Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

 From the 10/30/2020 newsletter

Student perspective

 

 Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

  

Morgan Lockhart, MCW-Milwaukee medical student

 

 Ms. Lockhart shares what she has discovered about research gaps, cultural microaggressions, and her vision as a medical student and descendent of the Cherokee Nation …

 

 Boozhoo MCW,

 A novel coronavirus swept the nation and, along with it, many standard summer research opportunities. As a member of the lowest socioeconomic status, unemployment was not an option for me. Since research is one of the forefront pillars of MCW, I decided to pursue research in a field of interest and passion: exploration of my Native American heritage and culture, as I had never had the opportunity to immerse myself previously. After weeks of networking, I found the Great Lakes Native American Research Center of Health (GLNARCH) and was accepted into a research internship created and funded by the Great Lakes Inter-Tribal Council (Glitc). I was the first school of medicine applicant, and I could not be more honored and elated.

 Throughout my life, procuring health insurance, let alone quality insurance, has been an ongoing struggle: I have always been enrolled in public low-income state insurance or been uninsured. This influenced my decision to develop a research project studying health care coverage rates among Native Americans. Based on interest and compatibility, I was partnered with a mentor, Margaret Noodin, MFA PhD, a member of the Ojibwe Tribe and Professor of English and American Indian Studies at the University of Wisconsin-Milwaukee. Due to SARS-CoV-2 disproportionately affecting residents on the reservations, my project needed to be based virtually. My research objectives evolved into a literature review to identify specific barriers that prevent access to and utilization of healthcare coverage and policies among Native Americans.

 In addition to mentoring my research, Dr. Noodin had several other students working on GLNARCH projects. We all convened weekly through virtual meetings. I had the opportunity to network and develop professionally and culturally with my peers. These relationships continue to prosper and we rely on one another, which I found paradoxical because of the importance our society places on egocentrism. The sense of community and proudness of one another goes beyond the individual; it is ethnorelativism, indicative of indigenous culture.

 From Kindergarten to M2 year, I have been one of few, if not the only, Native American in my entire education system. Microaggressions borne out of envy and ignorance have referred to me as a “Native token” or under the baseless accusation that my tuition is financed from “Native American-owned casino profits.” For the first time, I was surrounded by individuals that shared not only my heritage, but unnervingly similar life experiences. For the first time, I was a puzzle piece that was congruent with the edges of those around me.

 After reviewing the literature, I was disheartened to realize how few empirical research studies identified by the NIH National Library of Medicine have focused on the health of indigenous populations in the US. The few articles that have specifically studied indigenous people often amalgamate all tribes into one, despite each being a separate, sovereign nation. It is patronizing and disrespectful to assume the needs of one tribal organization are comparable with another; that is tantamount to claiming the needs of the United States are identical to that of a foreign country.

 Every barrier had a common denominator: profound mistrust that continues to be perpetuated by non-tribal members since 1492. Without a doubt, the most indisputable finding was not the lack of health care coverage illiteracy among Native Americans, but among non-tribal health care providers. The fault of incomprehension always appears to be placed on minorities, but the cultural ignorance should be shared by the majority. To exacerbate the burden imposed by the cultural gap, tribal members often feel invisible and unrecognized by non-tribal health care systems and often do not seek care outside of Indian Health Services and Urban Health Programs.

 Prior to starting medical school, I was optimistic that a culture of inclusivity and diversity would be at the forefront of medicine, but I find that it is still wading in the shallow waters of preliminary stages. As a second-year medical student, I, too, feel invisible and unrecognized; without representation in clinical vignettes, campus organizations, and the racial demographic of all four years of cohorts on all three campuses. In 2019, the AAMC reported that 0.3% of all actively practicing physicians identified as indigenous. According to the MCW Education 2018 – 2019 Report, 0.14% of students enrolled in any program at MCW were American Indian or Alaskan Native. Without indigenous or culturally competent non-tribal health care providers available, we cannot improve the poor health care encounters and outcomes experienced by indigenous people, including myself.

 

 Recently, I had the opportunity to present my findings to the GLNARCH council. My hope is to develop a study that determines the baseline knowledge of non-tribal healthcare providers on Native health care and policy. I aspire to collaborate with tribal leaders, healers, and members to most efficiently educate non-tribal members on the complexity of Native American health care and policy. My priority is to ensure the product of our efforts focuses on the gains that can be provided to tribal nations with education of non-tribal healthcare providers as an added benefit.

