When you think of a trailblazer, you picture someone who forges a path where none existed before Dr. Sophie Hawk did exactly that. She grew up moving from place to place, living both on and off reservations. By the time she was 16, she was already a high school graduate. And not just any graduate. The class valedictorian, she finished her undergraduate in just three years, and in 1987, she became the first Native American to graduate from medical school in South Dakota. It wasn't easy. In fact, some teachers tried to convince her that being a doctor wasn't for her. They told me, yeah, yeah, natives don't do that. You know, if you're lucky, maybe you can be an LPN, not even an rn, an LPN. And so the encouragement wasn't even there in the school systems to encourage me to look further. Thankfully though, I had some parents who said, Hey, if that's what you wanna do, let's help you do it. Because Dr. Hawk had already learned that when you don't see someone who looks like you in the place you want to be, sometimes that just means you're meant to be the first. being a role model out there, you know, showing people that you can do it, you can get through school. Get there, no matter what background you come from. I recently had the privilege of watching Dr. Sophie Hawk be inducted into the South Dakota Hall of Fame. I was deeply moved. She's a true trailblazer, a proud member of the Cheyenne River Sioux Tribe. Dr. Hawk became the first Native American to graduate from the University of South Dakota School of Medicine, and has spent her life breaking barriers in healthcare. She served in Indian Health Service hospitals. The US Public Health Service and now practices internal medicine with Avera Health, but beyond her incredible professional accomplishments, Dr. Hawk brings compassion, wisdom, and cultural understanding to every conversation about health and healing. Today we're talking about an issue that's close to both of our hearts. How substance use disorder and overdoses are devastating Native American communities at a rate much higher than the rest of the population. Together we'll explore what's behind these disparities and how we can move toward real healing, hope and change. Dr. Hawk, it is so great to see you again. Thank you for joining me on grieving Out Loud. Well, thank you for having me. This is definitely a very important issue to our people and you know, we definitely need to work on making a difference. When I heard that you were the first Native American, not just the first Native American woman, but the first Native American to graduate from medical school in South Dakota, the state that you and I both live in, just floored. I mean, how could that even be? But I, can you explain to me a little bit about why you think nobody had graduated from medical school before you who was Native American? So, um, medical school in South Dakota up until 1977 actually was only a two year program. So then people would transfer outta state for the last two years and then graduate from another medical school. And then in 1977, the University of South Dakota started graduating its first MDs. Um, so it was basically 10 years from the time that they first started till the time I graduated, but. It was very interesting 'cause I didn't realize that when I started medical school that I was the first Native American until I was getting ready to graduate. And they said, well, you know, hey, you know, you're the first Native American we've had. And it was, it was very sometimes cool, but also kind of very eye-opening for me to realize that we hadn't had any graduates before I graduated. So I started to look at it a little bit and I think part of the problem was that, you know, most of us who've gone to school on reservations have had a little lower quality of education. Uh, the people who come to teach there don't often encourage natives to do science and math. So we don't have a lot of the upper level science and math courses available to students, which is something that you need in order to do medicine is, uh, be able to have an understanding of those levels of courses. So that's part of it, you know, so the educational process is, is a little subpar compared to some of the other schools in the state. Um, and I was very fortunate. My father was an Episcopal priest. We moved a lot. Uh, we actually went. Lived in Vermillion for a while and I ended up graduating actually from Sioux City West. Uh, so I actually had exposure to the upper level math and science courses, so that helped me tremendously. Part of the other problem was we don't really have a lot of role models out there, so, you know, being the first, it's like, I need to do something about this. I need to go out and show others that they can do it, because when I was a kid, I actually wanted to become a physician. I knew that. Since I was a little girl and it was something that I actually was able to go to the hospital with. My mother, who was a medical technologist, had a doctor who took me on rounds, just shadowing, which is something we do these days with a lot of students, and they took me around and I said, Hey, I really like this. It was really something I liked and I said, this is what I wanna do. But when I went back to school. The following fall and said, this is what I wanted to do. They told me, yeah, yeah, natives don't do that. You know, if you're lucky, maybe you can be an LPN, not even an rn, an LPN. And so the encouragement wasn't even there in the school systems to encourage me to look further. Thankfully though, I had some parents who said, Hey, if that's what you wanna do, let's help you do it. So that helped. Um, and then the other part of it is, is just there's not a lot of cultural awareness out there. So a lot of times students will go to our schools and they don't have a lot of support when they go to college. You know, they're away from home. They're not only away from their families, but they're away from their culture and that makes it difficult. And then a lot of 'em aren't just able to continue. So