MetroDoctors Spring 2022: Indigenous Health: We are all connected

Spring 2022

Doctors Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

INDIGENOUS HEALTH: We are all connected

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CONTENTS VOLUME 24, NO. 1 SPRING 2022

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IN THIS ISSUE

Sharing Medicine Ways

By Thomas E. Kottke, MD, MSPH

4

PRESIDENT’S MESSAGE

A New Vision for TCMS

By Zeke J. McKinney, MD, MHI, MPH

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INDIGENOUS HEALTH

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COLLEAGUE INTERVIEW:

A Conversation with Mary J. Owen, MD

10 • Indian Health Board of Minneapolis: a 50 Year Vision for the Future

By Angela Erdrich, MD Page 6

12 • Honoring Health and Tradition in Minneapolis

By Antony Stately, PhD 14

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Page 3

Ain Dah Yung Center: Where American Indian Youth and Families Go to Thrive in Safety and Wholeness

Dream of Wild Health

By Neely M. Snyder •

18

Traditional Tobacco

20 • Black Bears and Blueberries Publishing for All Children

By Thomas Peacock

Spring 2022

• PAID EDITORIAL:

American Indian Quitline Helps to Reclaim

Doctors Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

22 • How Engaging Youth Strengthens Our Wellness Mission

By Sharon M. Day 24

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Be a Good Relative

By Melissa Buffalo and Wyatt Pickner Page 20

ENVIRONMENTAL HEALTH:

Integrating Indigenous Wisdom and Culture Into Western Medicine

By Lisa Martin, PhD, RN, PHN, AHN-BC, FAAN, and Mike Menzel, MD •

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Career Opportunities

FUTURE PHYSICIAN LEADERS

On Uplifting Indigenous Voices

By Shelby Snyder, Incoming Medical Student Fall 2022 Page 12 MetroDoctors

The Journal of the Twin Cities Medical Society

INDIGENOUS HEALTH: We are all connected

Original artwork by Angela Erdrich, MD, Turtle Mountain Ojibwe Tribal Member and Pediatrician at Indian Health Board. Dr. Erdrich is a watercolor artist, who in 2021 illustrated her first Children’s book, Josie Dances. The theme of the art piece is holistic Native health in the Twin Cities.

Articles begin on page 6.

Spring 2022

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Spring Index to Advertisers

Doctors MetroDoctors

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THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

TCMS Officers

Editor-in-Chief: Thomas E. Kottke, MD, MSPH Managing Editor: Nancy K. Bauer Editorial Board Members: Clare Buntrock, Medical Student Peter J. Dehnel, MD Edward P. Ehlinger, MD, MSPH Robert R. Neal, Jr., MD James Pathoulas, Medical Student Richard R. Sturgeon, MD Production Manager: Sheila A. Hatcher Advertising Representative: Betsy Pierre Cover Art by: Angela Erdrich, MD MetroDoctors (ISSN 1526-4262) is published quarterly by the Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113.

Periodical postage paid at St. Paul, Minnesota.

Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113.

President: Zeke McKinney, MD, MHI, MPH Secretary: Cora Walsh, MD Treasurer: Alex Feng, MD, MBA Past President: Sarah Traxler, MD, MSPH At-large: Ryan Greiner, MD TCMS Executive Staff

Nancy K. Bauer, Interim Lead Staff, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893; nbauer@metrodoctors.com Lucy Faerber, MPH, Program Manager lfaerber@metrodoctors.com Patrick Jones, Director of Finance and Operations pjones@metrodoctors.com Amber Kerrigan, Program Manager (612) 362-3706; akerrigan@metrodoctors.com Kate Feuling Porter, MPH, Senior Program Manager (612) 362-3724; kfeuling@metrodoctors.com

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To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113.

E-mail: nbauer@metrodoctors.com.

For advertising rates and space reservations, contact: Betsy Pierre phone: (763) 295-5420 e-mail: betsy@pierreproductions.com MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Nancy Bauer at (612) 623-2893.

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Spring 2022

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IN THIS ISSUE...

By Thomas E. Kottke, MD, MSPH Editor-in-Chief, MetroDoctors

Sharing Medicine Ways I was a second-year medical student in 1971. In an obstetrics Peacock (Anishinaabe Ojibwe) class the lecturer asserted that Minnesota had the world’s best describes how he co-founded Black birth outcomes. I raised my hand and asked how he could say Bears and Blueberries Publishing to that when the birth outcomes for Native peoples living in the produce the books that help Native Phillips neighborhood of Minneapolis were considerably worse children develop the positive than even those on the reservations. His response? “Well, if you self-image fundamental to health don’t count those…” and well-being.

Fifty years on, Dr. Mary Owen (Tlingit) and I have asked So, how can those of us who a group of Native authors to tell MetroDoctors readers how are not Native help? Certainly, Minnesota Native communities have organized health and neither by stepping in to take well-being programs in response to indifference, hostility, and control nor by disengaging. Rather, violence. Among other roles, Dr. Owen is a clinician, Direcit might be by asking, “How would you like me to help?” If tor of the Center of American Indian and Minority Health, the answer comes back, “Just step back and let us sort this out UMN Medical School, Duluth Campus, and President of the ourselves,” respect it. But always help when asked. Helping Association of American Indian Physicians. Her Colleague might mean advocating in St. Paul and Washington or in your Interview tells much more. For those seeking a retrospective of own city or county. Helping always means challenging the the physical and cultural violence Native people have endured systematic racism, false narratives, and biases that run deep in from first contact, Dr. Owen Minnesota society. recommends David Treuer’s, Before I close, I want to The Heartbeat of Wounded Knee thank Dr. Angela Erdrich for and Roxanne Dunbar-Ortiz’s, painting the cover art, and An Indigenous Peoples’ History I’d be remiss if I didn’t thank of the United States. Those Mangan Golden, Research seeking an autobiographiCoordinator, the Center of cal account of the American American Indian and Minority Indian Movement will want Health, UMN Medical School, to read The Thunder Before Duluth Campus, for her assisThe Bears Meet to Share Medicine the Storm, by the late Clyde tance in producing this issue of Sarah Agaton Howes, artist Bellecourt, and I would add MetroDoctors.

Louise Erdrich, another internationally recognized Native Wait — we’re not done! Please head to the TCMS Blog author living and working in Minneapolis. Those wanting to page (metrodoctors.com/tcms-blog) to read an article by John review the health statistics of the Minnesota Native population Hunter (Winnebago, Ojibwe, Creek), co-founder and director should turn to the Minnesota Department of Health Center of Twin Cities Native Lacrosse, on how this Native-inspired for Health Statistics reports. sport, also known as “Creator’s Game” remains a tradition, but In the same year that I was a second-year medical student, differs from today’s games played in high schools. a young Native woman, Gloria, died of hepatitis in the Phillips Finally, I want to say, “Welcome!” to my long-term colneighborhood when she could not find a physician willing to league, Dr. Ed Ehlinger, and a new one, medical student Clare treat her. This event led to the organizing of the Indian Health Buntrock, as they join the MetroDoctors editorial board.

Board (IHB). Its 50-year history and vision for the next 50 is described by Dr. Angela Erdrich (Turtle Mountain Ojibwe).

Best wishes, Knowing who we are, why we’re here, and where we came Tom from is critical for a positive sense of self. In his article, Thomas MetroDoctors

The Journal of the Twin Cities Medical Society

Spring 2022

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President’s Message

A New Vision for TCMS ZEKE J. McKINNEY, MD, MHI, MPH

The recent local murder of Amir Locke is an unfortunate reminder of how much work is still yet to be done to ensure the health and safety of our community. The systemic and environmental health hazards to those without the power, privilege, or agency to reduce those hazards are significant contributors to the health of our communities and our patients.

The literature continues to demonstrate that social determinants of health (SDOH), including access to health care and/ or health insurance; stable employment, nutrition, housing, and the lived environment; as well as the community context in which one lives, as a whole impact health outcomes as much as 50-90%. Perhaps unsurprisingly, systemic racism itself is a social determinant, as is colorism (a person’s skin tone). This effect is reflected in Black, Indigenous, and People of Color (BIPOC) patients consistently having comparatively worse health outcomes in a variety of contexts: maternal-infant mortality, treatment of pain, assignment of disability, rates/management of chronic disease, and all-cause mortality.

What does that mean for us as physicians? Considering that these SDOH are impacting our patients more than our ability to provide clinical care, it is at least in our own interest to try to do something about them. However, it is also in alignment with the biomedical ethical principle of justice. Classically, we hear about this principle in terms of ensuring we are provisioning care equitably for patients in the same clinical context. This breadth of consideration is not enough, and we have a responsibility to our communities to use our social capital, education, and financial resources as physicians to fight for justice for our patients. Most importantly, we must do this as partners with the community. That is where TCMS comes in.

The past year involved significant transition and organizational energy for TCMS as we amicably separated from the Minnesota Medical Association. This process is essentially complete and we are now focused on how to move forward with continuing to support our existing amazing efforts, and to grow our ability to initiate new projects. Our aim is to continue to facilitate community-oriented partnerships with physicians in the areas of education, advocacy, and programming. Although we are likely to change our organization’s name to reflect a footprint beyond the Twin Cities alone, the TCMS Board recently approved the following statements to reiterate who we are: Elevator Pitch: Why should I join TCMS? TCMS is the place where physicians that want to do something for their community can be plugged into things to do.

Gap Analysis: What need is TCMS filling?

People and organizations are looking for doctors all the time to help them with projects. Many doctors feel like they cannot always fulfill their passion for helping others with their clinical work. TCMS bridges that gap by giving physicians the space to try to fix what is broken about health care and medicine through the lens of asking the community what they need and how they want it.

Mission: Twin Cities Medical Society is dedicated to creating a healthy, equitable, and thriving state by engaging physicians and medical students in community-driven public health initiatives.

Vision: To be the organization where individuals or communities can turn for physician-led expertise and engagement, and where physicians can pour their passion for doing good well beyond what they may be able to do within their everyday work.

