Center for Health Equity and Community Engagement Research

Guthrie Capossela, Native American Community Engagement Coordinator, Mayo Clinic: Good day. [Speaking in Lakota] Excuse me. Good day, my relatives.

My name is Guthrie Capossela from the Standing Rock Sioux Tribe, and I'm Hunkpapa Lakota and Yanktonai Dakota. I work as the Native American community engagement coordinator within research here at Mayo Clinic. I work along Corinna in facilitating the Native American outreach within the Center for Health Equity and Community Engagement Research. I have a bachelor's degree from the University of South Dakota and a master's degree from Hamlin University in St. Paul, Minnesota. It's good to be with you all today.

Quickly want to go over some housekeeping items. I want to do this pretty quick so we can save the bulk of the time for Alayna and Tasha go over their presentation with you all. We will have time for Q&A at the end. Please post questions using the Q&A function. This is being recorded, so presentations will be available online after the presentation is done. We're also going to be doing something new today. Towards the end of the Q&A time, we will post a new Zoom link. And then we'll have an informal Q&A discussion with our panelists and the Native American outreach program here at Mayo after. So it will be 60 minutes of our regular presentation, and then an opportunity, non-recorded, to speak with our panelists and staff here at Mayo Clinic.

So let's get, let's get started. I'm really grateful to be sharing today's health topic with you all. Our presenters are from my Tribe and working on health and wellness in the community me and my family are from, as well as the other districts across the reservation. Today's topic is titled, Mni Wichoni Health Circle: The Resurgence of Kinship Practices in Health and Wellness. And the topic is being facilitated by our guest speakers, Alayna Eagle Shield and Tasha Peltier. I will turn it over to them to get started.

Alayna Eagle Shield, MPH, Co-Executive Director, Mni Wichoni Health Circle: [Speaking in Lakota] Hi everybody.

My name is Alayna Eagle Shield. I am currently the co-executive director of the, excuse me, Mni Wichoni clinic and farm. I grew up on Standing Rock. I am currently in my fourth year of my PhD program, so I'm officially a PhD candidate. I've been able to tailor the program around the work that we get to do. And it's just been beautiful and so transformative, and growing up around it, but then also getting to see how scholarship theorizes and builds methodologies around the things that we get to do in our community. And so it's really beautiful to share a couple of those things with you all today as well as sharing the work that we do and so, good to see you all. I'll turn it over to Tasha.

Tasha Peltier, MPH, Co-Executive Director, Mni Wichoni Health Circle: [Speaking in Lakota] Hello everybody.

[Speaking in Lakota]

Virtually, it's good to see all of you. My name is Tasha Peltier. I'm also Hunkpapa Lakota, I'm also from Standing Rock, a citizen of Standing Rock. I currently live in Mobridge, South Dakota. I think all of the work that we're going to share today is just really things that are near and dear to my heart. I am a public health professional through education. But also, I just think I'm a lifelong learner of our ways and really trying to understand our Lakota/Dakota ways. You know how those things can really lead our journey to health and wellness in our communities.

And so today we're going to, I'm excited to be with you all to share some of the things that we're working on and really grateful to be invited to be on the show today. Yeah, good to meet all of you.

We also want to introduce one of our other team members so we are a newer organization and we'll share a little bit of our history, but we have another team member that's not on the call today. Sunshine Claymore, she is our community engagement specialist. She's also a member of Standing Rock. She's been with us, with our organization for a long time and she's just coming on as a official employee. And so we're really grateful. She brings a wealth of knowledge about so many things that are relevant to the work that we do. And so we just want to make sure we acknowledge her and her role in everything. So that's Sunshine.

Then this is our board of directors. We currently have five board members. All of our board members that you see here all have a connection to Standing Rock in some way, shape, or form. That's something that's really important to us to make sure that the people that are really driving the work or helping to drive the work are connected to the communities that we're serving. And so that's something that's very important to us. We're very community-driven and we want to make sure that we stay connected to what's happening in our communities and what those needs are. So that's, so that's our board.

Alayna Eagle Shield: And just to point out, we'll share a little bit of our work around two-spirit. But that was some of the suggestions, that we have an elder and also two-spirit relatives on our board to help guide the work that we're doing.

And so Beverly Little Thunder is a two-spirit elder who has been involved in a lot of advocacy and work throughout the Nation. Not just Standing Rock.

And Zane Prentice is also two-spirit and has been doing local work within Standing Rock around the two-spirit movement. And they all bring a wealth of knowledge. But I just wanted to point that out, that we have been leaning into what it is that the community has been asking of us and also one of our board members, Baylee, I can say, Bailey is studying American Indian Studies, and just brings the beautiful Lakota thought and philosophy into guiding the work that we do in there. A young Lakota, and have just been being a trailblazer in their own way. And so we are super guided by our board.

Alright, so in an effort to move beyond land acknowledgments and create a call to action around the land back movement, we want to share a few steps with you all to take, to figure out how to take your own personal steps towards land back. And, land back is a call to action to return the land and all that is sacred to Indigenous peoples, to steward it as they see fit. So we just encourage you, one, to learn about the lands that you're — excuse me — to learn about the lands that you're on, using either Google or Native-land.ca, or other resources that are available to you. Research current actions by the Indigenous folks in your area. And if you're not Indigenous yourself, then try not to take up space, but determine how you can support based off of your skills, the things that you have, the relationships that you already have with Indigenous folks who are doing the work and learn how your skills could be of service to the community.

Use your privilege to speak up at local city council meetings, or other public spaces discussing changes like if your city hasn't changed Columbus Day to Indigenous Peoples Day or invite folks to return the land to Indigenous Nations. And I know that's not quite as easy as just gifting land to folks because there's assessments and things that have to be done. But just encouraging you to think of how your land could be used. Or folks that you know, who have land that could be used by Indigenous folks. Return your property.

If there had been collected within your family or within your city or town, that have collected Indigenous items, or sacred, sacred objects, just encouraging you to return those things to the Nations that they belong to. And just continue to create awareness within your circles. So it's not just doing land acknowledgments and acknowledging the land that you're on, but really self-reflecting to think of how you are being a relative to those folks of that land. And that's what we want to encourage right now.

So we're going to start by sharing a little bit of our organization history and then move into the current environment that we're in. So our organization was started — it's called the Mni Wichoni Health Circle. But it was actually started at the the Ocethi Sakowin Camp during the Water Is Life movement. When our Nation was opposing DAPL in 2016. And we wanted to acknowledge this beginning because it was such a monumental time for us. So we had been, um, you know, a reservation since 1873 is when Standing Rock first became an agency of their own. And since then we've kind of been prescripted these, these ways that we have to govern ourselves. And so when the No DAPL happened and the Ocethi Sakowin Camp was set up, that was really a time where we got to think about what it means to exert our sovereignty.

We started to ask ourselves like what does this look like? In education, kinship, wellness. And then carrying the spirit of Ocethi Sakowin Camp forward, you can go to the next one, Tasha, and carrying that forward and thinking about what it means to, to lean into health and wellness through, through our own lens. And so it was started by Dr. Sara Jumping Eagle, Linda Black Elk, Dr. Rupa Marya, and so many others. And it was called the Medic Healers Tent or Medic Healers Group. And they were responding to the, to the immediate needs within the camp. There were frontline actions, all kinds of things happening. And so they were bringing acupuncturists, and birth workers and midwives and body workers, herbalists, all these different pluralisms of health services to the camp. From there, it became the Mni Wiconi Clinic and Farm because they had initially wanted it to become a clinic and farm and wanted it to be this staple within the community that uplifted health and wellness.

You can go to the next one, Tasha. But as we started to meet with community, we started to realize how important it was for us to focus on the needs of the community. And so these are just some, some initial conversations before Tasha and I actually became the co-executive directors. We were board members first, but when they started to have these conversations, they wanted to figure out how to have a farm and have a clinic, a free clinic, and all of these other things.

But when we fast forward a little bit to after camps closed and everyone was going home, we started to have these conversations within our community. Like what does this look like? Is it a clinic? Is it going to be a large farm? And so we started to have conversations within our community. You can go to the next.

