Siobhan Wescott wants to elevate Native American voices in public health

As the primary endowed professor and director of American Indian well being on the College of Nebraska Medical Heart’s Faculty 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 instructional, 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 making an attempt to repair.

Wescott beforehand co-directed INMED, a College of North Dakota program that has skilled greater than 250 Native American physicians. She remains to be working to verify Native American medical college students are correctly accounted for and given satisfactory funding and sources. On the nationwide stage, 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 Activity Drive 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 lots of elite establishments and also you’ve defined your talent at being kind of a chameleon in plenty of completely different settings. After school, 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} powerful setting to remain in for lengthy?

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I didn’t like what politics introduced out in my persona. To achieve politics, you actually — to not sound harsh — however you may’t be true to at least one factor solely. So if in case you have a trigger, for example, that’s not essentially going to be just right for you as you attempt to make it as a congressional staffer, for example. Now, generally it may be, if in case you have the precise workplace that you just’re working for, with an elected official who’s fascinated about that very same matter. However if you happen to’re championing a extremely underdog concern, it’s very powerful. To outlive politics and to get forward, it’s a must to bend, and in ways in which I don’t like.

Your mom, Elizabeth, attended Harvard and Stanford, and she or he turned one of many first Alaska Natives to earn a Ph.D. How did that upbringing, of watching her pursue her training, influence you and form you?

It felt prefer it was attainable. There’s so many first-generation college students who’re like, “I’m making an attempt to navigate this unknown system,” and that wasn’t the case for me. I really feel like my mother made that doable for me. Particularly for her, however even when it was my time to contemplate academic 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 approach 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 need to examine authorities at Dartmouth?

Properly, I’m simply fascinated by collective decision-making and, definitely, the final couple of years have been a grasp class in how you can do it flawed, simply unfolding proper earlier than our very eyes. It’s the identical with why I like public well being, versus training medical drugs. With medical drugs, you would have very honest moments together with your sufferers and it’s simply the 2 of you, and that’s extremely highly effective. Typically there’s nothing higher. Nevertheless, if you happen to can change coverage that’s harming these sufferers they usually don’t should 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 tough so that you can merge a number of paths — your a number of identities, jobs, priorities — into one?

Completely. I’ve really simply been battling this lately, as a result of if you happen to look within the information, in South Dakota there was a Speedy Metropolis resort proprietor who determined to ban all Native People 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 not have white settlers if the tribes don’t comply with them. You realize, at what level do you proceed to attempt to discover widespread floor with folks you disagree with and at what level do you protest? … Should you by no means attempt to discover widespread floor, then you definitely’re only a zealot. However are there factors when the opposite facet is to date off that there’s no level in looking for widespread floor? And I assume that’s the place my experiences in D.C. actually helped me, since you shortly work out 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 useful to them.

There may be lots 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 on your work?

One of many articles that I’m engaged on is a examine 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 exhibits, 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 modifications in what the federal authorities makes use of.

While you acquired 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, bearing in mind how many individuals don’t take into account science and spirituality or pure drugs to be at odds with each other?

So, let me provide you with my abstract of med college: 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 lots of mysteries in between. And I don’t assume now we have the solutions. Now, I don’t assume that we must always abandon Western drugs. There’s some actually profound advances, and with correct care, there’s lots of issues that may be handled and should not lethal, which have killed 1000’s 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 if you happen to attempt to go outdoors of this, you’re “flawed.” Now, ought to all people 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 must be absolute. There’s plenty of room for knowledgeable selections and exploring what is perhaps proper, however I simply assume clearly Western drugs is just not 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 may test as many packing containers as you need, or as apply to you, however if you happen to tick multiple field, none of your race information is reported. You’re solely thought of in racial information if you happen to 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 college. However solely 177 of these report being solely American Indian/Alaska Native. So 83% of them below these necessities are misplaced totally, and that impacts funding selections to assist assist new college students. That’s one of many issues that I’m making an attempt 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 an entire motion known as community-based participatory analysis, the place there’s a researcher who has an curiosity space, they method 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, per week or a pair days earlier than it’s like, “Hey, are you able to ship a letter of assist?”

A whole lot of drugs is constructed on this basis of a hierarchy, with the doctor on the prime and the affected person on the backside, which may really feel very paternalistic. You’re making an attempt to flip that paradigm, starting with neighborhood and increase from there. How easy is that?

It’s very tough. 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, “Properly, 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, nevertheless you’re additionally, primarily, placing a mirror as much as them. In order that’s, on a macro stage, what I’m making an attempt to do is embody tribes, embody Native leaders, embody Native communities in decision-making.

You appear to at all times 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 lots of Native Hawaiians – they only can’t afford to stay 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.