The majority of patients suffering from coronary heart disease, stroke, hypertension or heart failure, and life-saving health services live in highly populated urban areas. But imagine having to drive five hours to see a physician, knowing there is a high likelihood that the doctor will not be there when you arrive.

That scenario is a frequent reality among American Indian and Alaska Native patients living in one of the 574 Federally recognized tribal areas in the U.S. Many of these reservations represent the most medically underserved areas in the country, where the quality of healthcare varies widely and significant physician shortages are chronic issues, eroding the level of trust and participation that patients have in their available health resources.

As part of a new podcast series exploring innovative technologies, partnerships and processes that could lead to breakthroughs in public health, I recently spoke with Rear Admiral (ret.) Jim Galloway, MD, a former Assistant U.S. Surgeon General to two presidents and currently the Chief Medical Officer of Native Arc, a Native American, woman-owned public benefit company developing novel, sustainable partnerships to reduce critical physician shortages and improve healthcare in Indigenous tribal areas.

From his decades of experience working as a cardiologist in some of the largest tribal areas in the southwest and across the nation, Dr. Galloway has witnessed the discrepancies in care provided to Indigenous populations, where congressional studies have found health provider vacancy rates approaching 50 percent in some areas, an issue that adversely affects the availability of services, waiting times and quality of care that patients experience.  

The pandemic underscored the state of health available to Indigenous populations relative to patients in the rest of the country. While New York City received headlines for its COVID-19 infection rate, the Navajo Nation—which covers parts of Arizona, Utah, and New Mexico—surpassed New York and New Jersey combined in mid-2020 for the number of cases it endured.

The result of the pandemic and years of neglect is an erosion of trust between patients and health providers. In certain specialized services, such as obstetrics, the impact of this loss of services and confidence is connected to disproportionately higher rates of mortality. For example, American Indian and Alaska Native women are twice as likely to die of pregnancy-related complications than White women and less likely to trust physicians.

To reverse this trend, Native Arc and its partner company, Arc Health, have developed and expanded a novel partnership model that fills physician vacancies with high-quality, mission-driven doctors and academic fellows from among the country’s leading medical institutions in a model to enhance tribal, Indian health and academic collaborations that improve health care services and facilities.

Medical staff take a collaborative approach to addressing health challenges unique to Indigenous tribal communities, weaving together the latest medical practices with a deep understanding of the cultural issues and social determinants impacting patient health in these areas.

The results of this partnership model are remarkable: A decline in physician vacancies, greater collaboration between tribal, Indian health systems and academic centers to drive improved quality, increased services and educational support, as well as improved professional development among doctors and other medical staff. Importantly, the academic institutions and incoming providers also better understand the culture and underlying socioeconomic issues that can be applied to understanding patient health in underserved areas.

One of the program’s most impressive outcomes points to the heart of its potential as a sustainable force for good: Many physicians and providers serving at these sites choose to stay on as full-time physicians for Indigenous tribal areas. These numbers are additive to the number of residents and students from academic institutions who return to serve tribal communities.

That’s a powerful testament and offers a possible path forward for improving the state of healthcare within tribal and rural populations, both in the U.S. and around the world. The more we can replicate partnership programs that place mission-driven physicians and fellows in areas of need and build meaningful collaborations between tribal and Indian health systems, the more likely physicians are to stay in those communities. This model also increases the opportunities to leverage the expertise, connections, and resources of both the physicians and academic centers to deliver long-term improvements to patient care.

Listen to the full podcast here to get the full picture of Native Arc’s innovative approach and Dr. Galloway’s powerful insights from his decades of service.

The post Reversing the Doctor Drain appeared first on Medika Life.

While American balladeer Woody Guthrie called out, “The Land Was Made for You and Me,” Rural Americans increasingly find themselves left out of possibilities for future prosperity. While more than 46 million Americans live in rural communities, rural locales lag behind non-rural communities in almost every measure of prosperity, from poverty rates to employment opportunities.

Though Guthrie’s famed lyrics, amber grain and spacious skies suggested unlimited possibilities, rural Americans often live hours away from primary medical care, emergency services, and specialist care providers. Their well-being — indeed, their survival — often relies on a tenuous broadband connection. What’s more, the systems put in place that are intended to address their needs are usually based on urban and suburban expectations.

Recently, more than 20 top leaders from academia, associations, corporations, and government met in Washington, DC, in a candid conversation to discuss these challenges — but more importantly — the solutions they both believe and know firsthand can make a difference in the lives of rural Americans. What made these conversations compelling was that they sat around the table — without slides or prepared statements — and talked about what they were doing and what was working. They united around a shared commitment to champion solutions. [Read the eBook Heartbreak in the Heartland here.]

