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 Fondulac band and I'm your host for our program tonight on indigenous Health the success of this program is very dependent on you the viewer so please call in your questions tonight or send them in ahead of time to our email address at Al ask pbsn North pbsn north.org the telephone numbers can be found at the bottom of your screen our panels this evening include Dr Ryan Dunley a family medicine physician for the Fondulac ban Dr Charity Reynolds medical director for the Fondulac Human Services Division and Ricky defo Elder and pipe carrier in ojoy country our medical students answering the phones tonight are rone Anderson from for for Worth Texas Nicole fall from Pine Island Minnesota and Laya Liller from Dent Minnesota and now on to tonight's program indigenous Health before we begin this evening I think it's really important uh to make a couple of points one is that many people don't understand or people have this false assumption that native healthc care is free it's in fact it's not free when the United States government negotiated treaties with Native American na Nations and Native people they promised in exchange for land for millions and millions of acres of land they promised Health Care indefinitely so the form of our healthc care comes or this form of this of what they offer us the government offers us is the Indian Health Service and that's a government um mostly a government run program however many tribes about 60 60% of our tribes since 1975 have been start have been running their own programs or starting to run their own programs since 1975 so Fondulac community our Fondulac Health Center for instance is run by the Fondulac nation and we have two clinicians tonight from Fondulac who work at Fondulac clinic and one traditional Elder so as we um go on to I think it's important that we start out just with tell us a little bit Dr Reynolds how is Fondulac how is native Health different than non-native Health that's a great question the native health is for the community so that's really important to know as you mentioned uh f is run by the band so the um reservation business committee those are elected members from the community and they are the ones that make the ultimate decision of how our health is run and they really want the best for the community so they do really well in hiring the best that there is we have you know Dr Dunley um and we have uh Ricky defo and we have yourself Dr Owen who is a part of our part of our team they really work really hard to have people um you know we have nurses we have medical assistants we have um family nurse practitioners we have certified nurse midwives uh we have lab technicians um we have x-ray Technic we have everything that we can possibly have that are you know selected from members of the community and it's especially for the community and we look for very specific things make sure they're passionate about the health of the community um it's really cohesive and we respond really well to the community so it's not someone else telling us what to do it's the community itself telling us like you know I really see a need for this and so we work towards that like okay we want to meet you we want to meet that need for you and so we'll work together we'll collaborate and be able to meet that need for people it might take us a little bit because sometimes you know processes take a little long but um it's for the community is the biggest thing Dr Dunley anything to add to that what how is our Healthcare different or what do you see you've now you were a resident in private care in private systems and now you work for Fondulac so how what are the differences that you see I think that I would agree that like one of the main differences that I see at least from my experience in residency and just like a regular hospital system is compared to like with Fondulac working there is that it is it is really Mission driven and a lot of the people who we have working are from the community and so that instills a level of investment I think in the work that we do um that you know in general people who go into Health Care they care about helping people but I think that there's another level of that in our Health Care system with with the people that you know we have have working there Mr defo one of our traditional Elders do you what do you see any differences you've probably experienced Healthcare in both private and in our Healthcare our own healthc care setting you see any differences can you clarify that a little bit more uh for between the the traditional way of seeing Healthcare versus the healthcare that's offered through um a non IHS or a non-tribal clinic versus our tribal Healthcare like when you go to asentia versus our own clinics well a couple things come to my mind uh when when I when I um view those two particularly for indigenous uh on reservations the the clinics uh two things attachment so so we belong to a community language culture the space is uh there the medicines are used um the familiar faces and things are there the role models are there um and also um being authentic being authentic um to our spirit the spirit of um Community the spirit of um love and compassion and um um being having an empathy part of that Community the respect is there so I think it really enhances Health um in the community um the old way of seeing the um Health Care Systems the access there was quite a many challenges there access to that um discriminatory practices and uh racism and things there's a long history of that and that shows in the disparities and um and uh Health outcomes so uh we welcome um traditional ways uh into Healthcare now can you tell us more about what those traditional ways are when people hear traditional medicine what do they think a lot of different things how do you define it well I think for um indigenous peoples I think we have to contextualize that first and first is the society that we've been born into in 2024 indigenous peoples have been born into a society that's very Society in American culture that has a ethos of violence and death the characteristic Spirit of that the history is there a gun culture xenophobic highly sexualized a very oppressive Society um in which really um sociopathic behaviors are manifested in that Society we've been born into that so for indigenous peoples to um the concept of Health and Wellness in that Society encompasses um multiple Dimensions particularly spiritual physical mental emotional social cultural and environmental to name a few but the the right to health is a component of human rights law so for indigenous peoples the right to health is interrelated to uh say um the United Nations Declaration of the rights of indigenous peoples which is a international document and also more nationally here with the United States the the treaties which supposedly ensure um health care and education our elders have adamantly said that we're not to conflate or equate in indigenous peoples to non-indigenous peoples uh any entity or even including minorities um vulnerable groups or local um communities so we have to uh we see the world in that way as distinct um people's cultures and ways because of the health outcomes that have in the history of Health