With all of this in mind, we will continue to rely on you to help us best serve our communities by informing us of where we can be most effective and by continuing to graciously give your time to our work. We sincerely look forward to traversing this year together despite the local and global challenges facing all of us. Thank you!

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Indigenous Health

Colleague Interview: A Conversation with Mary J. Owen, MD

M

ary Owen, MD is a member of the Tlingit nation. She graduated from the University of Minnesota Medical School and North Memorial Family Practice Residency Program before returning home to work for her tribal community in Juneau, Alaska. After 11 years of full-scope family medicine, she returned to the University of Minnesota Medical School, Duluth Campus in 2014 as the Director of the Center of American Indian and Minority Health (CAIMH). Her work includes developing and managing programs to increase the numbers of American Indian and Alaska Native (AI/AN) students entering medical careers, reaching out to local and national Native leaders to ensure University of Minnesota Medical School remains in tune with AI/AN healthcare and education needs, developing an AI/AN track for all students interested in providing health care to AI/AN communities and developing research efforts to address AI/AN health disparities. She continues to provide clinical care at the Center of American Indian Resources in Duluth and is the current President of the Association of American Indian Physicians.

American Indian/Alaska Native, Native American, Indigenous — what’s the difference in the terms and how should those terms be used?

All these terms can be used interchangeably. That said, many Native people prefer to be referred to by their Tribal identity.

Additionally, each person is different. For instance, when I use the term, American Indian, one of my aunties corrects me and says, “Native American.” The only term that I recommend against by people who are not part of the Native community, either by birth or acceptance, is “Indian.” Native people often use it themselves, but I recommend people use the terms American Indian (AI), Alaska Native (AN), Native American (NA) or Indigenous.

How does historical and intergenerational trauma express itself in the lives of the Indigenous peoples of Minnesota?

Historical and intergenerational trauma is expressed in part through the persistent health, education, and economic disparities of Native people in Minnesota and the United States. I will give an example of historical and generational trauma playing out in Native communities: by 1920, up to 80% of Native children were in boarding schools — institutions that have been revealed to have been created to assimilate Native people by disallowing their language and culture to be practiced. Once children graduated from or left the boarding schools, they returned to broken communities now dependent on government support because the 6

Spring 2022

traditional practices and ways of survival that Native Americans had practiced for centuries could no longer support them. Family and community structures were in flux, if not destroyed by the imposition of western ways. Young people, now speaking a different language, struggled to communicate with their families when they returned. The youth returning from boarding schools far away from their communities were not raised with common teachings such as how to raise children and families. As young people do, they got together and had children. Without those critical family and societal lessons on how to raise children, how to support your family and how to interact with your traditional community members, dysfunction naturally ensued. Because over half of Native children were sent to boarding schools, which were open through the 1970s, the impact was and is massive. In her book, An Indigenous Peoples’ History of the United States, Roxanne Dunbar-Ortiz expertly describes the “narrative of dysfunction” in our communities. She cites the teaching of Vine Deloria and other activists who state that “there is a direct link between the suppression of Indigenous sovereignty and the powerlessness manifest in depressed social conditions.”

How do you blend traditional health practices of American Indian tribes with allopathic “Western” medicine?

Native ways of knowing, including health practices were in place for centuries before Europeans came to this continent. As in western medicine, many of our patients are interested in healing MetroDoctors

The Journal of the Twin Cities Medical Society

practices outside of what physicians prescribe. Thankfully, many Tribal and Indian Health Service (IHS) facilities are incorporating traditional healing by employing traditional healers. I often ask about and encourage my patients to participate in culture, including healing practices, as cultural engagement has been shown by Dr. Melissa Walls’ and others’ work to improve health outcomes.

Reparations are a topic discussed mostly around the African Descendants of Slaves (ADOS). How should we think of reparations with Native communities?

Land Back is likely the movement that is closest to the reparations movement. The United States promised health care, education, and social services for Native people in perpetuity in exchange for millions of acres of land. The US has yet to pay its bill. Additionally, it has been made clear through history that Indigenous people are better stewards of land than non-Indigenous people.

The Land Back movement is not only about the US government giving back some of the land it stole, but more importantly, about allowing Indigenous people to have a say in how traditional Indigenous land is managed. It is also about recognizing Tribal sovereignty. For more information on the movement see: https:// bit.ly/LandBackMovement.

What is your assessment of the effectiveness of the Indian Health Service in Minnesota and elsewhere in terms of protecting and improving the health of AI/AN? It is important to recognize that the effectiveness of the Indian Health Service and Tribal health facilities throughout the United States is significantly impacted by factors outside the institution’s control. The IHS is funded at a fraction of what is necessary to provide health care for Native people. Consequences of underfunding are many, but include outdated buildings and supplies, high staff (including physicians) turnover, triaging of referrals, and limited monies for ongoing continuing medical education for all staff. All efforts by Minnesota IHS and Tribal health facilities are hindered by underfunding.

Another key factor in providing care for Native patients is that the Indian Health Service and Tribal health facilities still battle the issue of mistrust created by centuries of misdeeds by the US government and its institutions. Even as Native practitioners within our own Tribal facilities, many of us have encountered mistrust and assumptions that the care we provide is subpar to what a patient might receive in a non-Native facility.

Despite these factors, the IHS and Tribal health facilities have been very effective in many ways in providing for the health and well-being of Native people. An example of this success has been the IHS and Tribal health role in Native American communities having some of the highest rates of COVID-19 vaccinations.

Another example is the success achieved by tribally managed diabetes programs on lowering the rates of end-stage kidney disease in Native people. There are so many amazing people working for IHS and Tribal health — people who dedicate their lives to MetroDoctors

The Journal of the Twin Cities Medical Society

improving health outcomes in our communities, but they face persistent funding and mistrust that make this work a constant uphill battle.

I think it’s also important to remember that it has only been since 1975 with the passing of the Indian Self-Determination and Education Assistance Act that Native Americans have really begun to gain control of our health care through the Indian Health Service. Fifty years is not a long time to repair and make up for the impacts of centuries of genocidal acts against a population.

Over 60% of Tribes now manage their own healthcare facilities.

With appropriate funding and time, I believe that the Indian Health Service and Tribal healthcare facilities will continue to have significant impacts on the health of Native people. Importantly, however, we all know from our growing recognition of the impact of social determinants of health, that improving the health of a Native people will require the concerted efforts of many institutions outside of medicine. In this article, Dr. David Jones nicely summarizes the history of and the tremendous efforts necessary to improve Native American health outcomes: https:// bit.ly/DavidJonesInterview.

The numbers of AI/AN are small compared to some other racial groups so they often get overlooked in statistics that are presented to the public and policy makers. How can we do a better job of collecting and reporting data on Native peoples?

This is such an important question. An excellent example of the problem occurred at the beginning of the pandemic. News outlets were quickly reporting on the impact of COVID-19 on different populations and though Native Americans were hit immediately and possibly the worst, we were usually in the small “other” category on graphs and charts. Policymakers can’t be expected to fix a problem they don’t see. The National Congress of American Indians has been addressing our small numbers problem for many years. As they point out, disaggregation of data is critical not only for Native American populations but for subsets of many populations. For more information see: https://bit.ly/NCAIdata.

What incentives are available to get more Native American medical student applicants?

Since its founding in 1972, the University of Minnesota Medical School, Duluth Campus (UMMSD) has been attracting and retaining Native American medical school students. Dr. Gerald Hill and Dr. Joy Dorscher, former Directors of the Center of American Indian and Minority Health (CAIMH), implemented most of the support and retention activities that exist today for Native medical students attending UMMSD. A commonly cited struggle for Native students is being far away from their Tribal communities. Most of the work we do at CAIMH revolves around the creation and support of community for Native medical students. Retention begins as soon as students arrive for interviews.

(Continued on page 8)

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Indigenous Health Colleague Interview (Continued from page 7)

They are invited to meet for dinner with other Native students to welcome them to the community. For many, this meeting forms friendships and support lasting long after medical school. Within the CAIMH space Native students at UMMSD have a safe space to gather for studying and meeting. In a normal year, without the isolating effects of a pandemic, students will gather at my house for celebrations and to welcome interviewees. Throughout the year students meet with Native alumni and community elders.

CAIMH hosts and co-hosts events such as ribbon skirt making and a community sugar bush (maple syrup making). Another important incentive for Native students has been the required curriculum in Native health introduced six years ago by Dr. Melissa Lewis and supported by Drs. Ruth Westra and Alan Johns. These are just some of the supports available for Native American medical students considering school at the University of Minnesota Medical School.

How are NA medical students encouraged to serve NA communities?

UMMSD selects students based on their commitment to serving Native American communities. That said, service can come in many different forms. Because we are short of Native physicians in every specialty, we do not discourage students from choosing specialties outside of Family Medicine. Dr. Luke John Day, who works for the University of California, San Francisco, is one of possibly three Native gastroenterologists in the nation. He serves Native communities by providing specialty care for a local Native clinic and by his active involvement in Native healthcare equity as the President-elect of the Association of American Physicians.

Dr. Tiffany Beckman, perhaps the only Native endocrinologist in the nation, is a researcher at the University of Minnesota who has also provided health care for a Minnesota Tribe. Dr. Amy Delong, a UMMSD graduate and family physician, is the Medical Director for her own Tribal health organization in Wisconsin.

What are/please describe some AI/AN teaching-training examples that should be incorporated into the current Medical School curriculum, especially those that might apply to all medical students.

All people in this country should have a basic understanding of the people who lived in the Americas before Europeans arrived. They should be aware that Native civilizations maintained functional governments and ways of providing for the education and health care of its members for centuries before Europeans arrived. They should understand the history of colonization and its impact on Native Americans — a history that has not been told in US textbooks. All people should be aware that Native Americans were promised health care, education, and social services in exchange for millions of acres of land. The US government has yet to fulfill its obligations, with severe underfunding of the Indian Health Services, Indian education, and social services for Native people.

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Because US citizens do not know this history, Native Americans live with stereotypes and the false perception that we receive free health care, education, and many other benefits from the US government. Stereotypes and the lack of our history being told contributes to Native people being treated as second-class citizens on their own land.