there are programs like the University of North Dakota had a program. That's called in Med Indians into medicine. And so what they started to do was they would bring students in from like the junior high level and bring 'em up to the summer program up there. They would get them some background in biology and chemistry and try to get their interest in some of those areas, build their. Confidence up, build up their knowledge and then say, you know, hey, we bring other people in. These are mentors, these are people that you can talk to. You can find out how they did it. Um, and then if they go to the University of North Dakota, they actually had, um, a program there where they had support programs. They did a lot of work together. They had a lot of other native students, so they had that support base. Uh, the University of South Dakota was also started something similar. So, you know, now people have that, but when I went to school, they didn't have a lot of that there, so it, it was something that just needed to get done and it finally is getting done. And thankfully now the University of South Dakota has graduated about 60 Native American physicians, made a lot of progress. 6 60 you said? Yeah. That's that's fantastic. That's, uh, wonderful to hear. It should be more than that even, but, but it's wonderful to hear it's gone from one when you graduated to 60 today. I, I, I understand a little bit because I had done a quite a bit of reporting. Over the years in investigative reporting in South Dakota, and one of the things I had looked at was a, a program that was supposed to get Native American students college ready. sadly it didn't fulfill all of its promises, but one thing that I discovered during that course of reporting was that it was very difficult for Native American young people, native American young people, to leave the reservations, to leave their families. You had different exposures because you weren't on the reservation the whole time. Right, and that, I think it made a huge difference, you know? Um. When you grow up on the reservation, you really don't go anywhere or, you know, maybe go to peer to rapid, you know, you haven't had a lot of exposure to different things. And so it makes it difficult when you then get thrown into college classes with people from all over the country sometimes who have different ideas, different philosophies, and then you're, you know, now in front of teachers who have, you know, different ideas and don't understand your cultural background in order to be able to. Uh, do well. And, and so that makes a difference too, and, and, and know for me, that made a huge difference. And I know for my daughters, uh, you know, we traveled all over the country. I worked in lots of different places, and I think that made a difference for them as well. Certainly, and I think for those listeners to this podcast and viewers who, um, have never been on a reservation, it's hard for them to understand, right? The, the, how remote it is, how rural most of the reservations are, especially in South Dakota, and, and then the importance of those, of those family, especially those maternal connections. Yes. Um, that's, you know, that, that's the hard part I think a lot of people don't understand. I mean, if you grew up in a house that has good electricity, running water. You know, how would it be if all of a sudden you're in a house that doesn't even have running water? Um, it doesn't have electricity. You know how if you had to go a hundred miles to get to the doctor. Which is what we space sometimes on the reservations. Um, it was very interesting. I, I do a lot of talks about some of these issues and one of the things that I found was, is that they showed housing on our reservations and it's comparable to housing in third world countries like Africa and the Dominican Republic. Um, so, you know, imagine growing up in that situation and then not knowing if you're even gonna have food. Uh, some of our people don't have the ability to have three meals a day. Um, sometimes school was really the only place you got a good meal. Um, so that's why a lot of the schools have now started programs where they, you know, will make sure you get breakfast, you get lunch, um, they'll send you home things to have maybe for supper or for the weekends. So at least you have food, but you can't learn if you don't have good nutrition. Um, you know, and a lot of our people unfortunately, end up relying on things like commodities, which, um, you know, our commodity program certainly helps to make sure people have food, but it's not always fresh vegetables or fresh fruits. It's not good nutrition. So that you're, um, basically having, uh, problems learning. And then unfortunately, sometimes our school systems, you know, followed the guidelines and said, okay, well then every child has to have milk. Uh, for example, um, and unfortunately a lot of our natives are lactose intolerant. So now imagine that you're being forced to drink something that's gonna make you sick for the rest of the day, and then you're forced to try to sit in a classroom and learn something. It doesn't work. So, you know, getting those types of understandings and helping nutrition can make a big difference. Um, making sure that our places, you know, people have a place to go home and have good food, have a place to live, and then now you can start to learn. But some people still didn't even have that. We still have people who live so remotely away from towns that, um, you know, for example, during the blizzard we had about three years ago, some people couldn't get hot out of their places for up to three weeks. Uh, so, you know, it, it makes it much more difficult to, to think about learning and to think about what you're gonna do next. So many challenges, you know, to, to tell a child, well, you're gonna become a doctor or a lawyer or some other professional, it might, you might as well tell them they're gonna go land on the moon, right? I mean, it's just, it, it seems so impossible when just your daily