Tasha Peltier: So one of the first things that, you know, Alayna and I got to be a part of when we took a leadership role with the organization as the co-executive directors was we knew, like she said, we knew we had to start being in conversation with community, but also get input from them on how we move forward, what is the direction that this organization is gonna go? We recognized that there were needs around health and wellness, but what did that look like? And so we were able to host the strategic, strategic planning session with community. And really kind of looked at our collective history, identified what were the significant things that were impacting our house, present day. So that was a really, really good few days that we were able to spend just with community thinking about what that would look like. And what we did was, we came up, we co-created this kind of consensus vision statement. So if you look at this image, those top bubbles represent the things that we collectively decided that we are moving towards as an organization.

So moving towards accepting and understanding who we are, where we come from and applying it to heal our present and our future. We're also moving towards spiritual, emotional, physical and mental balance. And moving towards restoring and regenerating the pathways and environments for our sacred purpose and connection to happen. And so all of the dialogue underneath or the text underneath is what are those important things that are necessary to move us in those directions?

Through all of this community engagement, we were able to revise our, our organization's vision mission, what it is that we want to do. And we came up with really what we intend to provide: purposeful care that models, teaches and nurtures our people at every stage and in every role in the circle of life. We promote holistic community wellness by uplifting Indigenous ancestral knowledge systems while integrating contemporary practices to build spiritual, emotional, physical, and mental balance.

So this is really the statement that guides the way that we move, the work that we do, how we conduct ourselves. We just need, we reflect back to this when we're thinking about the work that we do.

So as we, so that's a little bit of our history. As we start talking about different, the work that we do in different concepts, we would like to start off with some of the definitions and history of our communities because we give this presentation or similar presentations in different scenarios or settings and we never know what the understanding of those settings are. So we always like to make sure that we're going over some of these concepts.

So of course, some of the, some of the basic questions that we get asked when we have these conversations are things like, what is the appropriate terms or how do we refer to Native Americans or Indigenous peoples? And so these are just some examples of definitions of common terms that we use. If you look at Indigenous, that refers to people with preexisting sovereignty who were living together as a community prior to contact with settler populations.

Another common one that we hear is Native American, American Indian Alaskan Native, Native Hawaiian. And those are all terms that refer to people that are living within what is now the United States.

Then you'll hear First Nations, of course those, we hear that a lot with the Indigenous peoples of Canada. First Peoples, is another term that we hear common, referring to a group of people whose ancestors lived in North America or Australia before Europeans arrived. And then Indian, we hear Indian a lot that's kind of, uh, sometimes it's an outdated term, but really that comes from language that is used in a legal context when you're talking about things like federal Indian law or Indian tacos. No, I'm just kidding. But sometimes we, sometimes we take ownership of those terms too and you hear them in our communities.

But really what we want to stress here is that everybody has, I think the most respectful important thing is to ask when you're working in community, when you're, when you're engaging with an individual, asked them what they preferred to be referred to as. And so that's just out of respect and just shows your commitment to understanding them. And so we just like to kinda start off with that then. But just as we, in this context, we often use the term Indigenous. We may throw other terms in there depending on the context that we're using it. But that's just a little information for you all.

Alayna Eagle Shield: But also just, yeah, like Tasha said, make sure that you're referring to the community or deferring to the community that you're in. Because like our community, we hear "Indian" a lot like, oh, big Indian or gee, you speak good Indian. As you can see, the definitions that Tasha shared. There has been a history of what the government thinks that we need to call ourselves. And so we have written in our grants and things like that based off of what it is that they're requiring of us.

But otherwise, a lot of times our communities call ourselves by our names. Like if we're Lakota or Dakota or Hunkpapa or Oglala, you know, those names. And so just thinking of those definitions, comparing it to this federal Indian policy timeline, we'll just share a little brief overview just to help folks get an understanding of the wave that we've been in within our communities. So pre-colonial times, we existed, we coexisted in ways that fit whether we were [garbled] or whatever it was.

Our Nations are tied to specific point, but we were never necessarily, for us in particular, we were never necessarily just stagnant in one spot. But we co-existed. There were wars and there were all these other things but we, we knew how to conduct ourselves with each other. And then the doctrine of discovery came. We ended up making treaties with the government. There was Indian removal, the reservation era, and then it moved into allotment. So we were given land.

Our land was divided up and given to the head of household, which is usually a male. So who knows when that actually started? But there was like this shift towards the patriarchy and uplifting men as, as being the ones to get to make those decisions over our, our, our land, our homes, our bodies. But before this, before colonization, the woman owned the home, the woman had the, made everything within the home and they would always live with a woman's parents.

For our people, in particular. It's important to know these things because when we think of like how the shifts within federal Indian policy has shown, shown up. We were self-sufficient, we were hunters and gatherers. We moved along the land for survival. And then after colonization there was this assimilation period and a lot of harmful effects where dams were put into place.

Our identities were questioned and became, became this monolithic, where they kind of grouped us all together. It was like, oh, Natives, and we all have different ways of conducting ourselves. The transfer, the inter-generational transfer of knowledge was impacted. Our health began to plummet because we were forced onto reservations and forced to take rations and not able to hunt and do all these things.

And then you think of how these other things had started to come into place like termination period and then reorganization period. And then now we're in this present time, where not that long ago, in 1978, we were given the freedom to practice our own religious practices, which we didn't consider them religious, but we were able to practice our — and all along, our people were practicing. It was either underground or in the ways that they felt were necessary.

And we were given our — Native American Languages Act was passed in 1990. The Native American Free Exercise of Religion Act was passed in 1993. There were so many other things that were passed. And we're showing this because we want to demonstrate that there were all these laws and things put on our people to try to control and govern our land, our bodies, our languages, our ceremonies. And then within the 1970s, 1990s, we were starting to get this, like, freedom. And it's because they started to feel like it was safe enough to give it to us now and we'll explain a little bit more of that later.

You can go to the next one, Tasha.

Because we were put into boarding schools, punished for speaking our languages. There were all these massacres. They wanted our land because there was gold.

You can go to the next one.

And the reason we say that it was safe, as I'm in, as I'm in my PhD program, I'm learning about all of these different ways that the government controlled, you know, our communities. And through Lomawaima and McCarty, they talk, they talk about these traces of Indian policy or these swings of Indian policy that basically perceived threats or benefits based off of what they felt less safe or not. And so they would create laws and govern us based off of what they felt like we were allowed to do or if we, if we were assimilated enough and accustomed enough to not be a threat to them anymore.

And so this is why the — You can go to the next one.

These are an example of like, little girls were playing, playing Indian, but we were able to be Indian. You can go to the next slide. The government was able to control our hair, our languages and religions, our economies, our family structures as a way to continue to force us into this, like this white gaze to kill the Indian and save the man.

And the reason we bring this up is because we understand how monumental and important it was for us to experience the Water is Life movement during Ocethi Sakowin Camp, as we were opposing DAPL, because we got to prove and show the government that we were no longer gonna be safe, that we weren't going to just let them take our land, pollute our water, take our languages and all these things anymore.

And so I feel like that's why it's such a huge movement right now that's happening. Not only on Standing Rock but throughout the world. Because we're, we got to see a space where where at the Ocethi Sakowin Camp, where in the beginning for sure, I don't know how many of you were able to be there. But in the beginning it was so beautiful to see everyone just being authentically their Indigenous selves. And stepping into language and two-spirit movement, and health and education, and all of these ways that we got to prove that we can lean into each other and feel ourselves.

Tasha Peltier: Yeah, so I think now we'll step into really, how is that, how has that movement, those thoughts, how is that guiding the work that we do? So we're going to, we've talked a lot about the disparities that have been caught — what is the status of our communities today because of all these negative things that were imposed upon our people?

And really what we're trying to do is think about, how do we uplift our own Lakota/ Dakota ways of life and teaching to really try to flip that narrative from focusing on what we don't have or what was done to us to really leaning into those protective factors, or things that we know have carried us for generations, right? How do we lean into those, those things? And so we'll share a little bit about the ways that we're trying to do that with our work.

We just wanted to share, this is a quote from Leksi Tim Mentz Sr. He talks about sovereignty. We're going to talk a little bit about sovereignty later on, but sovereignty really is a spiritual commitment to the people. And so we really try to be mindful of that as we're thinking about leaning into that sovereignty around health and wellness, specifically.

The work that we try to do with our organization, again, is led by leaning into that sovereignty. So we think about different things like, through the pandemic. Actually when Alayna and I started as co-executive directors, shortly after that was when the pandemic hit our communities.

