Good evening and welcome to Doctors on Call.

I'm Dr.

Mary Owen, associate dean of Native American Health and Director of the Center for American Indian and Minority Health at the University of Minnesota Medical School.

I'm also a family physician for the FondeLac Band.

I'm your host for our episode tonight on indigenous health.

The success of this program is very dependent on you, the viewer.

So, please call in your questions or send them into our email address askpbsnorth.org.

Our panelists this evening include Dr.

Arie Vineo from the Fondelac Band of Lake Superior Chipua, Minnesota Clinic and Mr.

Ricky Defoe from also from the FondeLac Band of Lake Superior Chipua Minoyuan Clinic.

Sorry about that.

Our medical students answering the phones tonight are Stephanie Kefir from Pualup, Washington, Andrew Tisher from Wheaton, Minnesota, and Ava Hill from Aurora, Minnesota.

And now on to tonight's program on Indigenous Health.

Thanks for being here, you two.

Uh this is um National Native Heritage Month, as you both know, and we get a lot of asked to do shows on this month, but um I still think it's uh great that the show is doing indigenous health, and I'm so happy that you both joined me.

I'm going to give you uh Ricky for joining me tonight and Dr.

Vo for joining me tonight.

Great.

Giving tobacco is not something that we do in my tribe, but it does it's um something prominent here.

And so I've learned to do when I ask someone to do something or join me on a show like this or or to help with teaching the students, I give tobacco.

What's the purpose of that here?

Well, I think uh tobacco is custom um part of the culture.

Commercial tobacco is the problem.

So, we want to be connected to the the bark of the of of the nishnab trees, the beans that are in the woods, uh the plant nation.

So, we don't have that connection and um that's our ultimate goal.

But to be partaking in the custom of asking someone with something that's so important, even if it is commercial tobacco, is a step in the right direction.

So, we got a ways to go, but we're um practicing something that has been um needed amongst our people for healing purposes for quite a while.

Um, so Iodapora, so I've accepted this tobacco in a good way and I thank you for that moment.

By the way, I gave you the good stuff.

Dr.

Vo, you got the old the the commercial stuff.

So I can still deal with that.

I carry the traditional stuff in my pocket and um and I I make it in the winter and there's a certain time of year that that you make it and um apakos gun is what the what I use and um as a physician I'm a scientist and when I went to medical school all those years ago, decades ago, um I kind of thought that medical school would would science my traditions right out of me and and that I would know the biochemistry of things so much that spiritual things and traditional things and um belief systems would get would just get science right out of me and it and it didn't and it's stronger and I've known Ricky for Guoance for I've been on Fondelac for 28 years so probably 28 years and learned much from him and we learn from each other.

And um giving tobacco is a when you give somebody tobacco, you give it to to honor them and to to make that moment between the two of you clear so you can ask and um and receive.

What does that have to do with health in your mind?

In my mind, traditional traditions and and um ceremonies were illegal for the longest time.

It was 1978 when the Religious Freedoms Act made ceremonies legal again, but before that they were illegal and um people got moved to cities.

There was boarding schools.

There's a lot of things that have happened in the past.

um boarding schools took a couple generations of parents away from kids and um and take making our ceremonies illegal made things hard and there was relocation programs where um people would be moved from the reservation into the cities with a promise of well-paying jobs and um and those jobs didn't necessarily surface.

My grandparents went to this to Minneapolis based on that.

And um and then they couldn't harvest traditional tobacco the way they the way they always did.

So they used they used commercial tobacco and and use it for ceremonies.

But it's so addicting that that people started using it casually.

And it's a powerful medicine and if if it gets used the way you just use this, it's a good medicine.

But if people use it casually, then it causes cancers and COPD and emphyma and all the other stuff that comes with it.

Ricky, anything to add to that on the health benefits of uh offering the tobacco, this tradition that's rich here among the Ojiway, not among my own tribe, and we're all different.

That's the point I'm making.

I think there's um excuse me I think there's huge benefit to reestablishing connection.

Um too often in today's world technological world you have texting and emails and phone calls and things like that that's impersonal.

When you make a connection with something that is in our world is as movement, spiritual movement, um you reestablish that connection and there follows wellness uh real personal uh relationship with each other um with um spiritual um because I think it's the elders have said to be whole you've got to include the unseen.