These are just some of the lessons taught at the University of Minnesota Medical School, Duluth Campus. Students learn that there are 11 Tribal nations in Minnesota, four Dakota and seven Anishinaabe. Students also learn of the impacts of historical and intergenerational trauma, how social determinants of health play out in Native communities and about trauma-informed care. They also learn about some common Native American values such as reverence for elders, the importance of humility, and a common belief that all things are connected.

Again, much of this is knowledge that all US citizens should have, but at the very least, people who provide health care and education for Native people have an obligation to know these basics. I am working now with other Native American medical scholars to develop Native healthcare proficiencies (competencies) and an Indigenous health curriculum that will be available to all United States medical schools. It will be most important to see these or similar curriculums in place in schools that exist in states like Minnesota with large Native American populations.

Are there plans to expand the Native American teachings at the UMN Medical School, Duluth Campus to the whole UMN system?

As we move to one curriculum for both campuses, I will advocate for required lessons in Native and rural health for students on both campuses. Anyone practicing in the state of Minnesota will at some time be caring for Native and rural patients. It is essential that they have a base of understanding of rural and Native cultures which are both different in many ways from urban, non-Native cultures. Additionally, services available in rural and Native American communities are often limited. Physicians transferring their patients back to rural and Native communities should have basic knowledge of available services and ideas on how to ensure appropriate longitudinal care.

I am also working with Dr. Michael Sundberg to develop a Native American track for students interested in serving Native patients. We hope to use the already developed Seminars in Native American Health to supplement required Native American health curriculum. We will add requirements for rotations at IHS and/ or Tribal health facilities as well as a research project on a Native health topic. Dr. Sundberg and I hope to develop an Urban Indian Health arm to the track with rotations at Urban Indian Health facilities. The bottom line is that there is tremendous need for additional physicians who are well-trained and committed to Native American health. The University of Minnesota, with its long history of educating Native physicians and others about Native American communities and their health, is well poised for this next step in the journey to improving the health of Native people.

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The Journal of the Twin Cities Medical Society

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Indigenous Health

Indian Health Board of Minneapolis: a 50 Year Vision for the Future

F

resh out of Family Practice residency at the Hennepin County Medical Center in 1997, Dr. Patrick Rock (Leech Lake Band of Ojibwe Tribal member) was hired by the Indian Health Board of Minneapolis (IHB). Dr. Rock became IHB’s first Native American staff physician. Over the years, IHB came to rely on Dr. Rock’s gift of seeing the big picture and he eventually accepted the role of medical director, then later became CEO. Now, after 25 years of service, a different leader might be tempted to take a breather or rest on the tremendous accomplishments of IHB, but not Dr. Rock. This small Federally Qualified Health Center (FQHC) has grown to include medical, dental, and counseling clinics, a psychology training program, chemical dependency and medication-assisted therapy programs as well as numerous culturally-integrated health and wellness grant programs, and an innovative COVID team. No time to rest, Dr. Rock finds himself looking to the future and drawing on his inner resolve to carry forth a community vision for the next 50 years.

Despite these uncertain times, IHB is in steady hands. The FQHC has expanded services and is poised to open a new campus on east Franklin Avenue, in the heart of Minneapolis’ American Indian cultural corridor. Getting IHB to this point necessitated staying power of key leadership, and skills one does not learn in medical school such as smart land investment decisions, political representation at the state level, and a

By Angela Erdrich, MD

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keen understanding of Urban Indian Programs nationally.

Dr. Rock might argue that IHB came this far by remaining true to the history and mission of IHB’s founding and the centered approach of a nine member community board of directors.

In 2021, IHB celebrated its 50-year anniversary as the first urban American Indian clinic funded by Congress. As IHB grew, so did the community of Native organizations and initiatives in the Twin Cities, but such growth was not always the case. In fact the clinic began as a direct community response to the death of a young Native American woman, Gloria. She had come to Minneapolis from a reservation in Minnesota seeking a better life. Instead, in the city, Gloria faced discrimination, poverty, and premature death due to hepatitis when she was unable to access hospitalization in Minneapolis. Native people organized

in grassroots fashion and founded IHB in response to her tragic story, which was detailed by Bill Moyers Journal in an episode entitled: “Why Did Gloria Die?” The Indian Health Board of Minneapolis is a place of tremendous history.

Just as a Native person might introduce themselves with tribal affiliation and where their family comes from, IHB’s origin makes better sense in context of the Phillips neighborhood and Federal Indian Policy. Phillips in Minneapolis is one of the most diverse neighborhoods in the US. While immigrant communities have historically found Phillips a launching pad to success, Native people claim Phillips as an own urban homeland. This is due in large part to Little Earth of United Tribes public housing, the only tribally-owned public housing in the country, and other nearby Native-focused housing, community meeting places, galleries, cultural centers, and businesses. Phillips retains its Native American identity despite bouts of gentrification nearby and demographic fluctuations.

In the nineteenth century, Native people were forcefully removed from Minneapolis and returned cautiously over the span of nearly a hundred years prior to the founding of IHB in the late twentieth century. The Indian Removal Act of 1863 forcibly drove Dakota people out of their homeland including the resource-rich Minneapolis area. Dakota people were exiled to reservations on leftover land in the west. At this time, Phillips was being developed due to its proximity to rail yards. While western

MetroDoctors

The Journal of the Twin Cities Medical Society

Phillips became a mansion district for some of the city’s wealthiest families, the eastern area was built for workers and industry. The latter left Phillips with a legacy of arsenic contaminated soil and other environmental challenges that still plague the community. After the Great Depression, housing in the area deteriorated and in the 1950s, parts of East Phillips were characterized as slum and rooming houses were the only housing option for many families. While some Natives came to the cities as part of the World War II work effort, many more began to move back to urban centers like Minneapolis due to the Federal Indian policy of Termination, which sought to remove tribes, and the companion assimilationist effort to move Indians off reservations, a policy known as Relocation.

At the time of IHB’s founding in 1971, Native people were living in Phillips due to Relocation, but neither thriving nor assimilating. Relocation is widely considered a failed policy that did not live up to the promise of jobs and prosperity. The tragic story of Gloria embodies the struggle of many Native Americans of the era. Gloria relocated to the cities only to face poverty and lack of opportunity. IHB’s formation came at a time when the government had ushered in a new era, ending Termination and Relocation and embracing Federal Indian policy that remains in effect today. In 1970, President Nixon proclaimed the beginning of the policy of Indian self-determination and in 1972 the Office of Economic Opportunity provided funds for urban Indian clinics in Minneapolis, Rapid City, and Seattle.

The original vision of IHB has not changed. Humbled by his predecessors, Dr. Rock states “It didn’t start with me.

My job is to carry forward the shared mission of serving the community.”

What has changed is that the community is more vocal about priorities and we follow our own lead on issues such as environmental justice, lack of affordable housing, homelessness, crime, addiction and overdoses, as well as human trafficking. With these serious issues in mind, MetroDoctors

IHB recently unveiled plans for a new culturally-centered campus located in the heart of the Native community. IHB Administrative & Specialty Services Center 27,000 SF, Future Sacred Garden Plaza, IHB Counseling Center 7,700 SF and a newly constructed IHB Medical & Dental Center 42,600 SF new building on East Franklin which will mark the eastern gateway to American Indian Cultural Corridor.

the leaders of IHB work to create financial sustainability through bonding and revenue for the next 50 years. Healthcare services payment parity remains a perennial lobbying item and recurring topic of conversation for Dr. Rock who has pursued equitable reimbursement with relentless determination. The Indian Health Service (IHS) partially funds urban sites, in IHB’s case, mainly in the form of grant initiatives. Although IHB operates under the umbrella of the IHS, IHB does not receive the higher IHS reimbursement rate from Medicaid/ Medicare. Clinic leadership continues to lobby the State of Minnesota to increase the reimbursement rate to match the IHS reimbursement rate for Medicaid.

Today, IHB’s new campus pre-development phase and building plans are coming into focus. In the new buildings, IHB will do what it does best: continue to address health inequities and remove barriers to care. Like the IHB of the last 50 years, the new IHB will be a place that builds community pride and serves as a trusted medical home for historically traumatized and marginalized people.

An orientation to Native American health initiatives in the Twin Cities should include clinics like IHB and its friendly competition, the Native American Community Clinic. Native

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American health is a holistic organic movement that is starting to permeate the entire Metro as we collectively acknowledge the Native origins of the land and as we take a hard look at the imbalance of prosperity and wealth that shaped the cities. IHB acknowledges that closing health disparities is a great challenge within our own community. We witness our relatives suffering displacement and illness while also celebrating the international success and genius of local Native innovators. As such, IHB serves as both a safety net and a vehicle of creative renaissance as we promote holistic health and collaborate with the local organizations and businesses who carry on Native traditions of food sovereignty, education, ceremony, dance, art, literature, and wellness. IHB finds itself envisioning the future from solid ground.

And we are far from alone in our vision and action, because we are only one of the many local native-led organizations honored to share responsibility for the holistic health of future generations in this great Native American metro.

Angela Erdrich, MD (Turtle Mountain Ojibwe Tribal member) is a pediatrician at Indian Health Board and can be reached at 612-721-9800.

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Indigenous Health

Honoring Health and Tradition in Minneapolis The Native American Community Clinic (NACC), located at 1213 East Franklin Avenue in Minneapolis, opened its doors in 2003 to address the health disparities within the urban Native American community of the Twin Cities. Their mission is to promote the health and wellness of mind, body, and spirit of Native American families, and offer a full range of healthcare services that include medical, behavioral health, dental, and substance abuse programs. The clinic has six medical providers, five behavioral health providers, five chemical dependency providers, two dental providers and two spiritual care provider elders in residence. Approximately 4,700 patients were seen in the clinic in 2021. The clinic provides high quality care regardless of ability to pay, and all individuals are welcome.

