Cultural Aspects of Care at Native American Health Center

by Sandra Tavel, Grants & Contracts Administrator

“Cultural Humility:  A lifelong process of self-reflection and self-critique.  The starting point for such an approach is not an examination of the client’s belief system, but rather having health care/service providers give careful consideration to their assumptions and beliefs that are embedded in their  own understandings and goals of their encounter with the client.”

-Dr. Melanie Tervalon and Jann Murray-Garcia

Native American Health Center, Inc. (NAHC) is a community clinic that serves approximately 12,000 patients per year and offers medical, dental, behavioral health and WIC services to American Indians and Alaska Natives, as well as anyone who is uninsured or has Medi-Cal in the five-county, San Francisco Bay Area.  There are no tribal or ethnic requirements to become a patient at NAHC.  Since its inception in 1972, NAHC has seen its patient/client population change, but it has always been diverse.  There are 468 federally recognized tribes in the United States.  American Indians and Alaska Natives from all nations came to the San Francisco Bay Area from 1952-1972 under the federal Relocation program that courted young, single people living on reservations to move to major urban areas to assimilate into mainstream society.  The government promised housing, jobs and education and delivered on its agreements inconsistently enough to leave a large population in an unfamiliar place to fend for themselves.  That’s how NAHC began—as a response to injustices that called for basic rights for American Indians and Alaska Natives.  NAHC has always moved from the belief that health care is a basic human right and not a privilege.

NAHC offers American Indian, culturally specific programs and activities for American Indians living in the area, as well as health services to a wide array of patients and clients from all races, ethnicities and cultures, as they reflect the surrounding neighborhoods and communities in which our sites are housed.  We are unique because we aren’t an I.H.S. (Indian Health Service) clinic and we serve everyone.  The first thing one could notice when they walk into our clinics is exactly how diverse our staff is—they reflect the community we serve.  Our Chief Health Officer, Dr. Linda Aranaydo, is Muscogee-Creek and Filipina.  She grew up in Oakland and started at NAHC as a medical assistant. She put herself through medical school; worked in her homeland in Oklahoma; and returned to the Bay Area to work for NAHC.  Many of our licensed medical and dental providers also have an MPH (master’s in public health) which speaks to their commitment to community health.  Our Associate Medical Director, Dr. Fumi Suzuki, calls community health the last arena where we can affect social justice.  Many of her colleagues share that sentiment.  A diverse workforce is certainly part of Cultural Competence, but what exactly does the term even mean?

Sandy White Hawk, a Sincagu Lakota woman committed to rehabilitating the foster care system for American Indian children and families taught a class on cultural competence that was funded by the California Endowment a year or two ago.  She said, “cultural competence is a fancy term that someone made up while they were writing a grant.”  She proposed that the idea that cultural competence feels daunting because it makes us feel as if we must be proficient and already know cultural nuances for everyone we meet that is different from us.  Instead, we should cultivate the skills to listen respectfully to what our clients value; have a deep understanding of our own values and triggers; and self-manage ourselves to the point where our patients and clients feel heard, seen and respected:  cultural humility.

One of the ways NAHC informs this concept is that all existing and new employees are taught about American Indians in the Bay Area—how they got here; the history behind Relocation and NAHC’s response to it; historical trauma; and cultural humility.  This teaching is part of all new hire orientations and there is always a cultural aspect discussed when NAHC hosts large meetings or trainings for staff.  The American Indian population within NAHC’s patient base experiences the same health issues as other disenfranchised communities:  type 2 diabetes, substance use/abuse, domestic violence, suicide and poverty.  NAHC has always offered, “wrap-around” care that addresses the health of the entire individual instead of treating single symptoms and issues in isolation.  In addition to offering holistic care, NAHC addresses cultural aspects by connecting American Indian patients to a culturally specific event and easing the point of entry into medical care from there.  In many cases, it’s more palatable for a middle-aged, American Indian man to attend drum practice than it is for them to come in and receive counseling on weight management or smoking cessation.  The latter items are certainly important—but so is the point of entry.  NAHC has connected many of its patients and clients to cultural aspects that have brought them closer to consistent medical care.  We have conducted Naming Ceremonies for babies in the community; hosted a “Wiping of the Tears,” Ceremony facilitated by a traditional consultant that dealt with the impact historical trauma has had on most of our patients; and hosts weekly traditional arts classes at no cost to the participants—just to name a few.  NAHC ‘s contention is that if we can ease our patients into care by offering the peer support and encouragement that happens in culturally specific groups, we may have higher success rates of patients staying engaged in care.  NAHC also believes that if we set an expectation for all staff to know their own values and triggers and to self-manage to the point where all clients and patients feel seen, heard and respected—we are following our mission to serve those for whom mainstream systems of care do not work.