, if they visit [her tribal nation], they may have this kind of feeling.

Contemporary trauma: “It extends into the present moment.”

NCIW described how historical trauma manifests in contemporary traumas, via embodied health disparities rooted in environmental dispossession. One NCIW explained how confinement to reservations and compulsory boarding school attendance played a role in the dispossession from traditional foods:

A lot of folks who ended up with commodity foods or who were taken away no longer had the ability to gather traditional foods and hunt. It clearly has to do with the levels of poor health, obesity, and diabetes that we see in our communities now.

Finding ways to release emotional pain resulting from such environmental dispossession is a natural response to trauma, and may be evident in behaviors leading to either disease or health. One NCIW described alcohol as one pathway for pain release in her tribal community: “…historical trauma affects contemporary disease. During the walk, a lot of us carry the pain, and we need somewhere to release the pain….drinking alcohol in my community is the way people try to release the pain.” Another NCIW not only recognized the impact of trauma embodied on personal and communal illness but also her ability to heal: “Holding things in your body will make you sick. It definitely used to make me sick, and I’ve learned ways to not hold it into my body as much.”

Resilience Embodied: “Because of Them, We’re Still Here.”

These NCIW’s stories describe not only how trauma is transmitted across generations, from cell to society, but also the intergenerational pathways of resilience. Through embodying their own Indigenous definitions of health as individual, communal, and place connectedness, and through resisting ongoing colonially imposed adversities, NCIW narratives demonstrated resilience embodied. Inspired by the Choctaw participants’ ancestral visions of health and resilience, walking on the Choctaw Trail of Tears helped NCIW connect with their own tribal ancestors’ strength and resilience. One NCIW recognized this intergenerational transmission of resilience:

…we’re here because of them and what they gave up for us. They had to deal with all of the hardships and straight-on trauma….They were resilient and able to stay here. Because of them, we’re still here even though there’s not as many of us anymore…

Connectedness to place is health: “Health means…the place that you’re in.”

NCIW narratives frame health as a multidimensional sense of connectedness across tribes, generations, and places—whether those places are their own or others’ ancestral lands. One NCIW explained: “health means more than just what is happening to your body…your experiences, your ancestors’ experiences, the place that you’re in, the people you’re interacting with, the way you’re interacting with them, all of those things influence health.” Another NCIW summarized the connection with the natural environment as part of the Indigenous community—a connection that facilitates multi-dimensional, multi-generational relationships:

When I have a chance to connect with people, I will have a chance to connect with the environment… And if I connect it with the environment, it will be easy for me to connect with the other generations, with the ancestors, with what happened there.

This multidimensional, expansive conceptualization of health as connectedness is prominent across all of the interviews. These connections can be made, maintained, and strengthened through cultural and spiritual practices that reinforce Indigenous identity and provide a coping mechanism to heal from trauma. Another NCIW described how she releases her trauma through practices which themselves can create places of prevention—practices grounded in teachings about the natural environment: “I have [cultural dance form], we have ceremonies, we have medicines, so I don’t have to carry it with me all the time.”

A shared path of resistance: “We’re trying to create…a path that was healing.”

Resisting in place—whether through re-walking the Choctaw Trail of Tears or through participating in cultural and spiritual practices that create and reinforce place connections—was viewed as key to multigenerational preservation of Indigenous health. One NCIW explains: “We’re still recovering from colonial processes, and this walk is part of that decolonizing work.” She describes how walking the Choctaw Trail of Tears transformed it from a path of trauma and health disparities to a “shared path of resistance:”

This is, this will be my life’s work… to shift this, to transform this…. the new Trail of Tears as the health disparities we’re all dying from…. Just the fact that we were there doing this, that you were all doing this especially meant that it was changing.

Cultural and spiritual practices that create and reinforce a connection to place was considered an “antidote” to contemporary traumas, which one NCIW defined as “trying to be healthy and well, having movement, [dance], eating well, going to ceremonies, and trying to learn our Indigenous languages.” Reclaiming these practices involved the adaptation and evolution of cultural practices, which is key to Indigenous resilience through the generations. She further explained:

There is a fierce resolution to be who we are regardless of where we get pushed to be…our cultural traditions; our cultural symbols have changed over time and history, the essence is still the same…this way that we maintain ourselves, our spirits, despite, colonial processes is what keeps us alive. We’re fighting for our health and wellness.

One NCIW summarized the transformation that both NCIW and Choctaw participants experienced by walking on the Choctaw Trail of Tears, as a vision for the health of future generations: “We were trying to create more of a path that was healing versus remembering it as a path of trauma and trying to make it different for the next generations and the younger people.”