So when we see some things moving in um uh with one another in in the spiritual realm um I think that's where healing takes place.

So it's reconnection and it's being authentic to oneself your spirit and um as a way so um it's a good thing to practice.

It's also one of the um many ways that we as native people in general in my own tribe we do it differently but practice reciprocity and uh one way of watching out for one another which of course is part of our healthc care too right taking care of the community so um we do have a question um first of all tell Arie hi from Ben ah and then the question is can you elaborate on historical trauma and its impact on indigenous peoples do you want to take that Um, well, you know, I talked about boarding schools a little bit and and um and that was a couple generations of lost teachings and lost tra traditions.

And um my my grandfather was in boarding school and he was fluent Oji way, but he wouldn't speak it.

He would, you know, if we asked him, you know, what is the northern lights?

what is a, you know, what's the name for a deer?

You know, he would tell us that, but he wouldn't speak it because he thought if we were fluent, the same thing that would h that happened to him would happen to us.

and um and with that loss of tradition and loss of culture and tobacco abuse and all the other things and poverty that followed and loss of land and traditions and not being able to wild rice and do maple syrup the way that they had always did, you know, when they were in the cities.

Then other things filled that void and um and it ended up with things like PTSD and depression and domestic violence and alcohol use and a whole host of other ills.

Do you want to add anything to that?

Can you clarify that question?

Can you please?

They're asking about um can you elaborate on historical trauma and its important to indigenous pe its importance to indigenous people particularly our hills.

Historical trauma, I think, is im important to know the past because if you say if you don't know the past and you you're in the present, it'll just keep repeating itself.

So to be able to heal the the ones that are yet to come, those are some things that you need to know.

Uh a lot of things are are hurtful.

Um there's a soul wound in in America.

um how it started and um the treatment of um our ancestors, indigenous peoples particularly.

Um so those things are very hurtful.

Lots of the young ones will say some stuff like uh we don't want to hear about all that hardships and things again.

We want to talk about the good things and stuff.

Well, to get to the good things, you've got to go through um some hard times and rough times because there's a balance there.

And really there it's it's out of balance and the injustices, social injustices and every injustice um against uh so we have to kind of um balance that.

How do we do that?

By um multiplying those healing moments in our life with each other um with our children and things.

So we we have those benevolent moments rather than those reflecting and wasting energy on.

We're not wasting the energy, but we're really um we have to find balance in in the use of our energy.

We don't want to focus on trauma particularly, but we have to be trauma informed.

and we just cannot write off what happened to our our parents and our our grandparents, our great-grandparents and things.

Um I I graduate of Philandry Indian boarding school in 1976.

Um these are eras and times in our life, chapters in our life and things and we move forward whether it was with trauma, whether it was with grief or not, we move forward with that.

So um it's a it's a part of who we are.

So we'll take that um along with all the the other moments in our um history.

And I I think the other important part of that is that as health care providers, we have to recognize that sometimes when patients are acting a certain way or doing certain, we have to always recognize that there often times are other things that are going on for a patient that we might not know anything about and it could be related to some of this history in the background and uh what their families have all been through and take that into account.

I want to change tac a little bit.

Um, all three of us work for uh the Fondelac Nation, Fondelac people, and we work for the tribal clinic.

I work in the one downtown, and you two work on the one um in the on the reservation out at Cloet.

And um but I don't think that everybody understands uh about our health care.

People don't understand that it's not free health care that it was uh we received health care as part of the trust responsibility in this country for all the lands that were given up in treaties and um our clinic the FondeLac clinic like my own clinic at home are is tribally run versus IHS run and people don't understand that when native people get healthcare and only 60% of them use the IHS but the IHS is the Indian healthcare direct services like at Red Lake or White Earth tribally run, which is what FondeLac is, or urban Indian health, which uh like in Minneapolis, there's the Minneapolis Indian Health.

So, but but FondeLac again is tribally run, and it has been since 19 actually, did you say 1968 or we're not quite sure?

No, because 1975 was the passing of the Indian Self-Determination Education Assistance Act that allowed for us to start running our own programs, but I'm not quite sure when um FondeLac went from IHS to triby run, but it is triby run now.

