Alaska Native Elders Research Articles

MAKING OLDER ADULT FALL PREVENTION A ROUTINE PART OF HEALTHCARE IN TRIBAL CLINICAL SETTINGS

Abstract Over one-third of American Indian and Alaska Native (AI/AN) elders (age 65+) report falling annually. This percentage is higher compared to other race/ethnic groups except for White non-Hispanic older adults. CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative provides guidance for making elder fall prevention a routine part of clinical care. The presentation will describe a survey of healthcare providers serving AI/AN populations to gauge their readiness to adopt STEADI. Additionally, it will focus on a culturally informed approach to implementing STEADI within tribal settings. The National Network of Public Health Institutes and Seven Directions, A Center for Indigenous Public Health, surveyed a convenient sample of healthcare providers in clinics serving AI/AN patients to assess providers’ knowledge and acceptability of fall prevention best practices, efforts to prevent falls, and receptiveness to receiving fall prevention training and support. The final sample included 94 healthcare providers from 27 clinics. Less than half of those surveyed reported screening elders for fall risk. Only 22% were familiar with STEADI. Most (84%) providers were willing to take part in fall prevention with additional training. Based on these findings CDC is funding two tribes to use an indigenous evaluation approach to improve their tribal health center’s elder fall prevention capacity through evidence-based clinical and clinical-community linked strategies. Results from these activities will be used to outline a best practices guide focused on coordinated care for fall prevention and tailored to the varied environments, governments, cultures, and capacity for public health action in tribal health centers.

Retention of American Indian and Alaska Native participants in the National Alzheimer's Coordinating Center Uniform Data Set.

The number of American Indian and Alaska Native (AI/AN) elders is expected to double by 2060. Thus it is imperative to retain AI/AN participants in longitudinal research studies to identify novel risk factors and potential targets for intervention for Alzheimer's disease and related dementias in these communities. The National Alzheimer's Coordinating Center houses uniformly collected longitudinal data from the network of National Institute on Aging (NIA)-funded Alzheimer's Disease Research Centers (ADRCs). We used logistic regression to quantify participant retention at 43 ADRCs, comparing self-identified AI/AN participants to non-Hispanic White (NHW) participants, adjusting for potential confounding factors including baseline diagnosis, age, sex, education, and smoking. The odds of AI/AN participant retention at the first follow-up visit were significantly lower than those for NHW participants (adjusted odds ratio [aOR]: 0.599; 95%: 0.46-0.78; p<0.001). These results suggest the need for improved strategies to retain AI/AN participants, perhaps including improved researcher-community relationships and community engagement and education. American Indian and Alaska Native (AI/AN) research participants were retained to the first follow-up appointment at lower rates than non-Hispanic White (NHW) participants. AI/AN participants are retained at lower rates than NHW participants for long-term follow-up. The majority of AI/AN participants were not retained to the second follow-up visit.

"Sorry for laughing, but it's scary": humor and silence in discussions of Colorectal Cancer with Urban American Indians.

Given high rates of cancer mortality in Native communities, we examined how urban American Indian and Alaska Native elders talk about colorectal cancer (CRC) and CRC screening. We conducted seven focus groups with a total of 46 participants in two urban clinics in the Pacific Northwest to assess participant awareness, perceptions, and concerns about CRC and CRC screening. Using speech codes theory, we identified norms that govern when and how to talk about CRC in this population. Our analyses revealed that male participants often avoided screening because they perceived it as emasculating, whereas women often avoided screening because of embarrassment and past trauma resulting from sexual abuse. Both men and women used humor to mitigate the threatening nature of discussions about CRC and CRC screening. We offer our analytic results to assist others in developing culturally appropriate interventions to promote CRC screening among American Indians and Alaska Natives.

Indigenous data sovereignty in the context of big data

AbstractBackgroundDespite evidence that 1 of every 3 American Indian / Alaska Native (AI/AN) elders will develop dementia, they remain substantially underrepresented in Alzheimer’s disease and related dementias (ADRD) research. In our partnership with the Oneida Nation of Wisconsin, scientists from the Wisconsin Alzheimer’s Disease Research Center (ADRC) find ourselves at the intersection of two influential and opposing movements: 1) a movement to ensure Tribal data sovereignty, driven by abuse stemming from unrestricted access to AI/AN data and samples; and 2) researchers' push toward free and unfettered access to big datasets, including genetic data. National ADRD datasets include information from AI/AN participants for whom Tribal affiliation is unknown and there is little to no guidance on how to conduct research with datasets where AI/AN race is identified but Tribal affiliation is unknown. We see a need to establish guidelines for researchers utilizing ADRD big datasets and repositories containing data and samples from AI/AN of unknown Tribal affiliation.MethodWe have contacted stakeholders of ADRD research using AI/AN data of unknown Tribal affiliation, including the National Institute of Aging (NIA) Alzheimer’s Disease Research Centers Program, the NIA Office of Special Populations, the National Alzheimer’s Coordinations Center, the National Centralized Repository for Alzheimer’s Disease and Related Dementias, the National Institute of Health Tribal Health Research Office, and AI/AN scientists who are stakeholders in the use of AI/AN data. Future efforts will involve Alzheimer’s Disease genetic, biomarker sample, and data repositories, and AI/AN elders, youth, and Tribal members.ResultWe plan to develop a process through which proposed analyses that include AI/ANN data will be culturally informed and reviewed by AI/AN scientist ‐ e.g., an AI/AN Advisory Committee. This would ensure that proposals to use AI/AN data and samples from ADRD big datasets and repositories do not inflict further harm to this historically marginalized group. Moreover, the review would ensure that data sovereignty measures are addressed prior to analysis and publication.ConclusionWe propose to convene an AI/AN Advisory Committee to guide ADRD researchers on culturally responsible management of data, samples, and genetic information collected from AI/AN participants, their Tribes, and their Nations.