NACC combines behavioral, medical, dental, and social services with traditional medicine. The clinic has blended an Indigenous traditional healing model with a Western biomedical one since its inception. NACC strives to honor health and tradition by providing spiritual care and access to traditional healing through their Elders in Residence. To promote traditional medicines and teachings, the traditional healing committee planted sage in the wolf garden outside the clinic. Sage is used for smudging within the clinic and is given to community members. The clinic has also planted tobacco, sweetgrass, cedar and other traditional medicines around the clinic to provide teachings and to be used by community members.

The clinic has a wholistic approach to health care, addressing root causes

By Antony Stately, PhD

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of health disparities including access to food, housing, and health insurance with services such as resource navigation, care coordination, outreach, and community-based activities through the use of our peer recovery coaches and community health workers. They offer a wide range of health promotion programs and assistance targeted to the individual needs of their patients and community, such as consultation with a Medication Team Management Pharmacist, outreach by their community health nurse and community health worker, home blood pressure monitors and home A1c monitors, reminder messages to keep up to date on follow-up appointments and laboratory tests, and even YMCA memberships for patients participating in other disease management programs. A wide range of health

education classes are offered that include Native American values and traditions and the clinic provides traditional medicine-related workshops that provide supplies and demonstrations.

NACC partners with Community Health Worker Services Made Easy Solutions to assess and assist patients with social determinants of health that impact ability to manage their conditions.

NACC’s Patient Advocates are trained to assist patients who are facing social and economic barriers, and can assist with obtaining and navigating medical insurance, housing and shelter referrals, food shelf referrals, assistance with Medicare questions, medical transportation, chemical dependency treatment referrals, tribal benefit information, as well as emergency and crisis support referrals.

NACC provides access to traditional medicines such as sage bundles and our Traditional Medicine Garden where we grow sage, cedar, sweetgrass, and tobacco.

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Sage bundle for smudging.

In addition, the clinic offers mobile medical services to the community, including diabetic eye exams, mammography and cancer screening education, and navigation assistance.

Behavioral health is an integral component of the clinic, working in coordination with the medical providers. The behavioral health team provides individual, couples and family therapy, group therapy, assessment and support for ADD/ ADHD, depression and anxiety, grief and loss, post-traumatic stress disorder, and substance use disorders.

In addition, NAAC offers several unique substance abuse treatment programs in partnership with the Red Lake Nation. They provide a heroin and opioid addiction program that includes daily dosing, harm reduction services, spiritual care, mental health care, nurse care coordination, and drug and alcohol counseling.

An intensive outpatient program is also offered, which is rooted in indigenous

NACC outreach staff, along with community partners, have been doing monthly popup events in unsheltered communities to provide telehealth services, HIV testing, and COVID-19 vaccinations.

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spiritual practices and offers a culturally-centered approach to treating substance use disorders. This program includes individualized programming with a gradual step-down, daily prayer and cultural teachings by NACC’s Elder in Residence, medication assisted treatment, health education, relapse prevention, individual, family and group therapy, and peer recovery support.

NACC is a unique and dynamic partner to the Native American community in Minneapolis. Native children are far more likely to die during childbirth than their white counterparts. Rates of diabetes, obesity, and asthma are all significantly higher in the Native population than in any other racial or ethnic group. Life expectancies are lower for Native people in this state than for any other racial or ethnic group.

Native adults in Minnesota are more likely to die of overdose (five times), liver disease (three times) and suicide (four times) than their white counterparts. These disparities are the result of generational trauma and lack of access to opportunity, education, and health care and the consequences of decades of failed policies aimed at “solving the Indian problem” and assimilating Indigenous people and eliminating our culture.

NACC’s philosophy is based on the simple premise of being a good relative — our approach to providing care is rooted in love for our community, respect for our patients, and the principles of harm reduction. The data is clear that this model works, and we are moving the needle on a wide range of metrics. It is time for us to bring our small-but-mighty clinic to scale.

NACC is determined to make a meaningful and lasting impact on the health of our community.

A Capital Campaign is underway to enable expansion of the following patient and community health focused areas: • Beyond testing and vaccines: COVID-19 Care and Recovery

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Increased implementation of telehealth • Expanded mother and child health • Broadened school-based programs • Augmented children’s mental health services • Increased HIV and MAT programs • Expanded Chemical Health Programs • Pharmacy Services • Integrated pediatric care clinic for medical, dental, and mental health services • Housing support and wrap-around services for individuals and families To learn more about the clinic, visit our website: nacc-healthcare.org.

Antony Stately, PhD, (Ojibwe/Oneida) received his PhD in clinical psychology from California School of Professional Psychology at Alliant International University in 1997.

He currently is the Executive Officer and President for the Native American Community Clinic in south Minneapolis, which provides primary care, dental care, and behavioral health services to the Twin Cities Native American community. He formerly worked as the Director of Behavioral Health Programs at the Shakopee Mdewakanton Sioux Community in Prior Lake, MN. He has served as a consultant and advisor to the CDC, HRSA, SAMHSA, the Native American AIDS Prevention Center (NAAPC), the US-Mexico Border Health Association (PAHO/WHO), and numerous NGOs and nonprofits delivering health services to tribal and indigenous communities nationally and internationally.

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Indigenous Health

Ain Dah Yung Center: Where American Indian Youth and Families Go to Thrive in Safety and Wholeness

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or more than 38 years, Ain Dah Yung Center has provided a healing place within the community for American Indian youth and families to thrive in safety and wholeness. The goal of our work is to move families, children, and young adults beyond crisis-oriented services through culturally-specific programs and interventions. We provide culturally-responsive services to help Indigenous youth in the Twin Cities imagine a hopeful, safe, and independent future.

Our staff speak the languages, sing the songs, practice the traditions, and combine this knowledge with case management expertise to create holistic solutions-based approaches that address the whole person, family, and community.

ADYC’s services include: • Emergency Shelter – The only Indigenous-centered youth emergency shelter in the Twin Cities, and the only East Metro shelter open 24/7/365.

Services include emergency and shortterm shelter, crisis intervention, advocacy, referrals, health care, counseling, and case management.

• Beverley A. Benjamin Youth Lodge – A transitional living program for youth ages 16-21 for up to 18 months, emphasizing training, education, and employment goals while creating community and cultural connections.

• Mino Oski Ain Dah Yung (“Good New Home” in Ojibwe) – Permanent Supportive Housing program 14

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for youth ages 18-24, providing culturally-responsive housing, case management, education, and workforce supports to at least 42 American Indian youth.

Zhawenimaa Safe Harbor – Meaning “They Are Loved Unconditionally” in Ojibwe, Zhawenimaa provides culturally specific, trauma informed care for Indigenous youth before, during, and after periods of sexual abuse and exploitation.

Ninijanisag (“Our Children” in Ojibwe) – Youth learn leadership, healthy living skills, and Native traditions such as drumming, singing, and cultural teachings.

Street Outreach Program – Case workers meet homeless and runaway youth where they are, providing food, transportation, and referrals. Annually, this program typically reaches 2,500-3,000 youth.

Oyate Nawajin (“Stand with the People” in Lakota) – Supports families through group learning, increasing positive social networks, connection to cultural teachings, case management, referrals, resource acquisition, and general support.

Suicide prevention program – Native youth learn healthy habits, leadership skills, and Native traditions and teachings — all of which provide youth with a solid cultural foundation and a community of support comprised of their peers and ADYC staff.

Impact of Historical Trauma on Homelessness

Homelessness disproportionately affects Indigenous people in Minnesota and the Twin Cities. The most recent Wilder Research Minnesota Homeless Survey (2020) found that 12% of homeless adults and a staggering 22% of homeless youth identify as Indigenous, while the entire population of Indigenous people in Minnesota is only 1.5%. In a 2017 study, 44% of homeless Indigenous adults reported experiencing homelessness as a child, compared to 25% of other homeless adults.

Ain Dah Yung Center’s overall approach is informed by an understanding of the historical trauma inflicted on American Indians for generations as the result of forced assimilation, recurring attempts to eradicate tribal culture, and ongoing threats to sovereignty and self-determination. Historical trauma is most easily described as “multigenerational trauma experienced by a specific cultural group” — it is cumulative and collective. In an article entitled “Trauma May Be Woven into DNA of Native Americans” from Indian Country Today, Michelle Sotero offers a threefold definition: “In the initial phase, the dominant culture perpetuates mass trauma on a population in the form of colonialism, slavery, war, or genocide. In the second phase, the affected population shows physical and psychological symptoms in response to the trauma. In the final phase, the initial population passes these responses to trauma to subsequent

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Ain Dah Yung (Our Home) Center provides a healing place within the community for American Indian youth and families to thrive in safety and wholeness.

generations, who in turn display similar symptoms.”

ADYC recognizes that the only effective way to address these traumas and disparities is to walk alongside youth to create a foundation for reestablishing positive cultural identity, self-esteem, and healing.

ADYC achieves this through our holistic, culturally-responsive model. While several agencies serving homeless young people are available in the Twin Cities, agencies incorporating Indigenous cultural practices are absent. ADYC’s culturally-responsive continuum of housing programming and support services therefore stands apart and has proven uniquely successful, helping unsheltered Indigenous youth achieve housing safety, stability, wholeness, and self-sufficiency.

Youth Suicide

The suicide rate among American Indian/ Alaska Natives (AI/AN) has been increasing since 2003, and in 2015, AI/AN suicide rates were more than 3.5 times higher than those among racial/ethnic groups with the lowest rates. Among American Indians, youth are particularly vulnerable to suicidal ideation, precursor/preparatory acts, and suicide attempts; in fact, 36% of AI/AN suicides, from 2003-2014, occurred among youths aged 10-24 years, in

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contrast to 11% of suicides among whites in the same age group. As noted earlier, the problem in the Twin Cities is exacerbated by the disproportionate levels of homelessness experienced by American Indians.

Of this same population, 60% of youth aged 24 and younger were suffering from a serious mental illness and further 16% had a substance use disorder. According to researchers, high rates of suicide, as well as addiction, mental illness, sexual violence, and other issues among Native peoples may be influenced by historical trauma.

