Building Relationships: MCW-Central Wisconsin and the Lac du Flambeau Ojibwe People

From the September 22, 2023 issue of the Transformational Times

Building Relationships: MCW-Central Wisconsin and the Lac du Flambeau Ojibwe People  

 

Amy Prunuske, PhD and Corina Norrbom, MD  

 

Drs. Amy Prunuske and Corina Norrbom, faculty members at the Medical College of Wisconsin-Central Wisconsin, traveled with a group of colleagues to Lac du Flambeau for a workshop in July. They share some of the moments that moved them and look forward to returning soon … 

 

Above all, we came to “Be Curious” – something branded on Amy’s purple notebook from a recent MCW Kern Institute for the Transformation of Medical Education workshop by its Human Centered Design Lab. 

 

We were excited to meet with tribal members and hear about their experiences. We wanted to explore connections that could be relevant to the MCW-Central Wisconsin Physician in the Community Pathway programming we direct; to build on Amy’s previous work of incorporating Indigenous perspectives into the medical school curriculum (Lewis and Prunuske, 2017). 

 

Brian Jackson, MS, EdD, our host and a new MCW faculty member, assured us we would feel amazing by the end of the visit. 

 

What we send out into the world is what comes back to us, he said. And if the mind is ready, the teacher and teachings will appear, he added. 

 

Brian encouraged us to be proud of who we are and to learn from each other’s truths. 

 

Over the next two days, Brian’s family members shared their stories. We gained a deeper understanding of how the Ojibwe culture and familial relationships could be used to promote healing and strengthen social cohesion. They created a welcoming environment and treated us as “celebrities.” 

 

We rode in the backseat, as Brian and his father, Dr. Sonny Smart, drove us to a boarding school originally used to “civilize” Native Americans — by separating the children from their families and their culture. Now the tribe uses the space to teach Indigenous classes; to “flip the script” and make sure this history is acknowledged. 

 

Considering the far-reaching impact of our actions was among the teachings shared with us over the weekend: 

“What our seventh generation will have is a consequence of our actions today.” 
— Winona LaDuke  

  

One evening, we joined in the dancing and music at a pow-wow. 

 

Dr. Brian Jackson, Melissa Doud, and their two sons

Getting in synch with the people around you makes your relationships better. This was a meaningful opportunity to connect with both the Lac de Flambeau community and our MCW colleagues. It was a chance to feel unconscious inspiration and gratitude. 

 

The next morning, Brian’s wife, Melissa Doud, shared a video that required us to focus on a task of counting ball tosses. Many of us got the correct number of tosses but missed the moonwalking bear in the background. This was an analogy that the Indigenous perspective may be in the room but is often overlooked. 

 

We relearned how to see and were encouraged to take time to build our own awareness of Indigenous Ways of Knowing (Deloria et al. 2018).  

 

Melissa reminded us that when we look at health disparity numbers, we must remember that the numbers represent real people and families. 

 

In the Ojibwe culture, each parting ends not with a “good-bye” but with a “see you later.” There is no beginning or ending; we will just continue.  

 

We look forward to revisiting Lac du Flambeau reservation in November, this time with a group of MCW-Central Wisconsin medical students.  

 

We will pick up where we left off.  

 

For further reading:  

 

Lewis M, Prunuske A. The Development of an Indigenous Health Curriculum for Medical Students. Acad Med 2017 May;92(5):641-648.  doi: 10.1097/ACM.0000000000001482.  

 

Unfolding Futures: Indigenous Ways of Knowing for the Twenty First Century. Daedalus: Journal of the American Academy of Arts & Sciences. Philip J. Deloria, K. Tsianina Lomawaima, Bryan McKinley Jones Brayboy, Mark N. Trahant, Loren Ghiglione, Douglas Medin & Ned Blackhawk, guest editors. 147 (2): 1 – 172. Spring 2018. Link here.   

