In this episode, Mallory talks with Dr. Melissa Lewis, Assistant Professor in the University of Missouri’s School of Medicine, Department of Family and Community Medicine.

Dr. Lewis shares details about her fascinating work in partnering with indigenous people to enhance their healthcare and how she is also working with healthcare communities to provide better care for indigenous patients who often experience bias and disparity in our healthcare system.

Transcript

Welcome to West Virginia University’s Women in Science and Medicine Podcast, brought to you by the Health Sciences Center’s Office of Research in Graduate Education. We will be talking to women with careers in these fields, gaining their insight into what it's like operating in roles that are still mostly dominated by men.

I'm your host, Mallory Weaver, and today my guest is Dr. Melissa Lewis. Dr. Lewis is an assistant professor at the University of Missouri School of Medicine, Department of Family and Community Medicine. Dr. Lewis, welcome to the show and thank you so much for being on the show today. Well, thank you so much for having.

I'd like to just start off by having you briefly describe your role at University of Missouri and maybe a short look into how you got. Sure. So I'm an assistant professor in the department of Family and Community Medicine. And I've been here for about five years. How I got here, I'll try to make it brief, but it is a bit of a longer story.

My, my academic background is primarily in behavioral health. I'm a licensed marriage and family therapist. But during my time as a clinician, I started working with the healthcare system then found a program at East Carolina University and medical family therapy that kind of aligned with the kind of clinical experiences I was having that really demonstrated there is a need for collaboration between behavioral health and medical health services, fields, and research which then.

A couple of other things occurred. I found a wonderful mentor at University of Minnesota Duluth campus, the medical school there. And so that was my first position in a medical school. And it was really just a nice fit. And so this is sort of my second position at a medical school. Even though I'm not a physician.

Very nice. What initially inspired you to pursue a career around this and at what age? Well, I actually. You know, I actually found a journal when I was in high school that I wanted to be a family therapist and that's not that odd. My father was a social worker and had a PhD in social work and taught in the area.

So. That, you know, that made a lot of sense, but again, it took until I actually was working in the field to realize that health is more than just these silos in which you go to a mental health. You know a specialist or you go to a medical specialist and actually our health is preventative and it lives in our communities and it's all of these spaces.

So it took me really working to see that there needed to be some collaboration and integration, and really spent time working with psychiatrists and, and working with clients to go to their. Medical appointments that was a need. They needed advocacy. You know, they, they needed support and understanding what the physicians were saying.

They needed support in trying to meet the goals that their medical teams are giving them they needed coordination of care. So all those sorts of things sort of led me to collaborate with medical systems. Yeah, that's really interesting. Especially given that mental health in general, the stigma around that or in this country around the world, it's just so huge.

And so I think any effort to really beef up our awareness and our support of that effort is it's so important because you know, a lot of people won't even know. Come forward. If you know, they're having issues too, you've had a unique role in helping indigenous communities during the pandemic. Can you describe the unique challenges the pandemic has presented to that community and also your role in helping these people during COVID right.

Well the last few years has really highlighted some of the challenges in the healthcare system, especially for indigenous people and people of color. So I think I work with my own tribe, Cherokee nation, and some other consultants to provide some training and support. To some of their staff. And I also worked within our school of medicine at University of Missouri to provide as, you know, as much as we could up-to-date information about health disparities around COVID-19 and it is just in indigenous communities, but none of this was really new.

These disparities weren't new, it just sort of right. It shined a light on the disparities and the health effects that colonization has had for hundreds of years and, and, and today. So you know, I don't think I contributed much to all the groundwork, but I hope that It gave others the opportunity to see the disparities that exist in indigenous community.

The lack of resources, the lack of our federal government providing the IHS dollars that are mandated and treaty obligations that contribute to lots of healthcare disparities. Cancer and heart disease and things, things like that, right. That kind of brings to mind that also the disparities, as far as vaccine rollout, you know, Omicron has, has been a direct result of these wealthier.

You know, rolling out the vaccine to as many people as will take it. Even the younger populations that initially were at much lower risk. And then, you know, these variants are developing and lesser developed countries and poor nations that do not have an even though the, the technology behind that the vaccines was developed worldwide.

Right. So. I think health, health disparities in general are super interesting. And I think any effort to close them as much as possible or really important. Well, what's really interesting about that. Sometimes we tend to fall into kind of a deficit paradigm thinking, especially about indigenous communities and, and targeted communities.

But what has been really interesting about You know, this time is that the federal government, you know, has, has a government to government relationship with the almost 600 federally recognized tribes lean on in the states. And. Tribes were really able when they, there was almost a choice, they could get funding through the state or through the federal government.

And it appeared, I haven't seen studies, but just from my tribe and others that I've heard about, it appears that when the dollars went straight to the tribes, they were able to roll out vaccines very quickly, very effectively. And I know in my tribal. Reservation area that our region has a, maybe I have to double check the numbers, but a much higher rate, possibly even double the rate of vaccination than the surrounding communities.

