We are finishing our third day here in North Carolina and it has been a busy couple of days. Tuesday June 6^th we had our first clinical day where we spent our time rotating between different units of the Cherokee Indian Hospital (CIH). One of the first things I noticed yesterday when looking at the front entrance wall was the big Cherokee sign that stated “It belongs to you”. This is the fundamental belief of the Cherokee health system. They believe that the health system as a whole belongs to their people and therefore they are ultimately the ones who run it. I spent the first four hours of the day in the Primary care pod. Their system is set up in six different pods. Each pod has two sets of teams and they are each comprised of a physician, a nurse, a case manager, and case management support. I learned a great deal about how their computer system functions and one of the amazing attributes that stuck out to me was their “alarm clock” system. The case manager and support staff have an application for every patient that “alarms” them for every preventative visit the patient is in need of. For example it informs the staff if the patient has had their mammogram, colonoscopy, pap, hepatitis C screening, and many others. I also learned quite a bit about the clinical aspect of this pod and I got to see firsthand how they use the “customer-owner” concept of the NUKA healthcare model. There was a patient who called with complaints of excruciating pain and they could not wait any longer to see a doctor. The case manager could not get the patient an appointment until July, however she and the physician worked together and were able to get the patient a walk-in visit less than an hour after they called. This really showed me how the Cherokee health system respond to their patients’ needs and how the patient’s wellbeing is truly at the core of their practice.

I spent the second half of my day at the urgent care clinic not far from the main hospital. Here the health team members consisted of a triage nurse, an LPN, a lab-technician, and three providers all with varying titles ranging from a nurse practitioner to a physician’s assistant.  It was here that I saw many similarities and differences between the Cherokee health system and our own. The urgent care clinic was similar in that it provided care to patients with a certain severity level of illness, they had a typical triage system, and all of the health team members worked together in the same facility. The differences I noted were first the quick response each provider had when a patient presented to the clinic. Every provider I watched received a patient’s chart and within five minutes was out the door and in the patient’s room doing their assessment. I often find myself waiting for hours at a prompt care back at home because our health care culture does not feel that sense of urgency these providers did. Another difference I noticed was the absence of judgment from all of the staff members. Working in healthcare I hear many professionals place judgment or blame on the patient for their condition before even walking into the patients room. I never once heard any of the staff “shrug” or show animosity towards their patients. I had the opportunity to speak with the LPN whose name was Mary Jo. She was a very nice woman who educated me a great deal on Native American culture and some of the things I found interesting were the complimentary/alternative therapies this culture uses. The CIH has an acupuncture and massage unit designed into their hospital to provide additional healing sources for their patients. Mary Jo also told me of some traditional medicines used in their culture. As an example, wild cherry bark tea is commonly used for fevers and gold stick has been used for asthma. Mary Jo’s two children both suffered from asthma, and she stated that “after they used the gold stick, they haven’t had asthma since” (personal communication. 2016).  Alternative medicines and complimentary therapies are a strange concept to me because I never grew up using anything except traditional medicine. It was a wonderful opportunity to learn about new therapies that have proven to be effective! Another aspect that I enjoyed of Mary Jo and I’s conversation was learning about the child-rearing practices of Native American culture. The Kitnwah Academy is an exceptional boarding school that is grounded in educating their children in the Cherokee culture. Here the children are given a vast knowledge about their history, traditions and practices. They are not only taught the Cherokee language, but are only allowed to speak Cherokee at the school. Mary Jo said this was different from the way she was raised.  She stated that she barley knows Cherokee because there was a time where the government forced children on the reservation to attend to government boarding schools and they were not allowed to speak Cherokee. This was an attempt to detach the Native American people from culture and ways of life. Her mother was a victim of this movement and as a result, her mother was shamed for being Native American and lived in fear about raising her children in the Native American ways. Hearing about the oppression that Cherokee people have had to overcome within just the past hundred years was eye opening. I have only begun to see the generational effects of the trauma and it is evident through their changing child rearing practices.

 After our long day on Tuesday, it was time to go out into the community and learn a little more about our population. We took a tour of the Indian Village which is a wonderful journey where you learn all about the Native American life beginning from the precolonial era up to modern times. I learned about their pottery, basket weaving, and weaponry making skills, we were able to see traditional Indian homes that they used, and were even able to participate in traditional Indian dances that were done in celebration of life and unity. I learned that the people who have the most respect in this culture are the elders. Elders are seen as the people who have years of wisdom and a wealth of knowledge that can be passed down. This is in complete contrast with my culture where unfortunately elders are not given the proper respect or admiration as Native American ones are. Many of the family structures I have seen are traditional in that the male is the leader of the family, the female is the nurturer, and the children are inferior in status. Though males take on the traditional male gender roles, one of the tour guides named Donald informed us that all Native American’s learned how to do everything. He stated “both males and females learned how to hunt, fish, gather, grow crops, and make weapons and baskets. This was done in case one of the spouses were to die” (personal communication. 2016). This was surprising to me but after hearing Donald’s rationale, it made complete sense.

After seeing so much in the past day and a half it has become clear to me that Native American culture differs from my own in a specifically large way; their value is in the community. The community supports everyone. This can be seen by how the tribe provides every member with the “per capita” system, how they provide free healthcare and employ their members first over others, and it can especially be seen in their education system. Their education system is completely one hundred percent free. The tribe gives incentives for excellence in school by paying students when they receive good grades. Additionally, they will pay in full for any one of their members college wherever they want to go. The Cherokee want their community to prosper and become a self-sufficient nation and so the community themselves have been the major support system for all Cherokee members. 

                     
             "It belongs to you"

       Blow gun weaponry and basket weaving                                       


       

                                            

Precolonial home

                                                               Just because