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Bundles of cedar, sage, and sweetgrass sit on a shelf in a student lounge at the University of Minnesota Medical School’s Duluth Campus. Native American art decorates the walls.
Throughout the day, Native medical students drop by the school’s Center of American Indian and Minority Health for a break and to connect with other Native students.
For many of them, the center is essential to their med school experience. Native students say they often experience less support and understanding in academic settings than their white peers. When their history and trauma are acknowledged and honored, even in small ways, they are more likely to succeed, they say.
Cailean Dakota MacColl, who uses they/them pronouns, stops by before anatomy class work with cadavers, honoring their mother’s Plains Cree/Métis teaching to wash one’s face with medicine water in the presence of death.
Since it opened in 1972, the medical school’s Duluth campus has prioritized Native American education. It’s also believed to be the only school in the country to require eight hours of instruction on treating Native Americans.
The school has produced more Native American med school graduates than almost any other school in the country. But that number is still low: This school year’s incoming class enrolled five Indigenous students.
Native Americans make up well under 1 percent of medical school students in the United States, a number that doesn’t reflect the 2 percent of Native Americans in the U.S. population.
Dr. Mary Owen works tirelessly toward increasing prospects for Native Americans in medicine: As director of the center, she leads a group that seeks to ensure that Native Americans across the country have a pathway into medicine—starting in kindergarten. She encourages other medical schools to adopt course requirements for Native American health education, provides clinical care at the Center of American Indian Resources in Duluth, and serves as president of the Association of American Indian Physicians.
Owen and current students say connecting with each other is invaluable to their medical school education, and ultimately improves the health of the Native American population.
ZhaaZhaa Greensky, 26, first-year medical student, Anashinaabe
ZhaaZhaa Greensky of Marble, Minnesota, remembers two moments pivotal in her decision to pursue a career in medicine. Growing up with elderly grandparents, she often helped her grandmother take her medications and accompanied her to clinic appointments. When she was 8, she visited her grandmother in the hospital. Her grandmother’s leg was bothering her, so Greensky repositioned the pillow to better support it.
“My grandma looked at me and she said something like, ‘You’ve done that better than any nurse I’ve ever had,’” Greensky said. “I started to realize that I really liked taking care of people.”
A couple of years later, a favorite teacher in elementary school challenged her when she said she wanted to be a nurse.
“Why stop there?” the teacher asked. “You could be a doctor.”
Greensky had never considered it, but that launched her journey to become a doctor.
Her decision was validated when her sister and father both had negative experiences with the medical system: A botched surgery to fix a broken hip resulted in three years of pain for her older sister, and accusations of pill-seeking and not following up with her physical therapy.
In another instance, Greensky’s father sought a second opinion about a blood infection when a doctor wanted to amputate his arm at the elbow. Another provider recognized that he needed only a finger removed.
Greensky started wondering: Would the first doctor have made that decision for any patient, or was it happening because her dad presents as very Native?
She realized she would never know for certain.
“These life experiences have pushed me into recognizing that health disparities exist in my community,” she said. “While some people do really, really, care a lot, others don’t.”
After graduating from Michigan Tech, where she met few other Native people, Greensky was thrilled to find the community at the Duluth center this year.
“It’s very hard for an Indigenous person to go through an academic setting,” she said.
“Our perspective isn’t inherently valued the same way as the mainstream.”
Before her first anatomy lab, Greensky participated in a smudging ceremony offered by the center and the Association of Native American Medical Students.
”We were smudging ourselves to prepare us to be working with anatomy patients,” Greensky said. “They had an elder come in and do a prayer. That was extremely helpful to me.”
Putting cedar in her shoes and sage next to her heart and having a Native classmate to check in with made all the difference, she said. It was the first time she had experienced that kind of support from Native peers and leaders in her academic experience.
Greensky’s dream is to practice family medicine on Minnesota’s Fond du Lac Reservation.
“I don’t think I would be willing to endure all the things I had to endure just for myself,” she said. “But to be able to help my community in a way that wasn’t available to my grandma, sister, and father—that is what gets me through the end of the day.”
Cailean Dakota MacColl, 29, first-year medical student, Cree/Metis
At home in Oregon, MacColl grew up with her “savant-level smart” surgeon dad and her writer mother, “a free-spirited medium who chases spirits around the house and writes poetry.”
MacColl remembers running around the hospital where their dad worked, occasionally getting to glimpse him in surgery. They grew up hearing stories of their grandmother nursing men with chainsaw injuries. She would treat them in her kitchen in the Saskatchewan bush, receiving instructions on how to sew them up over a ham radio.
Their other grandmother served her Cree community as a traditional medicine woman with “a good bundle and a bad bundle,” MacColl said. People who wronged their grandmother, MacColl said, seemed to pay for it later.
There was a family expectation for MacColl to go into medicine. But a sexual assault at age 15 near the family’s summer lake home in northern Canada derailed MacColl’s life during high school.
“When I went to the ER, the people in the ER asked if I was Native, and when I said yes, why I didn’t go somewhere else,” they said. “The reasoning they gave me is that ‘You Natives usually have brutal assaults but never get rape kits done, so we just patch you up and send you back. The [other] hospital is more equipped to do a rape kit unless you have any injuries you need us to address.’ So, part of it was the rurality, part of it was racism.”
