BOSTON — She’d just used a defibrillator to resuscitate a man whose heart had stopped, and now, in the next room, a baby’s head was crowning, the mother emitting a stream of loud, harrowing moans.
“I see a head,” shouted Jordan Owen. “The baby is coming!”
“You need to get the shoulder out,” said emergency physician Valerie Dobiesz, speaking calmly, but loudly over the mother’s agonized howls. “You don’t want her to tear her.”
Owen worked gently to ease out the baby’s rubber shoulder. Rubber, because this was a simulation and the mother and baby were high-tech dummies. It was thrilling but routine work at the medical simulation training center at Brigham and Women’s Hospital. But this recent day was anything but routine. In the labor and delivery room, and in two other simulation rooms nearby, every single trainee was Native American.
There was Kalista White, a member of the Navajo Nation from Whitecone, Ariz., who hopes one day to work in obstetrics and emergency medicine to help women in her tribe have safer births. There was Anpotowin Jensen, a member of the Oglala Lakota tribe in Pine Ridge, S.D., trained in environmental health, who is tired of seeing so many on her reservation die from preventable causes. And Owen, also a member of the Navajo Nation, who hopes to become a physician to help serve tribal residents who may face a three-hour drive to reach a hospital or a six-hour drive to see a specialist.
To say there are few Native American or Alaska Native physicians in the United States is putting it mildly. There are only 3,400 — that’s less than 0.4% of the more than a million physicians practicing in the U.S. The numbers are not increasing because trainees are also scarce in medical school; 43% of the nation’s medical schools enrolled no Native American/Alaska Native students in 2019. The eight trainees here in Boston are hoping to change those numbers, and by becoming physicians, help provide better care to those in the tribal and rural areas they call home.
They’re part of a pipeline program that began this summer bringing young Indigenous people who hope to be doctors to train at Harvard Medical School and Brigham and Women’s Hospital. The program is open to students and graduates of tribal and community colleges who might not have the resources, contacts, or know-how to successfully compete for spots in medical school.
In three jam-packed weeks, the trainees learned CPR and performed a variety of simulations, scrubbed for real surgeries, met with deans and admissions officials from Harvard Medical School, spoke with residents, and shadowed a variety of physicians as they worked.
The Ohiyesa program is the brainchild of Victor A. Lopez-Carmen, a Harvard medical student and enrolled member of the Dakota and Yaqui tribes who is a descendent of Ohiyesa, the first Native American M.D. trained in the United States. Also known by his Western name — Charles Eastman — Ohiyesa graduated in 1890 from the Boston University School of Medicine, the only Native American in his class.
More than 130 years later, Victor is one of only two Native Americans in his class. “That’s the progress we’ve made,” Lopez-Carmen said. “It’s not enough.”
In addition to a lack of physicians from their own heritages, Indigenous Americans face staggering health disparities, and higher than average death rates for nearly all chronic diseases. The county with the shortest lifespan in the U.S. is one that Victor considers a home, and hopes one day to work in: Oglala Lakota County, home of the Pine Ridge Reservation in South Dakota.
This is where Jensen lives, and where her father died in 2017 after an ambulance took nearly an hour to reach their home. Her training this month has her thinking about that painful time. “We just learned CPR and I wonder if someone in the family had been trained, would it have been different?” she asked. Jensen wants to become a physician in part to help work on some of the underlying structural reasons people in her tribe die so young. “The conversations about health disparities on the reservation aren’t being crafted by our own people,” she said.
The new program got its start after Lopez-Carmen published an op-ed in the Boston Globe titled “Where are all the Native American medical students?” He then connected with Dobiesz, who helps run the STRATUS Center for Medical Simulation and also leads programs for the Front Line Indigenous Partnership, a Brigham and Harvard project working to improve emergency medical care in Indigenous communities.
Dobiesz was able to receive funding for the pilot program from a private donor. The two founders agreed right away to focus on tribal and community colleges to find students that didn’t have as many opportunities to enter medical school. They decided they would not require grades or test scores that might rule out talented students that had faced hardships. Applications were required to write an essay explaining their goals and displaying their eagerness to enter medicine.
“They don’t get as much attention and they have so many obstacles,” said Lopez-Carmen. “A lot of them struggle and lose out because of that. We were looking at their passion.”
Once the students got started, Lopez-Carmen and Dobiesz felt confident they had made the right decision. “These students have faced incredible barriers and obstacles,” such as living in areas with no running water or having to stay home and care for family members instead of pursuing their careers, said Dobiesz, who is currently seeking funding to make the program permanent. “But all of them have the potential. All of them can do this.”
The students will leave with more than 50 hours of shadowing physicians — something medical schools like to see in applicants but that can be difficult for students at colleges not affiliated with medical schools. They will also receive mentoring and test-preparation help over the next year, and will have the chance to work with numerous physicians who could write recommendation letters for their medical school applications. “A letter of recommendation from Harvard Medical School can go a long way,” Lopez-Carmen said.
Perhaps most importantly, they are seeing the ins and outs of hospitals and medical training and doing so in a supportive environment. The students were showered with compliments from Tim Erickson, an emergency medicine physician at the Brigham who oversaw their attempts to resuscitate the animatronic dummy and shared real-world tips. “I always have one of these,” he said, as he distributed pocket-sized stress-relief balls to the group. “My pulse may be 140 during an emergency, but I use this so it looks like it’s 60.”
The hospital is home to two other longstanding initiatives helping to improve Indigenous health: a program that sends physicians from the Brigham to work in the Navajo Nation, and the Four Directions Summer Research Program for students at four-year colleges with a commitment to improving Indigenous health, which Lopez-Carmen attended while in college. Both are the work of Tom Sequist, the hospital’s chief medical officer and a member of the Taos Pueblo tribe of New Mexico. “It’s my joy when we see this work spread,” he said of the Ohiyesa program.
In addition to being Indigenous, many of the Ohiyesa students are non-traditional because they’ve been out of college for a few years. Tiffany Toppenheim, a member of the Lummi Nation on Washington state’s northern coast, for example, has 4-year-old twins.
Inspired by her positive experience giving birth, she grew motivated to return to college and take pre-med prerequisites and then attend medical school so she can bring better care back to her tribe. “When I grew up, we had a little tiny Indian health clinic, not a lot of tribal people that you’d see as nurses or doctors,” said Toppenheim, who knows of only one other Lummi physician. “When you grow up and don’t see anyone around you doing something like this, you don’t think you’re capable.”
In this year’s class, all but one are female. There were far fewer male applicants, a sign, said Lopez-Carmen, that “we’re losing a lot of young Native boys along the way in education.”
Dobiesz said the faculty may be learning just as much as the students. One speaker, a Harvard dean, told the group she had never been in a room with so many Indigenous youth before and was thrilled to learn about their lives. Other physicians are listening to the trainees to learn how medicine could better serve them. Medical training, for example, could make more space for Indigenous students to process deaths they experience, as their spiritual needs may differ.
Others may learn important lessons from students like Owen, who is tired of going to reservation clinics and receiving only Tylenol or ibuprofen and being sent home. ‘There’s not much patient care,” she said. “It’s not like here where they say ‘Let’s check this.’ ‘Let’s run these tests.’”
When she becomes a psychiatrist serving the Navajo Nation, Owen said, she plans to open a practice that is also a bookstore and cafe, a holistic approach to medicine that could serve her entire community. “We need these things,” she said. “Where I’m from, there’s nothing to do.”
This is part of a series of articles exploring racism in health and medicine that is funded by a grant from the Commonwealth Fund.