needs are not often met. Right. And then, you know, and then you don't see native. Professionals around you. So it's like, well, I don't see anybody else doing it, so how am I gonna be able to do it? So I think it's so important and that's why I've always tried to go out and see, have students, have residents, you know, when I go out, uh, do you know, junior high grade school even, uh, career types of days, because then they can say, Hey, she did it. I can do it too. Yeah, exactly. And, and, and it's amazing what you've done. I, I cannot say that enough, Dr. Two Hawk, I Nothing. Tell you that enough. But I, I also think when you talk about lactose intolerant kind of, um, I. Reminded me that when it comes to substances, mind altering substances, when I first started as a young reporter in South Dakota, I wanted to do a series on alcoholism and how it disproportionately was impacting Native Americans in the state. And I did a lot of research and I learned that even biologically alcohol affects. Native Americans' bodies differently than it might affect Eastern Europe people, Eastern European descent, or, or Northern European descent. Um, so you tell, talk a little bit about that. What happened, what has happened over the years when it comes to substances in Native Americans? So, for example, alcohol, one of the things that we've learned over time is that Native Americans have four times the rates of cirrhosis and other health related conditions for the same amount of alcohol consumption. As a Caucasian person. Wow. And the thought is, is that because of, uh, how we metabolize things is different, so it's been shown that natives will metabolize the alcohol into the, you know, when, when you metabolize things, it usually goes down the normal pathway and, and your body gets rid of it. But unfortunately the natives, it goes down this other pathway and it becomes toxic. So it builds up differently within the liver system. Um, it causes more problems with the fibrosis forming in the liver and causing the cirrhosis. And then the effects that we see with that. So. For the same amount of consumption, you know, we have more problems with it. And, and, and it's hard because unfortunately, we now know that alcoholism is not just a choice. Once you go down that path, unfortunately it's a disease. Um, your body craves it, you know, you, I mean, you wouldn't wanna get sick every day that way. Um, you wouldn't wanna do that to yourself. But once you've started down that path and your body actually craves it, and it needs to have it in order to go on, so that part is. One of the problems that we face, um, knowing that we get the toxic metabolites, we have more of the problems. I mean, we saw 22, 24 year olds dying of cirrhosis, you know, and, and part of it's because they started drinking at a bit younger age. You know, unfortunately, a lot of our native youth start 10, 12, 14 years of age drinking alcohol or trying other substances. Um, and in part is to try to cope with what's going around him. Are you ready to protect the next generation from the dangers of substance use? Emily's Hope has created a comprehensive K through 12 substance use prevention curriculum designed to educate, empower, and equip students with the tools they need to make healthy choices are age appropriate lessons, starting kindergarten and build through high school using science, real stories and interactive learning to help kids understand their bodies, brains, and risk of drug use. We're already reaching thousands of students across multiple states, and we're just getting started. Visit emily's hope edu.org to learn more and share our curriculum with your school administrators and counselors. At Emily's Hope, we believe prevention begins with education. Let's work together to keep our kids safe. So there are a lot of things at play here. First of all, there's a physical reaction, right? Yes. And then there are also the environment and generational. Issues when it comes to substances. All introduced, you know, by the white man originally, you know, coming in and, and introducing alcohol to the Native American culture. But it's gone, it's gone far beyond alcohol now. Uh, about two decades ago, methamphetamine. That was the story. Those were the stories I was going to reservations to do. You know, stories about how methamphetamine was impacting Native American people and now fentanyl, heroin, and fentanyl, um, is, is just infiltrated the reservations as well. So the substances have gotten worse, I guess, more powerful and the ability to, to, um, escape from that cycle. It's also a cycle at play, right? It's, I mean, it, it's been shown that a lot of it has to do with multiple factors. But, you know, historical trauma for natives is one of the bigger things that affects us. We know that, um, unfortunately there's been a lot of atrocities. Against Native Americans. You know, things that just, you know, we originally got put on reservations originally. The reservations in South Dakota were supposed to be basically most of West River for the natives in this area. But with the discovery of gold, the discovery of different things, you know, the land got kind of, you know. Divided up and, and the natives were left with the parts that were, you know, not good for farming, not really good for ranching, you know, very rural, isolated areas. So there wasn't really much that could be done there. And then on top of it, um, you know, there were, you know, other, uh, problems with, uh, not being able to hunt, not being able to practice our own religion. I mean, you know, as a native person, when I look at health, my health is basically a balance. We chose any. It's a balance of our mind, body, and spirit. But if you're not allowed to practice your religion, you can't do the spiritual part. It makes it very difficult to have that balance again, you know, as natives in this country, we weren't allowed to practice our religion until 1978. I. Right, right. People don't really realize that today. I mean, people don't really think about