http://www.cherokeephoenix.orgIn this 2014 photo Nicole Willis, a pediatrician at the Cherokee Nation’s Vinita Health Center, visits with 18-month-old Tinzlee Miller of Langley, Okla. Of the nearly 19,000 graduates of medical school last year in the U.S., only 31 were Native American. COURTESY
In this 2014 photo Nicole Willis, a pediatrician at the Cherokee Nation’s Vinita Health Center, visits with 18-month-old Tinzlee Miller of Langley, Okla. Of the nearly 19,000 graduates of medical school last year in the U.S., only 31 were Native American. COURTESY

Shortage of Native American doctors raises concern

BY ASSOCIATED PRESS
06/29/2017 08:30 AM
PHOENIX (AP) — Dena Wilson never doubted what she wanted to do with her life while growing up on the Pine Ridge Indian Reservation in South Dakota.

Her mother worked at the Indian Health Service as a social worker, and aside from a brief desire to be a bird in kindergarten, Wilson knew she wanted to become a doctor.

Wilson attended Chadron State College in Nebraska and then the University of Washington for medical school. After that, she pursued a cardiology fellowship at the University of Arizona’s medical center, and she worked for a Native cardiology program in Northern Arizona before coming to Phoenix to work for the IHS.

“Just growing up, receiving care in the Indian Health Service, knowing there was such a shortage, and never seeing any other Native providers, this was something I wanted to do,” Wilson said.

Wilson belongs to an exclusive club. Not only is she the lone cardiologist working for the IHS in Phoenix, but she’s also Native American, a citizen of the Oglala Lakota Sioux tribe.

Of the nearly 19,000 graduates of medical school last year in the U.S., only 31 were Native American. Here in Arizona, there’s an estimated 13,542 physicians statewide, and only 107 were Native American – that’s less than 1 percent, according to a database by the Association of American Medical Colleges using 2013 numbers.

Experts said the shortage of Native American doctors is concerning because it impacts the effectiveness of health care delivery overall, as well as the research into health disparities.
Historically, Native Americans have faced more health problems when compared with other Americans.

Native Americans die at higher rates in several categories, including chronic liver disease, diabetes and chronic lower respiratory disease, and they have a life expectancy rate 4.4 years less than all other U.S. races, according to the IHS.

The IHS, which provides health services to about 2.2 million of the nation’s estimated 3.7 million Native Americans, suffers from serious staff shortages. Earlier this year, the Government Accountability Office added it and other Native American programs to the “high-risk” list, meaning it’s viewed as highly vulnerable to fraud, waste, abuse and mismanagement.

But how do these disparities in health outcomes relate to a lack of Native American physicians?

“A lot of people think why should that matter?” said Dr. Lukejohn Day, the director of clinical gastroenterology at Zuckerberg San Francisco General Hospital and an associate professor of medicine at the University California, San Francisco. Day also is an Oglala Lakota citizen.

“What a lot of studies have shown is a diverse health care workforce supplies better provider patient communication, follow ups and treatment adherence,” Day said. “Also, what we’ve seen is the more diverse a workforce is, the more research there is on health care disparities.”

And then there’s the “people” part of the equation.

“People tend to comply better when they feel their physicians have a better understanding of who they are and where they come from,” said Dr. Mary Owen, director of the Center of American Indian and Minority Health at the University of Minnesota Duluth campus.

Owen, who also serves on the board of directors for the Association of American Indian Physicians, added that people from diverse backgrounds are more likely to go back and serve in those communities.

“What I try to provide to my patients is a familiarity and understanding of their day-to-day challenges,” said Wilson, the doctor from the Phoenix IHS. “I grew up on the reservation, and I understand that just going to the grocery store to get healthy ingredients to make a healthy meal is a challenge sometimes.”

From 2012-16, of the nearly 55,000 medical school graduates in the U.S., only 101 were Native American, according to the Association of American Medical Colleges.

Owen said there are a lot of reasons why Native Americans don’t go into medicine.

“To get into medicine requires so many different pieces of a puzzle to come together,” Owen said. “It requires a strong background in science and math, strong communication skills and societal awareness. Pulling all those together from a group of people that have had trauma as long as we have. We don’t have all the resources that other people take for granted in medicine.”

Owen said officials and community leaders need to make improvements to elementary and high school education for Native Americans, and they need to reach out earlier to Native students.

