It Could Happen Here - Healthcare for Indigenous People with House of Pod

Episode Date: June 13, 2023

A special joint episode with @houseofpod. James and Kaveh talk to Molly Hallweaver Victor A Lopez-Carmen, MPH  (@vlocarmen) about healthcare in the Indigenous community and how healthcare is administ...ered to Indigenous people. You can now listen to all Cool Zone Media shows, 100% ad-free through the Cooler Zone Media subscription, available exclusively on Apple Podcasts. So, open your Apple Podcasts app, search for “Cooler Zone Media” and subscribe today! http://apple.co/coolerzoneSee omnystudio.com/listener for privacy information.

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Starting point is 00:00:00 Hey guys, I'm Kate Max. You might know me from my popular online series, The Running Interview Show, where I run with celebrities, athletes, entrepreneurs, and more. After those runs, the conversations keep going. That's what my podcast, Post Run High, is all about. It's a chance to sit down with my guests and dive even deeper into their stories, their journeys, and the thoughts that arise once we've hit the pavement together. Listen to Post Run High on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. You should probably keep your lights on for
Starting point is 00:00:38 Nocturnal Tales from the Shadow. Join me, Danny Trails, and step into the flames of right. An anthology podcast of modern day horror stories inspired by the most terrifying legends and lore of Latin America. Listen to Nocturnal on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. And welcome to a very special joint episode of two shows that you hopefully love. One, The House of Pod. I'm Kaveh. I'm the host of that show. And it could happen here with my good friend, James Stout. James, hi. Hi, Kaveh. I'm very excited about this. This is a rare privilege. Yeah, I'm very excited too. We'll get straight to it.
Starting point is 00:02:04 Just a quick reminder if you're not following uh one of these shows and you're following the other yeah follow both why not and uh leave a nice review if you uh like the shows uh either way um but we're really excited so let's get straight to the episode how's that sound yep let's go. And welcome back! Oh, I know every week I say this is a special episode, and I'm usually lying. 99% of the time it's not special. But this week is very special. It's special because I've never done this before. I'm very excited. It's a topic I really
Starting point is 00:02:51 have wanted to cover for a while, but I'm going to be covering the topic with a good friend of mine who has an excellent show and we're doing a joint show release thing and I've never done it. It's like a Marvel team up and I'm very excited for it james stout james i'm gonna introduce your first journalist podcaster host of it could happen here which if you're listening to this on it could happen here you already knew that james welcome to the show hi thank you yeah um i don't watch many superhero movies so i'm now concerned as to which marvel uh hero or villain I would be. Well, I was thinking more of the comics, but if I have to pin you to a character, it's Moon Knight. I think that's clear.
Starting point is 00:03:34 It's gone straight past me, buddy, but I'm sure. I hope that was... Take my word for it. It's cool. It's cool. James, can you tell us a little bit about what we're covering today? Let's talk to our people about what... Then we'll introduce our guests, but let's tell people kind of what we're trying to cover today. Yeah, of course. So we're talking about like healthcare in an Indigenous context and how we can both learn from and stand in solidarity with Indigenous communities when it comes to healthcare, I
Starting point is 00:03:57 guess. Excellent. And to help us with that, we have two guests. We have a medical student at a little school called Harvard. I think it's a liberal arts school out in the east somewhere. Named Victor Lopez Carmen. He was the prior elected co-chair of the United Nations Global Indigenous Youth Caucus. He is a member of the Crow Creek Sioux Tribe and also from the Yaqui Tribe. Is that correct, Victor? Yeah. Okay, excellent. Welcome to the shows. Thank you so much.
Starting point is 00:04:25 I'm honestly props to pronouncing all that right. Oh, yeah. No, your stuff I'm going to get right. Our next guest, whose name is Molly, I'm going to probably destroy her name because those are the names I have a hard time with. Dr. Molly Hallweaver, is that correct? Correct. ER doctor at UC Davis, one of my favorite hospitals in the world. Is that also correct?
Starting point is 00:04:48 That is correct. I work at UC Davis. So I guess maybe we should start like, if we want to start out by explaining maybe how healthcare, like what things, when we look at healthcare in indigenous context what things we're looking at to differentiate it from healthcare in other contexts right what what would be the areas that both of you guys think that folks who aren't familiar with this uh because sadly i think a lot of the united states they either don't think they know indigenous people or maybe they really don't um like and we can explain that lots of Indigenous people,
Starting point is 00:05:26 most Indigenous people live off res too. I think that would be very valuable. But what sort of topics would we be looking at when we're looking at healthcare from an Indigenous perspective? I think like when you look at Indigenous peoples in the US, you think of our traditional health system as well. That was what we always had. That was what we've had for thousands of years and the efforts to maintain the traditional health,
Starting point is 00:05:50 traditional healing practices. And then you look at the Western health system, that the different systems we have access to today, including the Indian health service, which is unique to us, tribal clinics, tribal operated clinics, and hospitals, everyday hospitals that anyone else uses. Because like you said, the majority of Native Americans today in the U.S. live in cities or urban contexts. Molly, let me ask you, because people may be wondering, how did you become involved with delivery of healthcare to the Native American population? Yeah, thanks.
Starting point is 00:06:32 It's great to be here. Thanks for having us. I'm excited to chat with you all. I kind of had a unique opportunity. I've always been interested in Indian Health Service as like a healthcare delivery system and indigenous peoples. And when I was a, I started fellowship, I did a global health fellowship, and I started in 2020. So it was, you know, not a great year to be a global health fellow, for many reasons. And so I had very, you know, obviously we were on lockdown and work was hard and stressful as an ER doc.
