It is our first official day in North Carolina and I cannot begin to explain how wonderful this experience already is. We started our morning bright and early at six o’clock. While some girls were busy getting ready and eating breakfast, I sat outside on the deck of our cabin and enjoyed a cup of coffee as I gazed out at the smoky mountains. I had never seen the smoky mountains before today. The picture attached to this blog cannot do justice to the peace I felt while contemplating the beauty I saw.  

At seven we set off to our first destination, the Cherokee Indian Hospital (CIH). When entering CIH I first noticed the detailed colors and patterns across the entire outside of the hospital. As we walked through the inside of the hospital the same was true. The hospital was filled with different colors, patterns, and pictures that reflect the Cherokee Indian culture and their personal beliefs about health and healing. For example, the beams of the hospital were designed like trees and the floors had blue tiles with fish that were made to depict a river. I was taken back at how important it was for the Cherokee people to incorporate their cultural values into the design of the hospital. As we moved forward with our day we had the opportunity to visit with Kayla Holland Nurse Educator of CIH. Kayla took us on a tour of the hospital where we saw the entire outpatient facility and inpatient unit. The outpatient facility was comprised of a primary, dental, pharmacy, imaging, physical therapy, complimentary, and emergency department; they were all located in the same hospital. This was a “healthcare culture shock” to me. In our community it is customary to have to go to multiple different locations to receive holistic treatment. However, CIH has begun to implement aspects of the NUKA healthcare model I previously blogged about and I was able to see the efficacy of its design at CIH.

Kayla Holland spoke with us quite a bit about the reservation and how the CIH functions with its community. The CIH provides care to only members of the tribe excluding their emergency department. The services in which they provide are also based on “blood quantum”. Adding to this, because the Eastern Band of Cherokees is considered its own nation, they reserve the right to discriminate for employment. This was very interesting to me because it contrasts with a core cultural value of mine. I have grown in a culture where discrimination is not only frowned upon, but is illegal. When reflecting on this concept, though it is not how I choose to implement, I can see the rationale for this type of regulation. The Cherokee’s feel very strongly about not only the progression of their culture, but simply just keeping it alive and so promoting the growth of their people through employment is a priority. We also learned about the “per capita” system. This was an agreement made between the U.S. government and the tribal nations where the government would create a bank account and give a certain allowance to every person until the age of eighteen. Every reservation has the option to refuse this agreement in exchange for having a casino on the reservation. I learned that the Cherokee nation opted out of the “per capita” agreement and makes the majority of its income from the casino.

After visiting CIH we toured “The Museum of the Cherokee Indian”. Here we learned all about the origins of the Cherokee people and their progression throughout history. The Paleo Indians were the first to inhabit North America. Their hunting and scavenging skills were more primitive; they did not have the harvesting and exceptional hunting skills that I typically think of when learning about Native American history. As time progressed, the Cherokee people became strong in their ability to hunt, harvest, and build efficiently. While moving throughout the museum it discussed when the English came to America and their interactions with the Cherokee people. It is a known fact that the English forced the Native American people off of their land and on a journey commonly known as the “trail of tears”. Something I found so interesting and “eerie” though was the 1780 Civilization Policy”  that required the Indians to adopt the American way of life through “individual ownership of property, the speaking of the English language, the worship of the one true God, and would govern themselves with written laws”. I found this policy to be ironic because it consists of all those things I hold value to such as the right to own land, the right to worship, and fundamental American beliefs. Where the irony lies though is that you cannot enforce these laws without inherently depriving people of their basic human right to freedom of choice. It was strange to have to contemplate how my values and cultural norms have inflicted suffering on different groups than mine. It sheds light to the necessity for being culturally aware and flexible in my nursing career. In order to protect my patients’ rights to autonomy, justice, fair treatment and many other rights, I must be able to set aside what I hold value to and allow the patient be the ultimate decision maker.

While out and about I did see some similarities between this community and my own. This community puts large value on holistic health as evidenced by the incredible hospital and healthcare model they are implementing. While my community is behind in execution, our values and beliefs are changing to encompass and practice holistic health as well. We learned that CIH is beginning to turn much of their focus and efforts into the mental health of their community. They believe that the root problem of many of the health issues these people are facing can be addressed by first tending to the behavioral health needs that so many require. Western healthcare is shifting focus to addressing the mental health aspects of our patients as well. Unfortunately, we are just now understanding the correlation between mental/spiritual health and the physiological process, whereas the Cherokee people have understood this correlation for years.

This blog cannot encompass all that I was able to see and learn just in this one day. However, these were the major learning opportunities that stuck out to me and I am so looking forward to all that I continue to learn throughout this trip! 

                                                          1780 Civilization Policy

                           The Green Corn Ceremony where the Cherokee celebrated the harvesting of corn

                                                       Cherokee Indian Hospital
 

                                                            Outside the museum

                                                        

                                                            The smoky mountains

                                                  

                                               We have colored corn, they have colored bears!