Health and the Urban Indian: An Interview with Ralph Forquera

TC:  Do you employ any traditional healing practices in your work?

RF:  Well, we do provide some traditional healing practices. We have a traditional liaison position, but it's more cultural education, cultural translation work, working with providing direction for physicians and helping them to understand cultural healing practices. And we've been very successful at getting people some of that cultural healing. Within the context of the city it's pretty hard to do that because those kinds of practitioners are generally off on the reservations and other places. But with two hundred different tribes you also can't have an individual who's going to be able to service all of those people. So, one of the reasons that we created the position that we did, the idea of a traditional health liaison is, while he does ceremonial work and other kinds of healing work himself, his real role is to work with Indian people in identifying what kinds of healing practices they want themselves, and then helping them to find those healing practices, whether it be local, if at all possible, or if necessary, to help them get back home where they can get that when they need that.

TC:  Do you have a larger mental health practice or need at this facility because of the displacement and the need for support and so on?

RF:  I don't know if it necessarily makes it larger, but our providers tend to be extremely sensitive to those kinds of issues. And one of the things that we try to do in the Family Practice Residency Program and the training program over there is sensitize the physicians that we're training in asking those kinds of questions and making those kinds of inquiries as a routine part of their practice. It's not a part of normal training. It's one of those cultural things that I think really does differentiate the way that we do our work and the way other people do their work.

It's a sensitivity that providers have to have to these unique historical and cultural differences in the population, and being able to understand how to ask those questions in a proper fashion so that you can elicit the kind of information without, you know, doing it in a disrespectful way, but also in a way that they can help in that transition piece that is so essential to the work that we do. So, I think that those are all pieces that we're more aware of a lot of the emotional and mental health pieces of it. I think the whole society as a whole is still struggling with a variety of mental issues, especially the minority populations of people who are constantly confronted with overt and covert racism kinds of issues on a constant basis and all of us people of color kind of tend to always kind of have that sense of uncertainty about our lives in the society.

And I think that that's true of other populations of people and it's not assessed as easily as it has been among our population. So, in answer to your question, we do see a lot of people with depression. We see a lot of people with anxiety disorders. We see a lot of people with a lot of mental illnesses, including some that are classic, you know, schizophrenia or, you know, the kind that are physiologically based as opposed to just emotionally based. And I think that there are an awful lot of clients that we serve, since we serve primarily the lower income, uninsured population, that are particularly stressed, and so therefore those kinds of emotions and feelings, I think, manifest themselves a little bit more and are a little bit more at the surface than they would be for somebody who might have a little bit more income and might be a little bit more hidden from those kinds of things. We tend to work with people that are in the public, you know. And so, when you're very public, those kinds of behaviors are seen more frequently than among the people that tend to go home to their own little houses at night and you don't see them quite as frequently.