Compassion and community: Odeh Center welcomes providers from New Mexico to discuss health care and health disparities for Navajo people
American Indians and Alaska Natives born today have a life expectancy that is nearly 11 years less than the overall average in the United States. Causes include lack of infrastructure and challenges in accessing health care, running water, electricity and food, but also historical traumas that have led to mistrust between patients and health care systems.
On November 13th, the University of Illinois Chicago’s Odehmenan Health Equity Center hosted health care professionals from New Mexico who provide care to members of the Navajo Nation and other Native tribes. The Odeh Center, housed in the UIC Library of Health Sciences, has the mission of cultivating an environment of belonging and trust for underrepresented health professionals and facilitating action in pursuit of health equity. The presenters discussed several topics, including the barriers to care and historical trauma faced by Native Americans and the role of health care providers in establishing trust and promoting health equity.
Speakers also addressed their individual focuses on inpatient and outpatient care, gender affirming care, HIV prevention and reduction and substance use disorder treatment and shared insight into providing health care to patients who are from a community different than their own.
“It's decisions—laws, policies, treaties—that have happened before, decades before, centuries before, that dictate and lay the groundwork, the framework, to have this be the end result of what impacts health,” said Mia Lozada, medical officer at the Gallup Indian Medical Center. “It is all of these historical trauma events, that are aspects of structural racism, that are really decades and centuries of intentional and purposeful discriminatory decisions that are impacting individuals’ health today.”
The disparities faced by Native communities were exacerbated by the COVID-19 pandemic. At one point, Gallup, NM had one of the highest numbers of deaths per 100,000 people in the country. Staff had to make decisions about which of the thousands of patients would have access to their six beds and three ventilators.
“If I were to look at that,” Marisha Leonard-Bitahy, an intensive care nurse at Gallup Indian Medical Center, said, referencing her 2020 ICU patient logbook, “I would say that probably about 90% of them didn’t make it. If we had 100 individuals coming into our ICU, 90% of them didn’t make it. I don't know the data. I can't go back into those patients’ records to find out if they made it alive or not. But it was traumatizing. It was horrific.”
Because of the structural barriers and historical trauma faced by Native communities, it can often be difficult for health care providers to build trust and provide care, especially if they are not Indigenous themselves. The presenters highlighted the importance of cultural humility and centering the patient’s experience.
Lozada, who is not Native, expressed the importance of not holding a savior complex and coming to terms with always being an outsider.
“It's the challenge of being the intermediary between a sub-optimal system of federal government, all of the historical trauma, being non-Native and connecting to the individual human being, person who is Native, in front of me,” she said. “The term ‘instrument of betrayal’ comes into play a lot as a [primary care provider] when I am the face of an institution that can't do what it should and is obligated to do in a timely fashion, in a high-quality way. I feel like I have profound guilt and moral injury about that, and carry that with me daily, monthly, yearly.”
“We’ve all gone into medical care to have that one-on-one relationship with patients, and now to realize, in this day and age, that we have to go beyond that,” added Chief Clinical Consultant for Internal Medicine and Indian Health Service Medical Officer Jennie Wei. “Because, as we know, health care is not just delivered in the clinic anymore, but in fights far beyond the door.”
Panelists Heading link
Odehemenan is a Potawatomi word that translates to, “this heart of ours,” chosen to emphasize the high level of “heart work” that is needed to be able to take care of oneself and take care of patients and communities. In the spirit of the Odeh Center, many of the presenters shared the lessons they’ve learned over the years and the importance of cultural sensitivity for the next generation of providers.
“I think saying, ‘I don’t know’ or ‘Can you help me understand?’ is extremely important,” said Sheryl Bahe Livingston, licensed professional clinical counselor and SBIRT facilitator at Gallup Indian Medical Center. “And it’s humbling to be able to tell your patient, ‘Help me understand what you’re going through,’ or ‘I don’t know.’ I think it’s very important.”
“Let’s not forget the beauty. My patients continue to ask me to share their strengths rather than solely the images of suffering and disparities that are shown on the news,” shared Wei.
“Do your homework if you decide to work with Native tribes in the future,” said Mattee Jim, supervisor for HIV prevention/harm reduction services at Gallup Indian Medical Center. “Not just learning about that one tribe you’re working with but try to learn as many tribes as you can, because all our customs, language, are different throughout the country.”
Other advice the presenters shared included having strong mentors, being open to self-reflection and continuous self-growth, having friends outside of your profession, advocating for patients outside the clinic walls and focusing on intentional inclusion of all patient populations.
“We need to be soft on people and hard on structures,” Wei said. “We all, as people, are a victim and a part of these structures.”
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Launched in 2023, the Odeh Center brings together students, faculty, staff, alumni and community partners for education, advocacy, affinity groups, dialogues and programming. The center is the result of a joint partnership spanning years between the Office of the Vice Chancellor for Health Affairs and the Office of Diversity, Equity, and Engagement, and a generous donation of space from the UIC Library of the Health Sciences-Chicago. To learn more, visit their website.