Starting point is 00:07:06 And so we were trying to be creative and, you know, how we can do this global health fellowship. And so I got in touch with a awesome physician, Don Maggio, who is the ED director at White River, which is a Apache nation in Arizona. It's like three hours east of Phoenix. So he went to, he was a Highland alum, a Highland DM alum, which is in Oakland and now works full-time at White River. Anyways, got connected with him and everything that was going on during the pandemic, because as I'm sure you guys are all aware and probably a lot of our listeners that the Navajo and Apache tribes had much higher rates of COVID and of severe COVID. And so I went as first for kind of public health outreach. So I went and did some contact tracing and helped do they did a really cool program of outreach in the community to go and check on the locals. And we would go and
Starting point is 00:08:06 check pulse ox. So we'd see how high their oxygen saturation was and see how people were doing to try to catch disease early. So that's how I kind of got into doing it. And then I loved it there and wanted to keep working. And so I continued to moonlight, which means I worked kind of as a locums. I don't know if I need to explain that for medical jargon, Kaveh, but I worked, you know, every one to two months I would fly to Arizona and work on the res for a week. Very, very cool. So, Victor, getting back a little bit to where Native Americans are getting their health care. where Native Americans are getting their health care. What is your interest once you're done? When you graduate from medical, where are you?
Starting point is 00:08:50 What year are you right now? I'm a fourth year, so I'm in my last year. Oh, my God. Good for you, buddy. How are you liking it? I'm liking it less. You're a fourth year less? No, I'm not like, like, I like medicine. I still maintain, but medical school, like I'm, I'm ready to be done with school.
Starting point is 00:09:10 You got senioritis. Is that what you mean? Pretty much. Yeah. Fair enough. So you're a rising fourth year or have you already matched? No, I'm a, I'm a rising fourth year. I'm applying to residency now.
Starting point is 00:09:20 So, so talk to us about where, what you would like to, where you'd like to go and what kind of medicine you'd like to practice. Honestly, anywhere that will take me. I just want to be a doctor. But yeah, I want to go into pediatrics. I always wanted to help and take care of Native kids and back in the community, for sure. I want to go back and be a community member again. I've been gone for so long. I feel like I've been only able to go back for, like, you know, breaks and things like that. And it hasn't been enough for me as an Indigenous person.
Starting point is 00:10:02 So I'm ready to go back, back be a doctor be part of the community be there for ceremonies be there to treat patients that's my ideal i think one thing that's really interesting especially and like we have this chance to talk to you which we which we often don't have is you mentioned like balancing western medical technology with indigenous medical technologies, right? And I'm really interested in hearing how you would approach that for folks who aren't familiar or for folks who don't have the knowledge of Indigenous medical technologies that you might or you maybe have people who you go to for that. Yeah, well, I think it's important to just already start the conversation that so much Indigenous medical technology has already been appropriated by Western medicine, as Western medicine, aspirin, for instance, many traditional healing practices that were and
Starting point is 00:11:00 are still find themselves seeping into the field of psychiatry or around parenting, mental health, the way that, for instance, that Indigenous peoples, I think there's a growing understanding in the medical field about planetary health and the impacts of climate change on health. And a lot of that has already been said and fought for by Indigenous peoples for a very long time. And so there's already a lot of stuff there that we're working with. And I think it's important to give Indigenous peoples their flowers. But yeah, I think when it comes to integrating on the clinical level, it's going to differ from community to community. You might know, but in the Pascua Yaqui tribe, the health division employs a team of traditional healers that come up, I think, monthly from Sonora, Mexico, from the villages. And Yaqui patients can elect to see the traditional
Starting point is 00:12:00 healers with or without a Western trained physician. And there's a whole room where they have all these herbs and plants that Yaqui people have been using for thousands of years. And I think that that's very beautiful. One reason we've been able to do that is because our tribe elected to run their own health division rather than having the Indian Health Service run it for them. We had the capability to do that at the time. Not all tribes do have the capability yet. We had it, and I think it's been beneficial for us because it's given us more freedom to bridge Western and traditional medicine in a way that works for us. the yaki system is a really great one like
Starting point is 00:12:45 an um like people probably people won't be familiar with it i guessing most people listening won't be familiar with it but it's allowed the tribe to do all kinds of cool things like in i've been involved in a diabetes prevention cycling program there for 10 years something like this long time um But there are things that can be done because of that block grant or running their own system as opposed to having IHS run the system. Could you, like, because Molly,
Starting point is 00:13:12 I think you're more familiar with like an IHS clinic model, right? Would one of you want to explain the difference between the two of those for people who aren't familiar? IHS versus? The Pascua Yaqui tribe run their own system i think they get a block grant i correct me if i'm wrong victor they get a block grant from ihs and they spend that as
Starting point is 00:13:30 a c-fit yeah i can speak to the ihs side but um for me this and victor you can correct me if i'm wrong but it for me it was easy to it's kind of similar to the va for just for medical doctors to understand in that it's a a set of money that the government sets aside for a certain population and the veterans for the va and ihs for um natives and but there's obviously disparity between even those two like per capita spending is way higher in the va than it is on IHS. But it's a Western system. And all of the staff on the hospital, like the reservation hospital or the Indian hospital are all employees of IHS. So they're actually kind of like federal employees. And we can kind of get into the weeds of it later. But there's a lot of turnover because it's a sometimes it's hard places to live.
Starting point is 00:14:27 And so and they're young. They kind of recruit young doctors and there's a lot of turnover for the for the primary care doctors. And then in the ER where I work, there's very few board certified ER doctors. So it's staffed by non non certified docs. That sounds right to me. The only other thing I would add is that the Indian Health Service, it's predicated on what's called the federal trust responsibility that's built over decades of Supreme Court precedents, smaller court precedents, over the years that I think a lot of them were based in treaties made with
Starting point is 00:15:05 Indigenous peoples. And basically, this means that the government, because of the harm, the oppression, the colonization that has been dealt upon Indigenous peoples across the United States, there's a trust responsibility for the federal government to sort of to do something about the lingering impacts. They have a responsibility to provide health services to Indigenous peoples in the U.S. That was also in many of the treaties that were made with Indigenous nations. And I think it does go over people's heads sometimes that this is not a favor. This is not a gift. It's a responsibility based on centuries of oppression. And that responsibility is not fully being met right now because the Indian Health Service is severely underfunded. The way that the funds are
Starting point is 00:16:00 appropriated is unique to government health programs the way the veterans for instance veterans affairs is appropriated is much more effective than the way Indian health service is appropriated at the federal level. It might be worth explaining here just briefly that not all tribes are federally recognized right and not all indigenous people are part of federally recognized tribes and how would that impact their access to healthcare? Yeah, well, you know, federal recognition isn't perfect. It's a really arduous process, and not all tribes are federally recognized. For those tribes who aren't, they don't have access to those services, like the Indian Health Service or the Bureau of Indian Education, for instance,
Starting point is 00:16:46 and many other federal grants that Indigenous peoples and Indigenous nations can apply for or just automatically get. For instance, during COVID-19, there were specific funding allocated for tribal nations. Those tribal nations who are not federally recognized, they wouldn't have had access to them. Hey guys, I'm Kate Max. You might know me from my popular online series, The Running Interview Show, where I run with celebrities, athletes, entrepreneurs, and more. athletes, entrepreneurs, and more. After those runs, the conversations keep going. That's what my podcast Post Run High is all about. It's a chance to sit down with my guests and dive even deeper into their stories, their journeys, and the thoughts that arise once we've hit the
Starting point is 00:17:38 pavement together. You know that rush of endorphins you feel after a great workout? Well, that's when the real magic happens. So if you love hearing real, inspiring stories from the people you know, follow, and admire, join me every week for Post Run High. It's where we take the conversation beyond the run and get into the heart of it all. It's lighthearted, pretty crazy, and very fun. of it all. It's lighthearted, pretty crazy, and very fun. Listen to Post Run High on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Welcome. I'm Danny Thrill. Won't you join me as the fire and dare enter Nocturnum, Tales from the Shadows, presented by iHeart and Sonora.