Day echoed a similar sentiment.

“If you are hitting them in college and medical school, it might be too late,” he said. “Reach out at the high school and junior high level, and I think that makes a much bigger difference.”

Another challenge exists in the medical school selection process.

Owen said medical schools have a tendency to focus on things like test scores instead of recognizing what a candidate brings to the table that’s not reflected on an application.

Wilson said while her medical school did a great job recognizing the strengths she cultivated through her upbringing, she said the fixation on test scores can be a real problem.

“It’s not just about knowledge,” Wilson said. “Yeah, you have to have knowledge, I’m not saying everyone can get into med school and become a doctor. But just because you didn’t score the highest on your MCATs doesn’t mean you should be excluded.”

Then there’s the fact that just getting into medical school isn’t enough. To survive, one needs a lot of support.

Wilson said one of her biggest challenges was dealing with loneliness. Not only was she a woman in a male-dominated specialty, but she also was a minority. She said running into another Native American was rare.

“For me, sometimes just going home and being back home with my community, I needed that to recharge my batteries,” Wilson said.

Despite the obstacles, Owen said she is optimistic that more Native American physicians will soon enter the fold, but she added that medical schools must look at students in a more holistic fashion.

“All these states should have a much higher number,” she said.

Locally, the University of Arizona is trying to do its part.

There are 23 American Indian students enrolled at the University of Arizona’s two college of medicine programs in Tucson and Phoenix, according to the university.

Additionally, the school also has programs aimed at recruiting and preparing Native students for a career in medicine. These include a pre-admissions workshop with the Association of American Indian Physicians, the Indians Into Medicine grant from the IHS, and the Navajo Nation Future Physicians’ Scholarship Fund, which helps up to seven Navajo scholars per year pursue a medical degree from the university.

