All my relations -- a traditional Lakota approach to health equity | Donald Warne | TEDxFargo

This talk was given at a local TEDx event, produced independently of the TED Conferences.

Donald Warne, MD, MPH is Oglala Lakota from Kyle, South Dakota on the Pine Ridge Indian Reservation He is also Director of the Master of Public Health Program at North Dakota State University. His Lakota name is Pejuta Wicasa, which means “Medicine Man.” He comes from a long line of traditional Lakota healers. This discussion blends modern health issues with traditional Lakota philosophy and promotes cultural humility in human relations.

I am from a small town
called Kyle, South Dakota,

on the Pine Ridge Indian Reservation.

Anyone ever been to Kyle, South Dakota?

One? That's one more than usual,
actually, in a crowd this size.

Very impressive.

It is a very small town
on the reservation.

And, the original name
of Kyle, South Dakota

is Phezuta haka,
which means Medicine Root.

In this region, there are actually
a lot of medicine men

who come from there,
historically and in modern times.

I was very fortunate
to grow up in a family

with a lot of traditional healers
and medicine men.

My Lakota name is Pejuta Wicasa,
which means Medicine Man.

I always like to joke, when people say,
"What does Pejuta Wicasa mean?"

I say, "It is Lakota for 'Steve'."

(Laughter)

I was named after my grandfather.

I am very fortunate to come from a family
with a lot of traditional healers.

As I was growing up,
I was able to learn a lot

about our traditional ways of medicine,
our traditional ceremonies.

I really was on that path of becoming
a traditional healer as I was growing up.

When I was in college, I actually went

to Arizona State University
for undergraduate,

I was doing really well in school,
so I was encouraged to become a premed.

I was really worried about what my uncles
would think about that.

Does it mean I am going to the dark side
of medicine, going to medical school?

Because I have heard all the stories
of how our traditional healers

maybe have not been as respected
as they could be,

in modern medical situations.

But actually the opposite happened.

They were not discouraging, if anything,
they were very encouraging.

One of my uncles,
Ray Takes War Bonnet said,

"I think this is a good idea.

But if you do this,
go to their best schools,

learn their way of medicine,

and know it at least
as well as they know it,

because that's the only way you will be
taken seriously as a medical doctor."

I was very fortunate, I was able
to go to Stanford for medical school,

and I have my MPH from Harvard.

I have worked in a number
of different arenas of health.

This is a picture of Little Wound School,
on the Pine Ridge Reservation in Kyle.

On the left is where kindergarten is,
on the far-right is high school.

One of our big challenges that we face

is that less than half of the students
who start kindergarten,

actually graduate high school.

Less than half.

So, we have a big challenge
in terms of leadership,

in terms of educated people
going into health professions,

education, law, etc.

So it's a big challenge.

We have a lot of rich history,
but our biggest issue

is that we have now, a lot of poverty,
economically and educationally.

We also have challenges
with access to healthy food

in our impoverished communities.

This is a picture of the Kyle Cafe.

I think what they've learned here

is that you can bread and deep fry
just about anything

(Laughter)

and serve it for lunch.

The other reason I like this picture,

you can see the rez dog chasing
the little girl down the street there.

(Laughter)

Well, right across from that,
is the gas station,

which also doubles as the grocery
store, believe it or not.

So, if one wanted to have
access to healthy food,

they go to the gas station.

It is all prepackaged food.

Lots of sodas, lots of chips,

lots of things that can be preserved
for a long time on a shelf.

Is that healthy food?

Is that good for us?

Does it lead to things
like high rates of type 2 diabetes?

Well, unfortunately it does.

There is also a concept in public health
called the poverty tax.

When you live in a food desert,

or a population that does not
have easy access to healthy choices,

they tend to pay more for healthier foods.

So, trying to buy fresh fruits
and vegetables here

is much more expensive
than it is in Fargo.

Isn't that remarkable?

So, less money, and they have to pay more
for healthier food choices.