Starting point is 00:18:26 An anthology of modern-day horror stories inspired by the legends of Latin America. From ghastly encounters with shapeshifters to bone-chilling brushes with supernatural creatures. I know you. Take a trip and experience the horrors that have haunted Latin America since the beginning of time. Listen to Nocturnal Tales from the Shadows as part of My Cultura podcast network,
Starting point is 00:19:04 available on the iHeartRadio app, Apple podcast, or wherever you get your podcast. Hi, I'm Ed Zitron, host of the Better Offline podcast, and we're kicking off our second season digging into how tech's elite has turned Silicon Valley into a playground for billionaires. From the chaotic world of generative AI to the destruction of Google search, better offline is your unvarnished and at times unhinged look at the underbelly of tech from an industry veteran with nothing to lose. This season I'm going to be joined by everyone from Nobel winning economists to leading journalists in the field and I'll be digging into why the products you love keep getting worse and naming and shaming those
Starting point is 00:19:43 responsible. Don't get me wrong though, I love technology. I just hate the people in charge and want them to get back to building things that actually do things to help real people. I swear to God, things can change if we're loud enough. So join me every week to understand what's happening in the tech industry and what could be done to make things better. Listen to Better Offline on the iHeartRadio app, Apple Podcasts, wherever else you get your podcasts. Check out betteroffline.com. Let me shift gears a little bit here and get to a question that is, I think, going to be very difficult to answer. And it's one of those impossible questions because there's so many parts to it, I'm sure. And it varies so much.
Starting point is 00:20:26 But I'd like to talk a little bit about the major health issues that you guys feel are facing Native Americans right now and whether or not if they are at all different from the rest of the U.S. population. And then we could talk about what barriers there are to care in that regards. But we'll start with you, Molly. Can you tell us from your experience working there, what are the major health issues that you feel may or may not be the same as the general population? Yeah, I think at the end of the day, it's very similar. You're seeing the same disease processes that you're seeing in the general population. But you're seeing
Starting point is 00:21:07 everything's a little bit more severe, I would say. Like there's more, there's higher rates of the chronic disorders like diabetes and hypertension, and it's kind of more severe long-term effects of the diabetes and hypertension. at younger ages i think that was kind of what more was most striking to me you're seeing um the long-term the bad effects the long-term bad effects at younger ages you're seeing alcohol use disorder is a problem everywhere in the united states but on tribes alcohol use disorder is much higher um and again, like I, I was, it was shocked. It was honestly shocking to see 30 year olds who had end stage liver disease from alcohol use disorder. And I saw some of the sickest people I've seen have been from my, from my time there. is you know a little bit harder and the reasons for that as we can talk about are like totally multifactorial but in line with poverty funding is a huge like funding and poverty go hand in hand education um and just the fact that yeah they've been oppressed for centuries um but yeah i think
Starting point is 00:22:21 it's at the end of the day it was the same i was seeing the same things that I would see at UC Davis, but I was seeing it on a more extreme basis, I would say. Victor? sort of say that these problems exist all across the U.S. because there can be stereotypes associated with our health concerns like that that that are attributed to the way that we live or our culture or just inherent to who we are like there's this prevailing I think notion that I don't know what came first but I think in the medical field I still hear about it like in class sometimes they'll say like Native Americans have the highest rates of diabetes or heart disease, but they won't say why. And it makes people think that, oh, like, are they just not catching on? Like, are they just living badly?
Starting point is 00:23:19 And when you don't say why, it kind of I think it it creates a lot of ignorance and a lot of room for interpretation. So I think it's really important to talk about those background reasons. For instance, with diabetes, I think a lot on a lot of reservations, there's no access to one traditional foods, which have been, you know, through policy eradicated through government policies over the decades and centuries. And no access to healthy foods. These are food deserts. And at the same time, like Dr. Hall-Weaver mentioned, there's poverty.
Starting point is 00:23:57 So if you're trying to get healthy food, you don't have, number one, it's not on the reservation. You might not even be able to afford it if you can get off the reservation. Not a lot of people have, you know, not everyone has a car or the ability to mobilize, you know, an hour and a half to the health food store. And so, you know, a lot of that's just one example of like some of the systemic reasons why somebody could get diabetes quite early. And there's also a lot of lingering trauma and mental health impacts that I think play into the high rates of alcoholism. A lot of, you know, in policy, there was there were some early efforts to try to, I think, to try to limit alcohol on reservations that we still see today. On some reservations,
Starting point is 00:24:48 alcohol is entirely illegal on the reservation, but you'll still see businesses right on the border of the reservation just camp themselves there, right on the border, knowing that the population is vulnerable, maybe not knowing that it's because of the historical trauma and things like that, but there's something there, you know, so there's still an aspect of being targeted there by something that, you know, the community is highly vulnerable to still to this day. It's a really interesting point that you bring up, because I remember being in medical school and, you know, you sit in these lecture halls and some they would bring up like Native Americans
Starting point is 00:25:31 being a high risk for all these. It would be like one of these little footnotes that would be in a lot of our lectures and that sort of thing. They never explained why. I mean, medical school, particularly then, wouldn't want to touch anything that they might see as an even mildly political issue even though not discussing it made it one really um do you you must be annoyed by this do you does this happen to you like um do you are you like sitting in your lecture class and then like the
Starting point is 00:25:57 teacher will mention something about native americans then all like the white students in your class just turn their heads and like look at you to see your response yeah that happens sometimes yeah um you're like what listen i just like find a wall and i stare at it just anticipating it uh just looking in deep thought until it passes right smart student uh molly you're going to add something? It was only open, you know, from 9 a.m. to 3 p.m. on Monday, Wednesday, Friday. Like it had really limited hours. And that was their one grocery store for the entire reservation. And so it was just even, you know, during the pandemic, everything got a little bit worse. But yeah, they have very limited access to healthy foods for sure.