 

Amy Prunuske, PhD, is an Associate Professor at the MCW-Central Wisconsin campus and director of the new MCW medical school curriculum MCWfusionTM. She is active in the Kern Institute Human Centered Design Lab.  

 

Corina Norrbom, MD, is a Family Physician and Assistant Professor at the MCW-Central Wisconsin campus.  

They co-direct the Physician in the Community Scholarly Pathway. 

To be understood and appreciated: A trip to Lac du Flambeau

From the September 22, 2023 issue of the Transformational Times

"To be understood and appreciated": A trip to Lac du Flambeau

Bruce H. Campbell, MD, FACS

In July 2023, Dr. Campbell joined a group of Medical College of Wisconsin (MCW) researchers, clinicians, faculty and staff for Lac du Flambeau Family Circles Professional Development Training with the Ojibwe Community in Lac du Flambeau, WI. Despite many visits to Wisconsin’s Northwoods, this was his first effort to learn about the historical trauma the region’s Indigenous peoples have experienced ...

 

All human beings want to be understood and appreciated.

— Family Circles Traditional Parenting Program

Native writer Sherman Alexie, in his short story, “War Dances,” tells of an Indigenous son whose father has just come out of surgery. The father is shivering and, when the thin, white hospital-issue blanket is insufficient, the son sets off on a quest through the hospital—with its “white sheets in a white hallway under white lights”—looking for a “particular kind of patient and family.” He eventually locates a Native man who has an extra Pendleton wool blanket. After a blessing (“It doesn’t matter if you believe in the healing song ... it only matters that the blanket heard”), the son returns to his father and wraps him. The father begins to sing. The son joins in. “The sick and the healthy stopped to listen.” I have always viewed this as nothing more than a heartwarming story.

The roots of my own misunderstanding

As a white American male growing up in the 1960s, I read books that included Native stereotypes, learned the Eurocentric stories of Christopher Columbus, Plymouth Rock, and Thanksgiving, and watched TV Westerns and The Lone Ranger. In school, I dutifully learned about the Oregon Trail and a whitewashed version of America’s Manifest Destiny. I colored maps depicting the Treaty of Paris of 1763 and the Louisiana Purchase of 1803, never recognizing that these lands never belonged to the French in the first place. I studied versions of history written by the dominant culture.

As I moved toward adulthood, I learned about the forced removal of the Cherokee people via the Trail of Tears, the deaths of hundreds of Anishinaabe people in the Sandy Lake Tragedy of 1850, the 1890 Massacre at Wounded Knee, the American Indian Movement’s Wounded Knee occupation in 1973, and the Wisconsin Walleye War of the late 1980s. I read about rural poverty, domestic violence, meth, and alcohol abuse on reservations. The injustices, brutality, and cultural loss that Native peoples had suffered stood in stark contrast to the mythology I had studied as a child.

These competing narratives offered hard lessons, yet the depictions of injustice seemed distant from me and difficult to comprehend. I sensed there was much that I would never understand.

A brief, meaningful experience in understanding and appreciation

In July 2023, eighteen MCW people were graciously welcomed by Ojibwe trainers onto the Lac du Flambeau Reservation in northern Wisconsin.

Brian Jackson, MS, EdD, (spiritual name: Chi Ayaabe or “Big Buck”), led the training. He is an Anishinaabe educator and Assistant Professor in the MCW Institute for Health and Equity’s Division of Epidemiology and Social Sciences.

Dr. Jackson reviewed the development of the 24-session Lac du Flambeau Family Circles AODA Traditional Parenting Program, originally conceived and co-authored by tribal elders Dr. Alton “Sonny” Smart and Ernest St. Germaine. The program builds on traditional Anishinaabe values to enhance physical, emotional, spiritual, and intellectual resilience, awareness, and self- understanding. It guides parents and children to develop new skills while strengthening families and communities.

