Eastern Band of Cherokee launches culture-based health care initiative

CHEROKEE, N.C. - Prompted by a growing disparity between the health of Native peoples versus other U.S. populations, the Eastern Band of Cherokee Indians is leading an effort to address cultural distinctions that Western medicine overlooks in delivering health care to Native peoples in the South and East.

After two years of preparation and planning, Western Carolina University, in Cullowhee, and Wake Forest University, in Winston-Salem, have partnered with the Eastern Band to launch the Culturally Based Native Health Program. The initiative adopts a multipart approach that includes graduate-level certification in different aspects of Native health and an introduction to health care opportunities for Eastern Band youth.

''This is something very novel in the history of Indian health care,'' said program director Lisa Lefler, a faculty member in the Cherokee Studies program at Western Carolina University. Other initiatives have addressed Native health disparities, Lefler said, but the CBNHP is the first to focus specifically on tribes in the South and the East. Her hope is that the program will grow to include all such tribes.

The goal of the 15-hour graduate certification is to educate health care professionals working throughout Indian country about cultural appropriateness when interacting with Native patients. Many non-Native health care professionals are unaware of the nuances surrounding Native health care. For instance, they might not realize the long, complicated health care relationship between Natives and the federal government, or understand cultural protocol related to age, sex and degree of acculturation. Language also can be a barrier, resulting in a patient or doctor miscomprehending a diagnosis or condition.

''With a cultural foundation present, the relationship between provider and patient is strengthened and there is less room for noncompliance and misunderstanding,'' said CBNHP advisory council member Susan Leading Fox, deputy health officer with the Eastern Band's Health and Medical Division, and a member of the Eastern Band. She said the program also benefits tribe members who work in the health care field because it ''strengthens their ability to cross that bridge between being a community member and a medical provider.''

The courses cover four fields of Native health care: administration, behavioral health, clinical care, and culture and history. Native peoples partner with faculty members to develop the courses. Lefler, who holds a doctorate in medical anthropology, has partnered with Tom Belt, a member of the Cherokee Keetoowah Society, to develop anthropology courses on Indian health and tobacco and substance abuse. Other faculty members include Natives and non-Natives from Wake Forest, the University of Tennessee, Clemson University and the University of West Virginia. Classes are online so that distance education is possible. The certification, which WCU is scheduled to give final approval in May, also requires a one-week field study on the Qualla Boundary, homeland of the Eastern Band.

While the graduate curriculum is geared toward professionals, the CBNHP also extends itself to Eastern Band youth with the initiative Medical Career Counseling and Technologies. Based on the established, problem-based methodology of the Center of Excellence for Research, Teaching and Learning at Wake Forest University School of Medicine, MEDCAT will introduce young people to career paths in the health field with mentoring, training, summer programs and research opportunities. Training for instructors is under way, and the first class of 15 MEDCAT students and five instructors is scheduled for summer 2008 at Wake Forest University.

''We just want to create a whole package that would answer all the different questions that students have in regard to going to college and having a medical career,'' said Ulrike Wiethaus, a professor in Wake's humanities program, co-director of MEDCAT and an advisory council member with the CBNHP.

Elizabeth Butler, a registered nurse and health occupations teacher at Robbinsville High School in Graham County, underwent preliminary MEDCAT training at Wake Forest and is excited about the potential opportunity for her school's 33 Eastern Band students.

''If we can spark their interest, I'm all for it,'' Butler said.

A career in the medical field already has the attention of Eastern Band member Lucretia Hicks, 18. Hicks, a pre-med student at Wake Forest, is leaning toward medical or nursing school. While not a part of the MEDCAT program, she believes strongly in Natives serving Natives in health care.

''I think it's always easier if you can relate to the people helping you,'' Hicks said. A 2006 graduate of Cherokee High School, Hicks said several of her former classmates have decided to enter the nursing field.

Jill Ingram has written about and worked for the Eastern Band of Cherokee Indians and is a graduate student in history, Cherokee Studies track, at Western Carolina University.