Care in this culture that we have been born into thank you given that and given where you work now um and ab know where you trained all of that put together why do you work in Native Health now Dr Dunley I think that native Health was always something that you know I I hope to work in or at least thought strongly about working in and that starts with where I'm from my dad is a member of the maax band of ojibway here in Minnesota um and so I'm not a member myself but it's certainly a community that I grew up around um and also that Community helped with funding some of my Ed education like while I was in college and so I I always hoped to be able to go back and and give back um and so that was something that you know carried through my education when I applied to medical school um I picked the University of Minnesota duth campus in part because the center for American Indian and minority Health which you know well about um is there and was really happy to have that be part of my medical education um and then when I picked a Residency program I also looked for a place that I knew that I would at least get close work with tribal communities which which I did in Burl Oregon where I was and um and so then it was just a natural fit when looking for a job to to look for a place where I could serve a tribal Community here in Minnesota when I came back and um you helped helped me find a find a good place and happy to be here so yeah Dr Reynolds why do you work in vond deac or do you want to add to that well I just say we're happy to have we're happy to have Dr Dr Dunley um on our team I grew up in rural Arizona so I always wanted to work in a community that served a rural communities because of the health disparities like Ricky mentioned all the you know issues with um you know historical trauma and social drivers of Health social determinants of health and that influence and growing up in it in rural Arizona um I come from a a Latino community and I wanted to make an impact and what Drew me to you know in Arizona there's a lot of um different um Native communities as well um so you know just being drawn to making change and wanting to help and be an advocate uh is one of the reasons why I wanted to do that and um came to Minnesota because my husband is originally from Minnesota so that's how an Arizona person ended up in Minnesota um but we love winter we named our daughter winter and so that's okay and we love the community I've learned so much from working in Fondulac and you know I bring a little piece but I feel like I've just learned from Ricky from Dr vineel from everyone around me so much more and I'm being able to advocate for the community because I have the voice and I have that position to be able to say you know these are the changes um that we need this is what our community wants and then hopefully someday I can pass that torch over to you know one of your um Physicians that you're training to be to say okay it is your turn to continue you know um we really need um indigenous Physicians um for the wave of the future and and I'm yeah maybe Dr Dunley um Mr defo you are in um offering traditional medicine now at the fondet clinic and we are um that's such a privilege I think that we have a clinic that's a that we're able to offer that at are you seeing a lot of people come in the door for traditional medicine are you seeing more is there a trend one way or another well I think it's the the numbers are definitely going up I think the awareness is there the acceptance of um there I think uh will the greater acceptance will depend upon um being offered and then as the success um as the healing comes um through uh involvement with the the community members and relationships and things like that as we see that Wellness um come about um The Hope is that uh things will take off from there and I think it really the numbers are showing that uh again there's different um dimensions of of of healing that's taking place the processes is taking place to bring about some sort of uh um back to be in Balance uh healing is a a restoration to to some sort of normal uh mental and physical health and so the healing is taking place um we think about um because of the society that we live in there's lots of lateral violence that takes place um and it's become a huge social problem in indigenous country so we we we recognize that and we we just want to offer um um to be there for the ones that are are willing to um to join us in the healing Journey uh so I think the challenges are are many there and we're we're up for the challenge um if we don't do it um if we don't reclaim Revitalize um traditional healing ways uh if we don't practice these uh ways of life um then our children will see that there'll be some more additional spare in a very uh toxic culture called the American culture which is globally now so those are challenges that we face and I think um we have the ways and the means to um bring healing and uh in medicine I want to say that people say that um doctors and things because the definition to doctor I think is is a practitioner a qualified practitioner of Medicine and so um one that practices um medicine medicine's a huge huge field and it comes in the different practices and procedures that go about that so we want to be part of the prevention um the treatment and the uh relief from um any of those symptoms that come about in the society whether it's physical or mental em or what have you so we have a lot of work ahead of us and I think that um given a chance and we have been uh we're up for it and I think you were referring to something really important people often think it's just anecdotal when we say that our culture is protective or that there's power in our culture to help improve health but we know from good um research done from uh indigenous PE indigenous researchers like Dr Melissa walls that in fact you can show that people who are more involved in culture tend to have better health outcomes so thanks for pointing both of those out uh how can doctors speaking of traditional Medicine Dr Dunley how do you ask your patients or what do you recommend to non-native in particular doctors about asking um their native patients about their cultural beliefs how would they approach that I think that at least in my own practice um it's just something that you should ask about as you would ask any patient about their beliefs and what's important to them in life uh is from a primary care perspective that's a critical part of being able to provide someone adequate care and good care is knowing what they value and so if I were meeting a patient for the first time then I'm going to ask them about what's important to them be that cultural religious um or what have you and so with Native patients just like any other patient I think that it's important to ask what cultural Traditions are important to them and when I have when I establish care with a patient I I always make a point of doing that um you know some native patients are very involved with Native culture um some are less so some are trying to get more into it um there's obviously a long history of having culture uh you know banned and stolen from native communities and so that plays a role but yeah I guess on the most basic level you just you