Three years ago, Dr. Shilo Tippett was wheeled into a St. Charles operating room, where she was scheduled to have a hysterectomy.
“Everyone,” her doctor announced to the surgical team, “she wants to keep her uterus.”
Her doctor understood the significance of her request, but others didn’t. Someone in the room started laughing, Tippett said.
A member of the Confederated Tribes of Warm Springs and a psychologist at St. Charles Family Care in Madras, Tippett wanted to return to the earth with her uterus, an organ that helped give life to her three children.
“To me, that was so denigrating,” she said recently, sitting in the lobby of the St. Charles Madras hospital. Tippet, along with other members of the hospital’s Native American and Latino Patient Family Advisory Councils, had joined there to share their health care experiences through the lens of their cultural backgrounds. “It made me feel like a freak.”
In Madras, a community where one-third of the residents are Native Americans , one-third are Latino and one-third are “everyone else,” Chief Nursing Officer Candy Picar said she wants every person who is cared for at the hospital to feel understood. That means making the effort to find out where they come from, what they believe in and what changes St. Charles can make to improve their experience.
As part of her doctorate in nursing program, Picar — who is Filipino — began spearheading a project two years ago to implement evidence-based, culturally competent care guidelines for Native Americans . This year, her work expanded to also begin writing a similar set of guidelines for the Latino community.
“I felt like, ‘What do I bring that nobody else brings? Who am I at St. Charles and in the community? And what is my unique contribution to the whole of Central Oregon?’” she said. “And I was like, ‘Oh my gosh, I represent diversity. Diversity in leadership, diversity in culture.’”
Recently selected by the League of Oregon Cities to sit on a Diversity, Equity and Inclusion advisory group, Picar has spent many months with members of the tribes and Latino community. By generously sharing their time and stories (and traditional Mexican posole), they’ve helped Picar rethink the ways in which the hospital provides care and makes space for the cultural beliefs and traditions of its patients.
For Aurolyn Stwyer, a member of the Confederated Tribes of Warm Springs and owner of the Red Skye Trading Post, the experience of receiving health care off the reservation can be complicated and confusing. To start, many Native Americans experienced the historical trauma of boarding schools. Her mother recalls standing in line with the other children, none of whom spoke English, to have a tonsillectomy. One died during the procedure.
“We have distrust built in from that experience, from that practice,” she said.
On the reservation, health care is provided at an Indian Health Services clinic, where patients may work with only one provider. If they have to be seen at the hospital, “you’ve got multiple providers, multiple staff, multiple shifts and so on,” she said, “so it gets a little bit overwhelming, especially for the elders. Some of them have language challenges, also.”
For Mayra Benitez, who was born in Mexico City and moved to Southern California when she was 6 years old, doctors’ offices were nerve-racking places where she had to navigate the barriers of language and clinical terminology to get herself and her parents the care they needed.
“We had to explain ourselves what was wrong with us because our parents couldn’t speak for us,” said Benitez, who lives in Madras and works at the Family Resource Center. “So, it was kind of like taking ourselves to the doctor. We didn’t understand a lot of it.”
Two other Patient Family Advisory Council volunteers wanting to make a difference in Jefferson County, Jazmin Mendez, a medical assistant at St. Charles Family Care in Madras, and Luis Basaldua, the new manager of Mazatlan Mexican Restaurant, shared similar experiences.
Mendez’s mother, who was admitted to an Intensive Care Unit after a serious car accident, had difficulty communicating during her hospitalization. “She woke up in a helicopter and was like, ‘Oh my gosh, where am I?’ She didn’t know how to communicate her level of pain,” she said.
It is stories like these that have informed a new health system policy that is in the final stages of revisions and should be implemented sometime this year. While the first policy focuses exclusively on Native Americans, a similar one for Latinos will follow suit.
The policy recognizes that Native Americans, when compared to other racial and ethnic groups, experience a higher lifetime incidence of traumatic events, which are associated with depressive disorders, anxiety and post-traumatic stress disorder. It also explains some of the inherent cultural beliefs, traditions and lifeways of the local tribes (which include Warm Springs, Wasco and Paiute) during the health continuum, including birth and death and the traditions and rituals that mark those passages.
But Stwyer said the conversations have led to more than just a new policy. Some physical aspects of the hospital will change, too. The large, colorful mural in the lobby of the main entrance, for example, is going to be revised by the artist that created it to depict the local tribes (instead of Navajo, who are currently featured). In the hospital’s Family Birthing Unit, the interior design will be updated to reflect the Native American Indian and Latino cultures.
Eleven years ago, when Tippett had her first child, the Seattle hospital where she gave birth was unfazed by her request to keep the umbilical cord.
“Here we are 11 years later, and our area still has a longways to go,” she said. “But that would be my hope, that we are much more like other communities with natives. That we actually honor every culture.”