Starting point is 00:27:02 One thing that I was recently educated about during a discussion about diabetes prevention was epigenetics and like my i'm a doctor of modern european history so if i go off the rails at any point i'm gonna rely on one of you three to pretty gently guide me back uh but i found that fascinating the concept of concept of intergenerational trauma and epigenetics and how that can impact healthcare today. Is that something either of you could explain to listeners who, like me, are relatively ignorant on it? Hand that to the... I can take this one, actually. It's interesting because I did an episode recently about the intergenerational trauma of the Persian diaspora after the revolution and how this most recent set of protests sort of reignited this trauma. And excuse me, one of the one of the guests mentioned that there was a study in mice in which they looked at sort of epigenetics of stress response.
Starting point is 00:28:06 mice in which they looked at sort of epigenetics of stress response they had pregnant mice and they like they would give them the the scent of rose blossom or something and then they'd shock them and then the the mouse would grow to be really fearful of those shocks that are associated with the rose blossom and then what they noticed was that like the children of the mice would also respond poorly to like that same rose blossom scent, even though they didn't have the exposure to it. And I looked into it. I mean, because the truth of it is, I don't think you can inherit specific phobias. That just doesn't happen. But I kind of pushed back on that point a little bit. And I got a lot of messages from molecular pathologists who were like, so you can't stress during pregnancy. It can affect the DNA. It can affect the DNA. And that can be passed down, changes in the DNA, disruption in the DNA. You can't inherit specific phobias or fears or stresses per se, but it can clearly cause genetic damage when you have that much stress.
Starting point is 00:29:07 And then on top of that, of course, we're talking about the, the, the psychological impact it has on someone and then how they raise their children and how their children grow up. So it is, I agree. It's a very interesting subject, but I don't want to get any more molecular pathologist emails. Molly, what were you going to say? I was going to say, I'm glad you took this epigenetics question from me. You know, one thing about, you're going back to what you were saying, Victor, about the situations that have sort of predicated this. Correct me if I'm
Starting point is 00:29:40 wrong, but my understanding is most of the land that these Indian reservations are on in the United States, like there's 326, if I read that correctly, is not on great land. It's like land that's like close to like mines or places where there's some sort of radiation or there's some sort of issue. It's not great like for growing food itself directly there. Is that correct? Is that part of this? Correct. Yeah. I think a lot of it was, the intention was to put indigenous peoples on land that wasn't as fertile. And that kind of goes back into what I was talking about, traditional foods and how it's difficult. But I think, you know, I don't know if the science was
Starting point is 00:30:21 all there at the time. And I think now a lot of indigenous land, a lot of reservations, actually, they found out that they're, yeah grab more minerals from the land that they actually put us on, which they didn't think was valuable. And now they're like, wait, there's like copper under there. Yeah. That's a good example of that, right? Exactly. Yeah. Yeah. like a flat's a good example of that right exactly yeah yeah yeah well you know the uh podcaster and uh the rapper uh propaganda prop i'm james you probably have met him you know he
Starting point is 00:31:14 he speaks about how initially they they put the african americans uh in the the waterfront they said here you're gonna live in these places by the uh by the the ocean where you can't really grow things that well and then after a while they realized oh no that's really valuable property and then they started trying to find ways to get them out of there it seems to be our our national mo um can we get back to the ihs a little bit so you guys have mentioned indian health services it's come up a couple times and james i'd also want to hear your because you worked there as well i'd like to hear, what are some things that the IHS is doing well? What are some things that need work and how? I just want to say the IHS,
Starting point is 00:31:55 I think they're doing what they can't. A lot of it, they're doing what they, well, with what they can't, a lot of it, they're doing what they well with what they have. I would say, like, a lot of the issues are under funding, and we don't exactly know how well, like, we don't really know the potential quite yet, because they just don't have enough funding. So I think, like, I would just like to insert that caveat into the conversation first. Yeah. Yeah. And I, you know, I only have experience on one reservation and they're you know every everyone is different for sure i think someone might know more than me but the alaska health system indian health system is still part of the ihs but it's like kind of its own thing and they are the kind of the gold standard for or they're they're kind of the they are doing the
Starting point is 00:32:43 best with what they have and i i don't know maybe you guys know james or victor that if they have more funding is probably a big part of it if they just have more funding um but they are kind of touted as the the leader in ihs right now i know but less about this than either of you i'm sure but um I know I worked on an NIH grant years ago um with someone who'd worked with Alaskan native people and um they were talking about this promodores de salud model which I don't know if you guys are familiar with that it came from Oakland actually but uh like it's a peer mentor model for health education that they had implemented there and we were trying to get money to implement that and the yaki reservation didn't work shockingly um but um that model that they use of like using people
Starting point is 00:33:32 from the community to educate people from the community rather than like uh i guess you could call it like white men in white coats um what works very well for them and i think it's it's a very desirable model to replicate it's not that expensive either um and we were doing it with diabetes prevention right so like chiefly my thing is riding bikes uh has been my whole life and so uh yeah just a big old bike riding hippie um but like it riding bikes is very good for you, as it turns out, which is nice. So the thing that we've been doing with a lot of my friends on the Yaqui Reservation is getting folks, helping them out with a bike and helmet and lights and all the things that you need, teaching them to fix the bike, right?
