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 STAFF REPORTS
12/08/2017 04:00 PM
TAHLEQUAH, Okla. – Cherokee Nation physician Dr. James H. Baker was recently awarded a Mastership through the American College of Physicians for his contributions. According to ACP, “Election to Mastership recognizes outstanding and extraordinary career accomplishments and achievements, including the practice of internal medicine, academic contributions to our specialty, and service to the College.” During review of candidates, the ACP’s Awards Committee considers several qualities, including strength of character, perseverance, leadership, compassion and devotion. Clinical expertise and commitment to advancing the art and science of medicine are also taken into account by the committee. “I am so honored to receive this award from my peers and colleagues at the American College of Physicians,” Bake said. “I thank our Oklahoma ACP Chapter of 1,000 internal medicine physicians and medical students for nominating me.” Baker, of Muskogee, is a general physician with more than 30 years of experience. He serves as medical director for CN Three Rivers Health Center and the tribe’s Wilma P. Mankiller Health Center. Baker completed medical school at the University of Oklahoma in 1982 and completed his internal medicine residency at Kansas University in 1987. The mastership is the third award Baker has received from the ACP, including the Meritorious Service Award in 2014 and the Laureate Award in 2015. He is a former governor of the Oklahoma chapter of ACP and a current member. The ACP will honor 2017-18 master recipients at the organization’s annual convention in April 2018 in New Orleans. For more information, visit <a href="http://www.acponline.org" target="_blank">www.acponline.org</a>.
BY STAFF REPORTS
12/05/2017 12:00 PM
TAHLEQUAH, Okla. – According to an Oklahoma influenza summary for Nov. 19-25, the influenza geographic spread is “widespread” within the state. The report states that there were 162 positive rapid flu tests at sentinel sites with 78 percent of those positive specimens being influenza A. The summary also states that between Sept. 1 and Nov. 28, 105 influenza-associated hospitalizations were reported to the Acute Disease Service with ages ranging from 0 to 95 years with a median of 62 years of age. The report states that two influenza-associated deaths have been reported among residents of Johnston and McClain counties, and officials said that Oklahoma is experiencing a higher than normal level of influenza activity early in the season. “Our influenza-associated hospitalizations are the highest they have been at this time of year since the 2009-2010 pandemic,” Dr. Sohail Khan, Cherokee Nation health research director, said. “Our influenza-associated hospitalization count is three weeks ahead of the 2014-2015 season when our influenza activity peaked in December and declined to minimal levels by the end of March. This early activity does not mean we will have a more severe season. It does indicate that more influenza will be circulating during the holidays.” Flu, or influenza, is a contagious respiratory infection caused by a variety of flu viruses. Symptoms of flu involve muscle aches and soreness, headache and fever. It enters the body through the mucus membranes such as the nose, eyes or mouth. “Every time you touch your hand to one of these areas, you are possibly infecting yourself with a virus,” Khan said. “This makes it very important to keep your hands germ-free with frequent and thorough hand washing. Encourage family members to do the same to stay well and prevent flu.” Khan said there are three types of flu viruses: A, B, and C. He said type A and B cause the annual influenza epidemics that have up to 20 percent of the population sniffling, aching, coughing and running high fevers. Type C also causes flu, however type C flu symptoms are less severe. The flu is linked to between 3,000 and 49,000 deaths and 200,000 hospitalizations each year in the United States, and seasonal flu vaccines are created to try to avert epidemics. Khan said the best way to prevent seasonal flu is to get vaccinated each year, but good health habits such as covering a cough and washing hands often can help stop the spread of germs and prevent respiratory illnesses such as the flu. There also are flu antiviral drugs that can be used to treat and prevent flu. To prevent the spread of flu, Khan said to avoid close contact; stay home when sick; cover mouth and nose; clean your hands; avoid touching your eyes, nose or mouth; and clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. He also suggests getting plenty of sleep, being physically active, managing stress, drinking plenty of fluids and eating nutritious food.