Educators Melissa Doud and Doreen Wawronowicz walked participants through stories depicting the toll real people have suffered because of historical trauma. They highlighted the role of cultural resilience. Dr. Jackson also shared the history behind Wisconsin Act 31, a 1989 law that requires all Wisconsin public schools to provide instruction on the history, culture and tribal sovereignty of Wisconsin’s eleven nations and tribal communities.

A visit to the Boarding School

We visited a building from the Lac du Flambeau Government Boarding School. It operated from 1895 to 1932 before being converted to a day school. Eventually, the school that was widely reviled by Natives closed. Most of the buildings were demolished. The remaining boy’s dormitory serves as tribal office space and houses a museum.

In the era when the school opened, official U.S. government policy empowered Indian Agents to ensure that Native peoples would be trained to farm successfully and sustainably, be prohibited from using liquor, have their children instructed in English and industrial training, and be restricted to the reservation unless they had travel permits. The school was supposedly designed to accomplish these tasks.

Indian Agents and police patrolled the reservations, looking for children ages five to fifteen. Once they were seized and taken to the school, the students were given English names, their hair was cut, their toys and clothes were confiscated, and they were given uniforms and assigned to a Christian church. They were separated from their siblings.

Speaking Ojibwe was forbidden. Schedules were highly regimented, with bells ringing over twenty times each day to mark different assignments and activities. The goal of the school—and other Indian schools—was to Americanize and “civilize” the students through re-education. The graduates, having been separated from their families for years, emerged prepared for neither the Native nor the non-Native world. They were often lost.

Students, according to the Great Lakes Inter-Tribal Council’s Amy Poupart, program director for the Great Lakes Native American Research Center for Health (GLNARCH), were “processed not parented.” The effects of the stress and trauma suffered by these children has lasted for decades. Melissa Doud quoted Anishinaabe activist, Winona LaDuke, who wrote, “What our Seventh Generation will have is a consequence of our actions today.” The community’s intergenerational pain is best addressed by the Ojibwe people.

MCW researchers, such as Tim Meister and Matthew Dellinger, PhD, were recognized for their long, productive collaborations and respectful partnerships. Projects must be approved by tribal elders, are overseen by NIH-funded NARCH Centers, and adhere to the caveat that policies and practices reflect, “nothing about us without us.”

Moving forward

It will take time for me to revisit and correct the lessons I learned throughout my life. In contrast to the myths I learned about America’s Western expansion, Ojibwe scholar, novelist, and writer, David Treuer, writes, “American did not conquer the West through superior technology, nor did it demonstrate the advantages of democracy. American ‘won’ the West by blood, brutality, and terror.”

Although some have asserted Indian culture was destroyed in the late-1800s, Treuer writes with “the simple, fierce conviction that our cultures are not dead and our civilizations have not been destroyed.”

Each tribe is different from the others and, as non-Natives, we are challenged to not romanticize Natives and Native culture. Native history is complex and multilayered. The communities are active, vibrant, evolving, and resilient. These, too, are hard lessons that I barely understand.

Back to Sherman Alexie’s short story

I started this essay with a feel-good story about a blanket. On further reflection, though, I see the story is also about the father’s impending, premature death from his life choices and his alcoholism, the alienation between the narrator and the dominant culture’s healthcare system, and the very short-lived nature of whatever comfort his father would receive from the wool blanket.

The story ends with a crowd of nonNatives standing in the hallway listening to the father and son sing the healing song. I now see that not one of the hospital employees joined in, celebrated, or offered any form of comfort to the man. Still, one of the nurses—one who had been unresponsive to the man’s suffering earlier in the story—takes a few steps toward the singing. The narrator tells us, “She sighed and smiled. I smiled back. I knew what she was thinking. Sometimes, even after all these years, she could still be surprised by her work. She still marveled at the infinite and ridiculous faith of other people.”

So, to the Ojibwe trainers and people I met, I say Chi Miigwech for the training that has allowed me to take a few steps closer. I hope I have a better understanding and appreciation for the people I met and for the hard work in which they are engaged.