the, the trains, you know, where they took kids away from, you know, their families and, and the, the boarding schools and the, the, um, Christians that went through to, um, convert everybody right. To, to have everybody become Christian and to take away that sense of. Of balance when you talk about balance and and just some of the devastation that happened that has been now, um, I don't know how many generations we are in from those days, but certainly we're still seeing, We are unfortunately. of that. Yeah. And, and, and it's been, you know, well documented and, you know, unfortunately, we now know, you know, over time that that historical trauma does affect healthcare. You know, we, people will say, well, you should just kind of get over it and, and you know, it shouldn't be affecting the next generation. But over time we've learned that any type of historical trauma can actually help change some of the epigenetics of, of people, not the DNA, but just how our bodies respond to things or how react to things that turns on different switches. So we will react differently. Um, we tend to have more problems with. Things like PTSD and substance abuse, you know, because that's a way of coping with that. So substances are things that we've turned to over time to try to help cope with some of those things that we've had. And unfortunately, because there aren't really any good programs out there to teach our youth, to teach our people about. The problems that we see with substances, or once you do have a substance use disorder, you know, how can we better treat those people, um, in an area that basically we would consider a mental health desert in this state? Right. You talk about when you were talking about also the spiritual aspect of it and the balance. I have heard before that substance use disorder or addiction is when you get to. At the core of it or the root of it, yes, it's a physical problem, um, psychological problem, but also a spiritual issue as well. It. It is and and we've definitely found that the people who do well and can actually. Uh, get off of the substances often are people who've been able to get back to that balance and find a spiritual connection, whether it's the, you know, through the Christian churches that they've gone through, maybe many of them, for many of their, most of their lives. Or to go back and find that connection that we had originally that we. Weren't able to practice for many years. So, you know, going back to a sweat lodge ceremony for purification to being able to go to a Sundance for some healing, um, to, to go to some of the singing ceremonies or the Native American Church ceremonies. You know, those things are what our finding. Our help in, you know, and those, and getting that spirituality back is one of the ways that people get into balance. So the programs that do well and work well are the programs that are incorporating those into the program basis. Um, you know, whether they have a sweat lodge on site or whether they get a medicine person to come in and help with that, those are the ones that are successful. You mentioned epigenetics is kind of a hot term right now. What? What is your understanding of that as a physician and also as a Native American? Um, I mean, so basically, you know, when we talk about epigenetics, I mean, it's basically how the effects of trauma can affect one generation and just goes down to the next one's after that, you know, and people, you know, most of us know about DNA. You know, and how our DNA basically codes, you know, our hair color or how our eyes look or you know, how bare our noses or smaller noses, those types of things. But they don't understand sometimes that, you know, the, even though you have the basic building blocks there, there is something in there that turns a switch, so to speak, to turn, you know, how we respond to different things off and on, you know? So it affects our, our behavior, our our how we perceive things. And so epigenetics is that, uh, time when, uh, it takes the genes and it can modify those switches in response to some of that trauma that we've seen, you know, so, so some of the trauma, um, some of those types of studies came out originally after some of the things like the Civil War, you know, when they saw the different generations. Uh, were affected differently from north to south or, you know, those involved in like the Holocaust and, and how it's affected gen from one generation to the other. But we definitely see that as native people as well. So our responses to things, um, have changed. Um, and because of that, it's affected, you know, the next generations. And as native people, you know, we often do things. Um, to look ahead and, you know, what, how our actions are is gonna affect the next seven generations. So we wanna make sure that when we do things, you know, our behaviors are, you know, in such a way that we can help out for the next generations. And, and it's hard though when you're dealing with the changes that we've gone through and, you know, trying to make that a better change for the next generations. And then having to deal with some of the types of things as far as the behavioral health and the. Uh, substance abuses that we see now. Right, so. Substance use disorder or addiction impacts the Native American population at a much higher rate overdose death four to five times, uh, higher than the rest of the population. Um, I, I just find that so alarming at Emily's Hope we've. Work to get Naloxone on eight of our nine reservations within the state, and we're looking at that to try to model for other Native American reservations across the country. I think it's important to have that lifesaving tool and we wanna keep people alive, but, but that's not treatment, right? So. Right. You were talking a little bit about in, you know, incorporating cultural, um, practices into treatment. What will really work to, to break some of these cycles, the cycles that have gone on and, and some of the trauma that has happened, do you think? Um, so I think, you