I double-checked my toothbrush was packed, tucked in my guidebook to the National Parks, and looked over the draft of my first lesson, entitled “Public Health Interventions.” I thought that my checklist was all I needed to work on the Spirit Lake reservation for the summer teaching a public health course at the local tribal college, Cankdeska Cikana Community College (CCCC). However, my Native students would soon show me that nothing could have prepared me for the people, stories, and unsolved conflicts that awaited me there.
While I had studied the health statistics of Native communities—such as the O’odham of Arizona possessing the highest prevalence of obesity and non-insulin dependent diabetes mellitus in the world, and American Indian teenagers claiming the highest rate of suicide in the United States—I did not fully comprehend the disproportionate disease burden afflicting them. Over the span of that one summer, the students at CCCC quickly changed that.
The course I was to teach—Introduction to Community and Public Health—had been designed and previously taught by public health and medical students like me from the Icahn School of Medicine at Mount Sinai and the Columbia University Mailman School of Public Health, both in New York City. Every summer, the partnership among these institutions provided a new group of student-teachers with the opportunity to teach and live in a rural tribal community. The purpose of the course was to increase tribal college students’ public health knowledge and interest in pursuing a career in the health professions. We aimed to enhance their public health knowledge through lectures on topics ranging from public health interventions to maternal and infant health, interactive group projects, discussions with public health experts in the community, and presentations by an array of healthcare providers who shared stories and knowledge of their professions.
As educators, we must expand tribal college students’ perception of healthcare careers.
As we taught our course, we spoke about many public health issues common in Native communities. Our students, many of whom experienced these public health challenges directly, nodded in agreement and often shared their first-hand experiences. They spoke about the succession of youth suicides and their impact on the CCCC students and community. Today, I continue to interact with my students on social media and see the hardships they continually face, such as mourning friends and family lost to suicide or car accidents and questioning their own ability to pursue college.
Despite American Indian communities suffering disproportionately from disease morbidity and mortality, the number of Native students applying and being admitted to medical school and other health professions is declining (Association of American Medical Colleges 2006). The decreased number of Native healthcare providers leads to fewer culturally concordant providers caring for their own communities. I believe the staggering health, social, and economic factors afflicting these communities put Native students at a disadvantage to pursue public health careers from the beginning.
The primary education that American Indian students receive on reservations is often inferior to that received in other areas of the country (National Conference of State Legislatures, 2008). In 2011, Native students had the lowest rate of high school graduation out of any racial or ethnic group in the United States (National Indian Education Association, 2012). I also learned that some of my students were discouraged from pursuing higher education due to their families’ and friends’ fears that they would have to leave the reservation for their education, may not return, and would somehow feel superior to those in their community upon completion of their studies. When I asked one of our students if she had ever considered medical school, she confided, “People told me that medical school would be too hard for me. So I didn’t try.” Another said, “I’m afraid my family won’t accept me after I go to college. They’ll say I’m too smart for my own good.”
While many of the students I spoke to expressed interest in nursing careers, few indicated interest in other health fields. As educators, we must expand tribal college students’ perception of healthcare careers—whether it be as a home health aide, certified nurse assistant, medical assistant, social worker, public health advocate, physical therapist, paramedic, physician’s assistant, pharmacist, or medical doctor. There’s a staggering number of healthcare careers available today. In addition, Native students who become healthcare providers are enticed to work outside of their home communities due to the more generous benefits, which only perpetuates the lack of Native healthcare providers. The question remains—how do we break this cycle and empower Native populations in the United States?
In order to assess the impact of our Introduction to Community and Public Health course, we distributed a survey to the students at the beginning and conclusion of the course. The 30-question survey measured the course’s main objectives, which were to expose students to a survey of major topics in public health with an emphasis on American Indian health, introduce students to a variety of public health careers, and to measure their attitudes and intentions towards pursuing health careers. We hypothesized that participation in the health professions and a public health educational intervention would boost their public health knowledge and increase the likelihood that they would consider pursuing a career in the health professions. Overall, we discovered that students had an increase of knowledge in defining public health, recognizing important public health issues, and identifying American Indian health issues. Further, participants felt empowered that they could make a difference in the health of their community.
It is well known that Native communities experience poorer health outcomes when compared with other populations in the United States. While resources are focused on combatting these American Indian public health challenges, more must be done to ensure that young Native people are empowered and educated regarding the wide array of healthcare careers available to them. We must work to create the infrastructure to support them in the pursuit of these careers and to change the cultural perception around pursuing higher education in order to bring that service and knowledge home.
Editor’s Note: For a more detailed look at the research project’s methods and results, see Loretta Heueur’s web-exclusive feature.
Marielle Christine Leilani Young is Native Hawai’ian and a third-year medical student at the Icahn School of Medicine at Mount Sinai in New York City.
Association of American Medical Colleges. (2006). New Analysis Reveals Growing Gap Between Undergraduates and Medical School Applicants. Retrieved from http://www.newswise.com/articles/new-analysis-revealsgrowing- gap-between-undergraduates-and-medical-school-applicants
National Conference of State Legislatures. (2008). Striving to Achieve: Helping Native American Students Succeed. Retrieved from http://www.ncsl.org /research/state-tribal-institute/striving-to-achieve-helping-native-americanstude.aspx
National Indian Education Association. (2012). Statistics on Native Students. Retrieved from http://www.niea.org/research/statistics.aspx