So we had been on this trajectory of where we want it to go as an organization. And bam, just like everybody else, we were hit with the pandemic and it just really kinda stopped us in our tracks and we had to adjust. We had to adjust to what we were doing for community, based on what the needs were. And so we really leaned into, of course, there was a lot of resources given to communities, whether it was from the federal government or different organizations, states. But we've started to lean into the genius that existed in our communities, the knowledge that have been carried for generations to really help keep our communities safe and healthy.

So these are just some of the examples that we utilized grassroots and community members' skills and knowledge to really help keep our communities safe and healthy. One of the other things that Alayna mentioned earlier was that we're really trying to focus on being two- spirit centered. One of the things, through colonization and just other influences in our communities, some people have forgotten how we, how we upheld our relatives in our communities, how they had very important roles in our communities. And they weren't shunned or pushed out. They were held in very high regard.

And so we've let those influences creep into our communities and it's been — it's negatively impact — we see it across the nation that it's, our relatives are being negatively impacted. So we're trying to be very intentional in our, in our own communities to uplift that again and to really show our relatives that they have a place. And let's think about what that looks like. We've been diving into language and roles and societies. What do those things look like within our communities because we know we all have a place?

Then really we talk about, the title of our organization talks about kinship. And one of the areas that's important for us is really focusing on our relationship to the land. That's one of the things I think that it's easy for us to feel separated from the land in the modern-day world that sometimes we get caught up in. And so it's about recentering, being connected to the land, being physically on the land. There's really something — we know that there's something that, that does for us. And so we've had several projects and things that — a lot of the work that we do on the land, even sometimes when we just get together and meet it's on the land because we know that that's important. And so these are just some of the examples.

One of the projects that we've done is the Chansasa Revitalization Project, really trying to work with our medicines like that, reconnect with those medicines, understanding how those plant relatives take care of us. And these are just like I said, other examples of some of the things that we've done on the land, some of the community members that we've worked with. That's one of the things is, we have a really small team of employees, but we do a lot of work with the community. We have different opportunities for them to do work with us. And really we try to let them lead how the work looks because we know that coming in and telling people what needs to be done, that doesn't work for us, right? We have that knowledge in our communities and we really like to be intentional about that when we do the work.

Then food-centered. We hear a lot about the health issues that have stemmed from either lack of access to healthy foods. We hear terms like food deserts. And so really we start to think about how did we, because we never had the conveniences of grocery stores in our, you know, long time ago. So what were the things that sustained us? And so learning about, developing and strengthening our relationships with the different food sources. And so these are just some pictures of some of the buffalo butcherings that we've done in the past.

And those have been amazing learning opportunities for us because, you know from learning about how you need to, to make a relationship with that relative before you take its life, how important those little pieces are to that whole process. You know, it's so easy for us to walk into a grocery store and pick up a pack of meat and just eat it and not even think about everything that's happened up until that point. And so, these are opportunities, opportunities for us to slow down, think about that, re-connect to those ways and really help us look at food and nourishing our bodies and how all of those things, they're all related. And we need to make sure that we're thinking about those things.

And so those are, those are, these are some of the opportunities for us to learn those things and we're really grateful for it. We have a lot of people, Lisa and Arlo Iron Cloud have shared a lot of knowledge. We brought them, invited them to our communities and they've taught our community members how to do these things. And so we'll continue efforts like this because everybody's excited to learn, to do these things. And so we just know that these are so important for us as we think about making sure that our homes and our communities have healthy foods and can support ourselves in those ways.

Alana Eagle Shield: And also just on that same note that we are continuing the effort. So we have our first — I don't know if it's gonna be quarterly or annually. We're still trying to figure out, when it actually happens, how crazy it's going to be. But we have, our [speaking in Lakota] Buffalo Teachings Camp. And so that'll be May 10th, 11th, and 12th.

And we just have, we have a new organization, we'll share a little bit about our partnerships with them in a bit, but we have a new organization that just opened up their building. They had their grand opening yesterday in Cannon Ball, which is — so our reservation is like the size of Connecticut. 2.4 million acres, or so. It's huge. And so on the North Dakota side, we have three of our districts. On the South Dakota side, we have the other five. And so the Cannon Ball is like the furthest north district that we have on Standing Rock, and that's where it's going to be located.

So we're continuing those efforts, continuing to figure out, like, as we've been doing these buffalo butcherings, we're like, we know we can't do this in a day. We have been able to. But there's so many things that come up. We're there from morning, sunup to sundown. And even afterwards we have, like, our car is shining lights and cleaning up and putting things away. And so we wanted to extend it to three days now. So we could share a little bit more about that later as well.

But yeah, thinking of, like, the family supports that are needed. So we've been having these [speaking in Lakota] ceremonies, which is publicly welcoming the spirit of the baby. And that has been huge. We actually, a lot of the things that we're revitalizing and learning, we're doing it in community with other of our Ocethi Sakowin Nations. And so we learned this one specifically from the Oglala. They had said that they learned it from their elders back in the '90s when there was a high epidemic of SIDS. And again, you know, as we're educators, I'm in a PhD program, we understand that there's like evidence-based knowledge that needs to be shared for certain grants or things like that. But we know that through our community, that's — that's the evidence that we believe in.

And so they said that in the '90s there was a high epidemic of SIDS, and the elders got together and decided that they needed to do something about it. And so they started to have these baby welcoming ceremonies. So there's a whole process that happens where you, you pray for your baby, you prophesize over your baby. You, you eat traditional foods, you get painted. There're just all of these things that happen that are so powerful when you think about how intentional you are to be able to welcome that baby.

And also we've been having conversations around like fatherhood and motherhood and traditional medicines to use, like bone broth soups and elderberry syrup and blood building syrups and the support around menopause, like out here working through those stages of life. Like. what are those responsibilities? Excuse me. And then just thinking of like the supports that we need around, around our pregnant and birthing families, postpartum families.

We've been, we're actually going to hire two folks coming up and it's going to be within the next month and we're so excited about it. But they're gonna be, they're Indigenous birth and death specialists. So we're not requiring them to have a doula certificate or have any kind of training. Because we know that that genius, just like Tasha mentioned earlier, that genius and that brilliance within our communities. We know the answers. We've been doing this for years and generations and generations. Since our communities were first created.

Like since the Creation are people knew how to support our folks through birth and through death. And we also know that that birth and death portal is the same portal. And when we forget how to die, or forget how to birth and we forget how to die, like vice versa. And so we've been having like necessary conversations because it's so stigmatized to think of birth and death in the same breath. But our communities face them, those things all the time. And so we're so excited to hire those next folks in the coming month. And so look out for more information on that. My allergies are crazy.

And we have been working really hard to engage the youth because we know that that they will carry these things forward. And when they're exposed to these things or they have opportunities to be engaged in these types of things this is where the, just like Tasha and I grew up around the same ceremony families as when we were young. We have grown up in the same community. And these are the patterns that we've been able to pick up because we're like, oh man, these are not separate, you know, our, our food and our birthing practices are not separate.

Our health and our wellness and our traditional ways and our language, these are not separate. But we keep being taught through government funding or programming that like, oh, this program does this, this program does that. And so we know that there's a weaving that has to happen. And it starts when you're super young. Just getting them exposed to what it is that they want to focus on or what it is that they want to learn about. And so we engage the youth.

Okay, you can go to the next one. And we also understand the importance of our elders in our process. And it's not always the easiest dialogue. And what we've had to learn is that we made our circle, like Tasha and myself and other community members, and I've seen [speaking in Lakota] that we have to have these conversations together so that when there are elders that are either being harmful in the ways that they state things or the ways that they share certain things that we can take the good from what they're sharing. Because, because there's so much rich genius and brilliance within everything that our elders share. We can take that good, but we can leave the stuff that's like, may still be colonized or may still be not helpful for what we're trying to do. But we could still love them as a whole.

And so we've been having hard conversations and, but also restoring conversations and we've been able to strengthen our relationships with our elders and our community members and process these things in a way that help to continue to uplift us. Because we have, as you all know, if you're working in the health care field or if you're working in any revitalization efforts that it can be hard if you don't have a team or a group. And so we understand that we don't do any of this alone.