According to one of the gathering’s moderators, Sarah Dash, CEO of the Alliance for Health Policy: “We must continue to change the narrative about how rural America is viewed and overcome the stereotypes that continue to perpetuate. Rural communities are far more diverse, innovative, and vibrant than they’re given credit for. We must educate ourselves about the people we seek to serve and work with them to create the kind of programs that will move the needle in a meaningful way.”

Expanding Broadband to Connect the Nation

One of rural communities’ more significant challenges is high-speed internet access. The digital divide hinders education, economic growth, and access to vital health services. To address this issue, initiatives like the Federal Communications Commission’s (FCC) Rural Digital Opportunity Fund have been launched to provide funds for broadband infrastructure in underserved areas. Public-private partnerships are also crucial in expanding broadband access, with companies collaborating to build networks in rural regions.

“Poverty rates in rural communities are higher than those in urban areas, and the FCC’s Affordable Connectivity Program (ACP) helps ensure rural residents can afford the broadband they need for work, education, and healthcare,” shared Gary Lynch, a Global Practice Leader at Verizon. “At Verizon, we have health equity programs on top of the ACP that help those individuals get devices to manage their health. What will happen to the 20 million Americans using the program when federal funding runs out in mid-2024?”

Virtual Learning as a Path to Progress

Rural students often need equal access to quality education. The COVID-19 pandemic accelerated the shift toward online learning, highlighting the need for virtual education solutions. Schools and organizations have invested in virtual learning platforms and distance education programs to address this challenge. Mobile learning centers and Wi-Fi-equipped school buses have also been deployed to ensure that students in remote areas can access educational resources, but more investment is needed.

Agricultural Innovation Tapping the Great Potential of the Heartland

Farming communities are the heart of rural America. They face unique challenges, including fluctuating markets and climate change. To support rural farmers, varied solutions are underway, including training in sustainable farming practices, affordable loans and grants and promoting local food markets. Government agencies, nonprofit organizations, and agricultural extension services are working to support farmers in a changing world. But now all regions and farms are the same.

“The narrative around how rural areas are stereotyped as older, poorer, sicker, uneducated, and white must change, says Amy Elizondo, Chief Strategy Officer of the National Rural Health Association. ”If you look at one rural community, you have seen one rural community — it’s not representative of the entire spectrum of rural America. Rural communities possess a vast depth of innovation, as they often must use what little resources they have for the incredibly diverse communities they serve.”

Native American Empowerment

Native American communities face disparities across the board — in health, education, and economic opportunities. Solutions must be rooted in respecting tribal sovereignty and self-determination. Collaboration between tribal governments, Federal agencies, and nonprofits is critical to addressing these inequities. Initiatives that support tribal entrepreneurship, cultural preservation, and access to quality health are making a difference. Expanding educational opportunities for Native American youth, including scholarships and culturally sensitive curricula, is also a focus.

The Washington, D.C., gathering included one of the nation’s leading public health advocates for Native Americans — Rear Admiral (ret.) James Galloway, MD, formerly part of the Surgeon General’s leadership team and now chief medical and partnership officer at Arc Health, has dedicated most of his career as a physician and public health expert to rallying this community. According to Rear Admiral (ret.) Dr. Galloway:

“Particularly in light of the health care provider shortages, as well as for the overall improvement of patient care, the proposed and highly supported concept of the team approach to health care to include Community Health Representatives as an approach to rural health is an essential component of quality health care, especially in rural communities.”

Telehealth Brings Access to Care Closer to Home

Access to health services in rural areas has long been a concern. Telemedicine is a game-changer, enabling health professionals to diagnose and treat patients remotely. Expanding telehealth services has made it easier for rural Americans to access medical care, especially during emergencies and throughout the COVID-19 pandemic. Again, broadband technology has been vital to accessing this life-sustaining need and policies and companies are working to meet the challenge.

Rural healthcare professionals are using telehealth and tapping into electronic medical records to improve quality care delivery. At the same time, there is ample support for remote patient monitoring and digital health technologies as tools to bring physicians’ offices closer to peoples’ homes. The biggest concern among physicians on the frontlines of addressing patient needs is clinical training and financial assistance to keep community hospitals operating.