Because of internalized oppression as the result of historical trauma, traumatized people may begin to internalize the views of the oppressor and perpetuate a cycle of self-hatred that manifests itself in negative behaviors. Emotions such as anger, hatred, and aggression are self-inflicted, as well as inflicted on members of one’s own group. Our elders, teachers, and parents have suffered decades of historical trauma, leading to a generation of youth who have not been taught the beauty of their cultural traditions, losing their positive self-identity. In addition, youth are witnessing and facing the symptoms of this historical trauma and accepting that this must be their future. Ninijanisag challenges these assumptions.

Ain Dah Yung Center is fortunate

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to receive funding from the Minnesota Department of Health’s Suicide Prevention Grant program and SAMSHA to increase training, knowledge, and response to suicide for members of our organization, program participants, and the greater community on suicide prevention and postvention services. Because of the high level of knowledge and expertise of ADYC’s staff, the culturally-specific orientation of our services and our ability to serve families holistically, the Ain Dah Yung Center has maintained a trusted reputation within the community. We understand how to help our youth and families understand the impacts of historical trauma and help them develop healthier ways to respond to stress, and most importantly — heal.

Sheri Riemers (Nindaanisequay), White Earth Nation of Ojibwe, Interim Executive Director, email: sheri.riemers@adycenter.org.

Angela Gauthier, MA, LMFT, Associate Director, ADYC, email: angela.gauthier@ adycenter.org.

Main office: Ain Dah Yung Center, 1089 Portland Avenue, St. Paul, MN 55104.

References • Leavitt, R. A., Ertl, A., Sheats, K., Petrosky, E., Ivey-Stephenson, A., & Fowler, K. A. (2018).

Suicides Among American Indian/Alaska Natives—National Violent Death Reporting System, 18 States, 2003–2014. Morbidity and Mortality Weekly Report, 67(8), 237.

• Nelson-Dusek, S., B. Pittman. Et. Al. “Characteristics and Trends among Minnesota’s Homeless Population.” (May 2019). Wilder Research.

• Evans-Campbell, T. (2008). Historical trauma in American Indian/Native Alaska communities: A multilevel framework for exploring impacts on individuals, families, and communities. Journal of interpersonal violence, 23(3), 316-338.

• Pember, M.A. (2016). Intergenerational trauma: Understanding Natives’ inherited pain.

Indian Country Today Media Network.

• Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among indigenous peoples of the Americas: Concepts, research, and clinical considerations. Journal of psychoactive drugs, 43(4), 282-290.

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Indigenous Health

Dream of Wild Health Originally founded in 1998 as Peta Wakan Tipi, a garden program to recover and preserve the relationship between Native people and the land, Dream of Wild Health (DWH) is one of the longest continually operating Native American organizations in the Twin Cities.

The organization has grown into a 30-acre regenerative farm, native fruit orchard, and pollinator meadow in Hugo, Minnesota.

DWH has an office along the American Indian Cultural Corridor in Minneapolis and works with youth and families across the Twin Cities. Minneapolis is home to one of the largest concentrations of urban Native Americans in the U.S. The Corridor is along Franklin Avenue in the Phillips neighborhood of Minneapolis and is the heart of this community. It is a place where Native Americans live, work, and access cultural-specific services.

The mission of Dream of Wild Health is to restore health and well-being in the Native community by recovering knowledge of and access to healthy indigenous foods, medicines, and lifeways. We do this by: creating culturally-based opportunities for youth employment, entrepreneurship and leadership; increasing access to indigenous foods through farm production, sales and distribution; and community organizing and outreach around reclaiming cultural traditions, healthy indigenous food, cooking skills, and policy and systems change. Our programs impact over

By Neely M. Snyder

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12,000 people annually from our youngest community members to our oldest.

DWH is one of the leaders of a groundswell movement to reclaim Indigenous sovereignty through food.

The Vision of DWH is a place for our relatives to gather and rebuild a relationship with the land. It is a place of learning, celebration, belonging, and community.

The farm is a model of cultural recovery put into practice. The farm is a safe place for children where we cherish and protect the seeds of our ancestors and where we keep our values alive.

Dream of Wild Health considers the estimated 60,000 Native American people living in the Twin Cities our direct community, but we also work regionally and nationally, across tribes and cultures. The Twin Cities is home to one of the largest urban Native American populations in the country and can be considered the center of our primary geographic area, including people representing tribes across the country with the majority from Minnesota’s two dominant tribes, Dakota and Ojibwe, living in the Twin Cities and surrounding areas.

At Dream of Wild Health, we often state that we “grow seeds and leaders.” At the core of our work is a commitment to educating our youth to rebuild an indigenous relationship with the land and our food.

Dream of Wild Health Programs Include:

Native Youth Education and Leadership Program Our youth programs provide culturally-based lessons for youth, ages 8-18. The farm provides a safe and creative learning environment where they learn about regenerative gardening, healthy foods and nutrition, and Native traditions while gaining employment and leadership skills.

Programs provide a spectrum of learning opportunities from introductory to leadership roles, where multi-year commitments to the program advances youth development and engagement. Our Youth Leaders program is a year-round leadership development program where youth lead advocacy, outreach, and training, through an Indigenous lens. One parent recently shared, “I can’t stress how important Dream of Wild Health was...DWH was what [their youth] needed to connect to

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friends, culture, and the earth. Their health was greatly improved by being outside with a supportive group of staff and peers.”

Farm & Food Access The food grown at the farm is distributed to the Native community through: an Indigenous Food Share CSA (a community supported agriculture model); at local farmers markets; wholesale to Native chefs, restaurants, and schools; to youth and families at programs and events; and donations to community partners. In response to the pandemic, we increased donations, added a delivery option, and delivered meals and fresh produce to youth and families in our community. Since 2020, the farm has produced 15.85 tons of vegetables, including over 12,000 pounds of food that was donated to partner organizations.

Through our farm expansion efforts, we are strengthening our resilience in the face of future crises and developing a system that is not reliant on a global food chain vulnerable to disruption. By training more farmers we will increase the supply of food for the Indigenous Food Network and other markets serving Native community members.

Seed Stewardship Dream of Wild Health is home to a large number of Indigenous seeds with gifts of seeds pouring in from Native seed keepers, farmers, and community members across the country. Our seed team cares for and protects the seeds to reconnect this generation to an Indigenous diet, ensure they continue to nourish our future generations, and to re-matriate (or to return) seeds to their tribal homes, to ensure the sustainability of this work into the future.

Seeds are treated as living relatives and are not to be sold. Increasingly, the seeds must be actively maintained and grown out more frequently in order to adapt the seeds to the changing climate.

other organizations in our community.

Food sovereignty is the right of peoples to healthy and culturally-appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems. Each year, we connect with over 12,500 people through our outreach programs, including 1,700 youth and a majority Native people. Our community outreach may include sampling Indigenous recipes from food grown at the farm, leading a foraging walk or bringing foraged foods into local high schools, teaching about saving Indigenous seeds or making hominy, or presenting on our model for food systems change through the Indigenous Food Network. In 2019 we hosted our 3rd annual Indigenous Food Tasting, drawing over 700 people and featuring five Indigenous chefs from around the Midwest. Our Youth Leaders participate in this work and gain leadership skills through outreach, public speaking, and hosting demonstrations.

Network Leadership Working with partners is vital to the success of Dream of Wild Health programs as we rely on the skills and expertise of other organizations to complement the work we do in our community. Our network building and coalition leadership work helps us influence long-term systems change in order to improve the overall health of the Native community. For example, Dream of Wild Health is the lead organizer for the Upper Midwest Indigenous Seed Keepers Network. We work with tribes and organizations to develop training on growing,

protecting, preserving, and sharing our Indigenous seeds.

DWH is the lead organizer of the Indigenous Food Network, whose mission is to rebuild sovereign food systems within the intertribal Native community through collaboration. The long-term goals of the network include increasing access to healthier and more culturally-relevant foods for the urban Native community, improving economic opportunity among Native food producers, chefs and restaurants, cultivating community connectedness, and changing the systems and policies that lead to continuing inequities.

Our youth leaders have worked with local Indigenous chefs through our Chef Internship program where they gain food preparation skills, nutrition, and knowledge of Indigenous foods. The network has gained significant momentum and has expanded to the larger Native communities beyond the Twin Cities.

To learn more about Dream of Wild Health, follow us on social media or visit dreamofwildhealth.org.

Neely M. Snyder (St. Croix Ojibwe), Executive Director. She can be reached at: 612-874-4200 (ext. 115), or neely@dreamofwildhealth.org.

Community Outreach, Events and Workshops Year-round our Outreach staff is building community, teaching about and advocating for food sovereignty, hosting workshops and large events, and supporting MetroDoctors

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Paid Editorial

American Indian Quitline Helps to Reclaim Traditional Tobacco

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he Minnesota Department of Health’s (MDH) American Indian Quitline provides culturally specific support to Native people who want to quit commercial tobacco. Because 59% of Indigenous communities smoke commercial tobacco compared to 14% of the overall state adult population, the American Indian Quitline is an effective, essential tool to improve Native health in Minnesota.

According to MDH, commercial tobacco contributes to five out of six leading causes of death for Native people in the state. These include cancer, stroke, lower respiratory disease, heart disease, and diabetes. Native people also face targeted marketing by commercial tobacco companies, with many using Indigenous imagery to sell their products.

Unlike the traditional tobacco that the Dakota and Ojibwe Tribal Nations use in ceremonial and cultural practices, commercial tobacco contains many harmful, toxic, and addictive chemicals. Traditional ċanśaśa and asemaa (Dakota and Ojibwe words for tobacco, respectively) are typically not inhaled and do not carry the same risk factors as commercial tobacco. Asemaa is used as a sacred medicine and not for recreational purposes. Indigenous cultures across the state use ċanśaśa as an offering to the Great Spirit, laying it on the ground or burning it as a way to pray.

Tribal nations also use traditional tobacco to request help and to give as a gift.

