The Importance of Culturally Appreciating Medical Providers for Native American Patients

Nikolas Etcitty - Navajo Nation

Personal photo, 2020.

Sharing One Skin: Okanagan Community by Jeanette Armstrong

In the article “Sharing One Skin: Okanagan Community” by Jeanette Armstrong, she recognizes and represents the importance of community and our identity as human beings. The four main capacities we hold are the physical self, the emotional self, the thinking-intellectual self and the spiritual self. The physical self emphasizes our senses and our sensitive bodies that guide us through life, the emotional self is where “community and land intersect in our beings and become part of us”, meaning that it is our emotional self that promotes our “wholeness” and “well-being” in this world. The thinking-intellectual is described as reasoning and how when we perform certain tasks, we “engage ourselves beyond our automatic-response capacity”. Lastly, the spiritual self is represented as being abstract but holds great value into the interrelationships between us humans and non-human entities that eventually bring new knowledge and can be applied to all aspects of our lives. With constant change and conflict, we must remain resilient to external forces and remember who we come from and who we identify ourselves with, this would lead us to the balance and harmony we try to achieve throughout our lives.

Armstrong, Jeanette. “Sharing One Skin: The Okanagan Community,” in Jerry Mander and Edward Goldsmith (eds), The Case Against the Global Economy. San Francisco, CA, Sierra Club Books, 1996. Pp 460-470.

"Native American Identity" by Perry G. Horse (Kiowa)

In the article “Native American Identity” by Perry G. Horse (Kiowa), it's been described that there's a significant change in Indigenous lifestyle between what our ancestors and grandparents lived and our current lives today. Issues such as blood quantum were discussed, such as, how can a piece of paper from the U.S. and Tribal government determine if we have Indian blood? Ultimately, an Indigenous connection between our people and our Earth. Another aspect that was mentioned was their language and education and how the white privilege and cultural domination has influenced us Natives to be accompanied by their language and lifestyle. Although colonialism has caused our traditional ways of life to be placed on the back burner, it is a very personal matter for the individual to express their Native tradition and culture. Our Indigenous identity does not lie within appearance or a certificate of “Indian blood”, our identity lies in the traditions that were told from our ancestors and passed down from generations. Times have changed from 100-years ago but our resiliency as Native peoples hold strong within our cultural practices and our language.

Horse Perry G. (Kiowa). “Native American Identity,”. New Directions for Student Services,Wiley Periodicals, Inc. 2005. Pp 61-68.

Personal photo, 2021.

Personal Photo, 2017.

"The Frontier", Trauma Life in the ER

In New Mexico we experience health disparities and inequities quite often, due to rural and distant communities spread across the state. With only one Level One Trauma Center in the state, the television series, “Trauma: Life in the ER” represents the key function of the trauma center for the state of New Mexico. In the episode “The Frontier” in the first two minutes of the episode the narrator states: “Here [New Mexico] people value their freedom above all else, it's the freedom of the frontier. the closer you get to the edge, the more likely you are to get hurt. When you do, there’s just one place to go- University Hospital, the only Level-One Trauma Center for 400 miles”. Throughout the episode many doctors and healthcare professionals are filmed doing their day-to-day work where we get to experience what it’s like treating minor to critically ill patients. The “melting pot” of people presented in the episode represents today’s culture of mixed ethnicities and races that exist in healthcare, particularly in New Mexico.

“The Frontier”. Trauma: Life in the ER, created by Glenda Hersh, et al. Season 3, Episode 4, NYT Television for The Learning Channel, 1998.

Have You Ever Seen A Real Indian?, American Indian College Fund. https://dylanlee.net/AMERICAN-INDIAN-COLLEGE-FUND. Accessed 15 Dec. 2021

"The Scalpel and The Silver Bear" by Lori Arviso Alvord M.D.