But we'll share a little bit about the community of folks we've created. But we focus on ceremonies. Like, it's because we're in our own community, we can be, you know, centric or Lakota/ Dakota-centric because that's the way that we know and that's the, the ceremonies that we've been in Ocethi Sakowin neighboring reservations. We've been learning from each other in these ways. Excuse me.

So focusing on how these ceremonies have always helped us and uplifted us and created these paths for us to move forward. And we've heard from our elders that are our ways have never been, they've never been gone. We're not ever bringing anything back, but we're just helping to uplift these things again and remember them.

And so these images are from our Isnathi Awichalowanpi. So our Isnathi is a coming of age ceremony that we have. For right now, it's for menstruators, but we also allowed two-spirit to join. And we have, this year, our elder board member, she will be joining. And even though she's gone through menopause and all of these things, we know that these ceremonies haven't been afforded to our community members. You know, not everybody had that opportunity until we open it to, no matter what age you're in, or no matter what phase of menstruating or menopause that you're in. Because we know that these teachings are super important.

Okay, you can go to the next.

And so as we talked about the communities that we're building, one of the teachings that we've been doing is teachings around the tipi. So during our Isnathi Awichalowanpi, we share, we teach them to put up a tipi together because they're all, most of them don't know each other. But we teach them that they can put up their own home and that this is their home. And we teach them to communicate. And, you know, each, each pole has a different meaning. The way that you tie it to the ground has a meaning. There's so many things that are taught through the process.

And so we started to do this within the community. And from here we started — there's been a coalition that's been created. It's called the Oyate Oyuwitaya Community Coalition. And it's basically, since the No DAPL camp had started, there has been a lot of non-profits that have popped up. And so we are just doing our best to figure out what that looks like to work together. There's a lot of non-profits and LLCs and individuals and grassroots organizations, Tribal entities, all of these folks that want to work together, we just have created this. Not us, we created it with all of the other organizations together to figure out what it means to rebuild together, to have support systems, to share physical resources, to share community responsibilities, to offer historical perspectives, to connect over food, and re-learning these things together.

What does it mean to take each other as kin? To uplift language and culture and have community pride? And just to see the Indigenous brilliance and genius again, I'll say that forever because I just believe in it so much, that we have the answers. When I compare it to, like, if you go to therapy, a lot of times they'll tell you what's going on or tell you what's happening. But if you're with a coach who, who has certain facilitating practices, they'll continue to point you, point to you that you have the anthers. And so that's kinda where we are in our process of facilitating that.

Our community has the answers. We will do our best to try to find funding and create these spaces, but we want them to dig deep and figure out, like, you have the answers. What is it that you see the need is? How do you want to move forward? How do you work as a person? Are you more like bossy and out there? Are you kind of like waiting, sitting in the back or, you know, whatever it is, everyone has a role. And so that's what we want to uplift is those roles.

Tasha Peltier: And I think one of the other things, you know, kinda learning how sometimes the communities have a scarcity mentality. We forget how to work together and sometimes we even think we're in competition. So this is all part of the healing process for us as communities to remember how much stronger we are when we work together. And, but that takes time. And like Alayna said, we've been really trying to lean into some of that, highly facilitate some of that healing amongst each other. Because we know that a lot of our communities are still dealing with the negative impacts of colonization and we carry some of those unhealthy things, those habits. And so how do we start to work on that healing amongst each other, as communities, as families so that we can work to restore some of those things that we're working on?

And this coalition has been a really good example of that. It's just really beautiful to be able to lean on other people. And it's not always easy. I don't want to give the impression that it's all rainbows and unicorns. But, because there are difficult conversations we have to have, of course, as communities, but those are all necessary. That's important. It's natural, right? Those are natural parts of life. And so it's about how we work through those issues together. It's just been amazing to see the growth, I think as organizations that we've seen amongst each other, it's been great.

Alayna Eagle Shield: So we just, again, just thinking of how our way forward is through kinship. When we talk about kinship, when we call each other, like Tasha and I call each other sister or chuwe, or we call tunwin which is auntie, leksi is uncle. We just claim everybody like that, whether they're blood-related or not. Because we know that when you use kinship and you use those terms with each other, there's a responsibility that applies with those. So when you claim each other as a relative then you take care of each other as relatives. And so we believe that that's the way forward.

And, we had to leave 10 minutes. Blaze through it. I don't know how you want to do this.

Corinna Sabaque: Alright, thank you guys for the awesome presentation. I'm gonna go through a few questions that we have in our Q&A chat box.

So the first one here is, can you talk more about the two-spirit concept? I read recently that there's controversy around the term and also that non-Indigenous folks equate two-spirit to non-binary. But that's not quite right.

Alayna Eagle Shield: So I will attempt to answer. So we've had elders in our community that have told us that, like, this word's not our word and that's not what we use and all these things. And so our elder guide or mentor, Tunwin Beverly, she was a part of some of the movement that created the two-spirit word, back in — real recent, not too long ago. And she basically told us, it's not meant to be one of our words. This is a word that is meant to describe the movement now, into, for the two-spirit community.

And it's specifically for Indigenous folks. And so I've had non-Indigenous folks ask me like, I feel like I relate to two-spirit, and I just encourage them to find a word that describes them because this is an Indigenous-focused word and it's our word. It's our identification. So.

Corinna Sabaque: All right, great. So the next question here is, just out of curiosity, is there a lot of bed sharing with newborns? In my culture, it's very common. But in the US, it's strongly discouraged. And that leaves me feeling confused and guilty.

Alayna Eagle Shield: So we made up — oh, sorry, I'm just taking up space Tasha, I don't know if you want to answer too. But we just made a post recently, like a couple months ago, if you want to — I think it was like around the SIDS. And we talk about how important it is to figure out what that decision is for you. But we encourage bed sharing in a safe space like making sure that there's not blankets, whole bunch of pillows and things like that. But how traditionally, that's how babies self-regulate, how they are comforted. And we also encourage folks to use moss bags or cradleboards and things like that.

Corinna Sabaque: Let's take a couple more here. So do different Indigenous communities feel an innate kinship with one another? Or is it more that you've come together under a common banner to fight government sanctioned abuses?

Tasha Peltier: I don't know. I'll share a little bit what I think, and Alayna I don't know if you want to pipe in too, but I think that I've had experiences living in, I've lived in California, I've lived in other places and we just find each other no matter what community we're from, we, when you find another Indigenous family or person you just, like, cling to them because there are, of course we're all unique, we're all different, but we just feel some sort of connection, whether it's because we've maybe faced the same struggles. We have similar kinship systems.

We have — one of the things that I always laugh about, my husband was in the military, so we lived in California. So we had, we actually were friends with a lot of different nationalities, but they'd always say everybody is your cousin. Because when we would see people, other Natives, it was like, oh, that's my cousin when actually we probably were related in some way but they just didn't understand that because it was like, oh, that's not your first cousin, you know, but that's just how we are. We acknowledge those relationships and we just cling to each other. So I think that we do, we just have that innate kinship with each other no matter what Tribe we come from.

Corinna Sabaque: Alright, awesome answer. Last question here is, what is working for you to engage with youth?

Tasha Peltier: I think one of the things that we've, I don't think it's anything new to anybody but our youth want to learn things. They want to know, they want to be engaged in these things. And so one of the programs that we talked about was the [Lakota], or the land steward, the restore project. They do a lot of different things with gardening and harvesting and all of that. And when they bring youth along, they're just like sponges, they just absorb it. They want to do it, they want to learn about it. They want to do all these things. And so our youth are just waiting for us to engage them in those things. And so I think that if you create space for them, they will engage.

And then just being intentional, I think sometimes we get so caught up as adults of doing things where we're all in professional realms or whatever and we forget about our kids sometimes. And so one of the things I love about the work that we do is all of our kids are always there. They're with us, they're right there. They're doing those things, they're seeing that. And so that's important because I feel like in a colonized world, we try to separate the things that we do from our kids. All kids over here, adults, business, work over here, but we're trying to break that down and bring our kids with us.

One of the things that I think is so beautiful is Alayna and her family, they do everything together. They're always, no matter what it is. And like today, we've probably seen them in the background and I love that because, that's so important. We don't have to separate from each other to be successful or to do good work or to — So I think pushing back on that and just being inclusive of our youth is, our babies, it's so important. So yeah.

