(00:00:00) Good evening. I'm pleased to be here driving in this afternoon at felt almost like I was coming home. It's the way I was would feel when I go to Cass Lake when I was living here. When I left Duluth about three years ago, I had been working at a high-rise here with some of the geriatric patients in town many of my patients were Indian and this particular patient was not and the last words of advice. I got from a patient. This was a 90 year old gentleman that I had been clipping his toenails every month furry a year and he hardly ever talked to me, but he had read in the paper that I was going back to Cass Lake to work (00:00:39) and he read in the last words of advice as he looks at me. He has he's cataracts could barely see me and says, (00:00:45) dr. Annette, you're going to Cast (00:00:47) Lake and I said, yes you be (00:00:49) careful. There are a lot of Indians up there my involvement with Indian Health Service goes way back way way back to actually I feel like I'm telling a story, you know, when I was born. I was born in the white Earth reservation and they had an Indian Health. His Hospital there, then that's where my family went shortly afterwards. We moved to Red (00:01:17) Lake and at Red Lake is a closed reservation. Almost all Indians. I'm very proud that I grew up that Red Lake and we also had the traditional medicine healers on a reservation. So from a (00:01:30) very young age. I was aware of (00:01:32) the Public Health Service hospital where we went for some things and the Indian doctors where we went for other things and we seem to get well whether we went to one or the other one of the questions as an Indian physician that I'm or as a physician that I'm often asked is how can you believe that Indian medicine stuff, you know, isn't that kind of voodoo and a lot of superstition and I go as an Indian person, how can I not there are a lot of things in Western medicine that we cannot explain that work. You know you go to the doctor and I will give you a medications and we'll say this works and you know, we get really uncomfortable. Sometimes as Physicians when patients start saying well, how does it work? Because we don't always have the answers we know well through experiments. We find out that it works for this but we can't tell you how well traditional medicine has been working for thousands of years to and I don't ask how because I know how I feel sometimes in certain instances when I'm asked the same (00:02:29) questions. (00:02:32) Now being part of these two systems growing up at Red Lake. I (00:02:37) was very much aware of major health problems that (00:02:39) occurred in Indian people. I had three people in my class my Junior and Senior High School that committed suicide it wasn't always called that they said well your friend and I won't name it (00:02:53) climbed to the top of the water tower and fell (00:02:55) off. Okay accidental death, right that's suicide and that's (00:03:01) happened two three four times that I can think of while I was in high school (00:03:06) to students. Okay suicide. (00:03:09) My father died at the (00:03:10) age of 46 after smoking for several years. Very good, man had a massive heart attack and died. (00:03:17) My grandmother was diabetic really didn't follow her the regiment lost a leg at the age of (00:03:23) 50. I had several friends in high school who got pregnant had babies and it's truly babies having babies. We didn't know how to take care of them. We didn't have that knowledge being 13 14 or 15 years old. I saw alcohol affect everyone of us adversely somehow in the reservation. It was a wasn't directly in your family, you know, someone that's drinking, you know a friend that's getting beaten up. You know, (00:03:51) someone that's coming home (00:03:52) late at night that's drunk and it's affecting a family and it's affecting you wear a very tribal people. There's a ripple effect of it affects our friends or Tribal member it affects us. (00:04:03) If you think of these areas of health issues, there's teenage (00:04:06) suicide alcohol abuse diabetes heart disease teenage pregnancies. These are health issues that have been major problems for decades now literally for us as Indian people. Since her diet change with diabetes prior to the big dietary changes, I don't feel we had that much problem. (00:04:25) But these are (00:04:27) problems for us in this day and age now, how are we going to address these Indian Health Service and I feel very very fortunate to have a job where I can interact (00:04:38) with a system that's working with Indian people (00:04:40) in a real comprehensive approach. Now, I'm just going to give you an example of this (00:04:46) on on the Leech Lake reservation we say now, how do we look at (00:04:50) teenagers that (00:04:51) are pregnant? What can we do to help them? First of all, you want to get them in for good medical care for prenatal care, make sure they're not diabetic. They're not had their babies aren't getting too big and help out that way. (00:05:04) But then these people these (00:05:07) young mothers are going to have to know how to be mothers. So we're trying to teach some parenting (00:05:12) skills. That's not the medical group that's doing that. But it's a health approach as part of the health of this person. So we're having teenage glasses. We're developing some Innovative (00:05:23) programs there. One of them is called a stork's nest and you'll be hearing more of that. I'm sure in the near future, but what we've done there is we've had young mothers established kind of a (00:05:34) co-op people donate blankets diapers things people young mothers will need if they make the prenatal appointments if they quit smoking they get points and they can go and cash these in on these things that they can use for their baby. It's working very well, but it provides cooperation. It actually (00:05:55) makes