And that's for a few reasons because when our tribal people in our tribal government are very smart and they care about each other and you can see indigenous values. Almost always at the core is taking care of one another. And you could see at our, at our government buildings, the words, you know, things like You know, consider your elders, the youth, our language take care of our culture, get a vaccine.

And that really, I think, was the biggest driver. And there's some other studies that look at states that have. Larger population of, of tribal people, of, of tribal communities. And you can see the vaccination rates are higher there. There's some really neat things that happened that I saw at Fort Lewis college, where they partnered with Navajo students and their public health programming embodied the name.

Or Navajo values about taking care of one another and you get a vaccine to protect the people around you. So I think there's a lot that people can learn outside of indigenous communities about public health and about medicine. And that I think this pandemic demonstrated really clearly. Absolutely.

And that actually that very neatly ties into what I was going to ask you next. Because. When I reached initially reached out to you, I did mention you know, your approach of applying culture and community to health issues. And just to read you a few review and have your listeners, a few stats West Virginia has severe health disparities in the areas of obesity in 2018, the prevalence of obesity in Westminster.

37.7%, which was the highest in the nation. And that's per the DHHR in West Virginia nicotine use also in 2018, nearly a one quarter 24.8% smoke cigarettes every day or some days, which ranked West Virginia second highest nationally, also courtesy of the DHHS. And lastly, of course, opioid use is huge, a huge issue in West Virginia in 2018 West Virginia providers wrote 69.3 opioid prescriptions for every 100 persons compared to the average us rate of 51.4 prescription.

This was among the top 10 rates in the us that year. And that's per drug abuse.gov. Do you think a similar approach to. Community and that sort of caring can be applied to rural Appalachian communities. Well, I'm less familiar population in West Virginia, but I think, you know, with addressing. Health care disparities.

There's usually people that are vulnerable or another word would be targeted that there's historical and or current policies that prohibit people from living healthy, fulfilling lives. And I know for indigenous people, part of that is you know, legal and political sanctions prohibiting. Native folks from being able to practice their life ways, whether it's hunting or fishing to continuing to have a woman as head of the household, you know, there's just a long list, but it really ties to people want to.

People want to live in community. People want to know where they're from. People want to be a part of something. We know that you know, social connectedness, connectedness is very important. Health factor and preventative factor for health risks. So theoretically it could be applied. I imagine to other populations, but specificity is important.

Local communities regional beliefs and values are important. I know. You know, at Western Carolina university, there is a woman named Dr. Lisa Leffler and they have a conference there called rooted in the mountains. And it's kind of a, a collaboration between Cherokees and between people with kind of an Appalachian heritage to, to really think about.

No, you know, sometimes the way they're connected, but really just about the heritage, who they are, the core values of the communities where they've come from. Sometimes it's, you know, Scottish heritage, Scottish heritage, sometimes it's others, but it's there really seems to be some value in that program.

And there is you know, they really look at health. From that lens to their Western Carolina University and they have a native health certificate, but that, that, that conference is what comes to mind. We've kind of looking at the values of people where they're from connecting and reconnecting people to the land, to their ancestors.

I broke, I just wrote that down. Cause I actually, I want to look that up. I think that's fascinating. I, that connection because I'm sure you know, and I I'm aware, I'm not sure a lot of people here are aware that this was all native, native land prior to modernization and colonization. Definitely valid in a 2017 MPR piece that I found titled native Americans feel invisible in the U S healthcare system.

Eric Whitney writes the life expectancy of native Americans in some states is 20 years shorter. I found that absolutely incredible than the national average health programs for American Indians are chronically underfunded by. And about a quarter of native Americans reported experiencing discrimination when going to a doctor or a health clinic, according to the findings of a poll through NPR, the Robert Wood Johnson foundation and Harvard, the Chan School of Public Health.

What do you see or have research as the best way to combat some of these problems with our health system in serving indigenous populations within the country? Yeah, that's, that's a really good question. And that's a question that I think about a lot. You know, what we are currently doing is we've collected stories from some patients about their experiences of healthcare.

And there's some other really good articles out there about that. And I think if you don't walk in someone's shoes, you don't understand. You know, I hear very often from non-indigenous people, just a lot of myths and stereotypes and really just a completely. Unawareness of discrimination and racism that indigenous people experience every single day and is specially within our healthcare system.

So that's one, one thing that we have been working on is to document those stories, the very powerful stories of native patients. Yeah, I could talk a lot about that. But the other thing that we're doing with those stories is we've created an indigenous health toolkit and we've piloted that at several different universities and at some healthcare sites that see primarily, primarily native American patients.