Alayna Eagle Shield: Well, I think that when we do it in community, sometimes we have to be mindful of, are we doing stuff on the weekend or during the week? Because it's so much more convenient and helpful for families and community if we could bus them in from the schools. So that's something we also take into consideration is like when we're having that buffalo teachings in May, we intentionally made it during the week so that the students could get bussed in. Because we know that transportation can be an issue or a barrier sometimes. [Coughs] Excuse me. So yeah.

Guthrie Capossela: It's awesome you guys are working to overcome the barriers, or anticipate the barriers.

So one more question, but a comment here from Dr. Anthony Staley. Good job. Remember talking with you about this project a few years ago. So happy to see this come into fruition. Bravo. Echo his sentiment.

Kind of last. Oh, there's a couple of more questions. Maybe we might have time to get both. I noticed many Tribes are doing similar work you're all doing, but there's low turnout of community members. Do you all experience that? Pretty related kind of to the last question with the kids.

Alayna Eagle Shield: No. I think, yeah. Sometimes it can be transportation, sometimes it can be other things. And so we have been trying really hard. This summer we're working to get an RV or some type of mobile, mobile unit so that we can go into communities. But right now, we've been just trying to have things in the community that, because we have eight districts on Standing Rock, so we had a buffalo butchering in Rock Creek one time. We have different tree plantings in McLaughlin or Little Eagle or Bear Soldier. And so there's just, there's just different ways that we're trying to meet that, meeting with other communities. But I don't feel like there's a crazy, a low turnout. We have — The folks who show up are meant to show up and sometimes it's ones that we least expect. It ends up bringing more.

Tasha Peltier: And I think one of the other things that we recognize too is that in some of the things that we're doing because of colonization, people maybe don't feel worthy of those things or they don't feel like they can access those things. And so we're working really hard to make people feel accepted and where we want them to come and engage. But that's a process too, right? There's an internal maybe mindset that we're working on with people to understand that these things are for them and we welcome them.

Guthrie Capossela: Yeah, that's super true. Takes a while to kind of overcome that barrier. It's like an invisible barrier. I experienced that when I was doing language learning. That's really tough.

Alright, unfortunately, we've got one more question. Maybe we can answer that when we get to our informal Zoom piece. Corinna, can you toss the Zoom link in there too? Awesome. I'm going to share, Corinna did put the Zoom link within the chat. We're gonna get ready to migrate over to the more informal after-Q&A session, I do want to toss up the QR code on the screen real quick. That way, if that's easier for you to access, if you're on your phone. Can you guys see that or are you guys looking at yourselves? Okay. Perfect.

Thank you all for coming. I really appreciate it. We're gonna be migrating over to our post-session here. Please do fill out the survey. That really helps us improve. Corinna's talked a lot about that in terms of the feedback has been excellent and so we've been continuing to try to be responsive in that way. We don't have our next speaker lined up yet, but we will host it on the same schedule for the Thursday, April 20th. So look forward to seeing you all then.

If you're not able to jump on with us here in a few minutes, but hopefully see you all because I've seen a lot of names in here show up every week, but we haven't been able to see faces. So we're looking forward to meet some of you. See you all very soon.

Moderator, off screen: Hello everyone. Welcome to the Indigenous Health Topics sponsored by the Native American Community Outreach program, which is under CHECER within Mayo Clinic. Today we are very honored to have Dr. Lee as our guest speaker.

Could you go to the next slide? Just, just be aware that we will have time at the end of Dr. Lee's presentation for some Q&A. And then if you would like, you can do your Q&A over in the chat box as well. And then we will discuss at the end of the presentation.

So today we are very honored to have Dr. Crystal Lee, who is Dine and with United Natives. And I was very impressed over with her bio, but I think her bio really speaks highly. I know that she obtained her Ph.D. from UNLV out in Las Vegas and she is an assistant professor at the University of New Mexico. She also holds a master's in public health, and is doing some amazing work in Indian Country. And she will be presenting on today, the title of her talk is called, "COVID Impact and Associated Barriers and Solutions in Indian Country." And I'm going to turn it over to Dr. Lee.

Dr. Crystal Lee, Ph.D, MPH, MLS, Dine, United Natives: Thank you, Judy. I'm going to take off my mask. That's appropriate. Hey, everyone. I'm honored to be here. My name is Dr. Crystal Lee. I'm originally from Navajo Nation. My, my maternal grandparents are from a small community in Arizona, and my paternal grandparents are from Steamboat, Arizona. My Dine clans are [speaking in Dine Bizaad] I would like to start off with presenting this video.

I was honored and selected to be one of three persons in the United States changing health equity. And therefore, Scientific American did a short 12 minute documentary on the evolution of the work that we're doing in Indian Country. I think this video speaks best of the work that we're doing and also the impacts of COVID.

After that, I'll do a brief presentation and then open it up for Q&A. So if, Corinna, would you so kindly please start the video. Thank you.

Corinna Sabaque, off screen: Can everyone see the video? Yeah. Yes. Okay. I'll go ahead and start

Dr. Lee, in video: There was a lot of death. Every single day. I knew of someone that had passed from COVID and that does something to you because that's your family, that's your community. - Hi, Grandma - In a way you almost feel self-defeated. Like how do I help?

Grandmother: That time I was okay. Next day, I'm ok. Yesterday evening. It really hit me. It was really hurting on this side. Hurt, hurt, hurt.

Dr. Lee: Mentally and emotionally It definitely impacted me. Sorry You know, just thinking about my uncle who passed, and I grew up with him. He was closer to my age, although he was my dad's youngest brother, but we grew up together. And it hurts for sure.

The Navajo Nation is the size of West Virginia. But yet there's only 13 grocery stores that lie within the reservation. How do you tell a community in the United States that has no running water or electricity to wash their hands? Do they have the financial means to get gas to go to a hospital or clinic? Housing is overcrowded within and among Navajo households. Then you talk about preexisting health conditions, chronic diseases, also other infectious diseases. And in combination with the outbreak of COVID, it really hit our community extremely hard.

My name is Dr. Crystal Lee. First and foremost, I'm a scientist slash academic. Both my maternal and my paternal grandfathers were Navajo medicine men. I was eight years old and in a ceremony watching my grandpa pray for someone. I remember sitting there in the ceremony, and thought wow, that's what I wanna do with my life. I want to become a doctor and I want to help my people.

At the institutions I have been at, I was usually the first Native to graduate. I wanted to see how I can integrate policy with all this health and science because health policy is such a huge factor in making change. I actually made a recommendation at the United Nations Permanent Forum on Indigenous Issues back in 2018.

One of my primary recommendations was they improve international health policies in the event if a pandemic occurred, acknowledging that Indigenous populations globally would be the most adversely impacted. Now you bring us to 2020 when COVID hit the Navajo Nation. My hypothesis was absolutely correct.

Historical trauma in our communities has been such a deep and heavy issue for us. Native Americans, Alaska Natives, Indigenous people of this land. It was very purposeful to expose us to infectious diseases as a way to commit genocide. And that purposeful act, along with multiple acts, still impacts our health and well-being. For example, when the first round of federal funding came out to assist states to combat COVID, Tribes were not included in the first round federal funding at all.

Murray Lee: I hoped to get a different answer, but I talked with him and the money's pretty well spoken for.

Dr. Lee: A big reason why our points of care in our Indian Health Service system is so substandard is because we get discretionary funds at the congressional level. We are the last to get funded and the first to get cut. That was a huge layer of why it took our Tribal communities longer time to react because we literally do not have the fiscal resources.

Part of my academic training is infectious disease and preventative medicine. And when the virus first came out, I understood how the virus was most likely an airborne virus. My non-profit, United Natives, was the one who spearheaded all of the COVID-19 initial efforts in 2020. And with that, I made some culturally responsive recommendations.

For example, as Natives, we burn sage, cedar and/or sweet grass. There has been scientific knowledge that if you burn any one of those — sage, sweet grass or cedar — that what happens is the smoke weighs down the particles in the air and it falls to the ground. It doesn't kill the virus, but it weighs it down. So it's no longer lingering as airborne.

So part of my recommendation to our Native community was, if you had someone in the household that's coughing, that you think might have contracted COVID, let's resort back to some cultural preventative practices. Again, there was no scientific knowledge that it worked with COVID, but at least we could try our best to implement some prevention strategies that were cultural based.

