In honor of Native American Heritage Month (also referred to as American Indian and Alaska Native Heritage Month), the Institute intended on centering the voices of the HEAL Initiative’s Indigenous alumni doing impactful work in Indigenous mental health and Indigenous midwifery in our November newsletter. Due to delays in obtaining approvals with Indian Health Services to interview the HEAL alumni, we are bringing this important feature story to you in our December newsletter!

The origins of the United States “contain the historical seeds of genocide,” writes Roxane Dunbar-Ortiz in An Indigenous Peoples History of the United States. “Any true history of the United States must focus on what has happened to (and with) Indigenous peoples and what still happens.” The legacy of colonialism continues today seen in considerable disparities in poverty rates and health outcomes of Native peoples in the United States.  While still not enough, there are more resources being put towards narrowing that disparity by working directly with tribes and Indigenous communities who have been doing the work to fill the gap left by the U.S. government. To support the work of Indigenous healthcare professionals doing this important work, the HEAL (Health, Equity, Action, and Leadership) Initiative began a partnership with the Navajo Nation that led to the participation of over 60 Navajo healthcare professionals to date and over 20 physicians taking permanent positions with the Navajo Nation.

In honor of November’s Native American Heritage Month, we want to share the work of two initiatives led by HEAL alumni with the Navajo Nation sites administered by the Indian Health Services (IHS): The Zero Suicide Initiative at the Gallup Indian Medical Center (GIMC) led by and Adeline June, MPH, Safia Rubaii, MD, MPH, and a community task force and the maternal and child health work at the Northern Navajo Medical Center (NNMC) in Shiprock, NM with Fellow Donna Dineyazhe. Their important work aims to transform health outcomes for the Navajo Nation which can be translated to other Indigenous communities.

The Zero Suicide Initiative

A major effect of intergenerational trauma among Indigenous Americans (classified officially by the U.S. government as American Indian or Alaska Native or AIAN) is an ongoing mental health crisis. Suicide rates among Native Americans are disproportionately higher than the rest of the U.S. population. According to 2021 Centers for Disease Control (CDC) data, suicide rates among AIAN persons are 28.1 to 100,000 people compared to Non-Hispanic White persons at 17.1. Additionally, while suicide rates have been declining for most populations, they have increased by 26% for the AIAN community between 2018-2021. It is these dire statistics and her emergency department work experience that motivated HEAL Fellow and Gallup Indian Medical Center (GIMC) emergency physician, Dr. Safia Rubaii, MD, MPH to coordinate with Adeline June and others in their community task force to write a Zero Suicide Initiative (ZSI) grant as her Master’s in Public Health capstone at UC Berkeley, an opportunity she had because of the HEAL Initiative. “I’ve learned through HEAL that I could actually advocate very successfully,” she says. GIMC was awarded one of 15 grants by IHS to incorporate the Zero Suicide model into their healthcare systems. HEAL Fellow and DrPH candidate, Adeline June was a principal grantwriter and organizer. She coordinates the ZSI program and is helping the center take a comprehensive approach by integrating suicide screening throughout the health center including surgical units, pediatrics, the emergency department, and family medicine.

One of the most important components to the ZSI work is integrating community voice into implementing the screening process. This has been especially important in order to tailor linguistically and culturally appropriate screening tools. “Our tribe does not have a word for suicide and death is a topic we don’t talk about , so we found that when we implemented the Columbia Suicide Severity Rating Scale screening tool, we offended many of our community members,” says June. “We implemented universal screening in the latter part of 2019. Since that time it's gotten a little easier for our community to understand why we ask them about suicidal ideation and why the use of the CSSRS tool is important to prevent suicide.” These tools don’t always translate well. But the team at GIMC has been working to adapt so the tool is useful and effective for their community. June and Dr. Rubaii are seeing incremental improvements through the initiative. They do not see their work specifically as “righting” the wrongs of historical injustices, rather as a means to healing. June sees her work advancing Indigenous health justice. “The U.S. has a responsibility to Indigenous nations that are rooted in treaties and authorized by the US constitution,” she says, “for the most part those treaties don’t seem important [to the government], yet we sacrificed so much.” While funding like that of ZSI is helpful, she admits that more sustainable funding models are needed. “We’ve got a long way to go,” says Dr. Rubaii. "I urge readers to be part of this work with tribal communities and health care systems, including the IHS, and to be a part of our continued improvement process. It's also important for healthcare professionals to encourage all interested individuals in their advancement in health care to further strengthen healthcare for our indigenous communities."

Maternal and Child Health

Studies show that Native American women are much less likely to have adequate access to prenatal healthcare and, likewise, are least likely to initiate prenatal care in the first trimester. As a result, maternal and child health outcomes are greatly affected. According to the Centers for Disease Control (CDC), Native American women are 2-3 times more likely than white women to die from pregnancy related complications. Certified Nurse-Midwife and supervisor of the Midwifery Department at Northern Navajo Health Center, Donna Dineyazhe, is focusing her efforts to improve maternal and fetal outcomes on the Navajo reservation. Being a part of HEAL has allowed her to hear from healthcare practitioners from all over the world.

“We hear stories from our fellow HEAL colleagues in Africa, India, and Mexico and they have similar struggles for resources as we do,” she says. “That's where I feel like we're connected and bonded in that way. There's a common goal and camaraderie, which is unique.” She sees this peer mentorship translating to her work, particularly in how to train her staff to meet patients where they’re at.

"The work I do within IHS is to provide that safe space for our Indigenous women and to provide a culturally competent, evidence-based practices towards the health and well-being of our Native women and families," she says.

Donna’s approach is one of healing and she and her staff listen to and respect the feelings and beliefs of their patients. “Specifically for birth,” she says, “I feel like sharing that knowledge with my colleagues of our perception of birth is very sacred. From the time of conception to post delivery is considered a sacred time for both mom and fetus, so certain teachings and practices are to be followed by the mother and family” and are different from Western society. She brings this perspective to the care of women in an OB/GYN setting and actively spends the time to understand where they are coming from and if there might be a history of trauma. All of this, she believes, leads to better outcomes, more trust, and healing between people in the community and the healthcare center itself.

This is all why Dineyazhe believes Native peoples and healthcare professionals should be at the table and have a voice in making policy decisions. “We need more representation at the clinical level, we need to be a part of the conversations, we need to be a part of medical management policies that are put in place,” she says. She also wants more Native stories and positive stories shared from IHS, such as this one, to demonstrate how and why Native people can and should be at the table and have a voice. This is a place where allies and advocates can help with the cause by learning and sharing these stories and getting involved.

UCGHI is thrilled to have HEAL Advisory Council member and national president-elect of the Association of Native American Medical Students, Alec Calac, as a speaker at UC Global Health Day 2024. Register here!