And what do you think are some of the benefits of us running our own own programs, us running our own healthcare?

Well, we know our own issues and um you know, so we get to determine you how to take care of those things um using traditional healers and traditional medicine and being able to access that and um being able to refer somebody to to Ricky if we need to or um to the cultural center in general.

and you know to to let people know that going to ceremonies isn't something they need to hide from us.

That um that's an important part of their healthcare and um and people should access all of that and and they should be able to u do the things that have always been medicine for us.

And you know this tobacco that you gave us is medicine.

And um you know as a scientist it seems and you know everybody that goes to medical school is by virtue of what they have to do to get in there is a scientist and um but you know the science part of me wouldn't have believed that tobacco was so important but it is.

and you know to be able to use that freely in talking with patients and um Ricky did a ceremony for all of the medical providers and and the nurses different ceremonies at there's too many of us at at one time but so you know the people that work for the clinic could see why they're doing what they're doing you you know why it's important to and managed is the word for respect and um you know we respect our patients and we respect each other and we respect the traditional people in the community and you know being able to do that as part of a medical practice is important.

Thank you Ricky.

Why do you think it's so important that we be able to uh send our patients over to you for traditional healing?

Well, I think it's important because the people have skin in the game.

The Indian self-determination and education assistant act of what 1975.

It was an empowering um piece.

Um, and it's really uh reinforces tribal sovereignty, things that we've been pushing for for quite some time.

Um, to be recognized in that fashion that we're beyond just what stereotypes are attributed to us as a people.

So, we have skin in the game.

we make sure that um our health and wellness is tied up in the health and wellness of our family, our community, and the nation as a whole.

So, it's not just a job, it's a way of life.

Um and it really there's many so many different um dynamics and dimensions of health and wellness.

Um so, um each part is a critical piece.

So, I think that also known as public law 638 is is a piece of um self-determination.

So, um our skin in the game is all about health and wellness for um those children that are yet to be born, the grandchildren, the great grandchildren.

Um so, we have the seven generations connected.

I think um we welcome that and any uh any of those threats that are against that um we will continue to resist when it comes to our health and wellness.

Sometimes when I um am teaching with the students, I remind them that you know we are making up for 500 years or since um since arrival of Europeans um those health disparities have been here that long and it's only been 50 50 years since we've been running the show ourselves since 1975.

We're celebrating the anniversary of Isdia now.

So we've only really been able 50 years is not a long time to be able to pick ourselves up and start to repair all the damage that was done.

But the other thing that um that when we run our clinics ourselves, we offer different things.

We're much more u we're able to offer different services like we go out and pick up our patients or again we refer people over to you Ricky for traditional health services that we might not be able to if it were simply IHS run or a private clinic.

So you are starting to learn more traditional medicine yourself, aren't you Dr.

Vine?

Um I don't do traditional medicines as much as um want to learn the language and the the language when um with boarding schools and programs designed to to take away tradition and take away language.

Our elders were wise enough to hide our lessons in the language itself.

And there's there are words that um Ricky teaches uh Ojiway language and and sometimes in the course of it's not just learning a word, it's learning the the reason behind it and stories behind it and sometimes things take off on a tangent and and I like those tangents.

I learn a lot from those things.

And um why do you think uh learning language is important to uh the healthcare of um learning the Oji wayan language is important to the healthcare of the people you're taking care of the Ojiway people because when Ojiway people were the only people here um they had trade routes and Duth was a major trading port even for um you know for for native tribes but they had a culture that that worked for them and took care of everyone and respected elders.

Giya is a great being is the word for an elder.

And um and a lot of that has gone by the wayside.

Not for us so much, but you know, for the world in general, where when somebody gets old enough so they're not able to make money, they're not as useful as they used to be.

And for us, they're they're as useful as ever, even more so.

um you know they carry the knowledge and the wisdom and the memories that we need to to be better as a community and as a people.

Thank you for that.

I have so many questions I want to ask both of you but we better be respectful to these questions here.

Um what uh Dr.

Vineo this one I want to ask you here.

Um how do you incorporate traditional medicine into a patient's care when western medicine might be more effective?

example, type 1 diabetes, uncontrolled type two diabetes, heart failure, etc.

Risk versus benefits.