So our hope is that through the. It's kind of seven module training that we, we teach healthcare professionals how to more effectively work with native patients and to reduce bias and discrimination and, you know, preliminary data that we've collected, demonstrates that people learn the information. They remember the facts over time.

They increase their empathy. Towards indigenous people and their understanding, and we're hoping the next step will be to really see if the skills and techniques improve as well. We're hoping by You know, in a few months, we'll find out if the patients at some of these clinics were able to experience a different kind of healthcare.

These providers had these trainings, but we're also working with a handful of medical schools right now to add training. Some of them are anti-racism and some of them are indigenous specific knowledge. Again, preliminary results are very positive, but I think the advocacy is important. A lot of people say, well, we don't really have any native American patients.

So why is this important? And, and my answer is one, exactly what you said. No matter where you sit, you sit on indigenous lands. One, two indigenous people experienced that highest health disparities in, you know, non-communicable, chronic health disease. As a result of colonization, many of them have to do with the legacy of our healthcare settings that are academic centers.

Our universities on, you know, on lands that were taken from native people illegal. Or unethically. So there is an obligation that we have to indigenous people. And not only that, no matter where you are at, you are working with native people, you might not know that because of the biases and stereotypes that we've learned in our society, but you are.

And I think if we look at this population it's not an underserved, only population, although it is underserved and it's not only underfunded, which it is underfunded, but this is a population that has been purposely targeted and neglected. So in my opinion, every. Healthcare professionals should receive training about indigenous people.

Now, a lot of our training that we are delivering in this toolkit is content that probably should be delivered in K through 12. And so that's another place that I would really encourage, you know, there's some states Montana the state of Washington that have added. Mandatory curriculum, our undergraduate universities shut out mandatory curriculum.

And I think anyone working in a healthcare setting should receive training on how to work with indigenous patients to reduce the bias and discrimination that they receive, which does research has found a result in, in worsened health, healthcare care and outcomes. I absolutely agree with you. I think most of us are aware of racism and bias towards certain groups.

And we think of it in a lot of contexts, but the idea that it would affect someone's health care is I think mind-blowing, I, it was to me, you know, just the. I think is really important and how it, you know, that bias affects, you know, we focus a lot for the, in the workplace. For example, there's a huge stress on that.

You know, you cannot discriminate against someone in the workplace, but you know, a fundamental thing like healthcare that we all need to live healthy and productive lives. That's just very sad and disturbing to be sure. Yeah. I saw an interview. You did back in 2018, I believe I found it on YouTube.

And it was bringing cultural ways of healing to modern medicine. And in it, you talk about nature's ability to give us what we need specifically. You spoke of the health benefits of elderberries. Now I personally am a firm believer in, in a, in a. A mixture of both modern and natural medicines.

However, there is no doubt that companies have taken advantage of natural medicines. I think I think of, you know, weight loss, drugs, for example, and have peddled them recklessly in some situations leaving many of us with intense skepticism. What is the best approach do you think to responsibly educating people about the benefits of natural medicine without what.

Making it easy for companies to piggyback off of valid research to make outrageous and untrue claims, but also to limiting the reaction of some, to swear off amount of modern medicine altogether risking their health. And, and certainly we've seen during COVID risking the health of others even. Yeah.

That's, that's a good question. Certainly packed as well. If you, a few things come to mind, I'm not sure about best practices, but gosh, sorry. I'm trying to review several different things that, that came up. So. There certainly is the issue of appropriation and you know, profiting on indigenous people, especially around plant and food ways.

And we've seen that happen. And I think about, you know, people market different superfoods and what's happened maybe with, with quinoa for example. And I think maybe what you're referring to is presentation I did about indigenous foods which you know, I'm not an anthropologists an anthropologist, I'm not a food scientist.

So these are just you know, things that I have learned in my own, in my own community. So I know, I, you know, just thinking you're, you're absolutely right. There's certainly there certainly is a threat of Trying to commodify indigenous life ways, which we already see. I mean, you see Sage bundles all over the place.

You know, I think about the effects of the communities in south America after, you know, quinoa at other, other products were seen as superfood. So there certainly is a danger to that. But I think it comes back to just letting native communities lead, you know, the way in which they're revitalizing their food systems, the way in which the way in which people utilize harvesting techniques, you know, there's a lot there.

But the problem is when people come in and try to kind of commodify, like I saw someone even took like a word in the Cherokee language and made a beverage out of it, you know a word that means balanced TOKY without really any regard for, for the indigenous communities now. I certainly do believe that indigenous cultures in Lifeways are the key for, for healthy live ways.

But those are the decisions of tribal communities to make, I think first. Sure. And did I miss anything? I feel like there were several other things, you know, I don't know. I think, I think you answered that. Well, yeah. I typically ask us about specific challenges they see for young girls and women attempting to pursue a career in science and medicine.