In Lori Arviso Alvord’s book, The Scalpel and the Silver Bear, published in 1999, she makes use of her prior Navajo experience along with her medical training in surgery to understand the importance of balance and harmony in her patient’s lives. “Today’s medical environment provides more healing options than ever for a person who becomes sick (6)”, and “Yet another type of medicine is also being practiced on our planet. It is one that involves not only the body but the mind and the spirit; it involves not only the person but her family, her community, and her world. It involves song (6).” To the advantage that Dr. Arviso Alvord is a Navajo surgeon, her background and her understanding of her patient’s lives makes cultural accommodations more integrated and natural. Such as in one of her patient cases, Charlie Nez, after the singing of the medicine man, he appeared to be more convalescent and his vital signs stabilized. Whether ceremonies, songs or rituals that are performed are clearly accepted and acknowledged in Lori Arviso Alvord’s healthcare facility of Gallup Indian Medical Center. This concept of Navajo healing applies to all Native-Indigenous cultures across the world, it is the acceptance and understanding that needs to be equal across all healthcare providers and facilities.

Alvord, Lori Arviso, and Elizabeth Cohen. The Scalpel and The Silver Bear. Bantam Books, 2000.

“Indian Health Service: A Comprehensive Health Care Program for American Indians and Alaska Natives” by the U.S. Department of Health & Human Services and the Public Health Service

In the book “Indian Health Service: A Comprehensive Health Care Program for American Indians and Alaska Natives” by the U.S. Department of Health & Human Services and the Public Health Service, it describes the overall progression of the Indian Health Service in the late 1980’s. It was stated how the healthcare of Indian peoples were created, from the U.S. Army physicians to eventually join the new division of the Public Health Service, Indian Health Service. “The transfer of the Bureau of Indian Affairs from the War Department to the Department of the Interior in 1849 stimulated the extension of physicians’ services to Indians by emphasizing non-military aspects of Indian Administration and by developing a corps of civilian field employees”. Continuing from the early 1900’s, there have been added medical and health professionals that would provide “curative treatment” and “initiate a full-scale preventative program which would reduce the excessive amounts of illnesses and early deaths…” Also mentioned is the increased effort to recruit Native peoples to health care professions such as nursing and community health workers by providing education and training for those who wish.

U.S. Department of Health & Human Services, Public Health Service, Indian Health Service. Indian Health Service: A Comprehensive Health Care Program for American Indians and Alaska Natives.

IHS Publishes Public Health Reports Article on HIV in Native Communities, https://www.hiv.gov/blog/ihs-publishes-public-health-reports-article-hiv-native-communities. Accessed 15 Dec. 2021

Navajo Nation faces devastating loss from COVID-19 pandemic. https://www.cnn.com/2020/11/24/health/navajo-nation-coronavirus-losses-wellness/index.html. Accessed 15 Dec. 2021

“COVID-19 and the Indian Health Service” by the Congressional Research Service

In the article “COVID-19 and the Indian Health Service” by the Congressional Research Service, it demonstrates the financial problems that were experienced during the COVID-19 pandemic. It gives a brief introduction to the Indian healthcare system, such as the I/T/U (IHS, Tribal and Urban) System that “provides some funding for urban Indian health services”. It’s a complex system that requires approved funding; the Purchased Referred Care Program (PRC) may or may not approve funding if an IHS facility is unable to provide given care. Throughout the year of 2020, many IHS have reported cases of COVID-19 with the Navajo Nation greatly affected. Also mentioned, the main problems that were encountered by IHS Healthcare facilities is the lack of supplies and lack of medical providers. Due to this deficit, many Native Americans were more prone to COVID-19 and it’s devastating health effects. The efforts to relieve this crisis is additional funds to IHS and their providers due to lost revenue during the pandemic and funds for additional mental health services for service units. Telehealth has been highlighted as well, with patients getting seen with non-emergent signs and symptoms, with reimbursements for IHS-Medicare enrolled clients who receive the care from their homes.

