Native communities need doctors with the medical and cultural skills to work in Indian Country. "Native Pathways" is recruiting future doctors from the very people the program will serve.Sammi Jo Goodwin, a member of the Karuk tribe in Northern California, was working as an Indian education tutor when she was 14 and had her first child while she was still in high school. With that much responsibility weighing on her, the now 21-year-old admitted, “College was just not on my radar.” That is until recently when, she says, a trip to Illinois put her on the path to medical school.
Goodwin was one of three young tribal members from Northern California who recently traveled to the University of Illinois in Rockford for a three-day event hosted by the National Center for Rural Health Professions (NCRHP). At the NCRHP event, they were joined by Native American students from Wyoming to learn more about the university and a new Native Pathways program designed to recruit American Indian/Alaska Native (AI/NA) students. This project, encourages AI/NA youth to pursue healthcare professions and return home to practice.
The project is bearing fruit for Goodwin, who subsequently decided to enroll in college and pursue medical training. Though any medical degree is years away, the need for her skills will likely still be there in the future.
“There is a strong need for healthcare providers in rural areas, and the challenges facing Indian Country are even worse,” said Terry Supahan, a rural advocate and member of the Karuk tribe in Northern California. Supahan volunteered to accompany the three young tribal members to Illinois to be part of the Native Pathways Project, formally known as “Development of Recruitment Pathways and Support Systems for Native American Health Professionals: Meeting Healthcare Needs through Culturally-Appropriate Care.” He wanted to help because Native Americans tend to be more isolated, suffer more significant health problems than even rural populations and desperately need a host of medical professionals to serve them, he said.
About a third of Native Americans live below the poverty line, compared to 13% of all Americans, according to U.S. Department of Health and Human Services. Native Americans also suffer high death rates from alcoholism, diabetes, accidents, suicides, homicide and other causes, resulting in a life expectancy that is six years lower than the U.S. average.
For the last 20 years, the NCRHP has been recruiting future healthcare professionals from rural areas with the goal of returning graduates to their communities of origin to practice. Now they are expanding the program to target tribal communities. “There are not enough rural health care professionals that understand the unique culture and dynamics of rural life and this is even truer for Native Americans,” said Michael Glasser, director of the NCRHP.
Recruiting Native Americans for the program won’t necessarily be easy. “For most Native American students, the hurdle will be getting them to come here in the first place,” Glasser said. “Convincing them to go home again is not an issue.”
Supahan agreed. “I’ve heard local youth say it feels like you need a passport to travel outside Indian Country,” he said. “It is very difficult to understand and appreciate the challenges inherent in living in such an isolated area. The sheer size and distances between different tribal communities. The hours-long drive to the airport. Those feelings of isolation make it much less likely that tribal students will consider an education elsewhere.”
“Rural Times 10”
“This place is rural times 10,” said Goodwin of her home in Northern California. “Some people here have no running water and still get their electricity from a generator or pelton wheel,” a type of water wheel.
Goodwin grew up in Somes Bar (population 300), located in the heart of Indian Country. The Karuk consider the village of Katimiin, near Somes Bar, the Center of the World and Goodwin’s father is a ceremonial leader. She speaks a little of the tribal language and was raised on the river eating freshly caught salmon and acorns gathered from the nearby oaks.
Goodwin now has a second child and lives in Orleans, which is a few miles west of Somes Bar and has a population of about 600. She works as a medical assistant at the tribal clinic. “But the facility has no M.D.,” she said out, and the closest physician is an hour’s drive away. The nearest hospital is two. “We have no X-ray machine. No obstetrician. People here deliver babies, but they have no formal training.”
In true small-town fashion, Goodwin heard about the Native Pathways program by word of mouth from Terry Supahan’s son. She expressed an interest and hours later received an invitation to attend the Exploration Week.
“It opened my eyes,” she said. “I am a Native American and from a very small area. If I can become a medical doctor with the challenges I have, anyone can do it. The trail will be blazed. I want to help and inspire someone that way.”
