By: Amanda Schoenberg/Journal Staff writer on Monday, Aug 15, 2011
As children, Lisa Antonio of Laguna Pueblo and Raelene Zospah, who is Navajo, remember visiting Indian Health Service hospitals with their worried grandmothers.
“I always saw her get nervous, and she would hold my mom’s hand,” says Antonio.
Those early experiences with what they saw as a flawed health care system marked by long waits and insufficient information led both to pursue medicine.
The Center for Native American Health at UNM accepts donations to help Native medical students with extra expenses, such as trips home for tribal ceremonies. For information call 272-4100.
In July, Antonio, 22, started medical school at the University of New Mexico. Zospah, 33, entered her third year. Antonio and Zospah join a total of 20 Native American medical students at UNM, including four entering students. Last year, the first for the BA/MD program at UNM, the number of medical students jumped from 77 to 94. Since 2007, four Native American students entered each year, apart from 2009, when nine students entered UNM.
The numbers fall short of representing the state’s Native population. Among New Mexico’s more than 2 million people, those who identify as American Indian or Alaskan Natives made up 9.4 percent of the population in 2010, according to the Census Bureau. People who identify as American Indian and another race were 10.7 percent.
UNM is working to increase the number of Native students with recruiting efforts and help navigating the complex medical school entry process.
When Dr. Gayle DinéChacon graduated in 1993, she was the only Native student in her medical school class. DinéChacon, associate professor in the Department of Family & Community Medicine and director of the Center for Native American Health at UNM, says the experience was “very lonely and very isolating.” She was far from family and her larger community in Chinle, Ariz., and they didn’t understand the challenge of attending medical school while raising three children.
Balancing school and culture was sometimes difficult. Going home for a tribal ceremony was not frowned upon by the school but wasn’t supported either. Those kinds of dilemmas can affect student success, she says.
“If you’re not supposed to go home, if you feel guilty that you have to even ask, that affects your relationship with home, that affects your own spirituality,” she says.
DinéChacon remembers walking around UNM and spotting one student who looked like her. The third-year student, Cleora Shunkamolah, now a doctor in Oklahoma, asked if she wanted to meet for coffee.
“She immediately became a role model,” DinéChacon says. “It was really finding someone who understood.”
UNM as a magnet
While the numbers have improved, work is still needed to make UNM a magnet for Native medical students, DinéChacon says.
“I think we’re doing better than the rest of the nation,” she says. “We’re probably carrying the load for other schools. But we certainly need to do better just to catch up.”
Efforts include a free MCAT course for students in underserved communities and those who are “educationally disadvantaged,” students who didn’t have laboratories or AP courses at school, says Marlene Ballejos, assistant dean for admissions at UNM’s School of Medicine.
In April, UNM’s School of Medicine hosted the first pre-admission workshop for Native students with the Four Corners Alliance, including medical schools in Utah, Arizona, New Mexico and Colorado, and the Association for American Indian Physicians. UNM also reaches out to Native high school and middle school students.
Since 2009, Native students studying for health careers at UNM have a place of their own. At the Ervin Lewis Native American Center, students can gather to study, meet with tribal leaders or use resources like books on Navajo diagnostic terms.
Zospah often eats lunch there to laugh and unwind. She also frequents the Center for Native American Health at UNM, calling it her “saving grace.” As the first person in her family to graduate from college, Zospah says she needed to connect with people like DinéChacon who understand her cultural life and medical school experience.
“I would just go and talk to them like they were my aunties,” she says. “I don’t know if I would have been able to do this without them.”
Nationwide, the number of Native medical students remains low. Between 1978 and 2008, 75 percent of medical school graduates were white, 6.3 percent were African American, 5.5 percent were Hispanic or Latino and 0.5 percent were American Indian or Alaska natives, according to the Association of American Medical Colleges.
In 2010, 2.9 million people described themselves as American Indian or Alaskan natives, about 0.9 percent of the population. More than 5.2 million people, or 1.7 percent, said they were American Indian and another race.
To create a pipeline for Native doctors, the Indian Health Service funds a scholarship for 56 medical students per year, says Dr. Carmen Clelland, a doctor of pharmacy and director of the division of health profession support for IHS.
Getting more Native students into medical school means focusing on education on reservations, DinéChacon says. Parents also need help understanding medical school. She also advocates better relationships with tribes so new Native doctors can find land and housing if they go home.
By the time she was a sophomore in high school, Antonio knew she wanted to be a doctor. She wants to return to Laguna Pueblo to improve the health system.
Antonio, whose father was governor of Laguna for four years, watched her siblings finish higher education. One brother graduated from dental school, her sister has a master’s degree in social work and a brother has a degree in computer animation. Support and strong role models helped her succeed, she says.
“Not a lot of kids have that on the reservations,” she says.
After leaving home at 14 to attend high school in Utah, Zospah attended community college, then completed her degree at Montana State.
Leaving home meant losing touch with her community, she says. Zospah, who spent the summer studying for her board exam in Kansas, chose UNM because she wanted to work with Native patients. She plans to return to Shiprock to practice.
When she watched doctors interact with her grandmother, she remembers that they didn’t explain what they were doing. Navajo elders also tend not to ask a lot of questions, she says.
In her first year, she did a rotation at the IHS hospital in Shiprock, which she says opened her eyes to the complexity of the system. Problems were not always because of a doctor’s misunderstanding or cultural insensitivity, she says. Sometimes their hands were tied when it came to the resources they could offer patients, she says.
Zospah and Antonio say many elders do not trust the health system, in part because IHS doctors cycle through hospitals quickly.
As a doctor, Zospah hopes to earn her patients’ trust.
“I understand that they had to take two hours to get to the hospital,” she says. “I understand that they had to leave their herd. I understand their situation, their lifestyle, their language.”
Studies show that minority doctors are more likely to work in underserved populations. More Native doctors means more people familiar with Native patients, Clelland says. This does not mean other doctors can’t relate to Native patients but a shared cultural life does offer a sense of familiarity, Clelland says.
While Native students can benefit their communities, they should not be expected to return home, DinéChacon says.
“I don’t expect every student to go back to the reservation,” she says. “There have to be opportunities for them to be surgeons general, academics and policy makers at the state and federal level.”
Read more: ABQJournal Online » Outreach to Indians http://www.abqjournal.com/main/2011/08/15/health/outreach-to-indians.html