Heisler, Elayne J. “COVID-19 and the Indian Health Service.” Congressional Research Service (CRS) Reports and Issue Briefs, Congressional Research Service (CRS) Reports and Issue Briefs, 1 May 2020. EBSCOhost, search-ebscohost- com.sfis.idm.oclc.org/login.aspx direct=true&db=edsgis&AN=edsgcl.661497968&site=eds-live.

Personal Photo, 2018.

“American Indian Health Equity/Disparities” by Northern Arizona University

In the article, posted by Northern Arizona University, “American Indian Health Equity/Disparities”, it presents how health disparities and inequities affect the health of our Native American people. It mentions plenty of statistics, ranging from financials, socioeconomic circumstances, and physical/mental health of Native Americans and Alaskan Natives. Health inequity is defined as a “systemic, avoidable and unjust social and economic policies and practices” where barriers arise that prevent one from receiving quality care. A few of what was discussed is how much Native Americans/Alaskan Natives are vulnerable to preventable diseases, “Furthermore, in a recent study by the Indian Health Service (2016), AI have a higher rate of easily avoidable diseases such as diabetes, liver disease and more.” Employment was another barrier of opportunity that reflects its effects on Native health, “Native Americans have the lowest employment rate of any racial or ethnic group in the United States (Bureau of Labor Statistics, 2013). In the poorest Native counties, only about 1/3 of men in Native American communities have full-time, year-round employment (Beal, 2004).” Apart from the health disparities experienced by Indigenous peoples, the origin might come from the government themselves. In 2013, An annual budget of 3.1 billion dollars was issued to the Indian Health Services, and in 2020, the annual budget was 6.0 billion dollars. These are to be “prioritized or rationed” across all IHS operated and tribally operated health centers. The budget is not always distributed equally, which results in underfunded facilities, and stated that “Moreover, access to services through facilities is significantly limited with available funding often only able to support medical priority 1 cases, or those that threaten life or limb.” (Fox, 2005)”.

Northern Arizona University. “American Indian Health Equity/Disparities.” Center for American Indian Resilience, https://in.nau.edu/cair/ai-health-equity-and-disparities/. Accessed 17 Nov. 2021

“Indian Health Service Doctor Details Heavy COVID-19 Impact On Navajo Nation” hosted by Mary Louise Kelly from the National Public Radio

In the podcast, “Indian Health Service Doctor Details Heavy COVID-19 Impact On Navajo Nation”, Dr. Loretta Christensen, the Chief Medical Officer of the IHS Navajo Area, describes how the COVID-19 pandemic has greatly impacted the Navajo Nation. She mentions a very important aspect of how our Native communities have trouble performing CDC COVID guidelines, not because of choice, but within our culture. Native families across the country, not only Navajo country, where we have multigenerational families living in one home. We also have families who have no running water to wash their hands multiple times a day, and some do not have the funds to buy needed foods and supplies during the COVID restrictions. Before the pandemic, we already had health issues such as cardiovascular disease, diabetes, hypertension, and autoimmune disorders that make the Native population more vulnerable for respiratory illness and critical cases of COVID-19. Aside from the physical problem of the pandemic, healthcare staff “constantly adapt and innovate new ways to take care of our patients.” as stated by Dr. Loretta Christensen. With limited funding and supplies, healthcare staff can adapt and change within their given condition of the pandemic and their patients.

"Indian Health Service Doctor Details Heavy COVID-19 Impact On Navajo Nation." All Things Considered, 20 Apr. 2020, p. NA. Gale In Context: Middle School, link.gale.com/apps/doc/A621495315/MSIC?u=nm_s_santafeis&sid=ebsco&xid=a972384d. Accessed 17 Nov. 2021.

Mural by Navajo graffiti artist Ivan Lee, Farmington, New Mexico. https://www.voanews.com/a/usa_navajo-government-citizens-united-against-covid-19/6186933.html. Accessed 15 Dec. 2021