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(April 5) Primary care physicians help Native Americans access health care, cultural liaison says

BILLINGS - Kassie Runsabove knows firsthand how hard it can be for Native Americans to navigate the health care system, because she too had to figure it out.

Now the Child Ready Montana program coordinator and cultural liaison at St. Vincent Healthcare, Runsabove gave birth years ago to a girl suffering from asthma. Her daughter’s triggers included major features of powwows and other cultural events the family enjoyed - hay, dust and horses among them.

Runsabove decided to stay home with her daughter for the first two years until she visited a lung specialist and told the doctor “it’s important for me to be whole” and again participate in cultural events she loved.

“Let’s put her on allergy medications and boost her steroids,” the specialist told Runsabove, and it worked - along with the fact that Runsabove’s mother quit smoking.

“I am very proactive about the importance of cultural activities, and that’s why I share the information I do,” she told a group gathered over the lunch hour Wednesday at Billings Public Library.

Only 12 percent of adults, Native and non-Native alike, have attained a proficient health literacy, according to one national assessment. “Our hospitals are dependent that patients have knowledge before they enter our system,” she said. “Right out of the gate, Natives have to understand health insurance, because it’s not a concept we are used to.”

On the reservations, American Indians receive care from the Indian Health Service. “It’s been instilled in us that in exchange for our land we’d be provided health care and education,” she said. “Now it can be difficult to navigate. What our grandmas tell us and what the system tells us is often two different things.”

Native populations see high rates of diabetes and the complications that can follow that disease. But for some, entering a large hospital can be more challenging than visiting their local clinic.

“At the clinic, you know the receptionist and you know where each department is,” she said.

St. Vincent Healthcare tries to allay that fear by walking people where they need to go. “It’s a core value we have,” she said.

In the hospital emergency room, “the circumstance you have may not be urgent, so you don’t require immediate attention,” she said. “You may be seen last if the urgency warrants it, and that may make you feel like you’re not important. You may say that your problem wasn’t really treated and you’re still sick and hurting, and you may go a longer time before your next visit.”

Runsabove urges patients to establish a relationship with a primary care provider, “someone you can sit and talk with.”

She’s glad she did. One recent weekend she was dancing in Havre when she heard the fascia tendon in her foot pop. Her primary care provider and nurse told her to come see an orthopedist at a walk-in clinic in Billings.

“I knew the injury was painful and intense, but because I had a primary care provider, I knew it didn’t require an emergency room visit, which as you know can be expensive,” she said.

Mostly because of Medicaid expansion, providers are “starting to see a lot more insured patients, Native and not,” she said. St. Vincent Healthcare has a steering committee to aid Native patients, and administrators are discussing hiring additional people to increase cultural competencies.

“Now my work is more about building capacity within the system, helping patients to feel more comfortable,” she said.

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Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.