just ask the questions otherwise you'll never know the answers and I appreciated your comment about how people are changing right so one day they might not be into the culture and then later on in life as they go to one classes they may be more involved in their culture so you have to keep asking those questions yeah good Dr Reynolds looks like you wanted to add something to that no okay I did not okay so let me ask you a question Dr Reynolds sounds good if you were to implement one uh plan or had one goal how would you try to improve indigenous Health just one just one so it talks it just one and this has been on my mind and actually it's in one of my um one of my goals for next year um and working with Ricky about this more traditional Health in the westernized medicine so we you know we are trained in Western medicine um and it's not the answer um you know there's some things that it's good for but it's not the answer and I think um you know research is showing that there's neuro um neurobiologists who are say learning you know how important music is and how that is healing and you know Ricky knows this from from before before time and it's passed down how important you know drum ceremonies are and how vital these are um for health so I want to see more tradition um into the Western uh Western way we do things and be able to connect people um and a be able to connect um that culture so um there was that break right in racism and colonialism that caused um indigenous communities to lose that to lose that culture and they did it they did it for a purpose right so that people could be unhealthy so people could die off and wanting to um kill off the race and they broke that and you know the things we are seeing now on top we're seeing you know um cardiovascular disease cancer these things that we see on the outside is really because of history and what's happened and the trauma that's happened and how do we how do we connect that how do we fix that is going back to traditional traditional Health traditional medicine that connection like um you know parenting Styles those were broken the community was broken you know Ricky um Ricky has definitely hit on that point of how um you know American society is broken and not only for IND indigenous communities they've you know indigenous communities have had to suffer for a really long time and have had to build resilience but other um communities are seeing how um you know parenting right now is in a crisis of how much stress is going on and difficulties and um screens and you know the influences increasing anxiety and depression and things like that so if I had to do one thing is bring more tradition into the Western way that we um deal with health in um indigenous communities either you want to add anything to that very well stated yeah I I really think that it was well stated um uh I I I think the acceptance of uh by mainstream um medicine uh to embrace traditional ways of seeing the world and of healing um I think that encompasses what community is all about to have respect for one another and love and kindness for one another and that goes a long ways in healing moments life is made up of those moments so when we start to um lift one another the ways we practice um healing and being in community I think uh it's a win-win situation for everybody our elders have always said that that we can compliment one another um because there's a concerted effort that came about for many many uh Generations that our healers and our um ones that practice a way of life were um denigrated and actually incarcerated um for ways of um seeing the world and working and that was a concerted effort not only by the American public but also particularly by institutions such as the American Medical Association which is formed in 1847 but I think upon 1900 that's when they started to um really push that um uh denigrated um indigenous ways of healing um so now we fast forward to 2024 and there's an acceptance of um healings the uh from the American Medical Association that really goes to for instance the um Medicaid section 11:15 which is a waiver to U have discretion on indigenous tribes to to bring about healing Pro healing practices programs on on their homelands so it's been a long time coming we know the history of discrimination and racism in that uh the American Medical Association I'm not talking disparagingly of them but I want to bring out the facts that they did in fact uh you know apologize publicly to the um the African-American culture uh about the racism practices and things of discrepancies there's now a push for to include um um a sort of airm ative action even to bring about uh indigenous U people of color into the um medical profession so things are changing slowly we'll see what the future holds we have um hope and promise one of the concerns I have though is just like we know that there are low numbers of um Native students going into medical school we only graduate maybe 20 to 40 native medical students out of 20,000 Physicians every year or 20 20 to 40 Physicians and we see the same shortage in traditional medicine um you know I I was just comment we were just commenting on how often I call on you to help us with teaching our students things or um working in the community and and supporting our traditional ways but we can't keep doing that so we need more young people to um study traditional medicine as well as Western medicine would you agree or yes I agree wholeheartedly I think that the indigenous people have a huge problem a huge not in the community but the living in the society that we live in uh again a concerted effort we say generationally that it was a a genocide taking place um so when we think in those terms we think of the urgency so the um indigenous peop probably make up there's a couple different numbers 476 million people in in on the global and others said 370 million um but represent about 6% of the population and we like to think that of that indigenous peoples on this globe that they control 22% of the land base but of that 22% land base is 80% of the biodiversity on the globe so modernity and the modern world so civilized world so to speak represents that's why I said the ethos is violence and death in that Civilization so that's the them are the facts those are the truth in the in 2024 and metadata and things the truth is buried beneath all that data and we just got to expose it and and share it with our people and then our people would begin to heal and in the truth so our our intergenerational Tech knowes um are coming out um they become our experience in this Society we live in uh and they becomes Our Truth our individual truth our our um Family truth and our community truth so thank you Ricky I think this uh conversation tonight has gone faster than any of them because it's been uh so fascinating and such a great conversation so thank you all for being here I want to thank our panelists Dr Ryan Dunley Dr Charity Reynolds and Ricky defo and our medical student volunteers Ron Anderson Nicole fall and Laya Liller please join me again next week for a program on lung problems influenza pneumonia and empyema when my panelists will be Dr Andrew Thompson and Dr Jason wall thank you for watching good night [Music] [Music] [Music] e