Despite her enthusiasm, Goodwin knows the path won’t be easy. On her trip to Exploration event, she appreciated the Chicago skyline but the flat landscape and polluted waters felt foreign. “But we were able to get a feel for the school and area,” she said, adding that Dr. Glasser and the staff worked hard to make it feel “homey.” “I knew I was away from home but that it could be home and that was a motivating part. I felt like the people there wouldn’t let you fail.” Goodwin said it also helped to have other Native American students with her during the week. “We could relate to each other even though we live far away. We grew up with same stuff so I felt secure and like I didn’t have to explain everything.”
“These kids are coming from a strong Native American community and have no experience outside of that, which creates a significant cultural divide,” Supahan said. “Home is comfortable and where they are with people that have shared experiences with since birth. Leaving can be lonely. Fortunately this program creates cohorts of Native students that receive the support and encouragement of their peers, which can make all the difference.”
Local Native American culture doesn’t have a historic tradition of pursuing a graduate education. Going against societal norms may make attending the program even more difficult, Supahan said. “Fortunately this program offers a group of professionals who wants you to be there and succeed and will work hard to help you. And that’s gold.”
Sawar Young-Tripp, a Native American tribal member and practicing medical doctor, agreed that finding support, a sense of community and home away from home is critical to long term educational success.
Young-Tripp spent first five years of her life in the isolated mountain town of Weichpec, about 20 miles from Orleans, on the edge of the river with no running water and no electricity. She moved from a community of fewer than 150 people to “town,” with population of about 15,000, in elementary school and was fortunate to have teachers who recognized and encouraged her interest in math and science. They launched her on a series of pathway programs designed to encourage girls, and then Native American students, to pursue careers they may not consider otherwise.
With the support of many strong mentors, Young-Tripp attended a local university, intending to pursue a Ph.D. path. “But when I had my first child [while attending school] I realized I wanted to make the world a better place,” she said. She switched to an M.D. path, which eventually lead to the University of Washington Medical School and a program that emphasized rural and Native care.
“First I had to accept that by going to college I was doing something no one in my family had done, which was isolating, “ she remembered. “It was huge to feel part of program, like I belonged and was supported by both the students and instructors. “
After medical school, she practiced throughout the West Coast before returning to Northern California eight months ago. “My goal was always to end up back here,” she said.
Young-Tripp now works as a clinician for the local United Indian Health Services doing direct care for Native patients and their families.
“Many Indian people are dealing with historic trauma that has resulted in a distrust of authority,” she said, adding that they also often have more complicated health issues than the general population and that providers face cultural barriers as well. “I am always trying to identify and break down barriers to good medical care and I need to be sensitive in order to bridge the Native and medical culture. When you walk in room you introduce yourself with a soft handshake and often no eye contact. You need to come in with a sense humility and respect for the patient that isn’t always common in the medical field.”
Young-Tripp knows that a common background also helps. Her family attends the cultural dances and ceremonies that are so important to the Native culture. “It helps to build that trust and show that I am part of the circle and understand our culture.”
Already a Success
Sammi Jo Goodwin also hopes to bring a combination of expertise and cultural understanding back home to help her community. “I want to be like a modern day Dr. Quinn medicine woman,” she said. “Backwoods. If someone falls down the stairs at midnight I want them to call me. Our community is lacking someone who will do that.”
Goodwin knows she has a long way to go but is enrolled at a local college and is determined to complete her education.
“I know I am only at the beginning of my journey,” she said, “but I am only 21. By time I am 31, I will be an M.D. in family practice. My daughters will be 14 and 10 when their mother becomes a doctor.” And those are sculpting years she said, when they will decide their direction and know their mom went to medical school.
“I want to open their eyes. Our sense of the world can be like a bee hive. So small. But that trip was a turning point in my life and I don’t want it to stop. Like it started an engine and now I’m ready to go.”
Readers seeking more information about the Native Healthcare Pathways program may contact Dr. Michael Glasser, Ph.D., at firstname.lastname@example.org.