That's a thing that kind of flows back and forth.

You know, I don't want to make it seem like, you know, I'm only trying to do traditional medicine because um because I am a scientist, you know, I'm a physician.

I went to medical school.

I went to residency.

And um you know and we use up to-date and we use AI if we need to and you know we do X-rays and I read X-rays and I read EKGs and interpret labs and um and and all of that stuff I'm hearing from the question here.

That's okay.

Um they just wanted to know uh I I think there's a presumption in the question at least if they wrote it uh exactly the way the person asked.

How do you incorporate traditional medicine into a patient's care when western medicine might be more effective?

So I think there's a presumption that that uh it's one or the other.

And so I think you were hitting it.

Yeah.

It isn't one or the other.

It's both and it's fluid.

Exactly.

And it can flow back and forth.

and and I gift people tobacco in clinic sometimes, you know, if I'm if I'm having someone that's really having difficulty um with just life in general and loss that's that's too big and tragic um somebody whose son was killed tragically in an accident, but it's not the right order of things.

and and he couldn't go on.

And I had him I gave him tobacco in the clinic and I had him put tobacco out every morning for 30 days and come back and see me.

And and every morning when he did that at sunrise, he lost a little bit of his grief and he'll never lose all of it.

And um but when I saw him back, he was so much calmer.

His blood pressure was better.

And um and he and he he had that time for himself just just to put tobacco out in the morning and be thankful for the things he still had and thankful for the time he had with his son.

And um you know it didn't it didn't bring him back.

It didn't it didn't take all away take away all of his grief but it was it was the biggest thing I could have done for him.

Thank you.

And we all experienced that as healthc care providers.

Each one of us has experienced that.

But there's also research that shows it that traditional medicine benefits our patients that suicide rates go down, diabetes rates get better with traditional medicine.

So, thank you for that.

Um, there's a quick question.

Are these clinics just for Native American individuals or do they provide care to non-native people as well?

One of the benefits of our tribals of our tribes running themselves is we have a little bit more say so on who gets to come to the clinics.

Traditionally in IHS it's uh if you're tribally enrolled but our clinics like uh Fondelac gets to make more decisions on that and um they generally will serve mainly native patients but I know that they also see some some spouses.

It's important to remember though that our health care is so despite the fact that healthcare was promised to us it is so significantly underfunded every single year at the Indian health service poultry we should be funded about 70 um billion but each year we receive only around 7 to 10 million or 9 million billion at most so um we have to do with wi well with what we can and that's why traditional medicine incorporating that has been so important because it's probably the most powerful tool we have and I'm talking too much so let me get back to you guys and we bill insurance yes we new bill insurance.

Yep.

And um in fact, we're also able to just because of Medicaid now bill for even some traditional medicine um in at least five different states.

It's a project right now, a pilot project for Medicaid.

Um Dr.

Ricky, one uh if we can try to squeeze this one in.

What can outsiders do to help lessen the generational stress and historical trauma experienced by native communities?

Well, education is the key.

We've been educating uh non-native folks for generations.

Um and many have been friends of the so-called Indian and become allies and things.

the the challenge is to have non-native folks teach other non-native folks um the things that happen within our community because our as we age and and teaching gets uh more and more challenging.

Um we need the young ones to step up of course but it's uh respect is the key for any community.

You have to have the respect for one another back and forth recipro reciprocal and you always give your the respect.

If that other individual don't give it back to you that's their problem not yours.

So we give the respect and we look to be accountable accountable to um your ethical teachings, your spiritual teachings, your principles you live by and the discipline that you're taught by your elders.

So um how to follow those things.

So that's what we're accountable to.

Um I think empathy is the biggest piece about community where that's a starting point for the healing that takes place.

So in a in a in a nation that lacks empathy like in the the United States, we then um we're looking to foster that empathy.

Thank you.

Thank you so much.

I wish that we had more time.

This I we could go on forever I think here.

I want to thank our panelists Ricky Defoe and Dr.

Arie Vineo.

Please join doctors on call next week where Dr.

Christa Kaidy is joined by regional experts for a panel discussion about diabetes and other endocrine disorders with a panel of experts from around the region.

Thank you for watching and joining us for season 44 of Doctors on Call.

Good night.