In addition to that, we delivered mass Lysol products in total to about 70 different Tribal communities. We partnered with another company temporarily to quarantine Native people. We would pick them up and we secured an entire hotel with over 100 rooms. In March, April, and May our hotel rooms were completely occupied by people who were COVID positive. Out of the thousands of people we quarantined, only one passed from COVID.

And as a result of our quarantine phase, a huge observation was, our community members verbalizing that, my 14 day quarantine phase is done, I'm COVID negative. But yet I don't have a home to go back to. I don't have a job. I don't have food. I'm a female that's a victim of domestic violence. I don't want to go back home because I'm getting abused. Myself and my children are not safe.

There was a huge increase in substance abuse, a huge increase in domestic violence, especially among our Native women. And we knew that we had to come up with a plan very quickly. So we ended up turning that hotel into a mental-behavioral health facility because of the need.

As a result, I started my own company, again out of need, which is called Indigenous Health. And we do everything from medical health services to mental and behavioral health. We opened our doors January 10th of 2022. And Indigenous Health started as a mental-behavioral health company to address the gap in need.

We have Native American clinicians on our team. And we have evolved into a nationwide company now providing services for the urban Natives in Baltimore, Maryland; Washington, D.C.; Boston, Massachusetts. We will soon be in New York City and Chicago, Illinois, and Los Angeles. And we find that these efforts really help our Native community, especially those that are dealing with mental-behavioral health issues.

And I want to bridge the gap of access to care and quality of care. But not only that, I want to help with bringing culture and our, our Indigenous ways of health and healing and combine it with Western medicine to help our people. What we're doing now, peer support. You know, you've excelled this long in this program, now you feel that you are able to help your other peers who are incoming to the program, maybe the newer ones.

I have so many ideas, so many things that I want to do, for my people for myself, for my kid, I want to open a business, I want to go to cosmetology school, I want to go here — [group laughter]

Dr. Lee: Native Americans, Alaska Native people do not have health equity. And I do not believe that we will achieve it in my lifetime. However, we can make strides to get there. I had that vision at eight years old and for me to be able to live my vision and live my dream.

To honor what my grandparents had prayed for, what my ancestors survived for me to be here in 2022 as a Navajo woman, as a doctor, and to truly give back and help my community. I just really hope my ancestors are proud. I can think of my grandpa and my grandma looking down and saying, this is what we prayed for and we're really proud of her.

Everyone, what'd you all think of the video? I'm talking to two different crowds here. I don't know which way to look. [laughs] Hi. Good to see you. I definitely don't want to repeat, I know a lot of us here are Native. We understand a lot of the structural barriers that existed during COVID and after COVID. But for those of us on, especially the Zoom panel, chiming in, a lot of our participants are not Native. So I just want to go over some of the issues that we experienced as structural barriers during the time of COVID.

So when COVID hit, our communities were not ready. Our infrastructure is, when I talk about infrastructure, I'm talking about things as simple as roads. So accessibility. I'm talking about access to Internet, access to running water, and access to electricity, including heat. We, as most of the Navajo Nation, a third of our communities do not have running water, and a fourth of our communities do not have electricity. Also, I believe about more than 50% do not have access to Internet.

So when COVID hit, we were already behind of the recommendation by the Center for Disease Control. And how to, what, what could we do to address the prevention aspect of COVID? We couldn't just wash our hands. And in addition to that, we have households with a large amount of family members, extended family members that live in one household. So pretty crowded. In terms of acknowledging the how fast the spread could be within one household. And oftentimes, our households have elders in it because a lot of our family members do take care of our elders.

So acknowledging all these barriers in addition to the lack of resources. Again, access to roads, access to the nearest clinic and/or hospital. It could average anywhere from 30 minutes, plus, to get to the nearest clinical facility. Not, not that we had enough problems, but also the shortage of health care providers. Do we have enough clinical staff? I know a lot of physicians on the front lines, for example Dr. Michelle Tom, who is one of our partners. She's a Navajo physician out on Navajo Nation. She was working 16 hours a day, seven days a week, assisting with the COVID efforts and acknowledging that we didn't have adequate health care to help provide, especially with the rise in COVID cases. Not also confronting that our health care workers were also dealing with mental behavioral health issues.

During my consistent communication with our clinical team that we were working with, a lot of them did communicate to me on a personal level that they were combating mental health issues because of all the patients that they were seeing, and how much people that were — that the mortality rates were pretty high on Navajo Nation. But yet they still had to persist and care for our community members. And they were not doing well themselves. Not just the physical burnout, but also the emotional and mental burnout was a huge issue for ours, and for all health care workers. But especially if you are a Native clinician working and you're serving your own community and you're serving your own family members and there's that personal relationships, how much that impacted our health care workers.

I was in, also, communication with the Navajo Nation team for tracing, when it first started to erupt, when the first cases of started to transpire in Navajo, and how much the community health care workers assisted with this. So because our Tribe is so big, for those of you that do not know, Navajo Nation is about equivalent to the state of West Virginia, which is about 30,000 square miles. And because we have the largest land-base as a reservation-based Tribal land in the US, a lot of our communities are widely spread out.

And, and we just didn't have enough staff resources to assist with COVID. So that's when our community health workers really stepped up and stepped in to assist on tracing and tracking family members. But not only that, but also distributing resources out as well to our community members because they had those personal relationships with the community as community health workers. And so I think our Tribe did a really good job on utilizing what resources we had, although there was a lot of limitations.

Now we're talking about staffing issues, we're talking about clinical teams. We're talking about even access to information on the Internet, or news, how do you prevent it? What's going on? There was a lot of, a lot of gaps in communication from a health capacity, health care communication that resulted in getting those timely messaging to our community members. Now we're not even acknowledging language barriers at this point. And again, it was the community health workers who really assisted to, for the pipeline for the communication to coexist during COVID.

In addition to that, we're talking about 13 grocery stores in a state, in an area the size of West Virginia, only 13 grocery stores. Now we're talking about basic resources, basic access to water, to food, to PPE. I really commend those people, especially the managers who worked in the grocery stores, because they also had to be really mindful on ordering the supplies. We're talking about, because we could not have a shortage of supplies, because that's just an extra layer of access to resources.

So I give also credit to the managers of those stores who ensured that they were readily on top of ensuring that we had adequate access of ordering supplies to those different grocery stores throughout the reservation. And I think just looking at this totality of how we designed, without resources, designed this whole infrastructure. Again, I want to reiterate from the video that we did not get the first round of federal funding through the CARES act. Like, Tribes got nothing. We did not get any CARES, any federal funding until after the big wave of COVID occurred. And so we already went through the toughest part without any fiscal resources as well.

Now, now we're acknowledging some internal barriers at the reservation, Tribal level. But then let's also look outside. How — I want to pose the question, especially, especially to people at Mayo Clinic and who work in urban areas or not on Tribal land per se. But how does the partnership coexist? Because now we know a pandemic occurred. Now we know that we have to coordinate better partnerships and coordinated partnerships in case something like this occurs again.

And the question is, how well and how strong are your partnerships? Is there a policy, internal plan from an organization or company like Mayo Clinic to work with Tribes? How are you communicating with Tribes to assess these type of coordination of resources? Not just, not just to private organizations or companies, but also at the state level, at the county level.

A lot of states have communicated to myself that they weren't readily reaching out to Tribes because they thought that the Tribes were being taken care of by the federal government. So because it's out of their quote, unquote jurisdiction, they thought we were getting all the help and resources from the federal government, which was not the case. So therefore, the states and state organizations were not proactive on working with Tribes when COVID did exist as well. So we're looking at now cross coordination of resources and cross coordination of care.

I think that we, this is a teachable moment on how to strengthen this internal- external policy in working with Tribes. In addition to that, we're talking about statistics. We don't have true numbers because our data and our surveillance as well, from our reporting mechanisms, I think, there's — Navajo Nation is in three states, the states of Utah, Arizona, and New Mexico. And then how does the reporting — how well is the reporting, surveillance, monitored and administered to keep up with accurate data points?

And I think again, that is, that could be strengthened across states, across county lines about ensuring that we do have the right surveillance. Because that will help us, help us with acquiring more resources. It'll help us understand the mortality rate, the prevalence rate, and the incidence rate of any chronic and/or infectious diseases. Which also will help with funding because we need to produce numbers to allocate more resources and it all comes back down to data. And so that is a strong point that I want to make, is data is key to ensuring that we are able to allocate those resources.