Minnesota Tribal Nations continue to reclaim traditional tobacco as a way to fight the negative effects of colonization through cultural revitalization. While Native spiritual and cultural practices suffered greatly due to colonization, tribal communities have seen success in reclaiming traditional tobacco for its original purposes. Because

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tobacco companies have long misappropriated Indigenous cultural symbols to sell their products, reclaiming ċanśaśa/ asemaa while quitting commercial tobacco empowers current and future generations.

The American Indian Quitline is a vital tool in commercial tobacco cessation, with support specifically tailored for Indigenous people. Developed in collaboration with Indigenous community members and Quit Partner (a 24/7 Minnesota-wide cessation program), the quitline celebrates the long history of traditional tobacco use on Turtle Island, an Indigenous name for the lands now known as North and Central America.

The American Indian Quitline provides free support in quitting commercial tobacco products, including chewing tobacco, e-cigarettes, and cigarettes. Comprised of a team of Indigenous cessation coaches, the program provides emotional and practical support in quitting commercial tobacco. This includes up to 10 coaching sessions, 12-week supplies of nicotine lozenges, gum, or patches, and email and text message support — all free of charge.

Want to learn more about the evidence-based success of online quit programs? The Minnesota Department of Health developed quick, free and easy board-accredited online continuing education courses for busy healthcare professionals just like you. The “Special Quitline Programs for Commercial Tobacco Cessation” training module illustrates how adapting these online programs can address tobacco disparities for American Indians and other populations, including pregnant patients, those with behavioral health conditions, and youth. Learn more at CoursesThatClickMN.com.

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Discover CE Courses That Just Click RELEVANT Commercial tobacco topics and trends

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Indigenous Health

Black Bears and Blueberries Publishing for All Children

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oth my wife (Betsy Albert-Peacock) and I are retired educators from the Education Department at the University of Minnesota, Duluth. As educators we saw the need for authentic, Native authored children’s books in schools, libraries, bookstores, and communities. We talked about starting a Native owned and operated nonprofit publishing company for some time, realizing it would fill a great need to a small niche population, all the while giving Native authors and illustrators an outlet for publishing their works. Larger publishers ignore many Native book ideas because they are too small a market to make them a profit.

Our primary reason for starting the publishing company is that few authentic, accurate, Native-written children’s books are available in today’s schools. As educators, we know that non-Native students benefit from these books because they foster the development of empathy toward Native people. Native students have increased knowledge of one’s own heritage and develop healthy, positive self-concepts and identity. They see and read about characters that look like them and represent their communities and cultures.

We went ahead with the idea and hit the ground running. We brainstormed a list of potential names for our venture and settled on a catchy one thought up by Betsy, Black Bears and Blueberries Publishing.

I thought it was perfect as it captured the youthful essence and imagery of children.

As a nonprofit we don’t pay ourselves. We

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told people this was our retirement gig.

All the proceeds from sales go to produce new books, reprint existing ones.

Authors are paid industry standard royalties. Illustrators don’t work for free.

Graphic designers cost. Print companies have to pay for expensive equipment, ink, paper, and shop employees.

Our plan was to do this for a few years and find younger Native people to take over. We’re old you see — akiwenzi, miinawa and mindimooyenh (old man and old woman). We need our naps.

We published our first books in 2019: Grasshopper Girl by Teresa Peterson (Dakota) and Rez Dog by Heather Brink (Ojibwe), both illustrated by Lakota illustrator Jordan Rodgers, and Gitige by the Fond du Lac Reservation Head Start. All sold extremely well. Since our start we have gone on to release a total of 25 books, all by Native writers, and mostly Native illustrators. Some of the authors have gone on to publish books with other publishers. Teresa Peterson just released Voices From Pejuhutazizi (Minnesota Historical Society Press). Tara Perron (Dakota/Ojibwe), author of three of our books (Takoza Walks With the Blue Moon Girl, The Animals of Nimaamaa-aki, The

Animals of Kheya Wita) has three books from other publishers.

Meantime, we received contracts to publish works for Red Lake Schools (Minnesota), a series of English/Ojibwe traditional winter stories by Dr. Giniwgiizhig and several translators, Niizhobines and Zhaawanwewindamook. All of Red Lake’s books were illustrated by Native illustrators, including Jordan Rodgers (Lakota), Sam Zimmerman (Ojibwe), Cameo Boyle (Ojibwe), Bambi Goodwin (Ojibwe) and Anna Granholm (Ojibwe). Most are Neneboozhoo stories, the most recent one Neneboozhoo and Paul Bunyan. We also received a contract to publish Voices Rising, a collection of stories and poetry by Minnesota Indigenous women, through the Hennepin (Minnesota) County Library.

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We’ll soon release an art book by Sam Zimmerman (Ojibwe), Following My Spirit Home.

We’ve faced our share of challenges along the way with the COVID pandemic topping the list. Betsy, who does all our marketing, had scheduled many book events with schools, bookstores, and communities for our new releases in the spring and summer of 2000 only having to cancel all of them. Our home was filled with thousands of our latest releases, stacked neatly in our bedroom.

So, Betsy sat down at her computer and sent emails to all our previous buyers — schools, libraries, bookstores, and communities. We developed an online presence utilizing Twitter, Facebook, and a webpage and put our books on Amazon. com. We bought a tent and began doing direct sales at Saturday markets, particularly the one sponsored by the American Indian Community Housing Organization in Duluth, Minnesota. In the end it paid

off. We more than doubled our sales the second year, and again this past year.

In 2022 we plan to retire. We’ve already turned the publishing rights to our books back to authors and had one of our designers put them under their names on Amazon through Kindle Direct Publishing (KDP), so they can have their own books printed and continue to sell them and receive profits. We’re not in this for the money.

I’m a writer. I know how difficult it is to find publishers for our Native stories, histories, and cultures. For generations, non-Native publishers have determined what of our history, culture, language, and stories are worthy of publishing, of getting into schools, libraries, bookstores, and communities. Hence, non-Native publishers determine what of our stories are worthy of telling, knowing, passing on, because the written word is held in high regard in contemporary society. Colonial thinking, institutions and structures still

stand in our way everywhere. However, I’ll continue to write and, hopefully, find publishers for my works. I’m hoping for the same with all other Native writers and illustrators.

We all need to do our part, give back.

This has been one of our ways of doing it.

I just bought a new recliner. They deliver soon.

Somewhere out there though, hopefully, is a youngish Native person who dreams of owning a publishing company, of making sure our stories live on in the printed word.

Thomas Peacock (Fond du Lac Ojibwe), co-publisher of Black Bears and Blueberries Publishing, a publisher of Native children’s books. Black Bears and Blueberries Publishing: 218-310-8532 or 715-779-9532, blackbearsandblueberries.com.

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952-920-2020 edinaeyeclinic.com 3939 W 50th Street, Suite 200 Edina, MN 55424

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Michael S. Elliott, M.D.

Donald A. Ristad, M.D.

Rhondi S. Meiusi, M.D.

Shawn J. Gross, M.D.

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21

Indigenous Health

How Engaging Youth Strengthens Our Wellness Mission

H

ow does working with youth engaged in the art of storytelling, theater, and music strengthen an Indigenous organization in its mission and purpose to improve the health and welfare of its constituents, especially when the strategies are to reduce the rates of HIV, Hep C, and the attendant issues such as drug use and abuse, mental health issues of PTSD, commercial tobacco misuse, and food insecurity? I will try to explain how this works for us at Indigenous Peoples Task Force (IPTF).

In 1990, IPTF was known as the Minnesota American Indian AIDS Task Force and had a single mission to provide prevention and direct care services to people living with AIDS and their family members. In the early 90s people were dying from AIDS, and we had lost so many talented, creative, young, gay Native men and lesbians. The first two clients in our case management program were lesbians.

One was a nurse, the other was from Leech Lake. As many more gay men enrolled in the case management program, they became the population that was overrepresented in the Native community living with AIDS. IPTF knew we had to reach youth with a prevention message to protect and save their lives. With a $15,000 grant from The Bremer Foundation, we began a theater project based on research that said Peer Education works as a prevention strategy. We learned everything we could from the literature and then began to create an outline of the education we

By Sharon M. Day

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Spring 2022

knew was important: AIDS 101, death and dying from Indigenous perspectives, healthy sexual behaviors from a cultural standpoint, communication skills, and teen pregnancy prevention which included basic biology and physiology. We used a Planned Parenthood lesson where they created their reproduction systems using balloons and pipe cleaners. We are still using it today.

It was also important to include sessions on creativity and dreams, therefore for these lessons we used a progressive muscular relaxation exercise, meditation along with guided imagery. The students then drew a picture of what they visualized during the relaxation and guided imagery session. Later we learned this technique is known as devised theater.

Below is a piece that came out of one of the dream/creativity sessions and is included in the play, “My Grandmothers’ Love.”

I was walking down a hallway, and there was this big kid, and he started pushing me and shoving me. I ran and I ran, and I ran. The big kid kept on chasing me and I turned and hit him in the head and his head hit the floor and

went bang, bang, bang. All of a sudden, I fell down these stairs and ended up in this really junky basement filled with really bad smells. I ran and I ran, and I ran trying to find a way out, I had to find a way out. When the big kid was chasing me, I was really small, now, I was really big. I found a window, I opened it up, I climbed out. There were grass and the air smelt like springtime.

I looked back at the room, and I knew I had to keep going, keep living.

During the summer program, our students are multi-racial. These exercises work with young people of all ages and races. We spoke of our identities, our clan systems. The students from Somali, Ethiopia, Hmong, and Lakota and Ojibwe all have clan systems.

In this exercise, I asked them to think about their families, what makes them proud, and where is home. A young man shared that in his culture, once in their lifetime, they must make a pilgrimage to Mecca, a holy place. The Lakota students talked about going home to Sundance ceremonies and the Ojibwe students talked of traveling to Bad River to Midewiwin ceremonies. In the acting portion, all the students were marching to Mecca, hands clasped in a prayerful position. These young people connected in a spiritual way that was told through their authentic storytelling.