This is a picture of one of my relatives.

You can see he has an amputation.

The amputation is from poorly
controlled diabetes.

There is a program
in many of our communities,

in which if you need a wheelchair
and you have an amputation,

they will build a ramp for you.

That is wonderful,
so you can have access to your home.

But wouldn't it be better if we invested
in healthy food in the first place?

So we wouldn't have to pay
for extra services after-the-fact,

when things have
gone wrong, unfortunately.

But we face all kinds of challenges
trying to manage things like diabetes.

Here in North Dakota,

this is data from the North Dakota
Department of Health,

if we look at the prevalence of diabetes,
we can see that American Indians

have about twice as much diabetes
as the white population in North Dakota.

About double among adults.

So, if you have double the prevalence,

you would expect to see
double the mortality rate.

Right? Probably twice
as many people dying from the disease.

In truth, the mortality rate is about
six times higher for American Indians.

So, think about that.

There is a disparity
within the disparity, right?

Higher prevalence,
even worse in terms of rates of death.

Now this is true in the Dakotas,

it is true for American Indians
throughout the nation,

but it's also true of indigenous
populations everywhere in the world.

Two of my colleagues,

on the left is Alex Brown,
he is aboriginal Australian,

and in the middle is Terry Ehau,
he is Maori from New Zealand.

They are both medical and public health
faculty in their respective nations.

They see the exact same pattern
of health disparities and poverty

in indigenous populations
in Australia, New Zealand,

and in other parts of the world
that we do here, in the US.

Well, what can we do about this?

Does it have to be this way?

Are there things we can look at,

in terms of our traditional ways,
and how we used to live,

that we can recapture and move
forward in modern times?

So, when I start this discussion,

I always like to start
with a brief history of medicine.

Very brief.

2000 BC - Here, eat this root.

(Laughter)

1000 AD - That root is heathen,
here, say this prayer.

(Laughter)

1800 AD - That prayer is superstition,
here, drink this potion.

1900 AD - That potion is snake oil,
here, swallow this pill.

1950 AD - That pill is ineffective,
here, take this antibiotic.

2000 AD - That antibiotic is artificial,
here, eat this root.

(Laughter) (Applause)

So, we have kind of come
full circle, haven't we,

getting back to the roots of medicine.

OK, that's a bad pun,
I recognize that now.

What is really interesting when we look
at the history of modern medicine,

all systems of healing used to have
spirituality incorporated,

even modern medicine.

But we saw a huge change
in the twentieth century

because of advances in science.

And probably the biggest scientific
advance that we found in modern science

is the discovery of antibiotics.

So, we could suddenly cure
infectious disease that used to be deadly.

But if we look at antibiotics,
that is actually naturopathic medicine.

The original antibiotics were actually
isolated from mold and fungus.

The reason is that for millions of years,

bacteria and mold have competed
with each other for space and food.

So, they developed
chemicals to kill each other.

So, penicillin comes
from Penicillium, which is a mold.

Streptomycin comes
from Streptomyces, another mold.

So in truth, the biggest scientific
advance in modern medicine,

is that we finally harnessed
the healing power of mold.

(Laughter)

Makes me wonder what mildew
might have to offer us.

(Laughter)

Now what is interesting, when I talk
to my uncles who are traditional healers,

they talk about how over the years,

they would use different types
of mold for open wounds,

to help clean an open wound,
and actually use mold.

So historically our tribe
has been using antibiotics

for thousands of years, potentially.

And historically, we lived
in a much healthier way.

We had hunting and gathering,

so it was an all-organic diet
at one time, of course.

Many of our tribes also were farmers.

These are pictures,
on the left from Oklahoma,

on the right from New Mexico.

We had traditional farming
and very healthy food as a result.

Traditional foods are whole foods,
they're not processed or refined.

We also had a lot of variety of foods.

Did you know there is
over a hundred varieties of corn?

When we think of corn now, we just
think of yellow, sweet corn, right?