know, part of it's education. Um, you know, because we need to be able to teach ourselves about, you know, how substances affect us, but we also need to learn more about how different, uh, treatments will work for natives or not, or not work. Um, you know, so that's part of it because we definitely know that natives, again, you know, for example, the alcohol. We know we, we, our bodies. Respond to it differently. There's not a lot of research out there to look and see how one type of treatment, such as, um, buprenorphine or how, uh, methadone might work, you know, to help with some of the substance abuse disorders and, and how, you know, natives might respond to that versus anything else. Um, so, you know, part of it's gonna be education. Part of it needs to be research. Research and getting the money for the research. Right. That's always the, the hook, right, is that nobody wants to invest in that research because as a people, native Americans have been sort of forgotten, I feel like, by the rest of the nation. I agree. I mean, you know, and not only just funding for research, but just funding for healthcare. Because we definitely are very underfunded for healthcare needs. Um, right. but in order for, and, and then, you know, once we kind of get some of the education and the research and, you know, get those treatments, even though we know what treatments are good, what the gold standard of treatments are, getting that to the people is almost impossible because of funding, you know, Indian Health Services. how do you get someone into treatment when they're on a remote reservation where there's no treatment center or no place for them to go, or no one practicing, addiction medicine there? Right. Correct. I mean that's, you know, 40% of the counties in the United in, in South Dakota have no mental health provider available to them. Um, so, you know, for example, on our reservations, a lot of times, you know, you again, you have to travel 40, 50 miles to get even to the IHS facility. Uh, you know, we do have a lot of telehealth available these days and, you know, telemedicine. So, you know, the thought was, well, maybe if we could get some of those to the local community centers. But when you have no ability to get good broadband or good wifi, so to speak, you know, right. you know, hook up? With like we joined today to, to talk. Um, because psychiatry, you can do, um, remotely by doing this, and that would be one way to get more services out there. But if you don't have a connection, you can't do it. So, I mean, that's a challenge in of itself is to even get the connection out there. I've been out there trying to feed videos and things like that, so I can, testify that yes, it is, it is real challenge in these very rural remote areas where geography can create a lot of blocks as well. Um, that, that, that it's just not available. It's not. And, and so that's, that's one challenge. Um, the other challenge is just even finding enough mental health providers. You know, I've worked in hospitals where, you know, we had, you know, three or four maybe if we're lucky providers for the entire reservation. And then that was at a time when we had the highest suicide rate in the world for 15 to 24-year-old male. So, and the crisis is there. should mention that it's still extremely high, right? I It is. rates among young people on reservations, we're talking about substance use disorder, but it all goes hand in Well, absolutely because, you know, unfortunately with substance abuse disorder, um, you know, it, it affects people. And when the substances that you take inside of you changes your inhibitions, then it makes you more likely to actually complete suicides. Um, right. and it, it makes it, you know, even there's even some biological interactions too, because we have to remember that, um, opioids and a lot of our other substances, alcohol and are depressants, so it makes you more depressed. You've already in a depressed situation, now you're more depressed 'cause of what you took. Um, then your inhibitions go away and then all of a sudden, you know, suicide looks like a good thing to do. And, and, and that's hard because, and then, you know, or if you have those thoughts, how do you get help? You know, you can't get to the hospital, you don't have gas, you don't have a phone, you don't have the ability to get there. Um, sometimes they won't see you because you've been drinking. So now what do you do? And it's, it's just catch 22. You're, you're painting a pretty bleak picture for us, and, and, and I've been to the reservations. I, I understand what you're saying and for people who don't, hopefully now they have a better, you know, understanding of some of the challenges. There's so much, I also think judgment that's passed by people who don't have any idea what life is like on the reservations. And then again, here we are facing major federal cuts and, and federal money is very important to reservations. Major federal cuts for. treatment, recovery Yeah. healthcare in general. when there's just not enough. Yeah, Yeah, I mean, you know, 'cause Indian Health Service right now, I mean if you look at how much, uh, money is spent for healthcare, for a native person, it's around $4,500, somewhere in that range. Um, whereas if you look at the general population of the United States, it's more like 9,000. So, I mean, there's a huge discrepancy and it's been estimated by, uh, some of the studies that even the government accounting office did that, you know, they'd need to spend almost $2 billion more per year. To catch up because unfortunately the funding's always been kind of a straight line. Even though inflation goes up, medical inflation goes even higher, the funding has always been stable. So you're always behind no matter what you do. Um, and Indian Health Services funded a little bit differently. It's funded through the president's discretionary funds, so every year we'd have to fight for funding. Um, and then we, you know, would have to justify everything that we did and then. The