Often, we relied on our elders for providing the lessons about culture and wellness. They came in and sat with us in talking circles, they blessed the drums, hides, and furs we used as costumes, they spoke to us about respect and equality and about how harmful homophobia was for

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our relatives living with HIV. Homophobia was a real challenge and didn’t significantly change among our youth until I, a respected adult in their lives, came out to them.

The wellness of the Indigenous community is profoundly impacted by intersecting injustices. The Indigenous Peoples Task Force always centers a call for social justice in our work.

In the early days of HIV, we marched to rallies led by ACT UP! ACT UP was led

and Indigenous people whose relatives are missing and murdered who created a movement to establish the databases and wrote the legislation to bring some resources to finding our relatives and close the loopholes in jurisdictional issues between tribal governments and state and federal crime bureaus.

And it was LGBT Two Spirit people who created the Love is the Law all over this country, standing up to homophobia and bigotry.

The wellness of the Indigenous community is profoundly impacted by intersecting injustices. The Indigenous Peoples Task Force always centers a call for social justice in our work.

by people living with HIV who were dying and watching their friends die with little help from the federal or state governments.

Social Justice movements in this country have always been led initially by the very groups most affected. Our tribal people living on the Caribbean islands, and the people on the east coast were the most affected by the pilgrims and Spaniards fleeing religious persecution and then doing the exact same thing to tribal nations.

It is the women who were battered by their husbands and partners who began the domestic violence movements, MetroDoctors

IPTF has been a part of these later movements, ACT UP, Vote NO, Missing and Murdered Indian Women and Relatives (MMIWR), and of course trying to save our life source, the waters. Our youth have been involved in many of these activities, marching for MMIWR, walking for the water, putting their creativity to work to send messages to their peers about avoiding teen pregnancy, preventing HIV, educating their peers about cybercrimes and trafficking, and talking about historical trauma. At the heart of all these activities are our original teachings to be kind,

The Journal of the Twin Cities Medical Society

be loving, be courageous, seek knowledge and wisdom, be humble, be honest and generous. The Ikidowin Youth Theater Ensemble continues to tell the stories that are our stories — stories of resilience, stories of triumph, stories of love and inspiration born out of fire, born out of despair, born out of knowing this is our land.

This is our spot on the globe where creator placed us and we will protect it and each other. The young people at the heart of our work move us forward to preventing HIV, HEP C, and getting people motivated to get vaccinated to prevent COVID infections. We teach the youth to use their voice to demand justice and resources. We create our own resources as Indigenous people growing our own foods and asserting our sovereignty.

Sharon M. Day, (Ojibwe) is the Executive Director and a founder of the Indigenous Peoples Task Force (IPTF), formerly known as the Minnesota American Indian AIDS Task Force. She leads IPTF’s flagship program, Ikidowin Youth Theater Ensemble, and mentors youth via theatrical expressivity.

Day is an artist, musician, and writer. Her play, We will do it for the Water has been produced by Pangea World theater. As an actor she has performed with Pangea World Theater, Spiderwoman Theater, Illusion Theater, American History Theater and with festivals at the Guthrie and Ordway.

An environmental activist, she has led 20 plus Water Walks since 2011, walking over 10,000 miles to offer prayers for these rivers. She is an editor of the anthology, Sing!

Whisper! Shout! Pray! Feminist Visions for a Just World: Edgework Books, 2000.

She is also one of two contributors to Drink of the Winds, Let the Waters Flow Free, Johnson Institute, 1978.

Spring 2022

23

Indigenous Health

Be a Good Relative

B

e a good relative. This is more than a short statement or concept, it’s a foundational value and a way of life. As Indigenous community members, leaders, advocates, professionals, and many other roles, these four words, “Be a good relative,” have a deeper meaning and are engrained in so much of who we are, how we engage with each other, and the work we do on a daily basis. The American Indian Cancer Foundation (AICAF) embraces this value in our work to address the tremendous cancer burdens impacting our American Indian/Alaska Native (AI/AN) relatives as well as the impacts COVID-19 is currently having on our communities.

Our traditional ways of knowing and living have always been part of our thinking, our teachings, and most importantly our wellness. Despite the persistent inequities AI/ANs face, the historical trauma, and the loss of our traditional lands, we remain resilient through the deep connection to our rich culture.

Mnisota Makoce, known to many as Minnesota, is home to the ancestral lands of the Dakota and the Anishinabe.

There are 11 federally recognized Tribal Nations across Minnesota that make up just under 60,000 AI/AN according to the U.S. Census Bureau in 2019. A large proportion of the population reside in urban areas, such as Minneapolis and St. Paul, due to various Federal policies, such as the Indian Relocation Act of 1956. The act was the government’s mission to assimilate AI/AN into the general population, with a goal to weaken their community

By Melissa Buffalo and Wyatt Pickner

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Spring 2022

and tribal ties. Relocation, compounded by settler colonialism, legislation, policies, and violence have attempted to remove AI/AN from their culture, tradition, and land. As a result, many individuals and families move between urban areas and their traditional land bases as a means to stay connected, considering both home.

Little Earth, HUD-subsidized housing in Minneapolis’ East Phillips neighborhood, has been a place for urban AI/AN

health care with concepts of community wellness, healing, and culturally competent care. Many AI/AN community members also access large healthcare systems across the Twin Cities metro as their primary source of care, sometimes through referral and often times via emergency care.

In a perfect world, trust among these large healthcare systems and AI/AN patients would exist and culturally competent care, grounded in Indigenous ways

to create community, access resources, and build resiliency through belonging. This neighborhood, according to Culture Connections, has the third largest urban AI/ AN population in the United States.

Additionally, the federal government has a trust responsibility to provide healthcare services to AI/ANs. However, the funding for these healthcare services for AI/ANs is inadequate. AI/AN community leaders and members are often at the forefront of addressing this issue by identifying supplemental funding and resources to support efforts to integrate our knowledge systems and culture into health care.

Twin Cities urban AI/AN residents have access to the Indian Health Board (IHB) of Minneapolis and the Native American Community Clinic (NACC) for their

of knowing and being, would be at the center of all visits. Existing health inequities would not only be addressed by providers of western medicine but with input and guidance from the AI/AN community members and traditional healers.

This concept is at the heart of our work at the AICAF and how we heal with culture and reclaim Indigenous health. AICAF, a national nonprofit organization based in Minnesota was established in 2011 to address the tremendous cancer burdens across Indian Country. AICAF works to eliminate the cancer burdens of Indigenous people through improved access to early detection, treatment, and survivor support. We do this in partnership with Native communities because we know as Indigenous people, our communities have

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the wisdom to find the solutions to cancer inequities, but oftentimes are seeking the organizational capacity, expert input, and the resources to do so. AICAF supports innovative, community-based interventions that engage Indigenous communities in the discovery of their own cancer best practices. Through these efforts, trusted partners, community leaders, and relatives truly imagine a world where cancer is no longer the leading cause of death among AI/ANs. AI/ANs in the United States experience some of the worst cancer outcomes worldwide. As cancer mortality rates among most races have been decreasing in the last two decades, AI/ANs are not experiencing decreased rates (CDC, 2010).

In addition to this, due to the COVID-19 pandemic, there has been a reduction in lifesaving preventative vaccinations and early detection cancer screenings. Early reports suggest that HPV vaccinations dropped by >70% in March 2020, and HPV vaccinations remained 25–50% below baseline levels in June, with a cumulative deficit of over one million doses (Hart, 2020). As highlighted by the Centers for Disease Control and Prevention (CDC) in June 2021, the total number of cancer screening tests received by women through the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) declined by 87% for breast cancer and 84% for cervical cancer during April 2020 as compared with the previous 5-year averages for that month. Breast cancer screenings also declined for AI/AN women by 98% from January to June 2020 through NBCCEDP funded programs (DeGroff et. al 2021). The American Cancer Society recently released their Cancer Facts & Figures 2022 report that estimates 1.9 million cancer diagnoses this year with just over 600,000 cancer deaths, about 1,670 deaths per day.

Organizations like AICAF work in partnership with tribal leaders, clinics partners, and providers to ensure AI/AN community members have access to reliable information and are advocating for their health. To truly make this a reality for our Indigenous relatives, our history, culture, MetroDoctors

values, and experiences need to be seen, heard, understood, and valued in all the health care we receive. As we continue to heal with culture and reclaim Indigenous health, we encourage you as a healthcare professional to carry that foundational value that Indigenous people strive to live by, be a good relative.

Melissa Buffalo, MS, Chief Executive Officer, is an enrolled member of the Meskwaki Nation in Iowa, and Dakota from the Crow Creek and Lower Brule Sioux Tribes.

She received her undergraduate degree in child psychology from the University of Minnesota – Twin Cities and earned an MS in Human Development from South Dakota State University. Melissa has over 15 years of experience working in the public health sector in a variety of different roles. She brings a wealth of knowledge to AICAF. As the CEO, Melissa is committed to working with and for tribal communities, both urban and rural, supporting our Indigenous people with opportunities to heal; emotionally, historically,

The Journal of the Twin Cities Medical Society

spiritually, and physically from the burdens of cancer.

Wyatt Pickner, MPH (Hunkpati Dakota) is the Research Manager at the American Indian Cancer Foundation.

In this role, he supports Indigenous communities in the collection and use of population-specific data, aiming to find culturally-relevant health solutions that are both effective and resonate with our relatives. Originally from Crow Creek, SD, Wyatt now lives and works in Minneapolis. A graduate of the University of Washington School of Public Health, Wyatt is dedicated to improving the well-being of Native communities across the United States. He has 10 years of experience in working with tribes, tribal organizations, and Native-serving organizations at local, regional, and national levels on research projects, capacity building, training, and community engagement.

Website: https://americanindiancancer.org; phone: 612-314-4848

Do your patients have trouble using the phone due to a hearing loss, speech or physical disability?

The Telephone Equipment Distribution Program offers easier ways to use the phone.