That is pretty much all that we have
available to us, in terms of easy access.

But there used to be
many varieties of corn.

There are some varieties
that actually helped lower blood sugar,

believe it or not.

So, it was not all
just corn syrup, historically.

(Laughter)

So we have seen a dramatic change.

Is it possible to get back to this?

Well, we do have to recognize
we have a big challenge,

because modern-day hunting
and gathering is quite different.

(Laughter)

And unfortunately, we have the issue
with access to healthy food.

There is also what is called
the commodity food program;

- Some of you may have heard of that -

It is with the United States
Department of Agriculture,

and it consists of things
like sugar, flour,

it used to be lard,
now it is vegetable shortening,

white bread, some sort
of Spam-like meat product,

I'm not exactly sure what that was,
powdered milk, grape juice,

which I think was just sugar water
with purple food coloring.

And they used to actually
distribute pure corn syrup.

On the label it said,
"Use on your pancakes."

Now, is it any wonder we have
such high rates of diabetes,

and high rates of death due to diabetes?

We will not invest in healthy food,

but when you have an amputation,
we will build you a ramp.

Is that logical?

Is that intelligent?

Is it ethical?

Well, from my perspective, no, it's not.

There is much that we need to do,
much that we need to reconsider

in terms of how we address
health in the United States.

So one of my favorite old photographs,

this is actually one of my
ancestors from Pine Ridge,

and he is a medicine man.

You can see what he is doing here

is very different than what we see
in the modern clinic, isn't it?

He is touching the patient.

He is praying with the patient.

They are with the earth.

The family and the community
are participating in that healing process.

And for those of us who participate
in traditional ceremonies,

the power that you feel,

when you know your whole community
wants you to be better, is indescribable.

We do not tap into that healing power
very well in modern medicine.

We have a lot of laws around privacy
and health information protection.

There is a law called HIPAA that deals
with medical information privacy.

So when I am talking
to a group of physicians,

I always acknowledge,
this might not be HIPAA-compliant.

(Laughter)

But it is meaningful and powerful healing.

Do we have the opportunity
to embrace this?

Do multiple cultures have the opportunity
to embrace what they once had,

in terms of a healthier lifestyle?

Symbolism is very important to us

in many traditional
American Indian cultures.

I am sure many of you
are familiar with this symbol.

That is a single serpent
wrapped around a staff.

This is the Staff of Asclepius.

That is the ancient
Greek symbol for medicine.

Single serpent wrapped around a staff.

And I am sure you have seen this one.

Two serpents wrapped around
the staff with the wings at the top.

That is a Caduceus.

That is the ancient Greek symbol
for traders and thieves.

So somewhere along the line,
someone really screwed up, didn't they?

I think they thought,
"It is prettier, it has wings,

so we'll call this one medicine."

If you are watching the news,
and see this symbol,

and they say "Health Alert,"

you know the traders
and thieves must be sick.

(Laughter)

Well, this is a Medicine Wheel.

This is our symbol for many things,
including medicine and healing.

It is a beautiful symbol.

There is a lot of complexity built
into the simple circle and cross.

The cross demonstrates things
that are opposite to each other,

like east and west, or north and south.

The circle, connecting
the ends of the cross

shows that all things
are connected on this earth.

In a very real and basic way,
from the perspective of this room,

we could say east is opposite from west.

Right, we can agree, those are opposite?

But in truth, on this Earth,

if I go east, and I go east,
and I keep going east,

eventually where am I going to wind up?

Yes, right here.

So in truth, I am over there,
I am over there, I am over there,

I am over there, and I am right here.

It is all truly connected in a circle.

The way we look at health
and an individual,

whether it is the health
of the individual,

or the health of the family and community,

we look at four main components:

spiritual, mental,
physical, and emotional.

In order to be healthy,
one is in balance, in all four directions.

Now, another word for a modern
doctor is 'physician', right?

So, we are saying as physicians,
we deal in the physical arena.

