A recent formalized partnership between the Lummi Nation and the University of Washington School of Medicine will provide training opportunities for medical students to learn how to care for Indigenous populations by working at the Lummi Tribal Health Center.

The Lummi Nation and the UW School of Medicine entered into a legal memorandum of understanding on Oct. 2 that allows medical students going through the Indian Health Pathway at the university to do a four-week rotation at the Lummi Tribal Health Center on the Lummi Reservation in Whatcom County, according to Millie Kennedy, tribal liaison for the Indian Health Pathway, and a recent UW news release.

The Indian Health Pathway, which is open to both Native and non-Native students at the college, prepares students for careers in American Indian and Alaska Native health, and encourages research on health inequities among those populations, Kennedy told The Bellingham Herald on Friday.

Pathway students are required to complete a month-long clinical clerkship that rotates them through a tribal clinic. The experience provides Indigenous students with knowledge they can bring back to their own tribal communities, while educating non-Native students about caring for Indigenous people and communities, said Kennedy, who is Tsimshian and is from the Metlakatla Indian Community.

“The goal is to teach the students how to provide high quality health care to Native Americans. That includes learning how to communicate across cultures, learn about interacting with tribal community members and making sure that those members are being seen and heard,” Kennedy said.

While the university and Lummi Nation have had a longstanding relationship, the legal partnership formally recognizes the sovereignty of the tribe, according to the news release. It also clarifies the expectations both parties have while students learn at the tribal health clinic, Dr. Dakotah Lane, Executive Medical Director of the Lummi Tribal Health Center, said in a Monday interview with The Herald.

The university is currently working on scheduling students within the Indian Health Pathway to do future rotations with the Lummi Tribal Health Center, but it’s possible the clinic will have a UW student rotating as soon as January, Kennedy and Lane said.

Partnership’s start

The formal partnership, which has been in the works since December 2021, came about in part due to fourth-year Lummi Nation medical student Jason Finkbonner. While searching for a mentor, Finkbonner, whose specialty is psychiatry, discovered the Lummi Tribal Health Center is one of a few facilities in the U.S. that employs a full-time psychiatrist, the UW news release states.

Finkbonner then worked to establish a four-week psychiatry rotation at the Lummi Tribal Health Center and is the first student to complete the four-week clinical clerkship, according to Kennedy and the release.

“Growing up on the (Lummi) reservation, you’re part of your family but also part of an extended family — your tribe. All my aunts, uncles and cousins lived around us and we were always together and doing things for the betterment of the group,” Finkbonner said. “A mentality in the tribe for those who choose to leave and seek higher education is that eventually, you want to come back and take what you’ve learned and help the people here.”

In addition to the memorandum signed with the Lummi Nation, the university also signed new formal agreements with the Tulalip Tribes of Washington state and the Navajo Nation in Tuba City, Arizona, the news release states. Existing agreements with several other tribal nations are being revitalized.

Unique opportunity

Having medical students rotate through a tribal health clinic provides the students with opportunities to learn things they won’t elsewhere, while also improving overall care coordination for patients, Lane said.

By working directly with tribal nations, the medical students are exposed to differences between tribal healthcare and the private medical system, as well as the tribe’s community and culture, said Lane, who is an enrolled Lummi Tribal citizen.

The Lummi community focuses on treating the whole person, also known as integrated care or wraparound services, as opposed to just their medical needs, Lane said. The Lummi Tribal Health Center integrates a patient’s medical care into the rest of the tribe’s governmental services, including providing access to and care for a variety of other needs, including mental health and dental care, social work, pharmacy, and economic services, and familial needs, Lane said.

“You can’t just treat the medical needs. You also need to address the underlying socioeconomic things that many patients face,” Lane said.

Unlike in tribal healthcare, the private medical system is disjointed and patients are often referred out to various services, such as for physical therapy or public health, Lane said.

From the tribe’s standpoint, the formalized partnership with UW will allow the community to have access to UW’s talent pool of new doctors and its expertise, as well as further improve the relationship among the two entities, Lane said.

It’s also important for Native American people and communities to have access to care that is culturally specific and aware, Lane said.

For example, Lane said a diabetic patient may be having trouble regulating their sugar levels during the day because they’re having insulin access issues. Perhaps the patient doesn’t have access to a refrigerator or electricity to keep their insulin chilled, or perhaps they’re a fisherman who is too busy and forgets to eat or they don’t have easy access to healthy food, Lane said.

Having a doctor who is familiar with the tribal culture allows the provider to ask questions that dig deeper into the main causes of why someone may be having issues accessing insulin during the day and the doctor can in turn make adjustments so their care fits their lifestyle, he said.

“When you have cultural awareness, you’re more likely to have empathy for a patient’s circumstances,” Lane said. “Having that cultural awareness by providers allows them to provide better care for patients. And also, the patient will not feel judged for not being able to get better control of that type of thing.”

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