And I would, I would add for you any specific challenges you see to young indigenous girls and women? Yes. Yeah. Well, I think, you know, I didn't realize this until I was older and it's, I think a pretty common phenomenon, but. I had always told myself as a young person that I wasn't good at math or science.

I think in high school, I got a D in physics. I could barely pass math classes, but then I realized as I, as I got older, maybe where that came from, and that is pretty common for women. And then I really was interested in math. I took a non-linear dynamic math class in graduate school, which I could it, I mean, I barely passed it, but I was really interested because it made a lot of sense to indigenous principles that I've learned.

And even within physics, the way the Cherokee language that I'm, I'm learning and trying to teach my son. So I have a long way to go, but the way in which his Turkey languages is used, I understand that the way that you conjugate a verb it'll depend on the thing that's in it is if it is. Liquid, if it is solid, if it's a certain shape.

And when you look at the physics formulas, they're almost exactly the same. So I had this natural curiosity, but I wasn't, there was some sort of blockage that I wish, you know, I could still go back. And I guess, I guess the message would be that, especially for indigenous women, you certainly receive messages that there are certain areas, specialist, specialty stem that you don't have a skill set in.

And I also read an article that native American children are less likely to receive math and science classes. And there. Less likely to have teachers that are certified. So, I mean, there's so many educational barriers for native people and women. However, I think the message is like Western science and math is new, relatively new and indigenous math and science is like written in our DNA.

It's in our language, it's in our belief system and it's thousands and thousands of years old. So, so sometimes the messages that Western science is science, and that's just not true. Indigenous science is science. And what you've been taught in your families and your communities. That holds the key to, to a lot of important things that are occurring in our world right now.

Like I would say to young indigenous folks, you have the key to the solutions that we need. We know that, you know, something like 90% of the world's ecology is protected by indigenous people works represent 5% of the population of the world. And the practices that we've used and we've learned, we've been taught by our ancestors, haven't perfected over thousands and thousands of years, because we can't say is true with Western science, maybe, maybe someday, but Western science, new compared to indigenous science and, and these young people, I just I hope they realize how knowledgeable and valuable that they already are.

Right. I, it puts me in mind a little bit of a similar kind of when you mentioned, you know, practices as far as the land. I mean, I think of. Commercial farming and the effects on the environment. I think that you know, of pesticides on foods, so very relevant, I think. Yeah. You, you did mention a mentor early on in our session here, and I often discuss mentoring here at the HSC, but also on the show that impactful mentor, how did they inspire your career journey?

Yeah. So I was referring to Dr. Melissa Walls and she is now the director of the great lakes hub of John Hopkins University. Well, one, she helped me get my first job. It does help, but it, it, you know, she was the first of a lot of things that I had never seen before. Gosh, yes. So, you know, one. She was someone who came from her tribal community.

Maybe didn't expect to take the career path that she did, but if she continues to work with her own tribal community, using a community-based participatory research, Methodology. So that was really important and really helpful for me to see. And I've been able to attempt to model that in a tribal specific way with my own community.

Being able to see, you know, I remember asking these questions because. Getting a PhD and, you know, going, going through graduate education, you know, luckily it's different for indigenous people and non-indigenous people today. I never had an indigenous professor. I never had indigenous theory or methodology.

I didn't have any of those things. So when there would be sort of red flags for me, like this doesn't seem right. I didn't really have another alternative or person to talk to, to say like, am I, is something wrong with me that I feel uncomfortable with this theory of research, you know, really until I, until I met her and to be able to say, I remember, you know, I asked the question what about objectivity?

You know, in my community advisory board right now, I have my cousin, you know, and. Family. In fact, you know, when you look at indigenous research methodology is the opposite that what you're told and Western science, so having family and community, I like keeps you honest, but in Western theory, you know, that would you, you wouldn't be you would, you know, there is subjectivity involved, but with, you know, the work with Melissa Walls and being able to see what community advisory boards look like.

Being able to see how she mentored other young indigenous people. It's been very helpful. And to this day she is a mentor on a grant that I currently have doing a community-based participatory research project with my tribal community. Yeah, I think most of those connections, sometimes I think they go, they, they reach well into later years of career, which is wonderful when, when there's a good mentee mentor relationship that that, that can continue on for years.

And I think that's wonderful. I have one last question for you, and that is the single most thing you would want young women and girls to know if they are thinking about pursuing a path to a career in science or math. Gosh, well I might be repeating myself, but I just, I think, especially for young indigenous people and young indigenous women, that, you know, you, you already, you already within you, within your family, with your community, you are already a scientist and you are the scientists that the world needs right now.

I think that would probably be it I'd love that, that you know, what you want to be. You already are. You just need to go through the steps to get there. So I love that. That wraps up our discussion. Dr. Melissa Lewis. Thank you so much for being a guest on the women in science and medicine podcast today.