Starting point is 00:34:17 And then having them go ahead and ride the bike. And then having them bring friends and family members to come back and ride the bike and and have a goal event as part of that and that's worked very well for us too so that model that they implemented has been super successful within this very small context of getting yucky folks to ride bikes yeah just going off of that i mean that sounds awesome uh and i think one of the limitations of the IHS is that it's this huge bureaucracy. So it's hard to do stuff like that. Like, for instance, at the Yaqui tribe, I'm sure, you know, we're not the easiest tribe to work with.
Starting point is 00:34:54 But we're probably easier than the IHS. And I think that that's a huge limitation like even if you want to do a study on the ihs it has to be approved by like all of these government officials and bureaucrats and uh and i think that that makes it really difficult and especially because you know and there's so many branches of the government that the indian Service, there's just one small piece of it. And it's not necessarily one that's heavily prioritized by the government. But there are improvements that are being made. And I think in this last appropriations bill, the Indian Health Service got funded a lot more than it had previously.
Starting point is 00:35:43 So hopefully we'll see some improvements i think they're doing really well when it comes to uh digital health the integration of uh of electronic medical systems i think that made a significant impact uh when that was introduced and then you know i think the indian health, like the model, does well in giving a lot of freedom to tribes to choose. Do we want to continue with the Indian Health Service or do we want to take our health system over and run it ourselves, but still use the same money that would have been used anyways? I think that's what a lot of the clinics in Alaska did in terms of having like it's called 638 clinic or 638 clinics or tribal health systems it's really cool what they did in Alaska because those are some of the most remote villages you know in the U.S. and I think that is something that we should
Starting point is 00:36:39 be paying more attention to especially you know when we're talking about, you know, we talk about Alaska, that they're remote, but a lot of tribes in other parts of the US are maybe not as remote, but they're in very similar situations, and that they're kind of disconnected, like on food deserts. And I think the same model can be used, but not every tribe is at the place where they're capable uh yet of taking over like the the operations the staff there's a lot of work that needs to be done and every tribe is kind of in a different place i'm interested i'm interested i think you were mostly tongue-in-cheek but when you when you mentioned the yaki tribe is not that easy to work with what what do you mean like is it is is a is there a lot of different opinions is that why is there uh is it hard to why is it hard to manage or what why would that
Starting point is 00:37:30 be difficult we're just very militant um and i think uh i think we just you know we just do our own thing and uh very independent and yeah yeah we're just kind of like i think i think we just have a very uh rebellious nature in us like we're sort of uh but yeah just really headstrong and like we don't work the same on the same timeline i think sometimes it's like when for instance like like i'll tell you a story uh there was this uh this shrimp farmer dude our traditional one of our traditional uh spiritual leaders political leaders he passed away in early 2000s his name was anselmo valencia and uh they were bringing down they're trying to introduce uh shrimp farming in the traditional villages
Starting point is 00:38:23 in sonora mexico so they brought this guy all the way down he's this businessman and uh you know he's running on on time and uh they they brought him down to the traditional authorities in one of the pueblos and then all of a sudden uh in between right in the middle of the meeting, the snake, you see this snake on the floor go by. And then Osama Valencia, he's like, stop, wait for a second. And he grabs a snake and he looks at it and he says, we have to stop the meeting. I have to go back to Tucson. And this business guy is like, what the hell? You know, I just came from like Manhattan and I flew all the way.
Starting point is 00:39:03 I'm in this village. And they stopped the meeting. And, and this guy's like confused. I think he got really angry and that never happened to him in a business meeting before, but there was a traditional aspect that I think we just put that above everything else. Like during, even today, during times of ceremony, like no one's answering emails no tribal
Starting point is 00:39:26 government official is going to get back to you within that those like three four weeks because they're doing spiritual um practices and and honoring that so yeah yeah i get it from my perspective everyone is lovely and like it's nice to have a community where everyone cares about each other and like wants everyone else to be healthy and like that's nice to have a community where everyone cares about each other and like wants everyone else to be healthy and like that's great there are times when like recently we did a live show to raise money to buy more bikes and uh someone from iHeart was trying to get a w9 out of us and i was like nah it's it's like easter week it's not it's not gonna happen like um like it's just i did but it's fine you explain it and. I always attribute I'm not fully culturally
Starting point is 00:40:06 fluent. I'm a guy from England. It was different where I grew up. You're not Yaqui? You couldn't tell. Stout is right up there with Valencia. Obviously, I don't have full cultural fluency, so it's on me to listen and
Starting point is 00:40:24 learn over time rather than be frustrated and bulldoze shit when you're i mean obviously you're you're very good at that in my my opinion from what i've seen from you so far but i'm very curious actually from both james and molly like when you guys first started going to the reservation what um surprised you uh what was different than you had envisioned what you know because i'm assuming you got all your knowledge of what reservations were like like from hollywood like i did you know what what was fact what was fiction um yeah it was my first time like on a reservation um and i think it was it it it sort of felt like a little bit of a different country almost. Like you're in Arizona and you drive three hours and you feel like you're in a really different place.
Starting point is 00:41:13 It feels just a little bit different. And just, it's beautiful. The one I'm on was, or the one that I went to is in White River, Arizona. It really is beautiful in the mountains along a river but it's you know a lot of single-story housing that are all kind of government cookie cutter housing and I got to kind of go into the homes too when we were doing house visits so that felt I felt very like privileged and it felt special to be able to do that. Um, as a very foreign person, right. I felt, I felt like a, an outsider. Um, and yeah, I mean a lot, there isn't, they're not central heat for these houses, some of these houses, lots of the floors were, uh, dirt, like not actual flooring on the houses. Um, was i think surprising to me because it seems like that
Starting point is 00:42:06 is not something you think of when you think of america um but that was that probably was like the most surprising but then like the street dogs running around everywhere it was kind of classic i think that my first my first drive down i like had to stop because like a pack of dogs went by and that was kind of out of a out of a movie yeah i don't know like obviously i'm not american either so yeah it's shocking i actually am from texas i just watched the harry potter films on repeat uh that's how i learned to be a turf uh no um i am not a turf uh i i don't think they need to. I don't think they need to be settled. Yeah, those people should go away.
