Medicine is an inaccessible career choice for Native Americans

My path to medicine is tied to my family’s experience with poverty, and with the profound economic fallout a major illness can bring in such circumstances. I grew up on the Couer d’Alene reservation in Northern Idaho. My mother was a single parent who had to rely on government assistance to raise three children in subsidized housing. As the eldest, I was expected to help care for my younger siblings while she worked and attended night school. We grew up on government foods such as powdered eggs, multi-functional tomato substance, and powdered milk.

Nevertheless, my mother always told us that education opens doors, and she encouraged us in all that we did. Food banks, secondhand stores, and church potlucks helped us make ends meet. Over the years, I watched her study long hours and work late shifts, but she always had the energy to take us to our sporting practices or lead us on nature walks. Seeing the strongest person in my life succeed, fail, and keep going forward inspired me to expect the same strength in myself. These experiences taught me at an early age what it meant to live on limited resources.

During my first year of high school, my mother fell ill and could not work. She was uninsured and postponed care in order to avoid falling behind at a new job. As her condition worsened, those missed days and an unsympathetic employer rendered her jobless. We were a “working poor” family and fell through the cracks of the system.

In my mother’s case, because she wasn’t formally enrolled in the tribe, care on the reservation wasn’t an option. But even had she been able to receive it, what was offered was substandard at best. All emergency services and specialty care was at least 45 minutes away. The clinic struggled to keep physicians and turnover was high, as most who worked there were “traveling doc/locum tenens.” Access, consistency, poverty, nutrition (diets based on government commodity food and fixed EBT budgets), inconsistent education programs, and substance abuse made for poor outcomes.

During this time, my most important outlet was basketball, a sport that reinforced my faith that hard work could be the key to beating any circumstance. Eventually, I earned a scholarship to compete in college and had the opportunity to play in Croatia.

The percentage of Native Americans in colleges is low, as is the number of mentors who reach out to native students early enough to talk to them about options within the healthcare industry. Applying to medical school begins early in an undergraduate’s academic career, and without exposure to the field and how to prepare for it, medicine can seem a very foreign and inaccessible career choice for Native American students.

Still, in my college courses, I was drawn to the sciences, to physiology, and most of all, to the thought process behind putting together the grand puzzle of pathology, society, and justice. As I pieced together my own understanding of my mother’s illness and how the connection to poverty fit uncomfortably next to disproportionate economic consequences, I found myself increasingly oriented toward medicine. Deciding to pursue this course was one of the most intimidating decisions of my life.

Growing up like I did wasn’t glamorous, and I spent many of my formative years being embarrassed and angry about what my family was going through. The part of applying to medical school I feared most was that I would be seen as a “charity case,” and that because there were few physicians who looked like me or spoke openly about a story like mine, I would discover that someone like me wasn’t supposed to be a part of this guild.

Like any competitive premedical student, I battled my insecurities and stressed about preparing a solid application. I worried that if I was honest about who I was and how that influenced my decision to pursue medicine, that it would not be good enough. After a lot of reflection, I resolved to apply with sincere authenticity and the underlying feeling that I had something special to offer medicine and patients. I wanted to serve people and communities like mine in a capacity that fulfilled me both academically and personally.

My experiences growing up have given me a unique perspective on the intersection of health and the social determinants of it. Cultures, diverse paths, and backgrounds are all important things that must be reflected within the medical student and physician population. I’m proud to be graduating from a medical school that values these qualities as much as my academic feats, and is committed to training providers to care for a diverse patient population. I’m honored to play a part in changing the face of medicine.

Sharlay Butler is a medical student. This article originally appeared in The Doctor Blog.

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  • John C. Key MD

    I’m not sure what you are trying to say here. Obviously you had a harder road to travel than many, but I don’t believe you are unique. “Cultures, diverse paths, and backgrounds” are surely determinants of success but this is nothing new; I saw the same in my own class forty years ago. Nor do you explain how your school is different in the way it values “these qualities as much as academic feats”. There were numerous extremely disadvantaged students in my pre-med and medical school classes in our state university system. All reached the top of the greasy pole through hard work and dedication and their successes allowed them to return to and serve their disadvantaged communities.

    Your personal success speaks to your tenacity and ability, of which you and your community should rightly be proud. But it isn’t a new phenomenon.

  • ninguem

    How about Charles Eastman?

  • Eric W Thompson

    Congratulations! You did well.
    Poor children of most families have similar experiences; very little guidance and help.
    Children of single parents have it worse; statistically worse off from any race, culture and socio-economic status. So you have overcome a lot.
    Keep it up.

  • Ava Marie Wensko George

    I understand what you said. Not only were you in a minority culture, but you were even further outside of an established Native American culture – Outside the tribal structure. That could have been a saving grace for you, from what you described. I do have to agree with other comments that you made your opportunities. You could have chosen another path, which would have kept you down, but you did not. Congratulations on your success thus far. Continue on and become a role model for the Native American community. They are in desperate need of examples of success, even though you are still outside of your tribal affiliation.

  • SteveCaley

    First, congratulation on being a human being who has struggled on, regardless of some of the most challenging circumstances. You are clearly following a very strong calling. Do not disrespect that.
    Some of the obstacles you mention are more dilute poisons to others in our larger culture; but poisons harming all men and women and children of our culture, to a greater or lesser degree. We are a collection of humans that disrespects humanity.
    Being treated as a “thing” is the bane of our existence.
    we as a nation must undergo a radical revolution of values. We must rapidly begin the shift from a “thing-oriented” society to a “person-oriented” society. When machines and computers, profit motives and property rights are considered more important than people, the giant triplets of racism, materialism, and militarism are incapable of being conquered. Martin Luther King
    We live in the toxic myth that aggressive competition always brings for the best of the competitors. ” All reached the top of the greasy pole through hard work and dedication,” I read. Instead, it often discards the most worthy and capable, for the sake of the most endearing and powerful. I believe that you are unique; all humans are, each in their own way. Having a clear vision of what injustice is, going into the future, you can fight the truth and make a new, more human way.
    Finally – Doctors and the medical system are being turned into the “traveling doc/locum tenens” machine, which is grinding up doctors left and right. The care is mediocre, and the IHS has sold its patients to the locum tenens machine; but many other healthcare organizations have sold their patients to it as well. Look carefully at this machine. It will be part of your challenge to the future.
    “I sometimes wish to pray that I have an easier life. Instead, I pray for God to make me a stronger man.” John F. Kennedy

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