Phone: 800-657-3663 Email: dhs.dhhsd@state.mn.us Web: mn.gov/deaf-hard-of-hearing The Telephone Equipment Distribution Program is funded through the Department of Commerce – Telecommunications Access Minnesota (TAM) and administered by the Minnesota Department of Human Services.

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Mental Illness is...

REAL. COMMON. TREATABLE.

At PrairieCare, we provide each individual patient the psychiatric care they truly need. Our services and programs span the full continuum of mental health care, offering various levels of treatment and care plans for children, adolescents, and adults.

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Visit Prairie-Care.com for more detail on our services.

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• Therapists • Registered Nurses • Psych Techs We offer a comprehensive benefits package, generous PTO plans, education & training opportunities, a comprehensive benefits package, and a sign-on bonus, and MORE! EOE.

Learn more and apply today at Prairie-Care.com.

Environmental Health Integrating Indigenous Wisdom and Culture Into Western Medicine Dr. Lisa Martin is a Clinical Associate Professor at the University of Minnesota School of Nursing. As a Native American, Dr. Martin, has a personal and deeper understanding of the health disparities within the Native American community. In terms of climate change and health, the Native American community is disproportionately impacted by heat stress, air pollution, environmental pollution, and subsequent mental anxieties and illness.Her intimate relationship to the Native American community is revealed in her comments below: The pandemic has influenced healthcare providers with a growing understanding that the social determinants of health (SDH) are linked to a lack of opportunity, and a lack of resources to protect, improve, and maintain health. These factors are most responsible for health inequities.1 Native American populations continue to experience racism and marginalization and therefore suffer some of the highest health disparities as revealed by the COVID-19 pandemic. The healthcare system of the Indian Health Service/ Tribal Health Care/Urban Indian Health Care (I/T/U) is a healthcare service triad that struggles with under-funded budgets and a lack of recognition from national healthcare insurance programs toward the unique approaches that are needed to serve Native people in any environment — reservation, rural, or urban — toward improved health outcomes. Positive change is greatly needed and overdue.

As healthcare providers we all can play a role in the solution to improve health disparities for Native Americans. Indigenization of health care is an inclusion of Indigenous knowledge and worldview that can encourage insight into your own culture and background, privileges, or oppressions that have affected your own life, as well as biases or gaps in knowledge.2 The outcome is

a broader, more inclusive approach to health care by opening awareness and increasing creativity and innovation in solutions.

Indigenous knowledge systems are embedded in relationship to specific land, culture, and community and have much to offer in terms of possible solutions to climate change. Indigenous communities have long histories of farming, fishing, hunting, relying on the ecological markers such as the first snowfall, arrival of specific plants or bird species to guide when to plant, harvest or perform other tasks. However, because of climate change many of these ecological patterns have been interrupted.3

By Lisa Martin, PhD, RN, PHN, AHN-BC, FAAN, and Mike Menzel, MD MetroDoctors

The Journal of the Twin Cities Medical Society

New collaborations with Indigenous communities are needed to re-envision ways in which we create and include knowledge.

Bringing together Indigenization and Indigenous knowledge from around the globe can develop new understanding of solutions for ecology and greater health for all.

References 1.

Antoine, A., Mason, R., Palahicky, S., & Rodriguez de France, C. (2019). Pulling together: A guide for Indigenization of post-secondary institutions.

2.

Cornell Chronical. (October 6, 2021). Climate change adaptation requires Indigenous knowledge.

3.

CDC. (September 30, 2021). Social determinants of health: Know what affects health.

CAREER OPPORTUNITIES

Lakeview Clinic has what you are looking for! Join an independent, physicianowned group of 50 providers in the SW Metro.

Be a part of a collaborative work environment in a primary care group of family physicians, internists, pediatricians, general surgeons and OB/GYNs. • 4-day work week with 32 contact hours achieving excellent work/life balance • Excellent compensation with a 2-year partnership track to earn in the top 10% in the state • Outstanding benefits including 100% paid family health insurance and dental insurance, 401K and profit sharing • We have 4 sites in the southwest metro: Chaska, Waconia, Norwood, and Watertown

Due to retirements and growth, we are currently looking for: ◦ Internal Medicine ◦ Family Medicine

CONTACT: administration@lakeviewclinic.com PHONE: 952-442-4461 ext. 7215 WEB: www.lakeviewclinic.com

Spring 2022

27

FUTURE

Physician Leaders B y S h e l b y S n y d e r, Incoming Medical Student Fall 2022

On Uplifting Indigenous Voices

Disclaimer: I am not here as a spokesperson for everything Indigenous or other Indigenous experiences. There are many things I am still learning about myself, my connection to community and others. Additionally, the term Indigenous is not to say we are a monolith, but rather an amalgamation of distinct Tribal communities, cultures, and identities.

Yá'átééh, Shí éí Shelby Snyder yinishyé. Lók'aa' Dine'é nishłį. Hashk'aan Hadzohó bashishchiin. Italian dashicheii.

Belgian dashinalí. Hello, my name is Shelby Snyder. I am of the Reed People clan born for the Yucca Fruit Strung Out in a Line clan. My maternal grandfather is Italian. My paternal grandfather is Belgian. I am Navajo and Southern Ute. By introducing myself with my clans, I acknowledge my kinship ties to others and my positionality as a Navajo woman.

Growing up, I had the immense privilege to have my father, an Indigenous physician, as a role model. Additionally, from participating in cultural ceremonies to attending Dartmouth College and exploring summer programs, the culmination of my experiences as a Native person kindled my desire to go to medical school. In particular, much of what sustains me to go to medical school lies in the power of representation and community building, all of which the Native Americans into Medicine (NAM) program offered.

The Center of American Indian and Minority Health (CAIMH) at the University of Minnesota Medical School Duluth hosts the NAM program. The program aims to encourage college sophomores and juniors interested in pursuing a career in the health professions. NAM spans over two summers, accepting applications every other year. A new iteration of NAM starts in Summer 2022, with applications available in March 2022. I encourage all college sophomores or juniors interested in working with Indigenous communities to apply!

The breadth of the NAM program ranges from Indigenous mentorship, Indigenous research methods, and community advocacy. NAM focuses on engaging undergraduate students with the research process. Unique to NAM is its ability to do so while uplifting Indigenous voices that speak to Indigenous health inequities.

While in NAM, I worked with Indigenous and non-Indigenous peers to translate existing scientific literature to more accessible platforms to be used by clinicians or community members. Specifically, we developed infographics to assist with data dissemination in Indigenous communities. This program 28

Spring 2022

gave me the resources and skills to further my education in Indigenous research ethics, community-based participatory research, and data sovereignty. As an advocate for the incorporation of Indigenous knowledge in Western medicine, I imagine spaces where Indigenous people can receive care without leaving their cultural practices at the door.

Two aspects of the program that significantly impacted my drive to pursue medicine were mentorship by Mary Owen, MD, and learning from the Fond du Lac Band of Lake Superior Chippewa Institutional Review Board (IRB). Dr. Owen is Tlingit, a physician and director of the CAIMH. She is an inspiration exemplifying the strength of being an Indigenous physician. The Fond du Lac IRB emulated the benefits of research sovereignty and modeled practices Indigenous communities can take to have more autonomy in research done for, by, or with us. These lessons are all invaluable steps to navigate the impacts of colonization and improve the health of our communities.

Overall, I am humbled and reminded of my accountability to my community of Indigenous people — for those who have gone on, for those who are currently struggling, and for future generations. I am incredibly grateful for the opportunities I attained through the NAM program, where I learned more about myself and my ability to provide care to Indigenous people. As I am currently in the medical school admissions cycle for Fall of 2022, I am excited to see where the future takes me — to Indigenize¹ healthcare spaces and pave new paths for future generations of Indigenous people.

My definition 1. Indigenize (verb): to collectively celebrate, honor, and respect Indigenous knowledge, values, and teachings by and for Indigenous people NAM application page Summer 2022: https://med.umn.edu/ caimh/college-premed For more information regarding “Data Sovereignty” check out resources from the Urban Indian Health Institute: https:// www.uihi.org/.

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The Journal of the Twin Cities Medical Society

Brain building begins before birth At HealthPartners, we’re focused on helping kids get a healthy start. We partner with parents, families, schools and community partners throughout the Twin Cities to put children’s wellbeing first by emphasizing early brain development and family-centered care. Our Children’s Health Initiative promotes important health screening and everyday interactions that encourage learning.

Reach Out and Read Research shows that the opportunity gap begins when children are babies. The Reach Out and Read program helps parents and caregivers understand the importance and magic of sharing a book together for both brain and relationship building.

HealthPartners primary care clinics partner with the statewide Reach Out and Read program to give developmentally appropriate books to families with children six months to five years old at well-child visits. As of 2020, our care teams have distributed nearly 600,000 books in 10 different languages.

Learn more at reachoutandreadmn.org

Think Small’s ParentPowered texting program

Little Moments Count

Since 2018, throughout HealthPartners clinics, we’ve given

Whether or not a young child experiences daily moments of interaction – like playing, talking, reading and singing – can affect learning, brain development and health for the rest of their life.

That’s why HealthPartners, in partnership with 200 other organizations, developed a community campaign called Little Moments Count (LMC). LMC is a statewide movement that includes countless resources to help parents, caregivers and the community understand the importance of talking, playing, reading and singing early and often with children.

Learn more at littlemomentscount.org

out thousands of bookmarks each year to help promote Think Small’s ParentPowered texting program. Studies show that children of parents receiving these texts from birth are more prepared for kindergarten.

Parents can sign up for the program to receive fun facts about their child’s development and easy-to-implement tips on how to encourage intentional learning in everyday moments.

Signing up for Think Small ParentPowered Texts is free and easy. Text LMC to 70138. Use code LMC ESP to receive texts in Spanish and LMC SOM for Somali.

Learn more at thinksmall.org/texts

952-883-6000 | healthpartners.com HealthPartners is a consumer-governed, nonprofit health care organization with over 60 years of experience offering health insurance and care. With 90+ clinics and hospitals, we provide medical and dental care in Minnesota and Central Wisconsin. Our mission to improve health and well-being in partnership with members, patients and the community.