BY LINDSEY BARK
Reporter
12/05/2017 08:00 AM
TAHLEQUAH, Okla. – In 2015, the Cherokee Nation became the first tribe to launch an elimination project with the U.S. Centers for Disease Control and Prevention to screen and treat tribal citizens for hepatitis C. And since the project’s inception, more than 40,000 people have been screen. CN officials proclaimed Oct. 30 as Hepatitis C Awareness Day and said the tribe continues its efforts to reach it goal of screening 80,000 patients. “Hepatitis C is a virus that affects primarily the liver but it can affect other organs, too. It was isolated in 1989, although we knew it existed long before that time,” Dr. Jorge Mera, CN director of infectious disease, said. Hepatitis C was identified as non-A or non-B hepatitis before it was labeled as a third virus. Symptoms are not present unless it has not been identified or treated for a period of time and cirrhosis of the liver sets in. “The symptoms are basically symptoms of cirrhosis. So anything that inflames the liver for many years may end up causing a lot of scarring of that liver and when the scarring is sever enough we label it as cirrhosis,” Mera said. The virus can be contracted several ways. Mera said in approximately 90 percent of cases, people who inject drugs and share needles, syringes or paraphernalia, contract it. In the past, blood transfusions played an important role in contracting the virus until 1992 when blood banks began checking for it. Tattooing in a non-professional parlor can also play a role. There is also a small chance, roughly 5 percent, that a mother can transmit the disease to her newborn child, Mera said. He said there are ideal and practical ways to prevent the disease from spreading. “Ideal would be that people would not use illegal drugs and not inject them. We know that we can mitigate that but we will never reach zero on that. That’s a reality. People have been using illegal drugs for millenniums, and it’s not going away soon,” Mera said. He said if people use drugs they should use clean needles and syringes each time they inject and to not share needles with anyone. He added that there is a need for needle and syringe exchange services, which is illegal in Oklahoma. Other tribes and places in the United States, such as New York City and San Francisco, are creating their own hepatitis C elimination programs. “Now the advantage they have over us is that they have needle and syringe services. It’s going to be very difficult to eliminate hep C if you don’t have needle and syringe services because there will be a point that people will continue to transmit, and I can only go and catch them and treat them. But I would like to cut that transmission,” Mera said. To prevent the disease’s consequences once it is contracted is for people ages 20 to 72 years old to get screened. “We offer free screenings and free treatments at W.W. Hastings Hospital in Tahlequah, Oklahoma,” Mera said. “In Cherokee Nation, 3.4 percent of Cherokees ages 20 to 72 are positive for hepatitis C. In other Native American communities there have been reported rates as high as 8 percent and also lower rates.” He said hepatitis C is the top “killer of blood-born pathogens” than any other reportable disease of the CDC and has killed more than the rest of the reportable diseases combined. “Hepatitis C mortality is greater in Native Americans in general than non-Native American populations in the United States,” Mera said. Mera said the screening process is simple and all one has to do is request a screening in the Urgent Care or with their providers at W.W. Hastings Hospital. The screening contains a blood drop, in which results are ready in 24 hours. He said treatment options, depending on the severity of the virus, is taking a pill regiment for eight to 12 weeks, in which 95 percent cure rates have been seen. “It’s the only chronic infectious disease that you can cure and, to my knowledge, is the only chronic disease you can cure. Because you can’t cure diabetes or high blood pressure, those you have to treat for life, or HIV for that matter. But this is eight to 12 weeks and you’re done.” He said though the treatment is simple the hard part is getting people to get tested. Roughly 50 percent of the population of the 85 percent goal has been screened. Approximately 78 percent have tested positive and more than 90 percent have been cured of the virus. “On cure rates we’re meeting our goal. On screening we still have a ways to go. And in engagement of care there’s still room for improvement,” Mera said. “I would really like to eliminate hepatitis C from Cherokee Nation. That would be my goal.”
BY KENLEA HENSON
Reporter
11/24/2017 02:00 PM
TAHLEQUAH, Okla. – During the Nov. 13 Health Committee meeting, Secretary of State Chuck Hoskin Jr. said Health Services Executive Director Connie Davis had resigned and was being replaced in the interim by Dr. Charles Grim. Davis, whose career experience spans over 28 years in the health field, began her career at W.W. Hastings Hospital in 1988. In 2004, she joined Tahlequah City Hospital as vice president of patient care and chief nursing officer until she became the Cherokee Nation’s Health Services executive director in 2012. “She is going to devote some more time to her family, particularly her mother,” Hoskin said. “We certainly appreciate her service. Dr. Grim has been named interim executive director of Health, effective immediately.” Grim, a CN citizen, is a retired assistant Surgeon General and rear admiral in the Commissioned Corps of the U.S. Public Health Services. During his career, Grim has received honors and awards, including a Lifetime Achievement Award from the Oklahoma Area Indian Health Service, Health Leader of the Year from Commissioned Officers Association of U.S. Public Health Service, Community Leadership Award from the CN as well as multiple U.S. Public Health Service medals and citations, including the U.S. Surgeon General’s Exemplary Service Medallion. Since 2013, Grim has served as Health Services deputy director, in which he was second in charge of Hastings Hospital, eight outpatient health centers, Emergency Medical Services, finance and billing services, facilities management, the Jack Brown Youth Regional Treatment Center and a host of public health and community health services and programs. Prior to that, Grim served as Health Services senior director of for more than three years. Preceding his CN employment, Grim spent 26 years working for Indian Health Services in numerous clinical, administrative and executive leadership positions. In 2002, President George W. Bush appointed him as director of IHS with a unanimous Senate confirmation. During that time he administered a nationwide multi-billion dollar health care delivery program, with 12 administrative regional offices and over 16,000 employees. Grim holds a bachelor’s degree in microbiology from the University of Oklahoma, a doctorate of dental surgery from the University of Oklahoma College of Dentistry and a master’s degree in health services administration from the University of Michigan School of Public Health. “When I retired from the Indian Health Service and got hired to work for the Cherokee Nation it was pretty incredible for me. It’s a dream come true. I thought I might go the rest of my career and never get to work here. I’ve learned a lot over the years, both educationally and experientially and the thought that I have got to apply a lot of that here for my tribe and my citizens and my people has really meant a lot,” he said during the Health Committee meeting. Grim also thanked Davis for her time as Health Services executive director. “We have one of the biggest tribal health systems in the country, one of the largest populations to serve in the country, and she did a very, very good job of trying to stay on top of all the issues that were thrown at us on a daily basis. She had a good team of people around her, many of those sitting behind me but some of them you never see. You see some of them in your clinic when you’re going around, but I just wanted to thank her publically…” he said. Grim will serve as interim director until an executive director is named. “We always want to fill positions parentally, and the resignation was just tendered so naturally our first move was to name an interim, and we could not have a more capable interim than Dr. Grim. As the days and weeks pass we will be looking at a permanent person to fill that position, but we have all the confidence in the world in Dr. Grim,” Hoskin said.