 I am now an advocate for the indigenous people, my people, but we are responsible and accountable for actively learning about the culture and needs of all our patients, and it is high time we direct our attention toward the needs of Native Americans. As an initial step, I challenge you to translate the Ojibwe greetings within this text and learn the names of the sovereign nations that reside within Wisconsin.

 Miigwech

 

 Morgan Lockhart is a medical student in the class of 2023 at MCW-Milwaukee.

Physicians have Many Civic Duties and Voting is One of Them

From the 10/30/2020 newsletter
 
Director’s Corner
 
 
Physicians have Many Civic Duties and Voting is One of Them
 
 
Adina Kalet, MD MPH
 
 
This week Dr. Kalet explores why physicians have a stake in the enfranchisement of our patients and, despite being very busy people, must vote.…
 
 

My dear friends, your vote is precious, almost sacred. It is the most powerful nonviolent tool we have to create a more perfect union.
- US Representative John Lewis

 
 
Did you know that physicians vote at a lower rate than the general population? Would you have guessed 14% lower? In a recent study, over half of physicians were not even registered to vote. This is especially perplexing and striking when compared to other educated, wealthy Americans who typically vote at much higher rates than average citizens. I have heard many physicians say that they prefer not to mix “politics” with health care (more on that later) or that as physicians, we just do not have the time to vote. This is not inspiring news about what many physicians understand about the importance of politics to the lives of their patients.
 
 
This attitude starts early. Many medical students and resident physicians, who were registered voters earlier in life, don’t prioritize registering or voting as they relocate. This break in the habit of civic engagement is noxious. By not encouraging and enabling voter registration of students and residents, we silently condone the view that we are just too “busy” doing very important things to vote. But few things are as important.
 
 
There are always barriers to voting for busy people. For instance, the annual national meeting of a large medical education organization regularly takes place on and around US election day, requiring the thousands of American citizen attendees to go out of their way to request absentee ballots. I must admit, I myself have missed voting in a midterm election because I did not plan ahead. Television coverage routinely shows long lines, even for early voting. This year, there should be no excuses.
 
 
Simply put, politics is the way we make decisions as a group about how to distribute shared resources. The majority of funding for health care is publicly funded. The regulations and codes that determine how we deliver health care are legislatively based and can end up being debated in the Supreme Court. The complex machinations of the electoral college aside, in the US, we govern ourselves by voting as individual adults. But typically, just over half of Americans regularly exercise this right and responsibility by voting. Many recent consequential elections have been ultimately decided by a small number of votes. This must change, at least for physicians.
 
 
Social issues and political advocacy are “in our lane”
 
Social determinants of health (SDoH) – affordable housing, food security, high quality education, access to health care, stable loving communities all shaped by political, economic and social policies – are increasingly acknowledged as within the health professionals’ medical obligations. SDoH are associated with race- and wealth-based disparities in health, particularly for Milwaukeeans. These are things we should care about. And while we cannot personally act to address all these issues, we can vote for the people we believe will.
 
 
There are so many examples of why physicians have a professional obligation to care about public governance. Without nationally organized preparation and response to disasters – such as the COVID-19 pandemic or gun violence – the negative impact of SDoH are exaggerated. What if pediatrician Mona Hanna-Attisha, MD MPH hadn’t been activated to do research and conduct the advocacy needed once she realized that many of her patients had elevated blood lead levels – a potent neurotoxin – associated with a switch in the source of Flint’s water supply? Physicians make a difference every day, even though many opportunities are missed.
 
 
So, why don’t we vote?
 
There is no doubt that voter participation and health are linked. Places where few low-income voters turn out have much less generous social welfare systems. This is not surprising, since elected representatives, looking to the next election, prioritize the needs of their voters and donors. Non-participants risk being disenfranchised.
 
Not voting, as individuals or groups, means less influence on elected officials. This is why health care professionals should vote and help patients register, as well. Of course, it is unethical for physicians to coerce patients or anyone to embrace a certain political view but that is not the same as enabling voters to register.  Enabling registration can be done without favoring differing political views or party affiliation.
 