expectation is, is that hospitals then have to make sure that patients get Medicare, Medicaid, and private insurance, and then you start billing those. So 30% of the money for the facilities has gotta come from another resource. Um, and then there's two pots of money. So it's a, it's a totally different system. So you have one pot of money to run your hospital. So anything that comes in, any native who comes in, anything that gets seen within that building, that's covers that. But then if somebody needs. To see a specialist, to go to an addiction center, to see a psychiatrist that's not out. That facility comes out of a different pot of money, which is a very small amount of money, and compared to the needs. So then as a physician and, and the physicians at a facility, we'd have to go through every day and say, okay, what's basically something that's threatening, life threatening or potentially life threatening. So in other words, a priority one. And those things, if they had enough money, would all get funded for the day. And then everything else pretty much got put on hold. So it's, it's, how disheartening was that for you as a physician? it was very hard. I mean, we, we tried to learn how to do as much as we could in house to try to make sure people got seen. But you know, it, it's hard. I mean, for example, if you're an athlete and you know, you're a high school student, you play football, you got a knee injury, now you can't walk because you don't have a meniscus or a ligament anymore that works inside of your knee. You can't. Get the care to get that fixed. Um, and so you're, you end up limping the rest of your life and you, you know, can never go on and do some of the things that maybe you wanted to do in life because it wasn't a priority one that day. Yeah. Or you become addicted to opioids for the pain yeah, you can't get the proper treatment that you absolutely. Um, and that's, that's hard. It perpetuates everything and it makes it very difficult for people. And you know, the hard part is as, as a Native American, I mean, technically healthcare is a treaty, right? We were guaranteed health under the treaties. Um, as you know, long as the grass was green and the rivers would flow, um, you know, unfortunately, I guess it didn't define how good healthcare you got. Right. So many Americans struggling with healthcare right now, uh, Absolutely. are, are overwhelming when it comes to the Native American population. I mean, that $2 billion thing, uh, figure that you threw out there, I just think that's never gonna happen. Like It's that. culture, I, I just, uh, in this society, I, I can't ever see the priorities changing like that. It should. what other kinds of health problems do you see or have you seen as a physician all go back to substances, to substance use? I mean, so many right? That, that are all related. If, if you could somehow prevent kit, you know, native American kids from ever using substances in the first place, how, how, how much better their health could possibly be as an adult. Well, absolutely. I mean, if, if they even make it to adulthood, I mean, you know, right now, I mean, in South Dakota, you know, a couple years ago when they looked, I mean our life expectancy dropped, uh, we, you know, we were almost 70 for life expectancy, and then about two years ago it dropped down to 59. Um, and they're, you know, are showing that one out of four natives are gonna die before they're 45. Oh, And a large part of it has to do with opioid use disorders and suicide rates. Um, and you know, like I said, we're seeing cirrhosis, we're seeing coronary artery disease in 20 year olds. Uh, diabetes rates are so high. We, you know, and part of that, again, you know, you drink more alcohol, that's got sugar, you're using more substances, you're not taking care of yourself. You can't get food, you know, you're eating the food from the gas stations because that's, you know, quick and easy. And the infant, Mor, I think Todd County, South Dakota, which is the Rosebud Reservation. I think they have the highest infant mortality rate in the nation, or they did at one point. they did. Um, and, and, and that's another thing. You know, we see unfortunately, a lot of SID'S deaths, um, you know, sudden infant death syndrome deaths, uh, and. You know, not only does that affect, you know, the child, of course that died, but it affects the entire family. So, you know, now you have somebody who's depressed for the situation around and they're even more depressed now that they've lost a child. Um, so it just kind of perpetuates again, some of the substance abuse disorder because they turn to substances to help with their grief. Have you lost a loved one to overdose or fentanyl poisoning? I'd like to invite you to share their story on our new Emily's Hope memorial website called More Than Just a Number. They were our children, siblings, cousins, husbands, wives, aunts, uncles, and friends. So much more than just a number. You can submit a memorial today on more than just a number.org. Now you've spent decades as a physician working on some of these issues, so have you felt like you've been able to make a difference? Certainly at times I think, you know, some, some things have changed. I mean, you know, we got people in there who, you know, definitely looked at. How can we make this better? For example, one of the things that we did on the Rosebud to try to help make our infants healthier was to look at something called the Baby Friendly, A designation, which was a World Health organization designation to encourage breastfeeding because we know that if you're a breastfed baby that you have. Lower obesity rates, lower rates of diabetes, and, and if we could help improve that health, then overall down the road, you know, your healthcare would definitely be better. So that was one of the designations that we, um, strove for. Uh, we were able to do that. And, and it's hard because part of that is, is that, you know, it's education. You know, you're teaching people about breastfeeding