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.