Starting point is 00:42:50 So, like, I didn't maybe receive a lot of that, like, sort of ingrained kind of... Like, I'm British, but we fucking did settle a colonialism everywhere. I don't want to erase that for a second. But I, you know, so I would just go to the res to ride my bike through it um pasco yaki
Starting point is 00:43:07 res has nice roads lovely bike lanes um and it's much smaller than like uh the tohon autumn res which is next door um that's the size of connecticut for people who aren't familiar and um i know i i'm from a part of england that's very rural where people talk to each other. And that's the thing that I don't like about living in a town in California is that everyone just kind of lives in a little box and kind of moves around and doesn't talk to each other. And I at least in my experience on the reservation, everyone is friendly and nice. Most of the people I run into are friendly and nice. And so I really like that. First guy I ran into was a traditional artist, David Moreno,
Starting point is 00:43:56 who runs an art program there. He's a very lovely guy. And we just were chatting, I think. And I was trying to encourage him to come on a bike ride with me. like he didn't have a bike so then i was just trying to encourage like i was like maybe i could get some bikes and come back and i spoke to some people in diabetes prevention and and we got some bikes and came back but um it like obviously people's houses aren't super duper fancy but they're fine like people have some nice houses on the res like uh you know i didn't grow up in a super fancy house and and like the houses are not that distinct from those i see in san diego um the it's beautiful too like especially down if you go on the autumn reservation further down um we did a a ride there in 2019 and we went out the night before from the Yaki
Starting point is 00:44:45 reservation with a group of us and we did like a big camp out. And then we did a ride the next day. Their roads are not quite as nice as the Yaki roads. We all got, we ran out of inner tubes because everyone got so many punctures. But like it's, it's, yeah, it's beautiful landscape. It's really gorgeous. I think the biggest shock to me was the donkeys the the the donkeys on autumn roads or something else like just just wild ass donkeys that uh like at night it sounds like there's a murder occurring
Starting point is 00:45:15 it just make these horrendous noises and like you puncture on your bike and you go for a little bit of shake it's very hot and suddenly you realize there are like 10 bottles like just uh just chilling there too so uh that was the weirdest thing but like i know people shouldn't just walk onto reservations and start like trying to have their cultural immersion experience or whatever that's uh that's a bit cringe but um yeah like people equally shouldn't think that it's a scary or different or dangerous but like arizona feels foreign to me like i go to phoenix and that that is that is a scary or different or dangerous but like arizona feels foreign to me like i go to phoenix and that that is that is a scary experience for other reasons uh but like no i i've always felt very welcome and comfortable there yeah if i can just add one more thing i'm sorry just i think
Starting point is 00:45:59 the other that's a great point james but like the striking part for me too was that I felt very yeah I felt very welcomed um when I was there and they like have a very soft way of speaking and I'm like a loud annoying American and so like have obviously they're American as well but I've kind of a loud voice and they're very soft-spoken and so gentle and so um just like appreciative and I kind of for me i was like wow this is like amazing that you have the resiliency to feel appreciative when like i don't feel like you should you know feel grateful or appreciative to me um i thought that was like my the most striking that i felt molly's so nice she's like trying to apologize for being
Starting point is 00:46:41 listen you're talking to two podcasters we're like obnoxious is our nature it's like part of our dna you don't need to explain yourself there um victor uh you've already touched on this a little bit but do you find yourself still still dispelling myths and stereotypes about native americans even at medical school yeah, all the time. You know, we talked about the medical misconceptions and those things, but I think they're, it's like, like I said, I feel like the American educational system, it left so much room for interpretation. And what it did give was, you know, a lot of it wasn't true but um i think what i'm really battling is that people just the the level of exposure they have is is so minimal that they're coming into these conversations and discussions with with pretty much almost nothing uh and so
Starting point is 00:47:40 the average american knows very very very little about Native Americans. And when I say that, I don't mean Native American culture, because I don't think anyone, any Native American really cares if they know our culture or not. In fact, they might even protect it. But we're talking about what is the experience of Native Americans in this country? What happened? What were the policies? What are the issues that Native Americans in this country? What happened? What were the policies? What are the issues that are still going on today? You know, there's the level of education.
Starting point is 00:48:12 It's just not to the point where I find we can even have these discussions, the discussions that we need to have. So I think the most taxing thing on me is that whenever I talk about indigenous experiences or anything related to indigenous health, I have to give so much background that every time I have to educate someone on, you know, what is colonization, what happened, and the very basics of, I think that should be basic in this country, all these basics. And by that time, you know, I think people have gotten so much information that maybe they didn't know before.
Starting point is 00:48:53 They get overwhelmed. And these things can also be very touchy subjects, I think, because we haven't been bold enough in the U.S. to actually just talk about them. haven't been bold enough in the U.S. to actually just talk about them. And I think people, you know, might be a little afraid to acknowledge these things and somewhere inside. And I think what would have helped with that is if they were exposed to it in, you know, starting in elementary school history, starting in middle school, high school, all of these things I think will make, well, we need to start doing that in the educational system if we're really going to make progress.
Starting point is 00:49:32 Yeah. As like someone who teaches history or has taught history, I think that's very true. And sadly, it's only getting worse, like places like Florida, right? I'm making it harder and harder to talk about that but i think when people come certainly so like i teach a community college course an american history course and i think when people come to that course i'm in california like many of them for instance could not name the tribe who's the ancestral and current homelands they are sitting
Starting point is 00:50:03 in and learning and then obviously to understand those experiences you have to have a name for them right and if you don't have a name for the people then you're a long way from understanding i guess but it's something that's still desperately lacking in the american education system and it doesn't seem like people are pushing hard enough to get that rectified like it's uh yeah it's a very big gap even in places you know like you could be at school in arizona like you could be an hour from some of the biggest reservations in the united states right the autumn and the and the navajo. And maybe not an hour. Everything's a long way away in Arizona.
