As the primary endowed professor and director of American Indian well being on the College of Nebraska Medical Heart’s School of Public Well being, Siobhan Wescott wears many hats and, typically, a pale yellow flower behind her ear.
She was raised by a single mom, herself an educational, in a small cabin in Fairbanks, Alaska. However all through her profession, Wescott has discovered herself navigating prestigious, predominantly white establishments far completely different from her rural upbringing. As an Alaskan Athabaskan, she has typically been the one Native American or American Indian particular person within the room — although these labels, overly broad and imposed by the federal government, are misnomers she is attempting to repair.
Wescott beforehand co-directed INMED, a College of North Dakota program that has educated greater than 250 Native American physicians. She remains to be working to ensure Native American medical college students are correctly accounted for and given enough funding and sources. On the nationwide degree, she is a frequent advocate for ground-up public well being work that features Native leaders and communities in collective decision-making. She helped create the American Medical Affiliation’s Job Power on Well being Fairness to push ahead such coverage initiatives.
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Wescott is a doctor, a professor, an advocate, a researcher, and a 2022 STATUS Listing honoree. STAT spoke to her lately through Zoom. This interview has been edited for readability and brevity.
You’ve been by means of a whole lot of elite establishments and also you’ve defined your talent at being kind of a chameleon in plenty of completely different settings. After faculty, you briefly labored for a U.S. senator from South Dakota and as a fellow on the Senate Committee on Indian Affairs. Why was {that a} robust surroundings to remain in for lengthy?
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I didn’t like what politics introduced out in my character. To achieve politics, you actually — to not sound harsh — however you’ll be able to’t be true to at least one factor solely. So in case you have a trigger, for example, that’s not essentially going to give you the results you want as you try to make it as a congressional staffer, for example. Now, typically it may be, in case you have the fitting workplace that you just’re working for, with an elected official who’s inquisitive about that very same matter. However when you’re championing a extremely underdog situation, it’s very robust. To outlive politics and to get forward, you must bend, and in ways in which I don’t like.
Your mom, Elizabeth, attended Harvard and Stanford, and he or she grew to become one of many first Alaska Natives to earn a Ph.D. How did that upbringing, of watching her pursue her schooling, impression you and form you?
It felt prefer it was attainable. There’s so many first-generation college students who’re like, “I’m attempting to navigate this unknown system,” and that wasn’t the case for me. I really feel like my mother made that attainable for me. Particularly for her, however even when it was my time to think about instructional choices, the system isn’t arrange for minorities. … I went to a public highschool in Fairbanks, Alaska, and I bought into Dartmouth. That isn’t the conventional manner that one does that, however I simply felt like I shouldn’t tamp down my expectations of the place I would be capable to go to highschool as a result of that isn’t the conventional.
What made you wish to research authorities at Dartmouth?
Nicely, I’m simply fascinated by collective decision-making and, definitely, the final couple of years have been a grasp class in easy methods to do it incorrect, simply unfolding proper earlier than our very eyes. It’s the identical with why I like public well being, versus working towards scientific drugs. With scientific drugs, you possibly can have very honest moments along with your sufferers and it’s simply the 2 of you, and that’s extremely highly effective. Generally there’s nothing higher. Nonetheless, when you can change coverage that’s harming these sufferers and so they don’t need to have the horrible second that you just consolation them in a one-on-one physician’s go to, then that’s highly effective too.
Is it troublesome so that you can merge a number of paths — your a number of identities, jobs, priorities — into one?
Completely. I’ve really simply been fighting this lately, as a result of when you look within the information, in South Dakota there was a Fast Metropolis resort proprietor who determined to ban all Native Individuals as a result of there had been an incident. And the response of the tribe was to carry a rally of their car parking zone. And there’s an obscure piece of regulation — and we’ll see the way it all performs out — that really you can’t have white settlers if the tribes don’t comply with them. You recognize, at what level do you proceed to try to discover frequent floor with individuals you disagree with and at what level do you protest? … Should you by no means attempt to discover frequent floor, you then’re only a zealot. However are there factors when the opposite aspect is to this point off that there’s no level in looking for frequent floor? And I suppose that’s the place my experiences in D.C. actually helped me, since you rapidly determine who’s saying one thing that they imply and it’s coming from a spot of authenticity, and somebody who’s saying one thing to advance a profession or some kind of deal that’s helpful to them.
There’s a whole lot of variety inside the Native American/American Indian populations, however there are additionally shared histories and cultural norms and context. How do you see that as a gap in your work?