I have a funny story about this, this video, the last shot. And, and it kinda coincides with the structural barriers. I was really adamant to tell the videographer from Scientific American, you have to get a shot of me [speaking in Dine] house, which is my maternal grandparents' house. Very adamant. I was like, that's where I'm really from. Out of anywhere in the world, this is where I'm from. So I need a shot here. So it was just me and her. There was noone at my grandparents' house. They had since passed. And so it started raining, and mind you, we drove about — my grandparents live a good 30, 30 minutes, all dirt road, in the middle of nowhere. And it started raining. And the videographer didn't have rain equipment with her. So we go all this way to get a shot, but she couldn't go outside. And we just were parked there. We're like, ok, we're two smart woman we could figure something out. How do we get a shot?

So I'm like, I know there's an outhouse right there. [laughs] I'm like, go run in the outhouse, and you can sit in there, and you can shoot me, 'cause it'll protect you. [laughing] This New York City woman that lives in New York City, is a videographer, was sitting in the outhouse. [laughing] We were laughing so hard. But, you know, for her to understand because, just her to see the geographical layout, how far it took to get to my grandparents' house, how, that we still use outhouses because my grandparents' house has no running water. But I'm gonna remember that forever. [laughs] But we became innovative that day.

But I say that to say that we have so many structural barriers that also include policy. As I indicated, I, I'm part of the United Nations. I do a lot of human rights advocacy on behalf of Indigenous peoples. I've been doing this since I was 27 years old. And my consistent recommendations have to do with human rights and Indigenous issues and understanding international health policy. Again, how do we work with other countries? Because of our traveling and the exposure of infectious diseases. And we have to strengthen our, also, international policies as well. Not just at the Tribal level or the state and Tribal coordination, or the Tribal and federal, but also international policies as well. Because some of our Tribes are international, on both sides of the United States and Canada. They have, they have lands and on both parts. So they're considered international citizens at both the US and Canada.

And also there's some Tribes that also have that cross coordination between the United States and Mexico. So they're dual citizens, and that impacts us too at the Tribal level that they're dual citizens in both countries. And then how do we work within those systems for those types of policies as well?

And so just to bring up how important policy is, I really don't want to talk a whole lot. I also want to leave a lot for Q&A. Could you please start the PowerPoint? I just want to briefly go through some of the work that us and our team is doing. And then we'll go ahead and open up for Q&A.

So in the video, I indicated that we did quarantine. We were quarantining people. And as a result, people did not want to go home after the 14-day quarantine was ending because of unsafe housing, increase of substance abuse, increase of domestic violence, insecure housing, and also food insecurity. And because we fed the people three times a day. And this resulted in the mental-behavioral health portion of the ripple impacts of COVID. And we have, and that's how Indigenous Health was initially started.

And could we go, next slide, Corinna? So we have two sectors of what we do. We have our Indigenous Health company and we also have our non-profit United Natives sector. And they work hand-in-hand to assess our communities in multiple ways. Not just in the space of health, but also basic resources that we're providing.

Next slide, please.

So Indigenous Health and United Natives work together. So Indigenous Health focuses on mental-behavioral health services with some aspects of direct medical health care and also prevention education. And then our non-profit sector provides supplemental housing, cultural-based activities, and community outreach and engagement and activities as well.

Next slide, please.

So when COVID hit, our non-profit sector allocated a few million dollars. There were a lot of people doing good work out in Indian Country and a lot of different organizations and a lot of people who are proactive on helping with PPE and supplies.

There were other, whether they were community members or chapter houses, but we worked directly with the chapter houses and we obtained aa direct contract with Lysol. At the time, I believe I was the only Tribal organization that had a direct contract with Lysol. So we secured a whole warehouse in Flagstaff, Arizona, that was donated to us. And we had hundreds of pallets of Lysol, both wipes and the spray, that were disseminated to over 70 communities among the White Mountain Apache, Hopi, and Navajo communities, both Arizona and New Mexico sides.

Next slide, please.

We were delivering supplies throughout, myself included, and driving a big U-Haul on dirt road in the middle of nowhere, even got a flat tire [laughs] out on the dirt road in the middle of nowhere. But we had a great volunteer-based team. Again, we were working with frontline clinicians and other volunteer who really helped to obtain the supplies and help disseminate it through, throughout Indian Country.

Next slide, please.

Just some more pictures of some of our relief efforts. And you can just skim through the next three slides.

Briefly, all the communities that we hit or some of them. And where our donations went. We were actually featured in USA Today as one of the leading non-profits helping Indian Country in, during COVID.

Next slide, please. So, sorry. Next slide.

This gives some statistics for those of you that might not know. This data is Native and/or Navajo specific, that we have psychological distress compared to white Americans, 2.5 times higher in comparison. We also have the highest suicide rates in different age ranges. As you can see here, the suicide death rate is more than double than non-Hispanic whites. In addition to that, in Navajo Nation, in 2016, there were a documented total of about 211, but these are not real numbers. Again, I believe the numbers are much higher because of the data. And I know especially like in Pine Ridge area, suicide rates are extremely high. Higher than Navajo Nation, I believe the highest in the country per cases per population capita.

Next slide, please.

So because of the need, during COVID, just the lack, the lack in general of clinical staff on or around reservations. Or even in urban communities that work in our Tribal clinics. We don't — recognize that we don't have enough staff and we need to train more Native health care professionals. And I'm just lucky to have our team of Native health care professionals that have joined alongside this journey to help our community members.

I have developed Indigenous Health because again, out of need. Most of our, about 98% of our clinical team are Native American. We subcontract with different health care specialists as well throughout the country via telehealth. So our headquarters is in Tempe, Arizona. Our housing is through our non-profit sector, which is United Native, that is in Mesa. But we are working with all these communities in Las Vegas and New York City and Chicago, in South Dakota, in Boston, Washington DC, and Baltimore. And we are doing telehealth with all these communities nationwide.

Number one is a lot of our community members want to see Native health care providers, especially Native therapists. We have licensed therapists sitting here that are Native. And that's the number one request from especially our urban areas. So we — our team, not me, I'm not a licensed therapist [laughs] but our team does a really good job at coordinating the health care services via therapy to our people nationwide and working with our different facilities that we have.

Next slide, please.

These are just a few of our, of our scope of services that we integrate into our health care system. One thing that we do really pride ourselves on is the re-engagement of spiritual Native health healing and spiritual revitalization. A lot of our community members that are dealing with substance abuse don't have that connection or knowledge of the cultural aspect. So we do work with different medicine men and from different Tribes.

One thing that was novel about what we're doing is how do we do telehealth there? How do we do telehealth with medicine men? This is something that has never been done before. And then I had to talk with our team, like, how do we do this appropriately? So it's respectful. To ensure that the patient does not record sacred songs or prayers. So then we had to come up with the NDA, a non-disclosure agreement, because the telehealth- base.

And based on the medicine man that could help everyone or is the medicine man gonna be Tribal specific, to only help people from his community? Is, are they going to be open? So we had to come up with all these scenarios that had never been done before via telehealth. To work with integration of our spiritual healers by way of telehealth, which has been interesting for us to work with. [laughs]

Next slide please.

Just a few more of our services. And we could go on. One thing that we're, that we're doing is we're also creating an Indigenous Health app. We've been working on this app for over two years. So I hope to get it out soon.

So this app is going to have four major sectors, which will be Telehealth, the ability to provide telehealth services using the app. We're going to have a self-monitoring phase. So you can self-monitor your own health status. We're going to have a research phase. We want to work with Indigenous researchers and provide a space where they can put surveys in relation to their research.

But me as a researcher, I'm gonna be very selective on what type of research I'm going to, what type of research that we are doing, and especially who are the researchers that we're working with. Because I want to work with Native American researchers and/or Indigenous researchers. And because I believe that we can lead our own studies, but this will be an additional platform to provide data allocation for them, whether it's qualitative or quantitative data.

And then we're going to have a resource and information page. So people like Mayo Clinic, Native Health, et cetera, we definitely — and others, we'd definitely love to invite you all to put your information on the resource and information page as well. Right now we do have every Indian Health Service clinic or funded urban health, urban health clinic or 638, we have them all throughout the United States, all the information on the app. So you can just click on and then it'll bring you to the nearest Native clinic. So it's easy to navigate.