Discussion

This is the first known study to examine how supporting a tribally-specific HTE place-based healing journey influences the health views of Indigenous people from other tribal groupings. The key findings of this study include several themes that illuminate the power of being in places where HTE occurred. For NCIW, walking the Choctaw Trail of Tears evoked a visceral connection to both intergenerational stress and resilience (Dodge, 2007) that merely hearing or reading about the Choctaw Trail of Tears could not. NCIW drew connections between intergenerational, intertribal health disparities and their origins in HTE that disrupted the place relationship. Walking the Trail of Tears in support of the Choctaw women evoked a sense of empathy and solidarity among NCIW, as they recognized the common threads of historical and contemporary trauma between the Choctaw and their own tribal histories. Simultaneously, walking the Trail of Tears connected them with a sense of intergenerational, intertribal resilience. Their reconstructed narratives demonstrated that place connection is integral to connections with ancestors, community, and future generations (Mohatt et al., 2011; Walters, Beltran, et al., 2011), ultimately shaping conceptualizations of health. As HTEs are linked to health inequities, strategies of resistance are linked to Indigenous wellness and healing. Walking the Choctaw Trail of Tears, for these NCIW, encompassed micro and communal acts of resistance (Evans-Campbell & Campbell, 2019). From their personal commitments to health and wellness, to their communal organization as a group of intertribal Indigenous women, re-tracing their Indigenous ancestors’ footsteps, metaphorically, was their “life’s work.” While remaining in and re-tracing sites of destructive HTE can have adverse impacts on health and well-being (O’Neil, 1986), connecting with these same places can also facilitate narratives of “survivance” (Vizenor, 2008). These sites can be sources of healing and resilience where micro, communal and political acts of resistance (Evans-Campbell & Campbell, 2019) are merged to transform trauma to healing. Furthermore, Indigenous women have a unique relationship to land: they embody resistance to settler colonialism as an ongoing, gendered process (Arvin, Tuck & Morrill, 2013). Moreover, in many tribal matrilineal societies, Indigenous women are responsible for or actively participate in restoring tribal well-being when a great trauma has occurred in addition to protecting and maintaining ongoing land-based ceremonial and agricultural practices and responsibilities (Pesantubbee, 2005).

Findings should be considered in light of the study’s strengths and limitations. Strengths of this study include its innovative contribution to a neglected body of place-based Indigenous health literature. In addition, this study is a unique examination of the experiences of Indigenous peoples who voluntarily accompany descendants of survivors of a particular tribal nation and their tribally-specific HTE to the physical site of the original trauma. Furthermore, the sample is comprised of NCIW who belong to four different Indigenous groups of binational origins (U.S. and another country), at two different developmental stages in their 20s and 30s. Their distinct cultural perspectives cut across tribal specificity, a critical aspect for identifying common components that could be built into other Indigenous outdoor experiential health strategies. Yet, limitations may emerge from similar sample characteristics including gender, younger adult age grouping, educational level, and similar perspectives on health promotion and the role of historical trauma in health disparities. It is uncertain whether similar findings would emerge from a sample comprised of broader gender, age, and career groups. Furthermore, one NCIW is both an interviewer/participant—an insider/outsider positioned in a unique space of insight yet potential influence which must be bracketed as discussed in the methods section (Corbin Dwyer & Buckle, 2009). These qualitative findings aim to identify more nuanced and often neglected issues rather than be representative of the population. Future work could examine a larger sample in order to expand the range of in-depth perspectives that would help strengthen study saturation.

This study has important implications for theoretical expansion, intervention, and knowledge development necessary for culturally congruent social work practice with Indigenous people. Theoretical expansion might incorporate additional dimensions to conceptual models such as the ISCM (Walters et al., 2002) in terms of the person-place relationship as both a source of stress (e.g., environmental dispossession) and resilience (e.g., participation in place-based cultural/spiritual activities). This expansion could be useful for developing and testing measures related to health and place using qualitative, quantitative, and mixed methods designs. Findings may also assist in the development of new models to inform interventions aimed at decreasing Indigenous peoples’ health disparities. Additionally, conducting a future comparative analysis could shed light on differences and similarities between the experiences of Choctaw and NCIW participants on the Choctaw Trail of Tears. This may ultimately lead to a better understanding of experiences of intertribal participants in tribally-specific HTE-related healing projects. Moreover, future research on the role of gender in understanding Indigenous health and place-based interventions is warranted. This study also has specific implications for the field of social work. It contributes to the paucity of literature on the role of place in Indigenous health, which brings ample opportunity for developing culturally relevant, settings-based holistic practice techniques and interventions. Furthermore, expanding the literature on the impact of social and environmental determinants of health should include the role of place relationships in health equity, especially in light of the increasing threats of climate change that disproportionately impact Indigenous people globally (Billiot et al., 2019; Cunsolo Willox et al., 2013). Such efforts not only have significant implications for building crucial research infrastructure, but also for addressing ecological health inequities through culturally and methodologically innovative approaches. Through looking at the various aspects of the place and health relationship for Indigenous people, we can reach a more nuanced understanding of both the etiological origins and pragmatic implications for the place and health relationship as we aim to combat health disparities and inequities among Indigenous peoples (Billiot et al., 2019). Walking on the Choctaw Trail of Tears provided a pathway of transformation for NCIW, shaping narratives of healing for themselves and future generations.