'Physical' and 'physician' have
the same Latin root, 'physic',

which means the natural sciences.

So, it is very narrow focused
in modern medicine,

just focusing on
the physical aspect of health.

I have done a lot of work also
in alternative medicine.

In addition to being a family doctor,
I have training in medical acupuncture,

homeopathy,
and botanical medicine as well.

In my circles with traditional healers,

but primarily with alternative
medicine providers,

it is really interesting,
I have heard them say things like,

"We have found that when we incorporate
spirituality into the healing system,

it is much more fulfilling."

From a Lakota perspective,
that is kind of like saying,

"We have found that apple pie tastes
better if it has apple filling in it."

(Laughter)

So I tell them, "That is very wise."

(Laughter)

Another one of my favorite photographs
is actually Chief Red Cloud,

when he was meeting with one
of the federal government agents.

They were doing
the land settlements for the reservations.

The reason I like the photograph,

is there is a lot of symbolism
built into this.

In the traditional Lakota way,
you are supposed to be quiet and humble.

You can see he is in a seated position.

Also, a way to show respect
is to look down.

Actually, if you look someone in the eye,

that can be considered
a confrontational behavior

so he is looking down.

And then look at the federal agent
and the symbolism there.

Standing over him
from a superior position,

talking down to him,
and looking him right in the eye.

Now from each person's
cultural perspective,

they are behaving appropriately.

But my question is, at that handshake,
how well do they understand each other?

How well does Red Cloud
understand the agent?

How well does the agent
understand Red Cloud?

Well, if we look at the land settlements,
obviously not very well. (Laughter)

Let us look at this
from another perspective.

This is a traditional American Indian
person being diagnosed with diabetes.

He is working with a well-trained,
non-Indian scientific physician.

Is it possible that they could have
challenges in communication?

Well, when I think about diabetes,

and when I think about my modern training
in medical school and residency,

we focus on insulin-resistance
and high blood sugar.

But when a patient
is diagnosed with diabetes,

do they go to the doctor and say,

"Gee, Doc, my blood sugar
feels like its 362?"

No, they don't.

But are there emotional concerns?
Is there depression?

Is there anger? Is there denial?

In the spiritual realm,
I have heard patients say,

"Why would the Creator do this to me?"

"Why would the Creator
do this to my family?"

"What did I do wrong to deserve this?"

In the mental realm,
is there anxiety? Is there stress?

Are they worried about the future?
Well, absolutely.

And if all we are is physicians,

and all we can tell our patients
is that your blood sugar is too high,

we are not addressing the issue
from the patient's perspective.

We are just addressing
the scientific perspective.

I would put forth that all of us
can learn from this.

All of us can be more holistic
in the way we deal with each other.

I would like to close
with a picture of Black Elk.

He was a Lakota spiritual leader
and medicine man from the late-1800s.

We did not have
a written language in Lakota.

We had an oral history.

But he met with a writer
in the early-1900s,

and they wrote the book
"Black Elk Speaks".

This is my favorite quote from him,
"Of course it was not I who cured.

It was the power from the outer world,

and the visions and ceremonies
had only made me like a hole

through which the power
could come to the two-leggeds.

If I thought that I was doing it myself,

the hole would close up,
and no power could come through."

What he is talking about is humility,

recognizing that he does not
own the healing power.

The best we can do is try to access it,
and channel it in the right direction,

but as soon as we believe we own it,
we no longer have access to it.

Now, that is the core value in Lakota.

It probably doesn't surprise you

that was not the core value I learned
in medical school, humility.

But I think we all can be
more humble in our approach.

I think that we all could approach
each other with more respect,

even if we have different backgrounds,

we have different histories,
and we have different cultures.

And let us remember that we all drink
from the same stream of consciousness.

We are all connected
by that same stream of consciousness.

We are all related.

What we do to each other,
we do to ourselves.

Act kindly toward my people,
for indeed my people are your people.

(Lakota) Thank you,
everything is connected.

Thank you all very much.

(Applause)