I am grateful to the members of the Lac du Flambeau community who reviewed this essay prior to publication. Special thanks to Carol Amour who told me that many Indigenous and non-Indigenous people have significant issues with Sherman Alexie.

For further reading:

A summary of the visit to Lac du Flambeau:

A summary created by participants Cindy Mann and Tifany Frazer for the MCW Office of Global Health can be found here.

An in-depth journalistic examination of the Native American boarding school system: 

Since the visit to Lac du Flambeau, the New York Times published an investigative study exploring the lasting damage inflicted by the 523 Native American Boarding Schools in the US. This remarkable article, 'War Against the Children," has horrific stories, photos, old documents, historical information, and data. It can be found here.

Upcoming observations:

Sept. 30, 2023 - National Day of Remembrance for Indian Boarding Schools in the United States

Oct. 9, 2023 - Indigenous Peoples’ Day

 

Bruce H. Campbell, MD, FACS, is a retired Professor of Otolaryngology and Communication Sciences at MCW. He is on the editorial board of the Transformational Times.

Take 3: Building a Framework to Acknowledge Indigenous Ways

From the September 22, 2023 issue of the Transformational Times

The Great Lakes Native American Research Center for Health

Take 3 with Brian Jackson, Matt Dellinger and Amy Poupart: Building a Framework to Acknowledge Indigenous Ways

Brian Jackson, Matt Dellinger and Amy Poupart

Leaders who have helped build the alliance between Medical College of Wisconsin and the federally funded Great Lakes Native American Research Center for Health (GLNARCH) share the organization’s funding, goals and future. GLNARCH has established collaborative research, built capacity and promoted science important to the Tribes and Urban Indian organizations within the three-state Indian Health Service (IHS) Bemidji Area ...

Transformational Times (TT): What are the goals of the Great Lakes Native American Research Center for Health?

GLNARCH team: The Center is a collaboration between Great Lakes Inter-Tribal Council (the prime awardee) and the Medical College of Wisconsin (the primary academic partner). The GLNARCH team has also succeeded in securing supplemental financial support from partners such as Forest County Potawatomi Tribe and other Tribal sponsors the Wisconsin Partnership Program, University of Wisconsin (UW) School of Nursing, the UW Native American Health Research Program and Concordia University, as well as Medical College of Wisconsin/Advancing Healthier Wisconsin endowment to support American Indian and Alaska Native (AI/AN) students. Therefore, GLNARCH is a valuable resource for Bemidji region AI/AN communities and the only capacity funding resource for Bemidji Tribal Colleges and Universities.

The GLNARCH program has typically consisted of research/pilot projects, a four-phased student development program, and an administrative component. More recently, the Capacity Component was added as a merger with a previously separate Native American Research Center for Health, the Native Environmental Health Research (Douglas K. Stevens, PhD, Research PI). This merger led to a dedicated Tribal College engagement program that is a major focus of the current center priorities.

The overall aims of the Center are as follows:

• The Student Enhancement Component: Continue the highly successful student enhancement activities and update to modern educational opportunities.
  
• The Capacity Building Component: Build research capacity among Tribal College/Universities (TCUs) and AI/AN serving institution and establish an indigenized research and training agenda.
  
• The Administrative Core: Support all pilot/seed research projects. Ensure Tribes remain central to NARCH. Manage data collection mechanisms for evaluations and quality improvement.

TT: What is an example of how the partnership with MCW’s Epidemiology & Social Sciences Division enhances the work of GLNARCH?

GLNARCH Team: The most recent example of the partnership’s work was the visit by MCW faculty and staff to Lac du Flambeau (See the Executive Summary of the trip). The opportunity was co-funded with a match from MCW acquired by Laura Cassidy, PhD, professor and Director of Epidemiology. That professional development event took place in July of 2023 and included cultural immersion events at the weekly Lac du Flambeau Powwow and historical site visits.