One of many articles that I’m engaged on is a research of the phrases which might be used for our inhabitants in PubMed-listed articles. So are we American Indian, Alaska Native, Native American, Indigenous, Amerindians (that’s a time period)? However what was most fascinating about it’s we ran by means of all of the analyses and there was one thing not sitting proper, after which we realized, effectively, let’s depend how lots of the phrases have been imposed or have unclear that means, and what number of have been clearly significant. Over 90% have been imposed. Even the time period, or the authorized title of the Navajo Nation, the time period “Navajo,” is Spanish, it’s not their time period. So it reveals, even within the easiest issues — what will we name ourselves? — we don’t have a say in that. And the authorized time period utilized by the federal authorities in all reporting of information is American Indian, which is predicated on a 500-year-old mistake. So what I’d prefer to see is for Native leaders to get collectively and supply some steerage, maybe new phrases, after which for there to be authorized adjustments in what the federal authorities makes use of.
While you obtained your Covid vaccine from an Indian Well being Service clinic, you had the chance to “smudge,” which is a conventional Native cleaning ritual. How can we develop extra culturally delicate approaches to public well being and drugs, making an allowance for how many individuals don’t think about science and spirituality or pure drugs to be at odds with each other?
So, let me offer you my abstract of med faculty: You by no means know when a child’s going to be born … you by no means know when somebody goes to die. There are a whole lot of mysteries in between. And I don’t suppose we have now the solutions. Now, I don’t suppose that we should always abandon Western drugs. There’s some actually profound advances, and with correct care, there’s a whole lot of issues that may be handled and are usually not lethal, which have killed hundreds of individuals over the ages, the place there’s a easy intervention, whether or not antibiotics and even an appendectomy. What works for the affected person? … There are lots of people who actually cling to Western drugs, who work in Western drugs and when you try to go outdoors of this, you’re “incorrect.” Now, ought to everyone exit and do some kind of sweat lodge as a result of they heard that that’s what Natives do and that appears to be therapeutic? No. Nothing ought to be absolute. There’s plenty of room for knowledgeable selections and exploring what may be proper, however I simply suppose clearly Western drugs shouldn’t be sufficient.
What else is piquing your curiosity proper now?
The Division of Schooling has, identical to the Census, for U.S. college students, they’re requested their ethnicity after which they’re given six decisions for race. And you’ll verify as many bins as you need, or as apply to you, however when you tick a couple of field, none of your race information is reported. You’re solely thought-about in racial information when you chosen one race and that’s it. Everybody else is misplaced in a class known as “two or extra races” and there’s no additional evaluation. And that’s required, so I’d like to vary it. For Native med college students, there are 1,010 at the moment in med faculty. However solely 177 of these report being solely American Indian/Alaska Native. So 83% of them underneath these necessities are misplaced fully, and that impacts funding selections to assist help new college students. That’s one of many issues that I’m attempting to vary, after which there’s extra broad issues, the place I’d actually like to listen to from communities what they need, after which to have the ability to match researchers with them. There’s a complete motion known as community-based participatory analysis, the place there’s a researcher who has an curiosity space, they strategy communities and say, “Would you prefer to be concerned?” in order that they’ve neighborhood suggestions even earlier than they apply for funding, and never, like, every week or a pair days earlier than it’s like, “Hey, are you able to ship a letter of help?”
Loads of drugs is constructed on this basis of a hierarchy, with the doctor on the high and the affected person on the backside, which might really feel very paternalistic. You’re attempting to flip that paradigm, starting with neighborhood and build up from there. How easy is that?
It’s very troublesome. And I’m laughing as a result of the query actually jogs my memory, there was a time I took a motivational interviewing course for physicians. It’s not about you coming in and saying, “Nicely, right here’s what I believe your issues are, how we’re going to handle these.” It’s coming in and largely listening to the affected person, nonetheless you’re additionally, basically, placing a mirror as much as them. In order that’s, on a macro degree, what I’m attempting to do is embrace tribes, embrace Native leaders, embrace Native communities in decision-making.
You appear to all the time be carrying a flower behind your ear. Is it symbolic or only a ornamental flourish?
My pandemic delusion is I’m really in Hawaii. … Hawaii is such a vacationer vacation spot, it’s forcing out a whole lot of Native Hawaiians – they simply can’t afford to reside of their homeland. They don’t need vacationers coming there, and so it’s even higher in some ways in which I’m carrying the flower however I’m not in Hawaii or planning to go to Hawaii. I’m paying homage to the aloha spirits.