Starting point is 00:50:47 And not understand anything about those people's lived experience if you're in Scottsdale. In the Bay Area, I've grown up in the San Francisco Bay Area, and I knew very little about the Native people that were here until my oldest son had to do a project here in San Francisco on the Miwok tribe. And then only then did I learn, I'm like, Oh my God, they were everywhere here. You know, there's so much of the Ohlone tribe. So even, even here, you know, which is a relatively progressive,
Starting point is 00:51:19 not Floridian system, you know, did I not learn a lot about that? But I also, Victor, I also hear you like, I know it must be exhausting. And we appreciate you coming on to talk to us about it. James and I have talked about this before. It's something that I at least grapple with sometimes, like in terms of like bringing on guests, you know, like I want people to talk about these things that are difficult and sometimes may be even a little traumatic to like talk about but there's this balance of like well i want the people who've experienced it know the most about it to speak about it but also don't want to keep re-exposing people to like the same
Starting point is 00:51:54 exhausting trauma every time you know it becomes a tough thing for for me at least to figure out in balance you know yeah definitely yeah i think um you know these podcasts are a great way to to do that to have these discussions because it it actually i think it takes away from the taxation because it hits a lot of people at once you know and uh you know listeners in the tens we have listeners in the tens yeah that's much better yeah we'll do a qr code so you can just be like hey check this out yeah that's a good idea hey guys i'm kate max you might know me from my popular online series, The Running Interview Show, where I run with celebrities, athletes, entrepreneurs, and more. After those runs,
Starting point is 00:52:54 the conversations keep going. That's what my podcast, Post Run High, is all about. It's a chance to sit down with my guests and dive even deeper into their stories, their journeys, and the thoughts that arise once we've hit the pavement together. You know that rush of endorphins you feel after a great workout? Well, that's when the real magic happens. So if you love hearing real, inspiring stories from the people you know, follow, and admire, join me every week for Post Run High. It's where we take the conversation beyond the run and get into the heart of it all. It's lighthearted, pretty crazy, and very fun. Listen to Post Run High on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Welcome. I'm Danny Thrill.
Starting point is 00:53:46 Won't you join me at the fire and dare enter. Nocturnal tales from the shadows presented by I heart and Sonora. An anthology of modern day horror stories inspired by the legends of Latin America. From ghastly encounters with shapeshifters. inspired by the legends of Latin America. From ghastly encounters with shapeshifters to bone-chilling brushes with supernatural creatures. I know you. Take a trip and experience the horrors that have haunted Latin America
Starting point is 00:54:22 since the beginning of time. Horrors that have haunted Latin America since the beginning of time. Listen to Nocturnal Tales from the Shadows as part of my Cultura podcast network, available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Ed Zitron, host of the Better Offline podcast, and we're kicking off our second season get your podcast. tech from an industry veteran with nothing to lose. This season I'm going to be joined by everyone from Nobel winning economists to leading journalists in the field and I'll be digging into why the products you love keep getting worse and naming and shaming those responsible. Don't get me wrong though, I love technology. I just hate the people in charge and want them to get back
Starting point is 00:55:19 to building things that actually do things to help real people. I swear to god things can change if we're loud enough. So join me every week to understand what's happening in the tech industry and what could be done to make things better. Listen to Better Offline on the iHeartRadio app, Apple Podcasts, or wherever else you get your podcasts. Check out betteroffline.com. So, Victor, I'm sorry. i have one last question for you uh you know you mentioned that
Starting point is 00:55:49 you want to go back uh and practice uh on the reservation be a part of the the community again do you plan on on bringing in traditional healing components to your practice and if so are you going to do specialty training is there there like a version of a fellowship that you will do for that? Yeah, I really want to do traditional practices. I'm not a traditional healer myself, but I want to partner with them. I feel like I have the connections to traditional people to do stuff like that. One of the things like I really want to do is try to do a lot of public health initiatives out of my practice. Like for instance, I want to try to find ways to help people grow their own food, start their own gardens, do community gardens. I really want to
Starting point is 00:56:40 get our traditional foods up and running again. And there's a lot of people already working on this, which is amazing. I just want to be of service to that effort. And I think that is one of the most important things right now. I also really want to do public health initiatives around language revitalization. I think language is so important when it comes to the mental health of Indigenous youth. I believe that Indigenous youth who know how to speak their language are more mentally strong during the continuing tides of colonization that they face in this Western world. If they have their language, I think that that's huge in terms of resilience, as culture as well, I think, you
Starting point is 00:57:26 know, finding ways to, to sort of support culture as medicine, culture as prevention, participating in ceremonies, as you know, making it, you know, very apparent that to your audience and to the world that that is protective of Indigenous health, Indigenous mental health. And so, you know, there's all these facets of traditional or traditional ways of life that were all very healthy to us. And I think a huge part of the battle is that we're still having right now because of colonization is revitalizing those things. And then those things you know the more that they're revitalized the more that we decolonize the healthier we're going to be but at the same time recognizing that western medicine can also be very effective too
Starting point is 00:58:16 if it's just properly funded and if the service is effective and so that's the other the other side of the coin that i want to be working on as well oh excellent man yeah one thing i wanted to touch on before we finish is because it seems relatively current and newsy right is and i think victor made an excellent point that like colonization isn't a thing that stopped it's a thing that we keep doing uh like we not not weak including victor uh but you know like we people like me um like uh the indian child welfare act right um is the thing that the supreme court is is like set up to take a swing at um and i know that that is an area of great concern to many people and I was just in a tribal building last week looking at books for Yaqui children right to help them stay connected with their
Starting point is 00:59:13 culture if they're in a family which is not a tribal family and can you if you feel comfortable explain what Iqwa is and then the damage it does to young people to be pulled away from their culture and and sort of uh yeah like this little act of colonization that happens every time that happens yeah I'm glad you brought that up because colonization is definitely continuing for instance we think about the Black Hills in South Dakota and the gold mining, the gold rush there. Well, there's still dozens of gold mining permits that are pending right now in the Black Hills. There are dozens of gold mines still operating there. And the Dakota and Dakota are still fighting for the Black Hills. That's just one instance, but you see that all across the United States. And I think when it comes to the Indian Child Welfare Act,
Starting point is 01:00:05 that's another really good example. So basically the Indian Child Welfare Act, if a native child is in the foster care system and basically it helps to support those children to find a placement with a family who is from their tribe, from their cultural background. And the reasoning behind that is because they, number one, to stop the history of assimilation when it comes to taking Native children from their families. And we know about that through the U.S. boarding school system. That was one example.
