Native Americans Provide Lesson in Patient-Centered Care

John Commins, for HealthLeaders Media, December 17, 2008

Going to the hospital can provide considerable anxiety for anyone. But imagine going to a hospital where you don't speak the same language, where the nurses and physicians don't look like you or act like you, and where they make references to technologies, terminologies, and treatments that are foreign to you.

If you can imagine that, maybe you can somewhat understand the intimidation that some Native Americans can feel when they enter the hospital, particularly those who live a traditional lifestyle. "When people come from an environment that is much more immersed in traditional American Indian cultures, going to the non-Indian world is culture shock," says Donald Warne, MD, MPH, executive director of the Aberdeen Area Tribal Chairmen's Health Board, based in Rapid City, SD. "It's even more so going into a hospital because they also have to deal with the fears that everyone has."

While Warne says hospitals have made strides developing what he calls a "cultural competence" with Native American patients, they still have lots of work to do. "It's more than just language. It's belief systems. It's practices. Even approaches to the healing process, the recovery process, even the dying process are all culturally based," he says.

Banner Page Hospital, a 25-bed critical-access hospital located near the Grand Canyon in remote northern Arizona, has spent several years developing a treatment program that takes into consideration the traditions of the Native Americans who live on a nearby reservation. Banner Page CEO Sandy Haryasz says about half of the 22,000 people who fall into the hospital's service area are Navajo, and they make up 50% of the hospital's patients.

"They have different cultural beliefs and we've had to make some adjustments," Haryasz says. "If they need to be admitted to the hospital for whatever reason—whether it's having a baby, pneumonia, or surgery—sometimes if they're really traditional they like to have a medicine man come into the hospital and pray over them. We certainly allow that."

At the request of the Navajo, Banner Page built a hogan, a small building near the hospital that is used for healing ceremonies that involve burning cedar.

To accommodate the ceremony, Haryasz says the hospital takes extra steps to account for safety and liability issues. "We have to hold the healing ceremony outside because it involves an open fire," she says. "Because it is outside and there is no call bell we have to have a staff member in attendance in case the patient gets sick or hurt or needs something. We have looked at as many of the patient safety concerns as possible to make sure the patient is well taken care of while still being sensitive to their needs."

Warne, a member of the Oglala Lakota tribe, says modern medicine's focus is almost entirely science-based, while traditional Native American medicine incorporates spirituality. Even though they appear to be polar opposites, Warne says traditional healing can be integrated with modern medicine. "For example, many tribes use prayer ties or tobacco ties, and those are essentially encapsulated prayers for that individual. Some facilities where I've worked in the private sector allow the patients to hold tobacco ties while they are going through a surgical procedure," he says.

According to the 2000 U.S. Census, there are approximately 4.1 million Native Americans in the United States, mostly living on lands in Alaska, Arizona, Oklahoma, and North and South Dakota. But although some regions have a minimal Native American population, that does not invalidate the idea of cultural competency. "Any hospital needs to have a good cultural competency program, and the cultural competency should reflect the patient population," Warne says.

Because of its proximity to the Grand Canyon, for example, Banner Page also treats a wide variety of foreign tourists whose cultural needs might be different than those of a Native American. The overarching philosophy of care is no different, however. "We are here for the patient. We embrace the whole person and focus on meeting their needs, whether they are Native Americans or French or from North Dakota," Haryasz says. "We don't just give lip service to patient-centered care."

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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