Health

BY ASSOCIATED PRESS
07/19/2018 04:00 PM
OKLAHOMA CITY (AP) – The federal Centers for Medicare and Medicaid Services has approved Oklahoma’s Medicaid program for a first-in-the-nation drug pricing experiment that supporters say could save taxpayer dollars and provide patients with the most effective medications for their ailments. Under the “value-based purchasing” program approved in late June, the state and a pharmaceutical company would agree to a set payment if its medication works as advertised, but only a fraction of that if the drug is not as effective as promised. “When a company signs an agreement, we hope that they’re going to agree to only have us pay for the therapy that works .... and if it doesn’t work we should get a rebate on it,” said Nancy Nesser, pharmacy director for the Oklahoma Health Care Authority, which administers the Medicaid program in the state. “One thing we’ve learned is that some companies don’t really stand behind their drugs, and it’s kind of scary,” Nesser said. “We’re paying a premium for them and they’re not willing to say that they will work.” The companies are not required to take part, but Nesser said several, which she declined to identify, have shown interest and discussions are underway with three. She said she hopes the program can begin by Aug. 1. “This is a good thing,” said Matt Salo, executive director of the nonpartisan National Medicaid Directors Association, which represents state programs. “It paves the way for states and other payers to start really thinking about how to do value-based purchasing for prescription drugs.” The federal waiver would allow Oklahoma to get around a potential obstacle to value-based contracts. A possible pitfall is Medicaid’s “best price” requirement, which says if any purchaser gets a really good deal on a drug, then Medicaid has to get that lower price too. Some interpret that to apply to value-based deals as well, Salo said. That means that if a drug didn’t work too well, and a state paid only 10 percent of the original price, then every other Medicaid program could get the drug for that rock-bottom price, too. “This seems to allow for paying less for a failed treatment without triggering the ‘best price’ requirement,” Salo said. Oklahoma spent about $650 million on prescription drugs in the fiscal year that ended June 30, Nesser said, and the change could save “a couple of million, maybe.” Medicaid patients, primarily children who do not pay for prescriptions and the elderly, whose costs are fixed, would see no pocketbook impact, according to Oklahoma Health Care Authority spokeswoman Jo Stainsby. “The change we’re looking for is improved health outcomes,” Stainsby said. Oklahoma is “taking the lead” in working to bring down the cost of medications, the AARP director for the state, Sean Voskuhl, said. “It is a great example of how states can implement change in the absence of reform at the federal level,” Voskuhl said.
BY ASSOCIATED PRESS
07/13/2018 12:45 PM
OKLAHOMA CITY (AP) — Oklahoma Gov. Mary Fallin on July 11 signed into place strict emergency rules for medical marijuana that pot advocates say are intentionally aimed at delaying the voter-approved use of medicinal cannabis. The term-limited Republican governor signed the rules just one day after her appointees on the state’s Board of Health adopted them at an emergency meeting after last-minute changes to ban the sale of smokable marijuana and require a pharmacist at every pot dispensary. Those late additions to the rules infuriated longtime medical marijuana advocates who helped get the measure on the ballot in June, when nearly 57 percent of Oklahoma voters approved it. Her quick signature also came just as medical pot advocates were rallying supporters to urge her to reject them. “People are completely angry. They voted for (State Question) 788 and now you have the health department and our governor pull these shenanigans?” said Isaac Caviness, president of Green the Vote, a marijuana advocacy group that pushed for the passage of the state question. “It’s a slap in the face to all activists. It’s a slap in the face to all Oklahomans who voted on 788.” Groups that opposed legalizing medical marijuana – including ones that represent doctors, pharmacists, hospitals and chambers of commerce – earlier this week called for new restrictions on the industry, including a ban on the sale of smokable pot and the pharmacist restriction. The board approved the two provisions against the advice of the health department’s general counsel, who said the rules likely were beyond the agency’s legal authority. Marijuana advocates say they’re considering legal action against the board. In a statement on July 11, Fallin said she thinks the rules were the best way to quickly set up a regulatory framework for medical marijuana. “I know some citizens are not pleased with these actions,” Fallin said. “But I encourage everyone to approach this effort in a constructive fashion in order to honor the will of the citizens of Oklahoma who want a balanced and responsible medical marijuana law.”
BY STAFF REPORTS
07/12/2018 12:30 PM
TAHLEQUAH – According to the U.S. Centers for Disease Control, the most effective way to avoid getting sick from viruses spread by mosquitoes when at home and during travel is to prevent mosquito bites. “Mosquito bites can be more than just annoying and itchy. They can spread viruses that make you sick or, in rare cases, cause death,” the CDC website states. “Although most kinds of mosquitoes are just nuisance mosquitoes, some kinds of mosquitoes in the United States and around the world spread viruses that can cause disease.” The CDC states that mosquitoes bite during the day and night, live indoors and outdoors and search for warm places as temperatures begin to drop. Some will hibernate in enclosed spaces such as garages, sheds and under (or inside) homes to survive cold temperatures. Except for the southernmost states in North America, mosquito season starts in the summer and continues into fall. <strong>Mosquito-borne viruses in the continental U.S.