Culture Is Health

By Karonhiakwe:kon Parker

Just a little over six years ago, I left college and entered a training program to become an EMT (emergency medical technician).  I hated college.  I had just moved from my hometown of Kahnawa:ke, Quebec, a small Indian Reserve in Canada to Salt Lake City, Utah, and felt totally dissatisfied and alone.  I spent a lot of time talking on the phone with family about what I should do and as in most cases, my grandmother had all the answers.  She reminded me that we are Bear Clan, we are supposed to be healers and nurturers, and that if I felt medicine was the path I should take, to take it.  There might have been some yelling in Mohawk on her end, but that was the crux of the conversation.

Emergency medicine was an instant addiction for me.  I loved the adrenaline, the fast-paced nature that required me to think quickly and critically, and initially, the camaraderie involved.  But after a year or so, the shiny gloss started to fall off and I began to notice things I hadn’t before.  EMS, the fire department, and police services are still very much a “boy’s club,” and to me, that was fine.  I’ve always been thick-skinned, I can give as good as I get, and have no problem brushing aside general misogyny bullshit.  I was there to do a job and do it well.  What bothered me more, and more because it affected my patients, was the seemingly inherent racism entrenched in these public services.  For two years, I worked for an ambulance service that covered, among many other areas, a remote Indian Reservation.  Occasionally, we would get dispatched out there for a variety of things.  It was a long drive out there and on the way, the driver and the other EMT would invariably make jokes about how, “it’s just gonna be another drunk Indian,” or “I wonder how this car crash happened.”  And when we got there, their demeanor towards the patient was consistently condescending.  Male patient were always called “Chief,” regardless of the medical nature of the call, the first question was almost always, “how much have you had to drink?”  So I started pushing my way to the front of things, I took complete control of patient care and had my partner ride up front with the driver.  I chalked it up to the fact that this was a rural ambulance service and many of the other paramedics were, for lack of a better word, “country.”  I grew up on an Indian reservation with numerous border towns; these more subtle acts of racism were, keeping with the country theme, not my first rodeo.

I moved on from that job and worked in another state in a busy county jail and drunk tank as a medic.  Again, I loved the work and I liked hearing people’s stories as they came in.  Sadly, many people were regulars and I got to know them as they rotated through the jail and drunk tank on a semi-regular basis.  The city I was working in was very big and if you heard its name, the words progressive and liberal would probably be two of the first to come to mind.  Despite this progressive façade, I found the Native people were treated much the same way as they were at my first job.  And in fact, I was somehow assigned the position as the token Indian Whisperer.  When a Native person in the drunk tank was upset, I was sent in to try and calm them down.  “One of your folks is acting up again, K.”  Again, it didn’t bother me for myself, but for the people I was there to medically serve and protect.  But I did my best and if casual racism was the price for me to pay to keep others safe, then c’est la vie.

Two years at that job and I was ready for a change again.  I moved back to Utah and worked in the emergency room of a level one trauma center hospital.  I found doctors and nurses whom I respected immensely because of their incredible bank of knowledge.  This hospital is one of the premier teaching hospitals in the country and the world and I felt so lucky that I got to work alongside such talented medical professionals.  But during this time, I started to feel ashamed and embarrassed; feelings that I hadn’t been able to identify before at my other jobs, but could now put a name and face to.  When a Native patient came in and was drunk or had uncontrolled diabetes or “fill in the blank stereotype,” I felt shame.  I dreaded hearing the comments of my colleagues, whom I had such immense respect for because of their medical knowledge.  Many Native patients were seen in this emergency room and while I truly don’t believe any of the staff there intentionally treated Native patients with disrespect, the standard of care was vastly different, and in the end, intent or lack thereof, isn’t the problem.

Western medicine is an impressive thing.  It saves millions of lives and improves the quality of living for so many people.  But working in medicine for six years, I realized one thing that Western medicine lacks and that is cultural competency.  Not just for Native peoples, but for anyone non-White and middle-class.  I can only speak from my position as a Native woman and my observations and wouldn’t presume to speak for other cultures.  Please don’t misinterpret me not mentioning those other cultures in this piece as ignoring their struggles in the Western healthcare system.

For many Native cultures, mental well-being is intrinsically tied to physical well-being and what is nowadays dismissed as “kooky backwoods medicine,” has for thousands of years, been a part of our cultures and ceremonies.  During these past six years, I traveled back and forth from Utah to Canada as my grandmother was dying.  She spent a lot of time in hospitals and any effort on our part to incorporate traditional healing practices or prayers into her care were met with derision and scorn.  As they’d say in the South, “bless your heart.”  I tried to act as an intermediary between my family and the medical staff, but even with my medical knowledge, they completely discounted our concerns and questions about my grandmother’s care.  Yes, I told the doctors, I realize many of these things you see as “Indian mumbo-jumbo,” are not going to cure my grandmother’s cancer and they won’t take away all her pain, but this is her culture and what she has known for the last 89 years.  Her mental fortitude and connection to her history as a Mohawk woman is what is giving her the strength to physically fight this disease.

Sadly, my grandmother did die, but happily, she died at home just after telling one of my younger cousins to sit down and be quiet. “Satahonhsatat! Tha’tesatto:tat!”  And she died with her otkon, her spirit, full and happy.  She and I talked a lot during these visits and I told her about my experiences with other doctors and medical providers not factoring cultural practices and their importance into patient care.  Well, mostly I talked and she would stop me now and again to have me repeat something or make a joke about someone.  On one of my last visits before she died, I had been talking to her about mundane things when she suddenly stopped me and said, “culture is health.”  What I had been trying to piece together, unsuccessfully, for the last six years, my grandmother succinctly put into three words. Typical.

Pushing to the back of my mind how much I hated college the first time, I went back, this time majoring in Health Promotion and Education with a Community Health Emphasis.  Although I don’t need a college degree for me to know that my grandmother was right, I do need one to share that message with people who otherwise would never hear it or give credence to that idea.  As Native people, our connections to our history and culture are intertwined with every facet of health: physical, emotional, mental, spiritual, and environmental.  The recognition of this truth by Western medical providers is crucial, no one entity has all the answers for all the problems.  So, I suppose this piece is my introduction and my conclusion.  It’s my introduction to my goals and my purpose and my conclusion to the shame I felt and the words I never said, but am saying now.  Culture is health.