Rural Infrastructure and Remote Care

To boost economic opportunities in rural America, infrastructure investments are crucial. Initiatives like the Infrastructure Investment and Jobs Act allocate significant funding to improve roads, bridges, and public transportation in rural areas. These improvements enhance connectivity, create jobs, and stimulate economic growth.

The rise of remote work has opened up new possibilities for rural Americans. Rural communities can retain residents and attract talent while diversifying their economies by encouraging employers to offer remote work options and training programs to develop remote-friendly skills.

John Whyte, MD, chief medical officer of WebMD, has been partnering with companies like Walmart to improve quality care and make rural life sustainable: “We conducted a research survey with Walmart last year, and we surveyed actual rural physicians and compared their assessments of the quality of care for their rural patients versus urban physicians… We saw that physicians in rural communities rated the quality of care they provide lower quality than in urban communities. That really should be a wake-up call.”

Conversation and Collaboration Are Key to Making Progress

Companies like Arc Health, Exact Sciences, FINN Partners, GSK, Huma, LifePoint Health, Molecular Biologicals & PS Fertility, OffScrip Health, Verizon, Walgreens, Walmart, WebMD; and leaders from associations like AARP, Alliance for Health Policy, Asthma and Allergy Foundation of America, Biotechnology Innovation Organization (BIO), CPSI; government agencies such as Health and Human Services and National Health Institute, and Academic institutions including Ohio State University and West Virginia University, have essential roles at the table. All are in conversation and addressing rural America’s challenges. They are doing everything from expanding broadband infrastructure, investing in rural job creation, supporting local farmers, and providing affordable goods and services to underserved areas.

“Rural America knows what is best for rural America. We need to build programs and initiatives that empower individuals and their families. That leads to a sense of purpose in the community, which can stem the tide of many adverse health and social implications. Marrying purpose with economic empowerment is the real game-changer,” reflects Pritesh Gandhi, MD, Chief Community Health Officer at Walmart.

Walgreens has improved health access by expanding telemedicine, providing pharmacy services in rural communities, and working shoulder-to-shoulder with local health providers. WebMD has moved to upskill physicians and ensure they have access to breaking medical information. The private sector has the skill and scale to advance rural America’s technology, economic, and health challenges, contributing to the overall well-being of these communities.

In sharing ideas and possibilities, attendees show how to bridge the divide and ensure that rural Americans have the tools and resources to thrive. These practical solutions address problems and build a brighter future for rural America, where opportunities are abundant and quality of life is improved for all.

The post Bridging the Divide: Partnership Among Public and Private Sectors Rally to Rural America Needs appeared first on Medika Life.

FALLON, Nev. — Linda Noneo turned up the heat in her van to ward off the early-morning chill that persists in northern Nevada’s high desert even in late June. As the first rays of daylight broke over a Christian cross on the top of a hill near the Fallon Paiute-Shoshone colony, she drove toward her first stop to pick up fellow tribal members waiting for transportation to their medical appointments.

Noneo is one of four community health representatives for the Fallon Paiute-Shoshone, which the tribe said includes about 1,160 enrolled members. The role primarily involves driving tribal members to their health appointments, whether in Fallon, a city of just under 10,000, or Reno, more than 60 miles west. Noneo said she and her colleagues have also taken patients as far away as Sacramento, California, and Salt Lake City, round trips of nearly 400 and 1,000 miles, respectively.

Public health experts contend the role Noneo and others like her fill is an integral part of ensuring people receive the care they need, especially for chronic illnesses, by helping close gaps in areas with medical provider shortages. Besides transporting patients to their appointments, community health representatives provide health education, patient advocacy, and more. Noneo said she and her colleagues spend a lot of time helping young mothers and elders, checking on the latter, taking them to get groceries, or delivering their medication.

Yet, most state Medicaid programs don’t recognize or pay for services offered by health workers, such as Noneo, who work on tribal lands. That’s despite their work being essentially the same as that of “community health workers” in nontribal communities, a classification many state Medicaid programs cover.

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In Nevada, that disparity recently changed when the state began allowing workers on tribal lands to qualify for Medicaid reimbursement as community health workers. Tribal leaders say the Medicaid payments supplement existing personnel funding by covering the individual services the workers provide. That in turn should allow tribes to train and hire more community health representatives, which could expand health and support services for tribal members.

Only two other states, South Dakota and Arizona, treat community health representatives serving Native American populations as eligible for the same Medicaid reimbursement as their similarly named counterparts in nontribal areas, according to Michelle Archuleta, a community health representative program consultant for the federal Indian Health Service. However, she said, the tribes the CHRs work for have not begun billing the states’ Medicaid programs.

