FEATURE-Powwow's drumbeat draws American Indians to doctor
11 Jul 2007 18:03:47 GMT Source: Reuters
By Ishani Ganguli SILVER SPRING, Md., July 11 (Reuters) - As Wendy Friar put the final touches on a health screening and powwow for Maryland's American Indian community, she had doubts about how the combination would be received. "To be honest, we hope it's appropriate," said Friar, a community health director at Holy Cross, a Roman Catholic hospital in Silver Spring, Maryland. As it turned out, the singing and dancing made all the difference. "You say powwow, that's where it's happening. That's the magnet," says Rico Newman, a Piscataway tribal council member from southern Maryland. "If you don't say powwow, good luck." Hospitals are increasingly turning to cultural events such as powwows or church gatherings to reach underserved communities, promoting often-invasive screening procedures such as pap smears and rectal exams for conditions that disproportionately affect these groups. American Indians and Alaska Natives in particular have three times the rates of diabetes and cervical cancer as other Americans, and are more likely to die from diabetes, alcoholism, tuberculosis, and mental illness, according to government figures. To help narrow these gaps, healthcare providers are trying to be more sensitive to customs and beliefs that can affect health and access to services. So with state funding in hand, Friar teamed up with Maryland Commission on Indian Affairs executive director Keith Colston. He knows how to throw a good powwow. POWWOW IN A CLINIC At 9:30 on a Sunday morning, the classroom at Holy Cross Hospital's community clinic is populated by eight hospital staffers and freshly papered exam tables in private back rooms are empty. By late morning, loud welcomes signal the arrival of the intended guests, representing 12 different tribes. Friar's staff had distributed dream-catcher-decorated fliers, but most are here through word of mouth or Colston's encouragement. Doctors and nurses from Holy Cross and nearby hospitals lecture a slightly fuller audience on topics such as cervical cancer. In the lobby, attendees browse displays on mammograms and bone density screenings, signing up for on-the-spot tests. "If we can just get two in for screening ... I will see that as a plus," said Arlee Gist at the Maryland Department of Health and Mental Hygiene. "We already have more than that," Friar said. Out of 80 who arrive throughout the day, 30 get blood tests, eight go in for a digital rectal exam, and three opt for pelvic or breast exams. Urie Ridgeway of Toms River, New Jersey, has driven four hours with his wife and three kids to set up speakers for the powwow. In the morning, he has his blood checked for signs of prostate cancer. Troy Richardson, 27, of Hollister, North Carolina, and the Haliwa-Saponi tribe, is particularly interested in the talk on asthma -- a problem he has had since childhood. Later that afternoon, he gives his lungs a workout, singing and drumming as part of the "Northern Boys" ensemble. After a lunch of sandwiches and soda, Friar clears blood pressure testing booths to make way for drums and dancing. Colston relates the health benefits of screening as a dozen or so dance, their ribboned and feathered costumes offset by adhesive bandages on their arms. "It's pretty laid back," Richardson said of the event. "I thought it was going to be pretty serious and uptight." At the end of the day, Colston and others leave sore -- from some combination of dancing and prodding, he says. TREADING LIGHTLY A culturally diverse and geographically dispersed people -- there are more than 650 tribes spread across the United States -- American Indians have long had difficulties getting appropriate medical care, particularly screening, says Gist. Cultural sensitivity is easier said than done for these patients, as only five percent of the 900 doctors in the Indian Health Service, an agency of the U.S. Department of Health and Human Services, are natives themselves. While programs help more American Indians become doctors, non-native doctors like Charles North, acting chief medical officer for IHS, learn to compensate. When North began treating American Indians more than 30 years ago, he "spent a lot of time learning to not make eye contact (with Navajo Indians) and still communicate." He also became sensitive to what Colston and others call Indian Standard Time: "Somebody had made their appointment if they showed up on the same day instead of the same fifteen minute interval," North says. Health risks from smoking are particularly tricky to address, as many tribes traditionally use tobacco in prayers and as gifts, said Dr. Steven Kariya, a lung specialist at the George Washington University School of Medicine. Thirty-two percent of American Indians smoke, and smoking-related illnesses including heart disease, cancer, and stroke are the primary killers among Natives. Lack of trust is another healthcare hurdle, according to Colston. "Our people keep to themselves," says Urie Ridgeway, a member of the Nanticoke-Lenni Lenape tribe. "We don't trust outsiders ... If they're not dying they're not going to go get a physical or get checked up."