and some people in this country still have some stigma about breastfeeding, especially in public. Um, but that was part of it. The other thing is, is that. Part of that was that you don't allow like formula companies to bring in samples anymore to the hospital. So, you know, people couldn't go home with samples. Um, and it, it was an educational process and we got the entire hospital, you know, together and, you know, so we could work on the, and, and then the communities involved. And I think that made it a great difference. Um, you know, for a while with the, some of the suicide rates, you know, we could definitely got a lot of experts to come in and help us and they were. Successful when they started incorporating some of the cultural practices, you know, involving. Uh, our tribal spiritual people in, in getting some of the, the practices put into place. Um, some of our hospitals now actually have a spiritual room, whether it's, it's a, a room within the hospital where you can come in and, and pray. Um, use the sweetgrass of the sage to help. Um, some of the ones in the southwest actually have like hogans for, for ceremonies to be done right there at the hospital to help. Um, so I know that those types of things definitely have helped. Um, and we've actually see that people who, um, go to, um, those types of facilities that are, are, for example, addicted to alcohol, you know, they actually have a better. Rate of cure, so to speak, or abstinence than Caucasians do, going through a normal program. So using the cultural practices actually helped. Um, but unfortunately, you know, um, a lot of things change over time and, you know, there's some politics that get played in some of it as well. So sometimes, you know, there's a wax and a wane of this. But, you know, I, I think overall, in order to help with that, we have to, uh, look at how we can make things better, and especially for our young people, because if, you know once. They kind of go down that road, it's, it's a little bit difficult to try to get 'em back. So if we can try to prevent it. So prevention, I think is gonna be our biggest key. And, and that's gonna be whatever we can do to help our youth. Um, you know, getting them more involved in sports, getting more active at school, uh, you know, getting them better nutrition, getting them better educations. So, you know, those are the things that are going to make the difference in the law. And I think also giving young people, um. The ability to understand what's happening in their families when they have family members impacted by substance use disorder. I, I had a really eye-opening conversation. Uh, our at Emily's Hope Substance Use Prevention curriculum is on the Rosebud Reservation being taught at Rosebud Elementary, and we're so proud of that and we've had so many kids go through it now. It's been, it's been there for three years and I was able to talk to the kids after they got the curriculum they really opened up about. Um, you know, one, one of them hadn't seen their mom because of drugs. One of them, their uncle was in Mm-hmm. of drugs, and they were able to talk about it and then really understand that their loved one's brains were impacted by these Absolutely. Right? And I don't think that, that they maybe saw it that way before they had this prevention curriculum. Um, and so I hope that that is helping in some little way. I know it takes a lot more than just a cu one curriculum. Um, it takes a lot more than that, but, But it's a start and, and if we don't make that effort to even start, it's not gonna get done. Right. Right. So what gives you hope, Um, so, you know, looking at my children and my grandchildren, I mean, that's what gives me the hope and knowing that I need to do something to help get the world better for them to live in. And knowing, you know, impacting the next generations. You know, so whatever I can do to help make the difference, um, you know, being a role model out there, you know, showing people that you can do it, you can get through school. Get there, no matter what background you come from. You know, I grew up fairly poor. My father was an Episcopal priest. My mother was a medical technologist at times. Um, not always working, but you know, at home, stay at home mom. And so, you know, we, we lived very poor as well, and sometimes kind of worried about, well, whether we're gonna be able to eat as well. And, and so that, you know, kind of is the background. And it's like when I tell people that it's like, well. Hey, maybe I can do it too then. Um, you know, and, and having encouragement, having somebody as a role model, having programs that are out there that, um, take students and say, Hey, you know, what can we do to help you? Um. And I also think it's very important that the Native American population itself, the communities, um, also help you like someone like you to, to actually go in and. facilitate change and, and to work together because when someone comes in from the outside, it's not always effective. I mean, we've seen that over the years in South Dakota where groups will come in and they're gonna make some big change or you know, everything is gonna change.'cause some outside group comes in and that doesn't always happen. Right. Yeah. I mean it definitely if, if you're gonna do it, you definitely need to involve the local communities, making sure that you know they can help you. They can, you know, you know, one of the things that you know, as a physician, you know, part of my job as I was the medical director and actually, and even the chief. Executive officer for some of the hospitals and clinics, you know, and we'd bring in new doctors and you know, part of the things that I always did was make sure they had a good orientation and I'd have the public health nurses take 'em out to the communities to see how people lived, to see where they were, so they'd have a better understanding when they prescribed them. You know, you need to go home and wash this wound, for example. Well, if they don't have running water, how