</strong> West Nile virus is the most common virus spread by mosquitoes in the continental United States. People can also get sick from less common viruses spread by mosquitoes such as La Crosse encephalitis or St. Louis encephalitis. In rare cases these can cause severe disease or even be deadly. Most people infected with these viruses do not have symptoms, or have only mild symptoms like fever, headache, nausea, and vomiting. • West Nile is a virus most commonly spread to people by mosquito bites. In North America, cases of WNV occur during mosquito season, which starts in the summer and continues through fall. There are no vaccines to prevent or medications to treat WNV. Fortunately, most people infected with WNV do not have symptoms. About 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness. • Most cases of Saint Louis encephalitis virus or SLEV disease have occurred in eastern and central states. Most people infected with SLEV have no apparent illness. Initial symptoms of those who become ill include fever, headache, nausea, vomiting and tiredness. Severe neuroinvasive disease (often involving encephalitis, an inflammation of the brain) occurs more commonly in older adults. In rare cases, long-term disability or death can result. There is no specific treatment for SLEV infection. Care is based on symptoms. • Most cases of La Crosse encephalitis virus or LACV disease occur in the upper Midwestern and mid-Atlantic and southeastern states. Many people infected have no apparent symptoms. Among people who become ill, initial symptoms include fever, headache, nausea, vomiting and tiredness. Some who become ill develop severe neuroinvasive disease (disease that affects the nervous system). Severe LACV disease often involves encephalitis and can include seizures, coma and paralysis. Severe disease occurs most often in children under the age of 16. In rare cases, long-term disability or death can result from La Crosse encephalitis. There is no specific treatment for LACV infection. Care is based on symptoms. • The Zika virus is still a problem in many parts of the world. Puerto Rico and U.S. Virgin Islands are areas with risk. Many areas in the United States have the kind of mosquitoes that can spread Zika. It can cause birth defects in babies born to women who were infected during pregnancy. The CDC recommends pregnant women and their partners and couples considering pregnancy know the risks and take prevention steps. <strong>Prevention</strong> • Use insect repellent: When used as directed, Environmental Protection Agency-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women. Use an EPA-registered insect repellent with DEET, Picaridin, IR3535, Oil of lemon eucalyptus, Para-menthane-diol or 2-undecanone. • Cover up: Wear long-sleeved shirts and long pants. • Keep mosquitoes outside: Use air conditioning or window and door screens. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.
BY STAFF REPORTS
07/06/2018 08:00 AM
TAHLEQUAH – Tribal Councilor Wanda Hatfield is one of two new appointees to the Oklahoma City Indian Clinic board of directors. The board is comprised entirely of Native Americans. Hatfield, a Cherokee Nation citizen, joined the board earlier this year along with Gena Timberman, a Choctaw Nation citizen. “It is an honor to be appointed to the leadership committee of a health institution like the Oklahoma City Indian Clinic, one of the largest and most successful urban Indian clinics in the country. So many Cherokee Nation citizens reside in central Oklahoma and utilize the health and wellness services provided by OKCIC,” Hatfield said. “As a member of the Cherokee Nation Tribal Council, I have advocated for more and better access to quality health care for our citizens, and in my new position I will be just as committed to improved health care opportunities for all Native people in the Oklahoma City area.” Hatfield will serve a three-year term, overseeing the clinic’s finances and directing the strategic plan along with 11 other board members. “Councilor Hatfield has been a champion for American Indian health care and will expand her responsibilities in this new role. She has helped Cherokee Nation Health Services connect and collaborate with other institutions that provide quality care to Indian people, including the Children's Center Rehabilitation Hospital and especially the Oklahoma City Indian Clinic,” Secretary of State Chuck Hoskin Jr. said. “Growing up in Adair County, she knows the health care challenges we face in rural Oklahoma, and as a retired school teacher in the Oklahoma City area, she has a unique grasp of the things our urban tribal citizens need.” Hatfield grew up in the Cherry Tree community near Stilwell in Adair County and attended Stilwell High School. She later received a bachelor’s degree in education from the University of Oklahoma and was an educator at Mid-Del School District in Midwest City for 28 years. She is also a member of Cherokee Nation Businesses advisory board and the Indian Education advisory boards for Mid-Del and Moore schools. “Both of our new board members embody the spirit of the Native American community that we serve,” Robyn Sunday-Allen, OKCIC CEO and Cherokee Nation citizen, said. “Their expertise and individual talents bring energy and fresh ideals to the table. We are honored to have them join our board.” The clinic sees more than 18,000 patients from over 200 federally recognized tribes each year.
BY ASSOCIATED PRESS
06/28/2018 12:00 PM
