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Features
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Indian Health Pathway:
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Published studies have suggested a link between alarming disparities in healthcare for minority populations in the United States and the dearth of minority physicians practicing in communities of color. Nowhere is this more apparent than in Indian Country, where the Association of American Indian Physicians in 2001 reported a severe shortage of Indian health care providers to serve the nation’s Native American population. |
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"It's a huge problem," says Polly Olsen, Acting Director of the Native American Center of Excellence (NACOE), based at the University of Washington School of Medicine. |
Polly Olsen |
An AAIP report on racial and ethnic representation in health professions indicates that proportionately, American Indian and Alaskan Native physicians combined are represented at only 0.7 percent compared to the general U.S. population. It's a problem Olsen is helping to change. In 1992, NACOE started Indian Health Pathway to attract and prepare Indian and interested non-Indian medical students for careers in Indian health care and to encourage research on Indian health issues. So far about 47 Indian and 15 non-Indian students have passed through the program to become doctors. Indian Health Pathway begins recruiting at the high school level and mentors students through to their residency programs. Native American students come from reservations or urban populations and non-Natives usually come from communities where Indian tribes are present. About 90 percent of the students who have completed the program have returned to Indian communities to practice. "That's a good statistic," says Olsen, "but it could be higher."
The Indian Health Pathway program has been growing steadily over the years and is one of few programs in the country that offers a curriculum and a certificate in Indian health studies. It requires students to study issues in Indian health and complete an independent research project on an Indian health topic. They can also study traditional Indian medicine. Most advanced students do clinical rotations at the Seattle Indian Health Board, an urban community clinic in downtown Seattle. But they can also accompany practicing physicians to reservations where they learn to examine and treat Native American patients. "All Native medical students participate. It keeps them connected to their communities and provides them access to their culture while they learn Western medicine,” says Olsen, a member of the Yakama Nation who has a degree in cultural anthropology from the University of Washington. She has been working for NACOE for two years and took over as acting director in 2002. The program draws students from around the country, particularly from the five WWAMI consortium of states (Washington, Wyoming, Alaska, Montana and Idaho), which are home to about 24 percent of the United States’ Native population, according to Olsen. A study released in July of this year by the U. S. Commission of Civil Rights entitled "A Quiet Crisis: Federal Funding and Unmet Needs in Indian Country," reported than Native American health conditions and services remain substandard to that of other American citizens, and that Native Americans have a lower life expectancy and higher disease occurrence than other ethnic groups. Part of the reason for these disparities stems from the lack of access to basic health care services. Most Native Americans do not have private health insurance and they make fewer visits to the doctor than any other population group. The Indian Health Service, the federal agency which sees to the medical needs of more than half of all Native Americans, operates with only about 59 percent of what it needs to provide adequate health care, according to the report. But it is the low numbers of physicians practicing in Indian Country that have many alarmed. In June, national healthcare leaders launched the Physician Diversity Project, a coordinated effort to boost racial and ethnic diversity in the U.S. physician workforce. Racial and ethnic minorities make up more than a quarter of the U.S. population, yet only 6 percent of practicing physicians mirror the nation's diversity. Project leaders plan to devise a sustainable approach to increasing physician diversity which they hope will translate into better minority healthcare access and outcomes. In Indian Country, observes Olsen, "Diabetes is the number one concern right now."
The disease has been more devastating to Native communities than to any other population group. The Centers for Disease Control, in the August issue of its Morbidity and Mortality Weekly Report, finds that the rates of diabetes are two to three times as high among American Indians and Alaska Natives than among all racial and ethnic populations combined; the CDC reports that 15.3 percent of American Indians and Alaska Native adults suffer from diabetes, twice as high as the national average of 7.3 percent. Part of the problem stems from the breakdown of traditional Indian folkways as a result of colonization. Commodity foods such as peanut butter, lard, flour, processed cheese and fast-food products have replaced Native diets that once included fish, elk and fibrous roots. Less active lifestyles have replaced outdoor activities like hunting and fishing that once provided invigorating exercise. More Indian doctors, says Olsen, are needed not only to treat the growing epidemic of diabetes and its ill affects, but to educate Native Americans about healthy living in an imposing cultural environment. "It's all encompassing," she says. "We're just getting started. There are great programs out there, but it's hard to get people to change." She notes however, that doctors working in Indian populations face unique obstacles, from the oftentimes confining politics of tribal governments and the additional layer of federal and state bureaucracies to deal with, to the hardship of working in culturally and geographically isolated communities and the intense workload of treating so many needy patients. It is why turnover and burnout among Native doctors in Indian communities is high, says Olsen, but all the more reason to keep new doctors coming into the Indian health care system. "Rural medicine is challenging," says Olsen. "You really have to be ready to commit." For more information:  To view other Health News feature articles, please visit: This article may be reprinted with permission.
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