Starting point is 01:00:53 But it kind of transitioned at a point once boarding schools were terminated, those forced boarding schools, it kind of transitioned into the foster care system. And at one point, a huge proportion of Native children were in foster care, and they were being placed with white families. And those white families were not exposing them to their cultural background. And that in itself was potentiating assimilation, because that's another Native child, dozens of Native children, thousands of Native children who don't know their language, their culture, because they've been removed from community due to systemic factors, right? And so this bill, it doesn't say, oh,
Starting point is 01:01:39 you can only go with a Native family. It helps to ensure that if there is a suitable Native family from their tribe, that they will get first priority because they know that culture is also very important to Indigenous child well-being as well. So the battle right now is being brought on by this lawsuit that primarily handles like mining and oil companies, but they're taking this Indian Child Welfare Act lawsuit pro bono because if you can get rid of the Indian Child Welfare Act on the basis that they're claiming it's racism, right? They're claiming that Native people are getting some unjust preferential treatment when it comes to adopting Native children over white people on the basis of race. Where that falls short is that the basis of the Indian Child Welfare Act is that Indigenous peoples are not a race. They're sovereign nations. They have a political status distinct from any other race in the U.S. And that is the basis that tribes are arguing for. That, hey, we have this political status. We're a tribal government. We have the rights to raise our children. We have the rights to teach our children, to make sure they grow up in community with our culture. That's not a race issue. That's a political issue.
Starting point is 01:03:07 That's a that relates to our political status as a tribal nation, as a sovereign nation. And so they're going to be battling that in court. But if the Supreme Court decides that this Indian Child Welfare Act is racist or discriminatory based on race, it means that a number of other bills and other things in the law that, for instance, that exist due to the political status of Indigenous nations have the potential to also be thrown out on the basis of racial discrimination. And that, I think, will, you know, will lead to a lot of a lot more land grabs, a lot more, a lot less services being provided, for instance, like the Indian Health Service, for instance, they might say, Oh, why do Native Americans get this healthcare? They might, they might start taking
Starting point is 01:04:04 down a whole a whole bunch of other things that are really important to us. So it's a huge issue right now. It's a troubling time. And I could see how people in the past might have said, oh, don't worry, that won't happen. I think it's pretty clear that these things can happen pretty quickly, pretty aggressively now. I think the last couple of years have shown a lot of people that things can get worse somehow you know and that these things can be taken more and more can be taken from people that have already had so much taken from them so i guess i like to finish off normally instead of just being like here is some sad shit and just pointing to it and then kind of like dropping the mic uh
Starting point is 01:04:45 asking people how they can do something to stand in solidarity so like if either of you want to mention i know this bears ears oak flat there are other attempts to expropriate and colonize indigenous land sacred spaces and fucking border wall is bulldozing kumeyaay graveyards like as i'm talking to you um are there ways that people can stand in solidarity with indigenous communities i'll go first because victor will have a better answer than me and he can he can he can jump in after me but i think as um like a low level entry thing that people can do and it kind of um touches on how trying to remove the burden on asking for education and doing the education yourself um for that white people can do is just you can read books by native authors and that
Starting point is 01:05:31 teaches you a lot of history and there's like some incredible native authors who are writing beautiful stories that are weaved with fact and fiction um but books and then like uh native media um res reservation dogs is like a tv show on hulu that is a really great show that everyone should watch um so i think you can do some like easy things that just takes remove some of the needing to be taught to on yourselves and you can just learn about what we're missing so So those are like very, very easy. And then in terms of like, just from my point of view as a, as an MD, there are a lot of ways to, to get involved because these, the reservations are chronically understaffed. They're just like rural medicine, IHS or not IHS, rural medicine is very under, understaffed in, in our country. IHS, rural medicine is very understaffed in our country.
Starting point is 01:06:29 And so there's always opportunities for doctors to go and work. And it's like valuable and amazing for us and for the community to be able to do. So there are ways to do that through locum companies and directly through the IHS sites. Victor? Yeah, yeah. Yeah, I think, I think conversation, you know, I would love if white allies would talk to their family members and their friends. And I think there are a lot of moments where in these day to day personalday personal interactions, when Natives might come up to stand up, like if you hear something that is ignorant,
Starting point is 01:07:12 you hear something that might be racist, to stand up to the people that you know in your own circles and say, hey, no, that's not correct. To talk to your friends and family about what you learned with regard to colonization or the issues that Native American people face. Because I think some of the people that we listen to the most are the people that we love, our friends and our family. And I think there needs to be a lot more conversation in those spaces, a lot more accountability, because I know that it can be very hard when difficult things come up in those personal interactions to challenge someone. But I think that that is where that sort of thing can really move the needle in the long run. And I think that sometimes
Starting point is 01:07:58 people just choose to stay silent. And I would like that to change. Yeah, very well said. That seems like a fantastic place to close it here. Thank you both so much for coming on and hanging out with us. You've been listening to the House of Pod and It Could Happen Here. Let's get some plugs in for you guys. Can you, let's start with you, Victor. Tell us where people can find you or plug anything you want to plug. Come to the res. Just ask for me. Original Facebook. Yeah.
Starting point is 01:08:36 My Instagram and Twitter are VLOCARMEN. V-L-O-C-A-R-M-E-N. Very cool. And Molly? I exited the Twitter sphere after Elon Musk took over, so I'm off. But you can find me in Sacramento. All right. You guys have been so awesome.
Starting point is 01:08:56 Thank you both for coming on. We hope to talk again sometime. Thank you. It Could Happen Here is a production of Cool Zone Media. Thank you. at coolzonemedia.com slash sources. Thanks for listening. Hey guys, I'm Kate Max. You might know me from my popular online series, The Running Interview Show, where I run with celebrities, athletes, entrepreneurs, and more.
Starting point is 01:09:38 After those runs, the conversations keep going. That's what my podcast, Post Run High, is all about. It's a chance to sit down with my guests and dive even deeper into their stories, their journeys, and the thoughts that arise once we've hit the pavement together. Listen to Post Run High on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. You should probably keep your lights on for Nocturnal Tales from the Shadow Broth. Join me, Danny Trejo, and step into the flames of rife. An anthology podcast of modern day horror stories inspired by the most terrifying legends and lore of Latin America.
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