As my husband, Mark Schwartz, MD, pointed out in his guest appearance in this space on October 7, 2020, it is common to hear the following explanations for avoiding civic engagement “We can’t fight big money,” “Science and politics don’t mix,” and “It’s not my job.” See his column for a deeper dive into why those responses are “wrong-headed.”
 
All this makes it even more perplexing as to why some physicians are unlikely to vote.
 
 
Getting and staying involved
 
Physicians, as well as society, must heed the lessons of a traditional civics education in order to protect democracy itself. Across the continents and centuries, the profession of medicine and physicians have not fared well when societies ceded power to autocrats. Consider how medicine was corrupted in Mao’s China or Hitler’s Germany. Physicians acquiesced and were stripped of their ability to protect patients and their profession. Medical “experimentation” led to horrific abuses, genocide, and eugenics.  As has been pointed out, autocracies are insidious because, at first, they make life easier for the educated and affluent, but ultimately physicians cannot assume we will be protected by our ancient traditions, our highly respected place in society, or our valuable knowledge.
 
As I have argued many times in this space, physicians need to be prepared to understand, how local, state and federal law influences how health care is organized and financed. We need to be “good citizens” of the systems in which we work while prioritizing our individual patients and the communities we serve. We must educate ourselves as effective advocates and understand the public health system and structure.
 
Physicians have no defensible excuse for being passive. Democracy is too delicate to leave untended. One in four physicians didn’t vote in any of the last three presidential elections. Let’s change that calculus. Society needs to hear our voices.
 
 
 
 
Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin
 
 
 

Take 3: Comments from a Leader and Vascular Surgeon

 From the 10/23/2020 newsletter

Take 3: Comments from a Leader and Vascular Surgeon

 

With Julie Freischlag, MD - Former MCW faculty member and President-Elect of the American College of Surgeons

Julie A. Freischlag, MD, FACS, FRCSEd(Hon), DFSVS is a former MCW faculty member. Over the course of her career, she has broken new ground by serving as Chief of the Zablocki VAMC Surgical Service, Chief of Vascular Surgery at UCLA, Chair of Surgery at Johns Hopkins, Vice Chancellor for Human Health Sciences and Dean of the School of Medicine at UC Davis, and CEO of Wake Forest Baptist Health and Dean of Wake Forest School of Medicine in Wake Forest, NC.

 She serves on the Executive Board of the Association of Academic Health Centers, the Council of Deans of the Association for American Medical Colleges, the Aga Khan University Board of Trustees, the University of Pittsburgh School of Medicine Advisory Board, the University of Illinois Health Advisory Board, and the American Hospital Association Changing Workforce Task Force.  She is the 2020–2021 President-Elect of the American College of Surgeons (ACS) and will be installed as ACS President in October 2021.

 Despite her administrative responsibilities, she still spends time in clinic and the OR, offering her expertise in the surgical management of thoracic outlet syndrome. She is also an attentive wife, mother, stepparent, and friend. She took time from her schedule to talk about mentoring, resiliency, and work-life balance.

She was interviewed by her medical school classmate and Editor-in-Chief of the Transformational Times, Bruce Campbell.

 

 

Question 1:  You have a reputation as an engaged and positive mentor for both men and women in medicine. How do you approach your role as a mentor for women who are contemplating demanding specialty careers?

 

I always tell students and residents to “Go to your passion.” As they rotate through services and specialties, I tell them to look to see if they are passionate about the disorders and diseases that the specialty treats. Mentors are great, but the student must look beyond whomever is their inspiration and see if the career holds the things that most love. Some specialties are particularly demanding of time and attention. The student should not be afraid of the demanding specialties, particularly if it is their ideal fit. If they do, they will spend years wondering if they made the right choice. 

 

Next, I tell them to “Be the best you can be, whatever it is.” I want them to understand that they will spend the early part of their careers doing whatever they can do to be great. I tell them, “Energy gets you competent. Then you get competent.” 

 

That said, I believe that COVID-19 might change how even the most demanding specialties are practiced. We are getting more accustomed to doing some of our work from home, to virtual visits, and to shared responsibilities. We might see less need for exhaustive daily rounds and face-to-face time. This type of change might be particularly valuable for dual-MD couples and people with shared childcare duties. 