The Community Health Representative program, established by Congress in 1968, is among the nation’s oldest community health workforces. It’s jointly funded by each tribe and the IHS, an agency within the Department of Health and Human Services responsible for providing health care to members of federally recognized tribes. As of 2019, more than 1,600 of these tribal linchpins worked in the United States, according to the IHS.

Last year, the Centers for Medicare & Medicaid Services approved Nevada’s plan to make community health workers who complete training and certification requirements eligible for Medicaid reimbursement when they assist with chronic disease management and prevention.

And in December, leaders with the Nevada Community Health Worker Association helped tribes make sure their community health representatives would receive the necessary training for certification. The association would “fully support” tribal clinics submitting their community health representative training for recognition in the state and it would not require a change to state law, said Jay Kolbet-Clausell, program director for the group. For now, community health representatives are receiving double training to be able to file for Medicaid reimbursement.

Training and certification requirements for community health workers vary widely by state and employer, as workers are often hired by hospitals, local organizations, health departments, or federally qualified health centers. But a movement has been emerging across the country to bring more uniformity to those requirements and formalize the roles, said Sweta Haldar, a policy analyst with the Racial Equity and Health Policy program at KFF.

As part of this process, states are expanding coverage for community health workers under Medicaid. According to a brief Haldar co-authored, 28 of 47 states, and Washington, D.C., reported having policies that allow Medicaid reimbursement for services provided by community health workers. Arkansas, Georgia, and Hawaii did not respond to KFF’s survey.

“There’s a really robust evidence base that is growing every day that community health worker interventions can be effective in reducing health disparities, particularly in communities of color,” Haldar said.

Studies have also shown that community health worker programs are effective in improving health outcomes for people with chronic conditions and that they reduce health care costs.

Soon after Nevada implemented its program, about 50 community health representatives completed the requirements. Another cohort of 20 finished the curriculum later, said Kolbet-Clausell. The goal is for those who have completed the recent training to help their peers through it, they said.

Even before the tribal workers were included in the community health workforce, one of its greatest strengths was its diversity, Kolbet-Clausell said. In Nevada, the 2022 student group was made up of greater shares of people who are American Indian or Alaska Native, Hawaiian or Pacific Islander, Black, Hispanic, or from rural areas than the state’s general population. They said it’s likely one of the most diverse health programs in the state.

Community health representatives such as Noneo are typically tribal or community members themselves, which, public health experts say, allows them to connect more easily with the patients they serve and better connect them to health care.

For example, the first person she picked up that June morning was her cousin, who had a 6 a.m. dialysis appointment.

Kolbet-Clausell said they’re optimistic about the growing workforce and the support it’s getting from state leaders.

“Five, six years ago, there was a lot more resistance,” they said, because lawmakers saw the efforts to expand the community health workforce as simply spending more money. “But this actually just benefits rural communities as much as it benefits underserved urban communities. It serves everyone.”

Back in Fallon, Noneo reflected on her 27 years as a community health representative for her tribe as she prepares to retire in September. She has been there with her fellow tribal members through important and hard times in their lives — like driving an expectant mother to Reno to deliver a baby, taking people to receive treatment for mental health crises and addiction, and bringing patients to their dialysis treatments on her week off around Christmas so they wouldn’t miss their appointments.

The most challenging part of the job, she said, is experiencing the loss of someone she has regularly seen and provided years of services for.

“We all have compassion,” she said. “In this kind of job, you have to have that.”

After decades of shuttling patients, Noneo has the work down to a steady and familiar rhythm. Four hours after dropping off her cousin for dialysis, Noneo picked her up at the clinic as she dropped off the next dialysis patient. On a clipboard, she logged the hours and mileage for each appointment.

The post Tribal Health Workers Aren’t Paid Like Their Peers. See Why Nevada Changed That appeared first on Medika Life.

But my father also supported human rights, freedom and self-determination for all people, including Latino agricultural workers, Native Americans, and the millions of impoverished white men and women who were treated as second-class citizens. —

Mental health in rural America is almost nonexistent and dispensed by the few professionals who work in these areas. Is this because there is no need or care is absent for those who live in these humble, widely separated areas?

Recently, I happened across a note from a rural area practitioner in mental health. She was asking a listserve of mental health professionals for some pharmaceutical guidance. What medication should she prescribe?

A young woman patient, Native American, had recently come to her office for help. The woman had had a miscarriage and was very upset since previously she had children without incident. Now, the woman was disturbed by intense, frequent panic attacks during the day, disrupting her entire family and leaving her in tears.