And with Navajo Nation, we're doing one specific for Navajo Nation that has all the numbers and information for social services as well. Because sometimes you don't know who to get, how to get them. They're so sparse and it can be trouble getting the resources. All the information will be on the app.

Um, and then we also have an elder wood program through our non-profit. It's really cold. Again, lack of electricity, which is lack of heat. A lot of our community members rely on firewood to heat their, their house. So we have an elder wood program. We have a team of volunteers that are based in Flagstaff and we have delivered over 600 truckloads, truck loads of wood out into the community. We also work directly with the chapter houses. And then the chapter houses re-disseminate it out to their community members who know that need the wood. So through our non-profit United Natives, we have a free wood program. If you are interested, please let me know because it really helps. Especially our elders.

Next slide.

So just some more pictures. We also have a water program that functions like our wood program. So we disseminate both water and wood. to the more rural parts of the reservation. Next slide, please.

Just more pictures. Look at all the work. We have different community-based activities, back-to-school drive.

Next slide, please.

Our non-profit sector did a football camp that was conducted by UCLA's football team this past summer we had over 200 Native kids come. It was here at Mesa. We're also partnered with the Arizona Cardinals, the Phoenix Suns, the Arizona Coyotes, the Las Vegas Raiders, and soon to be the New York Knicks to help Tribal communities and especially youth engagement. So please look out for, for some of our services.

And then we also have a Native American scholarship program. So our college students, we disseminate $2,000 each semester for are those who are recipients of our scholarship program.

Okay. I think we're done. [laughs] Now. We'd like to open up for Q&A.

Guthrie Capossela, off screen: Do you have anybody in the room that has questions, first of all? Trying to get questions.

Dr. Lee: Trudy.

Audience member: You mentioned the location for IHS and 638? Because at the Mayo Clinic we work a lot with Natives, so I'm just curious, is that across [garbled] because we serve Natives across [garbled] as well as Alaska.

Dr. Lee: It's throughout the United States. So this app has every clinic, hospital, 638, that is IHS funded or tribally, tribally funded throughout the US. That was our starting base. But of course, we're always open to adding more resources, especially to those entities that serve Indian Country. It's a great resource.

Audience member: What would be your suggestion or your suggestion to Mayo Clinic in reaching out to Tribal communities and to build that partnership with them? What would be your advice, I guess? How would, how can they be better at doing that?

Dr. Lee: So the question is, how can Mayo Clinic, what is my recommendation to Mayo Clinic to establish these partnerships? Number one, always lead with transparency. I think it's very important on, on the reason why you want to partner with us. And I think every, every reason is important. Is it because you're trying to strengthen your diversity and inclusion? Is it because you all got a grant, and you need, and it's written for certain populations? And, and I think all those things are important to communicate and be transparent across the board on why you truly want a partner. But then also what are additional things that you could offer in terms of the partnership and what does it look like? How does it benefit the Tribe, not you? I think that's a leading way, because we have to think about the communities that are under-resourced, which makes them, it make us vulnerable because of our limited resources as well. And I think as Native people we're tired of people taking advantage of our vulnerability. And it should be us to self-determine based on the information that is derived to us if we want to make that partnership agreement or not. But give us all the information so we can make a true, informed, a true, informed decision on what this partnership will look like.

Corinna Sabaque, off screen: Alright, There's another question online, Dr. Lee. So earlier in the chat, someone had posted, thank you for sharing all the amazing work you are doing to support Indigenous communities across Indian Country. Their question is regarding the US president's end of emergency COVID declaration that will end in May 2023. Is there work being done to help Native health organizations with the changes that may impact costs and to American Indian and Alaskan Native populations?

Dr. Lee: This is pertaining to the US government, correct?

Corinna Sabaque, off screen: Yes. And the emergency COVID.

Dr. Lee: Um, I, I think this administration is doing a better job than the last administration of federal funding. What I do know is they're trying to make, they're trying to make the federal funds that parallel with the output of the VA system. Because Indian Health Service functions like the VA system. In the aspect of, it's federally funded and it provides direct health care services to veterans across the nation. Kind of like IHS. The only difference is the VA funding is a lot better in terms of its consistency. Because they also keep up with inflation, which Indian Health Service dollars do not. Because they're considered discretionary funds. I know that there is commitment to having our federal funding more consistent and also increase that keeps up with general inflation as well. I haven't learned where they are with that, but I do not know any other thing that this administration is currently doing in terms of US policy and working with Tribes.

Guthrie Capossela, off screen: Hey, Dr. Lee. Thanks so much. A couple of more questions in the Q&A here. So question one, how do individuals start the process of becoming involved in human rights impacting Native Americans? Is the requirement to move back to the reservation and continue with this endeavor?

Dr. Lee: No, you don't have to, you do not have to be on the reservation to either be an ally or to be a supporter. There are, what I do know in a lot of urban areas, I know there's different initiatives that Natives are centering around. One of them is definitely the missing and murdered Indigenous women. Addressing that epidemic, which, which incorporates a lot of other human rights issues. Not just the act of homicide or kidnapping, but also the aspect of sovereignty. Criminal, criminal vs. civil cases that, that can or cannot be done on Tribal jurisdiction land. And it brings up a lot of other political issues as well. So I know that a lot of people are getting behind that initiative.

Um, also access. I know there's a lot of water rights coalitions that also occur, which, which affects us because of our lack of water and our access to water. So these environmental rights are largely supported by Tribal initiatives and also our allies. But there's a lot of support that could be done in different arenas. My suggestion is probably just look at Facebook groups to start in your local area and see what initiatives are going on in those that you want to get behind.

Guthrie Capossela: Awesome. Thank you. I have a couple of more, kind of, a little more in the housekeeping side of things. One is, a number of folks have been asking if you'd be willing to share your PowerPoint presentation that you delivered today. And then two, in regards to the app, does the app support languages other than English?

Dr. Lee: We're trying to get there. [laughs] We are, that would be another added layer that we could definitely work on in the future. I think starting with the Dine language, that could be — especially medical terminology that can be used for translation — would be an added feature as we evolve with the app.

The app itself is extremely innovative because it's definitely a resource. And we're not just going to use this app, we're using a pilot nationally, but we're going to hope to go global and work with other Indigenous communities, particularly First Nations in Canada, the Maoris in New Zealand, and aboriginal folks in Australia to expand on and working with our international brothers and sisters. But yeah, we hope — follow us on our website and our Instagram page. And we can, we'll be having a date that everyone can download the app. Another cool thing about this app is we want to work with the missing and murdered Indigenous women initiatives. By way of doing so, people can report some of their missing relatives to us. We will need a standard missing police report. So we know it is valid. If they, if they supply us with the police report, we can then for everyone who has the app downloaded, we can send almost like an Amber alert message out, like a text message, through the app. So we could have the information of the person who went missing. And that could hopefully be a way to reach people in real-time quickly to help find missing relatives.

Guthrie Capossela: One more app question, and I'll quit, promise. Is it free?

Dr. Lee: Yes, it's free. I just need a piece of fry bread. [laughs] Send me a bag of flour. [laughs] Kidding.

Corinna Sabaque: Awesome. Are there any more questions in the room? Alright. It is the end of the hour. I just want to thank you again, Dr. Lee, for the really awesome presentation. There are a lot of comments. Just everyone appreciating all the work that you are doing. And then especially about the app, it sounds really exciting and we're all looking forward to seeing that. Thank you again. And I just wanted to remind everyone, if you could all please complete our short survey to provide feedback on our speaker series. And if you would like to see this presentation or any of our previous presentations, I know we did drop our link in the chat, but it is under our Native American Community Outreach website here at the Mayo Clinic. We will have an upcoming presenter in March. So stay tuned. You should all see some e-mail invites coming out soon. I just wanted to see if you have any last words, Dr. Lee?

Dr. Lee: I just would like to thank our team, our Indigenous Health team that's sitting here today. They're the ones that do a lot of the work and I just talk. [laughs] Dr. Ebony Granados from the Lakota Nation, Mr. Fidel Curtis from the Dine Nation, and Mr. Justin Arnold from the Seminole Nation. I just wanted to thank our team because without, without our team and teamwork, and especially from the community as well, this wouldn't be possible. So just wanted — my true appreciation for everyone.

Corinna Sabaque: Alright. With that I will go ahead and stop recording and sharing here. So thank you again and you guys enjoy the rest of your day.