Elder in Residence Seeks to Rebuild Trust in Medicine Among Tribal Populations
Author: | November 11, 2020
Photo of Rick Smith by Zulema Rosendahl
A woman left a doctor’s office in tears. At age 26, she and her husband struggled to conceive a child, so she asked her physician why, hoping for a “womb transplant.” That physician informed her that, six years prior, a different doctor with Indian Health Services had performed a hysterectomy on her, after she sought out help related to alcoholism. This story, detailed in the American Indian Quarterly, is one among an estimated 25% of Native American women between the ages of 15 and 44 during the 1970s who were sterilized without consent by their trusted physicians.
History — and seemingly recent history — like this has almost irrevocably damaged relationships between medicine and American Indian and Alaska Native (AI/AN)* communities, as well as Black, Indigenious and People of Color at large, and it shows. Today, with connections severed and mistrust on high, an “interactive syndemic” has emerged in AI/AN populations: diabetes and dementia.
To address these health disparities in Minnesota, the state legislature backed the University of Minnesota Medical School in developing the Memory Keepers Medical Discovery Team (MK-MDT). Led by J. Neil Henderson, PhD, a professor in the Department of Family Medicine and Biobehavioral Health at the Medical School, Duluth campus, the MK-MDT will work to better understand AI/AN health and links between diabetes and dementia under the label of community-based participatory research.
“We engage in research that is responsive to community changes, wishes and teachings to us by tribal communities. Instead of research that pre-determines ‘what’s wrong with you people, here’s your solution, you’re welcome,’ it’s pretty much the opposite of that,” Dr. Henderson said. “It’s very common across all Indian Country to use the phrase, ‘Don’t plan for us, without us.’”
Yet, even as a member of Choctaw Nation himself, Dr. Henderson’s Oklahoma roots do not afford him the immediate trust from Minnesota’s tribal communities. Before he and the MK-MDT could even begin brainstorming research theories and approaches, in hopes of providing solutions to AI/AN health disparities, they needed someone deeply trusted and well-respected by Minnesota’s tribal communities to partner, advise and, ultimately, protect AI/AN interests. They needed an Elder in Residence.
Elder in Residence
Rick J. Smith, M.Ed., humbly introduces himself first as a husband to his wife, Dianna, of 44 years, a father to three children and a grandfather to three grandchildren. A member of the Red Cliff Band of Lake Superior Chippewa, Smith has served, for 33 years, as the director of the American Indian Learning Resource Center at the U of M Duluth, and for 17 years, consulted with the Blandin Foundation as a cultural liaison, trainer and recruiter for the Blandin Reservation Community Leadership Program, which works with all 11 reservations in Minnesota to offer training in community leadership. Today, he is the MK-MDT’s Elder in Residence.
“I’ve been fortunate and blessed to have become quite connected to those communities,” Smith said. “When Neil asked me to serve as the Elder in Residence, I was humbled. When you’re asked to help in Indian Country, you do it without hesitation. You have a responsibility to do that. I look forward to our work, hopefully, diminishing the health disparities in Indian Country.”
As the Elder in Residence, Smith — known as a “teacher and knowledge keeper” — will provide guidance, insight and spiritual understanding to the MK-MDT by mentoring them about Indigenious knowledge, health and medicine, history, relationships and culture while developing a tribal ethics review process. But, he won’t do it alone.
Elder Advisory Board
To ensure representation of the voices from all 11 tribes in Minnesota, part of Smith’s role as Elder in Residence is to develop an Elder Advisory Board. This board will participate and consult the MK-MDT during the conceptualization of research proposal ideas and provide discussion around the relevancy or need for that research within their respective tribal communities.
“The only currency we have is our integrity because of the negative history and mistrust, and this board will bring credibility to the research,” said Smith, who is developing the board in partnership with Annamarie Hill, a member of the Red Lake Band of Chippewa. “There is a stigma attached to researching Indian people, and I have to say, that’s one of the reasons I took on this role. You need trust to work in those communities and to get people involved. So far, we have 10 of our 11 members on the board.”
As MK-MDT begins to receive grant funding, including one from the National Institute on Aging to understand how two Minnesotan tribes define and care for dementia, the team will rely heavily on both Smith and the Elder Advisory Board for safe and respectful approaches to their research.
It was very important to me that his position and this board not be window dressing,” Smith said. “I have felt very included, and I am appreciative of the respect from both the faculty and staff with the MK-MDT as well as their interest in doing research that is culturally appropriate.
“Rick attends all of our meetings,” Dr. Henderson added. “Rather than only consulting him when something comes up, there is a kind of continuous experience of reflection on Rick’s part in all of our discussions. He’s a part of us, and that has really been a wonderful thing.”
*For this story, Rick Smith preferred the use of American Indian and Alaska Native (AI/AN).
The origin of the name,” Memory Keepers” Medical Discovery Team is significant. In many American Indian cultures, respected adults and elders of the tribe are responsible for preserving sacred medicine bundles, songs, and stories. In this spirit, the research to preserve brain health will enable American Indian communities to continue to benefit from the wisdom of their adults and elders far into the future.
The University of Minnesota Medical School is now second in the nation for successfully graduating Native American medical doctors. Working together with local and national Native American communities, University departments, nonprofits and government, the CAIMH has played a key role in this success.
Researchers at the University of Minnesota Medical School recognize that Native American youth bear a disproportionate share of our state’s mental, behavioral health disorders and associated mortalities, yet access to services and available therapies are often limited. Anna Wirta Kosobuski, EdD, has been actively partnering with tribal communities this year to help youth who are experiencing these adversities..