Under the leadership of MCW Department of Epidemiology & Social Sciences faculty members Laura Cassidy and Matthew Dellinger, PhD, the GLNARCH Program has expanded its funding and number of supporting NIH awards. The center is now funded by two concurrent NIH S06 grants with four-year project periods. Under this funding, the team has hosted numerous professional development and community engagement events on the Lac du Flambeau reservation at the Great Lakes Inter-Tribal Council (GLITC).

More events will be planned in partnership with Bemidji area tribal colleges to provide professional development and enrichment for those students and faculty. 

Learn more about the GLNARCH Team here.

TT: What future opportunities do you see? 

GLNARCH Team: The partnership will:

• Build a framework for MCW to acknowledge Indigenous ways of being and serve as a general briefing guide to enhance cultural pedagogy.
• Provide specific orientation and training—including opportunities to share awareness for Indigenous values—that will adapt intervention initiatives and systems to fit cultural contexts within tribal communities.

Brian Jackson, MS EdD, is an assistant professor in the Department of Epidemiology and Social Sciences at MCW. He serves on the Great Lakes Native American Research Center for Health (GLNARCH) Community Scientific Advisory Committee. He is a Family Circles AODA Prevention Program facilitator, providing instruction in language, traditional cultural practices, history, and culture of Native people will be preserved, thereby restoring pride in the identity of Anishnabe.

Matthew Dellinger, PhD, is an associate professor in the Department of Epidemiology and Social Sciences at MCW. He is a co-investigator at the Great Lakes Native American Research Center for Health (GLNARCH).

Amy Poupart is the Program Director for the Native American Research Center for Health (NARCH) at the Great Lakes Inter-Tribal Council and serves on the board of the Northern Highlands AHEC. NARCH is a federally funded program supporting health research, research career enhancement, and research infrastructure enhancement activities.

MCW's Student Assistance Program: Build It, and They Shall Come

From the September 15, 2023 issue of the Transformational Times - Student Mental Health 

Take 3 with Dr. David Cipriano - MCW's Student Assistance Program: Build It, and They Shall Come

Dr. Himanshu Agrawal, co-editor-in-chief of the Transformational Times, converses with Dr. David Cipriano, Director of Student and Resident Behavioral Health at Medical College of Wisconsin, about student mental health services. 

 

As the director of student and resident behavioral health at MCW, what would you say has been the greatest accomplishment that MCW has made in the last five years? 

 

David Cipriano, PhD: I would say that one of the greatest successes we have achieved has been improved accessibility. We accomplished this through increasing the number of sessions that are available to each MCW student at no cost to them (from five sessions to ten sessions per academic year) and through bringing ComPsych, a Student Assistance Program onboard (to increase choices, flexible scheduling and out-of-network care options). This has coincided with an increase in utilization of mental health services by MCW students. Please be on the lookout for a detailed description of these results in an upcoming paper to be published in the Wisconsin Medical Journal. 

 

Our second biggest accomplishment is that we have seen a significant decrease in stigma around mental health in survey data that we have been collecting for several years now. This also undoubtedly contributes to increased utilization of our services.  

 

As the director of student and resident behavioral health at MCW, what will be your top priority for the next five years? 

 

David Cipriano, PhD: We have two top priorities: first, to ensure our clinical services are inclusive and welcoming for all students, including those underrepresented in medicine; secondly, we aspire to increase and improve group offerings. This will include general groups as well as specialty groups.  

 

 

As the director of student and resident behavioral health at MCW, what is the one thing that you wish to say to each student at MCW? 

David Cipriano, PhD: I've said this before and I will say it again — there does not need to be a major crisis or a major diagnosis for you to come to us, to seek help.

The stress of training, moving to a new city, leaving behind your old support system, or any of the myriad of personal situations is reason enough to talk to a therapist for a new perspective, more tools and better coping strategies.

David J. Cipriano, PhD, is a psychologist and an associate professor in the Department of Psychiatry and Behavioral Medicine at MCW. He also serves as the Director of Student and Resident Behavioral Health.