you cooperate in terms of being a doctor the young mothers that are running the program the nursing that's very (00:06:01) involved the teachers that let their students go to be part of this program. (00:06:07) What will what that has shown me is (00:06:09) that Health just isn't of course in the realm of me as a physician or the nurse or the dentist or the pharmacist that works in the Health Service Unit, (00:06:18) very important part, I won't be emphasized that but health is such a broad (00:06:23) spectrum in the community must work together Now Indian people are facing (00:06:29) all of these problems. We have a young population. (00:06:34) We at the Indian Health Service (00:06:35) are trying to take a preventative health approach in other words before you have problems with (00:06:40) alcoholism. Let's look at alcohol use is there such a thing as social drinking talking to our kids about that (00:06:49) smoking? Okay, you can smoke if you want to sometimes with the young kids. I say it gives you yellow teeth and bad breath. And I know when I was an adolescent that would have been enough for me to quit but you have to approach the students and try to get them to stop this behavior from what they know, (00:07:06) you know from (00:07:07) from what they know that you go I go into the middle aged people and say hey, you know what my dad had a heart (00:07:12) attack at 46 and he died, you know, and he was smoking two to three packs a day and you're smoking two to three packs a day and you're 50 and you're having chest pain, you know, I wouldn't push it. I mean you have to work with people. from a personal level to I (00:07:28) feel Now some other things in Indian Health, I'm going to touch on a variety of topics. One of the things that Mike talked about was that we are moving (00:07:40) towards (00:07:41) tribal tribes assuming responsibility. You know, I think this is an exciting time for (00:07:47) Indian people. Finally. We're taking some control. In fact, the government is encouraging us to do that. Wow. I think that's (00:07:57) Innovative for us to self-determination to (00:08:00) take over the control of our own health. (00:08:03) It's one thing to know you have the responsibility. It's another thing I know to feel that you have the control and power to do something about that. You'll see I think a greater move for tribes (00:08:15) to take over the running of their own facilities. It's not going to be someone else running it for us. It's going to be us doing that. It's going to be us doing that and who is to say that we can't do a better job of than what's being done the job that's being done is good. But what's stopping us from being creative and Innovative and doing doing (00:08:34) more? Now currently I'm working as chief medical officer for the Bemidji area and a lot of Indian people that I've known ask me Kathy know. What are you doing? Aren't you really being a doctor anymore? And I get about a twinge of guilt and I think maybe I'm not because I'm not practicing clinical medicine seven days a (00:08:56) week as I have been doing the past three years. (00:09:00) I still do that couple one to two days a week, but I'm also working for several tribes. I this is the way I look at it. There's 29 tribes in our area. There's all different programs that are working Fond du Lac has done just an outstanding job in developing their program. (00:09:19) No, there are tribes that (00:09:21) are could do the same thing, perhaps and Michigan and (00:09:24) Wisconsin and I seem part of my (00:09:27) role is to carrying on the success stories like this and saying contact so and so they're doing a good (00:09:32) job on alcohol rehab Michelle was in is a fine Indian Treatment Center in this area. I think part of my job is to say let's utilize what we (00:09:42) have. Okay, (00:09:45) another area of concern for us is recruitment of (00:09:48) Physicians. We have a hard time sometimes filling (00:09:52) spots. Getting Physicians to come and work on a reservations. Well, I think the tribes are going to start taking over some of that responsibility and believe me you can go and get a physician to come work for you a lot easier than having someone try to resist represent you to do that. So physician Recruitment and is another big area that we must work on. I guess the last oh boy talking while I'm out of here. I think I was back in clinic trying to get my 25 patients to get see in a day aids is a bit is a big problem Nationwide and what we have been told is Indian people as you know, it's not really that much of a problem. We've only got 93 cases Nationwide 93 known cases it nationwide and I say listen if we can if we've got the time to prevent more cases, that's what we have to do. So there's a big push in Indian Country Now for AIDS education and prevention. It's not an easily acceptable topic sometimes but you'll be amazed when you talk to Indian people about listen this remember smallpox. Remember tuberculosis, let's not let this get out of hand. Let's do what we can now so an Indian Country. We're working on combating the AIDS problem (00:11:16) before it becomes that much of a problem for us (00:11:20) one case. I think it's tragic for us (00:11:22) is as a people for any (00:11:25) people. (00:11:28) There's so many successful programs and I think the most successful programs I've seen on various Indian reservations or Indian areas are those programs were the tribe the (00:11:41) IHS works with private foundations and traditionalists to to form a good Indian Health program. They all learn from each other and cooperatively you get the best out of that, and that's what I encourage (00:11:57) now. I think I'm going to stop now and (00:12:00) take any questions at the end with the rest of the panel, and I thank you for inviting me and it's been wonderful being back in Duluth even for a day. Thank you.