MacColl and their family pushed to get a rape kit done at the rural hospital to avoid further delays. They were successful, but “it was a really traumatic experience.” Their case was eventually thrown out, MacColl said. “The crown prosecutor said, ‘That young man has his whole life ahead of him, and he seemed very sorry for what happened.’”
Afterward, MacColl was diagnosed with PTSD and depression and dropped all academic endeavors for a time.
“I was 100 percent going to drop out of school,” they said. With no plans to go to college, they started DJ’ing.
But when MacColl’s older sister got sick, MacColl became her caretaker. They cleaned equipment, took care of infections, and supervised medication as the sister went through surgery after her colon was removed due to ulcerative colitis. It was humbling, MacColl said, but it also became obvious that they had a knack for it.
“I couldn’t escape that call,” MacColl said. “My ancestors were calling me back to that healing space.”
Eventually, they realized that medical school would be a way to bridge their two academic worlds and hopefully blend a Western medical career with traditional cultural knowledge and practices.
As MacColl studied for the medical college admission test, though, their dad was diagnosed with cancer, and an Indigenous community in Canada discovered a mass grave of children. Waves of grief, panic and pain washed over them, and they knew they needed to find a school that would understand their trauma and honor their desire to combine two worlds.
So when they discovered the Duluth campus of the University of Minnesota, they were intrigued. And when MacColl met Dr. Owen for an interview, “I just had this relief,” they said. “It was like talking to an auntie.”
When MacColl asked Dr. Owen whether they would be allowed to attend the school if they got a traditional face tattoo, Dr. Owen replied, “Of course!”
MacColl said seemingly small gestures, such as a pride flag displayed in the main student lounge and the herbs in the center’s lounge, have made her feel affirmed. It was something her dad never had during med school. During a recent reunion, he cried when he saw that the school had placed a Metis sash, a garment that can be worn around the waist or the shoulder or used for decoration, on the podium.
“We’re really traditional people, but we have really nontraditional stories, and this school gave us the chance to be ourselves,” MacColl said. “The more people who can see themselves as people in white coats, that’s how we live representation. The more people like us who take up spaces, with bigger bodies, tattoos, negative experiences, and can still become doctors—that is helpful to our communities.”
Dr. Mary Owen, UMN grad, Tlingit
Dr. Mary Owen had never met a Native physician until she enrolled in med school at the U of M’s Duluth campus in 1995, when Dr. Gerald Hill served as the head of the center. She remembers the importance of Hill’s mentorship and the center during her med school years.
“It was a place to go to say, ‘Man, is today sucking,’” she said. “We always had that kind of support, the validation that you’re not crazy. We needed that.”
Finding the center was also a relief after years of “garbage jobs” in her native Alaska after graduating from Carroll College in Helena, Montana, with a degree in international relations and French. And it affirmed that she could impact her community as a doctor.
A visit to the Alaska Native Medical Center for a urinary tract infection after college had made Owen realize the acute need for Native doctors.
“There were no Native nurses or physicians,” she said. “I remember standing in a hallway holding a cup of urine. Nobody would make eye contact with me, and I remember feeling like a foreigner in my own health care system, and feeling angry about it.”
After graduating from medical school and spending 11 years as a family doctor in her Tlingit community in Juneau, Alaska, Owen decided to return to Minnesota in 2013, this time as director of the center. She felt burned out after working full time in a clinic, and wanted to make a greater impact on improving Native health outcomes.
While there is growing recognition of the injustices that Native people have encountered for hundreds of years, she said, systemic injustices still curtail progress.
The number of Native Americans pursuing medical degrees hasn’t changed in four decades. It’s not hard to see why, Owen points out: Compared to an overall high school graduation rate of 83.8 percent in Minnesota, the Native graduation rate is 55.7 percent, the lowest among all categories tracked—and lower than the national average.
“We’re doing our side, but where the hell is the U.S. government in educating Native people?” she said.
In addition, Native Americans are in dire need of quality health care. Current vacancy rates at Indian Health Services clinics and hospitals in the Duluth area are 46 percent, according to Owen. A 2018 federal Government Accountability Office report cited 25 percent vacancy rates across Indian Health Services nationally.
That’s part of the inspiration behind the new course requirements, Owen said. Native patients are more likely to have historical trauma and higher rates of comorbidity. And most doctors will take care of a Native patient at some point in their careers, she said, but it’s hard to take care of people appropriately without knowing anything about their culture.
“We have to educate whites on how to take care of us,” she said.
The eight course hours aimed at doing just that incorporate historical events, how that history impacts Native people today; health disparities; how to provide care to people who have experienced trauma and lessons on traditional medicine. The coursework will be incorporated in all University of Minnesota medical school curriculum as early as the 2023-24 school year.
“Any medical school that is near a population of Native people needs to do what Minnesota is doing and add curriculum for students,” she said.
In the meantime, she is mindful of her work at the center, validating the experiences of students like Greensky and MacColl. In that center tucked into the med school, her door is always open.