are they gonna do that? You know? So, so, you know, they'd have to be a little more creative in trying to figure out how you're gonna take care of that patient. So having that cultural orientation, um, and even, you know, for example, even at Avera, you know, we take care of a lot of natives that coming here from the reservations, so. If you don't understand the culture and you don't understand what they're going back to, you know, you're not gonna give 'em the best possible treatment. So, you know, having that cultural orientations make a difference for the medical school. I mean, that's one of the things that I always tried to do when I started, you know, say, okay, I'm the first one. We don't have a really good curriculum, you know, teach how ly the views of medicine are different. Um, sometimes even the things that we were taught in medical school about how to interact with patients, you know, look them in the eye. Yeah, touch them. You know, some of those things are actually somewhat disrespectful to natives. You know, we're taught, um, to, you know, not look 'em in the eye, but to kind of maybe look down a little bit, um, as to show a sign of respect. Um. So having a better curriculum, a better educational process has definitely made a difference and make people more culturally aware. It gives them a better confidence as a native person coming in and having somebody who maybe understands, um, in order to be able to have a good outcome. Having that, uh, rapport with a patient and a rapport with your doctor makes a big difference. To build trust. To build Absolutely. trust, you can't fix any of the issues that we've been talking about during this podcast. Right. Correct. Yeah. Well, thank you for all that you do. It's just been such a eye-opening conversation to talk with you about this, and I think, I think I know a lot because I've covered the reservations. I've Sure. for a lot of years, but I learned many things from you that even I, I didn't know, and so. I hope that this will facilitate more conversations like this, um, that we, you know, back in the days of, um, in the nineties when Governor George Mickelson was in South Dakota and he talked about reconciliation, uh, in the state and that, that sort of went away after a while. And I think, you know, times changed, politics changed all these things, but, um, for, for. People are gonna live together in the same area. And we have a huge divide, you know, among and, and everybody's identified by their political party these days, Correct. Um, but, but those divides have been there culturally for a long, long time. And, um, to try to bridge some of those divides is really important Well, absolutely, and I think, you know, we can learn from each other, but I, you know, I mean, even in, in the field of medicine, for example, a lot of the medicines that we use on a daily basis today are based on things that Native Americans use as herbal medicines. You know, my great-grandmother was a, a, a person that, that took care of that herbal medicine so that, you know, in our culture of society, you know, the men kind of did help with the spiritual and the women kind of took care of those types of things. Um, and, you know, so I was named after her and, and, you know, and her great-grandmother, she was named after her. So I mean, that, that would've been in our family for many years. But the, for example, aspirin, which, you know, some people are on aspirin every single day, is based on. The willow bark tree. Um, it, it's from that bark. And that's something that we've used in our culture for generations, uh, to help with aches and pains. So, you know, some of the things that we have known and used in our culture are things now that we use in modern medicine. Um, and that approach to medicine, like I said, that balance between the mind, the body and the spirit wasn't something we were taught. When I went to medical school, it was, okay, you have this person, you have, this is what the disease they have, and this is the medication you give. And you didn't kind of take anything else into consideration. But now we're kind of switching gears and say we have to treat the whole person in order to get them better. So I think, you know, we can learn a lot from each other and in order to move forward and in order to get things better, we're gonna have to do that. I. Exactly, and modern medicine was really focused on diseases of the body. Right? But there are also diseases of the mind, such as substance use disorder, mental health challenges, and, and they're just as severe and just as, um, the person who has them is not at fault for Correct. of the mind, just like the person is not at fault. Uh, I mean, sometimes lifestyle contributes to it, of course. But, um, just trying to change that thinking, I think. Absolutely. Yeah. Absolutely. Yeah. Well thank you again for this conversation and um, congratulations on being inducted into the Hall of Well, thank you. very, very grateful to know you. Thank you very much. and thank you for listening to this episode of Greeting Out Loud. If you found it helpful, we'd appreciate it. If you just take a minute to rate and review this podcast, it makes a huge difference. Also, be sure to join us next week when we take on a controversial question. Marijuana, is it a gateway drug? And has legalization brought unintended harm to our communities? It's like a love affair with this drug. There is no other drug that people will. Destroy their lives over, destroy their marriages, um, and, and defend it as if, as if this is the most important thing in the world to them. That's Chrissy Groen Wegan, the Director of the Parent Action Network. She's made it her mission to help parents and families share their stories in meaningful and impactful ways to educate lawmakers, advocate for policy changes, and keep public health and safety ahead of profit. That's coming up next week on Grieving Out Loud. Until then, wishing you Faith, hope, and Courage. This podcast is produced by Casey Wonnenberg King. And Kayli Fitz.