BY STAFF REPORTS
11/15/2017 04:00 PM
CLAREMORE, Okla. – The Claremore Indian Hospital will sponsor a Veterans Affairs Enrollment Fair on Dec. 7 in the hospital’s Conference Room 1. Hospital officials said the fair is set for 10 a.m. to 2 p.m. to assist their Native American veteran patients in applying for eligibility for health care services through the VA. “We will have Claremore Indian Hospital benefit coordinators and representatives from the VA and Disabled American Veterans to assist with the application processes,” Sheila Dishno, Claremore Indian Hospital patient benefit coordinator, said. “Please make plans to attend and bring your financial information (income and resource information) and DD-214 (military discharge) papers.” If already enrolled, call 918-342-6240 or 918-342-6559 so a hospital official can update your file.
BY STAFF REPORTS
11/13/2017 12:00 PM
TAHLEQUAH, Okla. – According to a Cherokee Nation Communications release, the tribe’s Health Services has screened more than 40,000 tribal citizens for hepatitis C after becoming the first tribe in the country to launch an elimination project two years ago with the U.S. Centers for Disease Control and Prevention. Principal Chief Bill John Baker declared Oct. 30 as Hepatitis C Awareness Day in the CN as tribal and Health Services officials gathered for a proclamation signing ceremony. The release states the tribe’s goal is to screen 80,000 patients between age 20 and 65 for hepatitis C during a three-year period. In October 2016, the tribe had screened 23,000 patients. “When this program started in 2015, we had high hopes for what it would mean for the long-term health of Cherokee Nation citizens,” Baker said. “The positive results have been beyond even our highest expectations. We have treated and cured more than 680 people with a 90 percent success rate. That success is allowing people once afflicted with the hepatitis C virus to live healthier and happier lives. The Cherokee Nation Health Services staff has collaborated with international infectious-disease experts to create and sustain this modern health care blueprint. It’s not often a disease can be completely eliminated from a citizenry, but it’s something we are achieving in the Cherokee Nation with our hepatitis C efforts.” Of those screened, about 1,200 patients tested positive and more than 680 patients are either currently being treated for hepatitis C or have been cured. “The Cherokee Nation is demonstrating to other communities across the United States how to effectively test and treat those living with hepatitis C and prevent new infections, so that someday the threat of hepatitis C will be eliminated,” Dr. John Ward, director of CDC’s Division of Viral Hepatitis, said. Hepatitis C is a liver infection caused by the hepatitis C virus, usually through the transfer of blood. Most people become infected with the hepatitis C virus by sharing needles, through unlicensed tattooing or because they had a blood transfusion before 1992. For some people, hepatitis C is a short-term illness, but for about 70 percent of people who become infected, it becomes a long-term, chronic infection, according to the CDC. Dr. Jorge Mera, Health Services’ Infectious Disease director, said the project continues to gain momentum with his office looking more at prevention of hepatitis C and the potential increase from the opioid crisis happening throughout the United States. “Our efforts now need to be directed at preventing hepatitis C, which in the United States today is driven by injected drug use,” Mera said. “Prevention strategies include expanding our medication-assisted treatment program for opioid addiction. We are also beginning a serious discussion about needle- and syringe-exchange programs.” Health Services has partnered with the CDC and the Oklahoma Department of Health to track and share knowledge. For more information about the elimination project or to get screened, visit <a href="http://www.cherokee.org/Services/Health/HealthCentersHospitals.aspx" target="_blank">http://www.cherokee.org/Services/Health/HealthCentersHospitals.aspx</a>.