OKLAHOMA CITY (AP) – The head of Oklahoma’s health agency said on June 27 there’s a framework in place to get the medical marijuana industry rolling in the state soon, despite concerns from Gov. Mary Fallin that a statewide vote “opens the door” for recreational use. Oklahoma voters easily approved a state question on June 26 allowing cannabis to be used as medicine in the traditionally conservative state. The measure says applications for a medical marijuana license must be available on the agency’s website within 30 days of the measure’s passage. A regulatory office to receive applications for medical marijuana licenses, recipients and dispensary growers must be operating within 60 days. Interim Health Commissioner Tom Bates said the Oklahoma Department of Health has been developing proposed rules and regulations in case the medical marijuana program was approved by voters since he was named to the post on April 1. He said the agency is prepared “to implement a medical marijuana model as required by the state question.” “We do have a lot to take care of in a tight timeframe,” Bates said. Bates said state health officials would meet July 10 to consider emergency rules for the new Oklahoma Medical Marijuana Authority. Application information and requirements will be available on the agency’s website by July 26, and applications will be accepted by Aug. 25. Oklahoma’s was the first marijuana question on a state ballot in the U.S. in 2018, with elections scheduled for later this year in Michigan and Utah. Voters in neighboring Arkansas legalized the drug for medical use in 2016, but Oklahoma is among the most conservative states to approve its use. Voters came out in droves in Oklahoma to weigh in on the issue, which made it onto the ballot through a signature drive. The Oklahoma State Election Board says more votes were cast on the marijuana question than in the 2014 general election. In Oklahoma City, 33-year-old Meaghan Hunt said she cast her vote in favor of legalization because she views marijuana as another form of treatment for patients with various ailments. She said she wants them to have as many options as possible. She also believes state coffers could benefit from the cash marijuana crops would deliver. “I’d like to see more taxable revenue coming into our state and if that’s an opportunity to collect taxes, all the better — hopefully for education,” Hunt said. The term-limited Fallin said before the vote that she would call lawmakers into a special session to develop rules to regulate the industry, but she toned down her comments after the election results were clear. “I believe, as well as many Oklahomans, this new law is written so loosely that it opens the door for basically recreational marijuana,” Fallin, a Republican, said in a statement. GOP state Senate leader Greg Treat said he doesn’t think members of his party, the majority, are interested in a special session. “Whatever we do will just to be so make sure we don’t overturn the will of the people,” the president pro tempore-designate told reporters on June 27. Attitudes have shifted sharply on marijuana in recent decades in Oklahoma, especially among young people, said Bill Shapard, a pollster who has surveyed Oklahomans on the issue for more than five years. “I’ve found almost half of all Republicans support it,” Shapard said. Oklahoma’s tough-on-crime ideology also has come at a cost, with the state’s skyrocketing prison population consuming a larger share of the state’s limited funding. In 2016, voters approved a state question to make any drug possession crime a misdemeanor, despite opposition to that proposal from law enforcement and prosecutors.
BY KENLEA HENSON
Former Reporter
06/22/2018 04:00 PM
COMPETITION, Mo. – As the 2018 “Remember the Removal” cyclists made their way to Tahlequah, Oklahoma, and the end of their three-week journey, one may have noticed the riders’ various ages. Although Cherokee Nation cyclists range in ages 16 to 24, the Eastern Band of Cherokee Indians gears its “RTR” bike ride towards improving its citizens’ health. The ages for EBCI cyclists this year ranged from 17 to 62. After finishing day 12 of riding, the older EBCI riders reflected on the nearly 1,000-mile trek to Oklahoma and why they wanted to take it. At age 62, Jan Smith said she took on the challenge to honor her ancestors. She said as an EBCI citizen she receives benefits that help her, and for that, her ancestors deserved some appreciation. “There’s people that paid for that (benefits). They’re the ones that struggled, and if they hadn’t been resilient then I wouldn’t be able to reap those benefits I have,” Smith said. “It’s just a small, small way to pay them back.” Like all cyclists who make the journey, a lot of preparation goes in months before the ride begins to ensure their physical endurance can stand against the strain they place on their bodies. Smith knew her age would work against her, so she started training early. “The first training ride I went to was like 10 miles, and I did terrible, and I thought I have to get in better shape. So I started training and eating better,” she said. “I probably worked out five to six days a week. It takes a lot of hard work.” The consecutive days of riding for hours at a time have been hard on Smith, but she said seeing some of the significant sites along the way have been worth it. EBCI cyclist Lori Owle said she rode ride to learn about the Trail of Tears history firsthand. However, the 47-year-old admitted the physical aspect has been difficult. “Before each ride I get knots in my stomach because of the unknown, but once you complete the day you get a sense of completion,” she said. On day nine, a deer hit Owle and knocked off of her bike. After three hours in the emergency room and three stitches in her finger, she was back on her bike the next day. She said being one of the “older riders” was hard, but that the younger riders were a “blessing.” “My main thought was it was us older riders that would need to watch over the young riders and make sure they don’t get hurt, but then it was me that got hurt,” she said. “They take good care of me, and I think the ride has developed patience in them. It’s really good to know that the younger generation has that kind of compassion.” For EBCI cyclist Bo Taylor participating in the ride had been a goal he worked toward for two years. The 48-year-old was selected for the 2017 ride, but a training accident two days before the ride began left him with nine broken ribs. He said he was determined to ride this year. “What I’ve always said about Cherokees is that we always get back up no matter what happens,” Taylor said. Once his ribs healed, he trained on spin bikes and eventually got back on his bike. He said his favorite moment this year was climbing the Cumberland Gap in eastern mountainous Tennessee without stopping. “For an old dude, knowing I can still do things is good. Two years ago I couldn’t do what I am doing now, so it’s been an awesome journey. I’ve found out a lot about myself.”