 

In fact, I tell my surgical colleagues who over-engage to take it easy. If someone is sending emails at 3:00 in the morning, what does that tell trainees about our specialty? Does that sort of behavior tell trainees that we don’t trust them? Who would want to go into a field where that kind of intensity is normal?

 

Question 2: What are the opportunities for creating learning environments for students and residents that will propel learners successfully into their careers? How can we help students and trainees see the value of self-care over the long haul?

Back when I was in training, that seemed the furthest from anyone’s thoughts. Basically, it seemed liked we were engaged in the survival of the fittest and it was assumed that those of us who survived would do okay. That, clearly, was not the case.

 

We were all concentrating on self-care when COVID-19 hit. The virus has made us all rethink how we will model and practice self-care. We will all have to reacclimate to being in the same space again; our pre-clinical students were anxious about working with standardized patients and sitting together in classes.

 

I tell students that they need to “learn” their own space. I ask them, “What do you do that helps your relax, but is also easy?” For many, this includes, exercise, family time, hobbies you can continue over a lifetime, music, or writing.

 

Despite my schedule, I try to model self-care. I concentrate on what is important. I talk with them about how they find their “peaceful times.” We have an Office of Wellbeing that offers a weekly wellness newsletter, strategies, and activities. We organized virtual yoga and meditation sessions.

 

Another surgeon recently talked about how she wakes up each morning to spend a few minutes being thankful and happy about a few things. She lets go of things she can’t control. I tell trainees that it is futile to spend time beating down a door that is closed. Don’t even go in through the window. Find another door.

 

Finally, I cannot believe how quickly time has flown, but I have tried to pay attention to how I feel and to take care of myself. It’s a marathon, not a sprint. I try to help trainees see that we all are better when we work together.

 

 

Question 3: You have worked as a faculty member, department chair, dean, provost, and medical system CEO while maintaining your surgical career and raising a family. What do you tell others who are considering leadership trajectories about handling multiple roles?

 

Handling the challenges of work-life balance differs depending on your phase of life whether you are in a leadership role or not. I remember back at MCW, I was deep into a complex vascular case when my son’s childcare center called and said he was sick. I reached out to one of my partners who graciously came and finished the case. I told the family what had happened. When I stopped by to see the patient the next day, his first question was, “Is your son okay?” You see, people will understand if you tell them what is happening.

 

As he grew, I build my schedule around his whenever possible. I was a timer for his middle school basketball team. I went to his games. I took time out for family. As one of my MCW mentors told me, “Taking the kids to the swim party isn’t as good as staying to watch them.” I never forgot that.

 

I’m not saying it is easy. I actively managed my schedule. I took time to be organized.

I learned to say, “no.” It has been very rewarding and great fun.

 

Kaleidoscope is Partnering with the Milwaukee Bucks to Offer a Virtual Session

From the 10/23/2020 newsletter

 

MCW Kaleidoscope Announcement

 

Kaleidoscope is Partnering with the Milwaukee Bucks to Offer a Virtual Session

Adrienne German

REGISTER HERE 

 

Kaleidoscope is back!  After an eight-month COVID-induced hiatus, this first program back looks to be terrific.  While Kaleidoscope events have typically used film as a mechanism to explore diversity, the virtual world allows for new ways to connect and reach a broader audience across all schools and campuses.

Tune in on Thursday, October 29, 2020 from noon – 1:00 p.m. CT for “Confronting Racial Injustice: The Change Begins with You.”  In this virtual session, members of the Bucks organization will discuss the bold decision that the Bucks players made to boycott their play-off game against the Orlando Magic this past summer to demand justice for Jacob Blake and action from the state legislature regarding police accountability. The discussion will be led by Arvind Gopalratnam, Vice President, Corporate Social Responsibility and Kareeda Chones-Aguam, Vice President, Partner Strategy and Management.  

Although not everyone has as large a platform as the Milwaukee Bucks, everyone can still have an impact.  The October 29^th session will align with MCW's mission to becoming an ant-racist institution and teach people how to become an ally/accomplice against racial and social injustice.

 

Adrienne German is the High School Outreach Coordinator for the MCW Office of Academic Affairs.

 

Editor:

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.