The mental health practitioner admitted that mental health care and normal healthcare, were spotty in her area and that Native Americans frequently don’t receive the evaluations and the medical testing that might be indicated by their medical presentation. In fact, the healthcare worker wasn’t familiar with the genetic disorder ultimately diagnosed.

Fortunately, the Native-American woman had been atypically referred to a clinic quite a distance away from her home, where she was tested and found to have a genetic disorder, MTHFR. This particular disorder has a range of indications where microemboli can cause miscarriage, stroke, and several other vascular problems.

In addition to the vascular problems which have been seen, there are psychological problems.

As both DNA methylation and folate are important in mental health, reduction of MTHFR activity or folate deficiency have been associated with an onset of several psychiatric diseases, schizophrenia, bipolar disorder, depression, autism, and ADHD.

In particular, stress-related psychiatric disorders have been noted “with a focus on major depressive disorder and posttraumatic stress disorder (PTSD).” The question arises here as to how this particular disorder should be treated since it is genetic in nature.

Are psychotherapeutic medications appropriate? It reveals a hole in the current understanding of psychiatric illnesses and their genesis.

The Plight of the Forgotten in America

Americans who fall at or below the poverty line suffer from a void of healthcare services. Where can they turn?

When there are few resources to provide direct mental health services in a community, local healthcare professionals may need to refer patients to facilities outside of the community. The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains the National Directory of Mental Health Treatment Facilities 2020, an online listing of federal, state and local government, and private facilities that provide mental health treatment services.

The “solution” begs yet another question; how do you get to these services if you don’t have the financial means to travel? In a land where technology has blossomed like a welcomed spring, the poor have been left wanting and Native Americans are treated as second-class citizens.

It began with an American genocide and the Trail of Tears.

President Andrew Jackson signs the Indian Removal Act, authorizing the Army to force Cherokee, Chickasaw, Choctaw, Creek, and Seminole tribes, including some of his former allies in the War of 1812, out of Georgia and surrounding states. This sets the stage for the Cherokee Trail of Tears and other forced relocation marches.

Estimates are that up to 4,000 Native people died on that perilous journey where they were uprooted from their homes and weren’t even allowed to prepare adequately for the trip. They were placed in undesirable parts of the country where resources were scarce and still are.

The Southern States where they had lived is not similar to the arid lands where they were forced to live on poorly served reservations.

The young woman who presented with daily panic attacks to that ill-informed clinician was from one of those who live on the reservations. Change for the better has come as slow as molasses in winter for these original keepers of our lands.

The plight of Native children has been no better than this woman’s experience with mental health. Previously, Native American children were sent to boarding schools away from their parents and it was here that the tragedy was shocking.

Even worse, the National Resource Center on Child Sexual Abuse (1990) cites evidence that many Native American children were sexually abused while attending boarding schools.

American Indian adolescents were much more likely to be diagnosed with AD/HD and substance abuse or substance dependence disorders. The rates of conduct disorder and oppositional defiant disorder were also elevated in the American Indian sample.

The intent of the move westward for these people had devastating effects.

A Tale of 20th Century Reservation Schooling

Two doctoral students I was mentoring received summer internships on a reservation. Eagerly, they anticipated what they would teach the children, lesson plans and field trips were outlined and packed away as they left for a summer of learning — or so they thought.

The emails I received depicted a land of broken alcohol bottles, puppies hanging from trees, and a school with a library that had not one book in it. The science lab was even worse; one broken beaker, and a Bunson burner that didn’t work. They were crestfallen, so they decided to remedy the situation.

The two ordered supplies with their own funds and asked peers for donations. But were stopped by the local council. It would be embarrassing for them to admit they had a school without supplies, so the students began a series of secret purchases.

Books and lab equipment were ordered and delivered to a post office miles away. The supplies were picked up and hidden in their quarters until they could be quietly introduced without fanfare. It was a summer to remember.

Questioning why there is so much alcoholism, suicide and physical abuse on reservations is an admission of ignorance.

According to a study from the National Institute of Justice, some 84 percent of American Indian and Alaska Native women have experienced violence in their lifetime, and more than half have endured this violence at the hands of an intimate partner. More than two-thirds of the women, or 66 percent, say they have been the victims of psychological aggression by a partner.

There is no hope, little motivation, and discrimination awaits outside their homelands. Has the United States contributed to the plight of the Native peoples and has it been perpetuated by current administrations?

The post The Healthcare Trail of Tears appeared first on Medika Life.