Alaska Native elders’ cultural beliefs, practices, and values: The case for culturally informed holistic dementia care

AbstractBackgroundAlaska Native (AN) people are projected to experience Alzheimer’s disease and related dementias at an increasingly high rate in comparison to other US races. However, due to colonization among AN tribes and the subsequent institutionalization of modern medicine, cultural practices and values that greatly impact holistic health and dementia care have been overshadowed and in some instances eradicated. Thus, more can be known about the psychosocial factors that have and can contribute to optimal dementia care for a population that experiences health disparities (e.g., heart disease, chronic lower respiratory diseases, cerebrovascular diseases) and barriers to care (e.g., language, rurality, access to resources).MethodIn order to understand precolonial and present cultural practices that comprise optimal dementia care for AN people, a grounded theory, exploratory study was conducted. Twelve semi‐structured interviews with AN Elders assessed the etiology, course, treatment, caregiving, and the culturally derived meanings of memory function, loss, decline, and disease.ResultQualitative analyses revealed eight culturally grounded and salient themes: 1) Traditional Knowledge Systems and Values; 2) Caregiving Networks; 3) Memory Function; 4) AN Spirituality; 5) Stories, Generative Sharing, and Healing; 6) Historical Change; 7) Connection, Communication, and Compassion; and 8) Assisted Living. These themes are best understood through AN lifecycle theory, which is a holistic representation of the culturally specific psychosocial protective factors, disease preventive, and caregiving practices that comprise an AN caregiving model.ConclusionThis study highlights the overall themes of continuity, connectedness, spirituality, intergenerational transmission, history, and belief systems, which emerged as a result of investigating cultural practices that comprise optimal dementia care for AN people. The culturally adaptive and congruent representations that AN Elder’s utilize in understanding memory functioning, loss, decline, and disease (i.e., forms of dementia) both explain and transcend Western biomedical models. Further, more meaningful beliefs are the outcome of an internalization and lived expression of the AN lifecycle. This AN lifecycle theory provides proscriptions for living life holistically, with a strong connection to land, and provides a fulcrum that allows one to understand the complexity of dementia caregiving as it relates to AN culture, history, and traditions embedded within the current sociocultural context.

Traditional Cultural Practices Provide More Frequent Feelings of Happiness and Calm for Native American Elders

Though American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) elders are an understudied population, available data demonstrates higher rates of depressive symptoms among these elders. In addition, AI/AN/NH elders are a medically underserved population, with geographic isolation a common barrier to accessing emotional/mental health services. However, cultural practices are important sources of resilience for AI/AN/NH elders. Survey data from “Identifying our Needs: A Survey of Elders” Cycle VI (2014-2017), conducted by the National Resource Center on Native American Aging, were analyzed using ordinal logistic regression; N=18,134 adults age 55+ from 164 tribal survey sites. Respondents indicated how often (from none to all of the time) they participate in cultural practices (e.g., traditional food, music, customs). Frequency of participation varied; 27% of elders reported participating in traditional cultural practices a good bit of the time or more, 28% some of the time, 18% a little of the time, and 27% did not ever participate. We explored the relationship between frequency of cultural practices and frequency of feelings of happiness, calm/peacefulness, nervousness, and being downhearted/blue. A significant positive association was found between higher frequency of cultural participation and feelings of happiness and calm/peacefulness; no association was found with nervousness or depressive symptoms. While the frequency of participation by elders in cultural practices is directly related to better self-reported levels of happiness and peacefulness, nearly half (45%) never/almost never participated in these types of practices, which underscores the need to support availability of and elders’ participation in cultural practices.

“The world was shifting under our feet, so I turned to my devotionals as his dementia worsened”: the role of spirituality as a coping mechanism for family caregivers of Alaska Native elders with dementia

ABSTRACT Background: Providing direct care for an individual with Alzheimer’s Disease and related dementias (ADRD) is a source of chronic stress for caregivers. Spirituality and religion are important to Alaska Native (AN) identity and this study explored the role of spiritual practices as a coping mechanism for dementia caregivers. Purpose: The aim of the study was to (1) identify stressors experienced by AN people caring for someone with dementia and (2) describe the role of spirituality in coping with those stressors. Methods: This exploratory study conducted interviews with 21 AN caregivers of those with dementia. We employed thematic analysis to interview transcripts to examine relationships among the narratives and explore themes that populated the participants’ understandings of ADRD in each of the domains of Kleinman’s Explanatory Model of Illness. Results: AN caregivers reported chronic stress related to caregiving, and subthemes included poor health, lack of support, and lack of education on dementia. Caregivers reported using spiritual practices to cope with stress. Conclusion: The use of spiritual practices is identified as a primary resource during challenging caregiving experiences. Community organizations and health care providers should incorporate spiritual practices as part of the support they provide to AN dementia caregivers.

Understanding the burden of trauma and victimization among American Indian and Alaska native elders: historical trauma as an element of poly-victimization

ABSTRACTResearch on recognition of adverse childhood experiences (ACEs) and poly-victimization has transformed our understanding of violence and trauma exposure. Both concepts point to the importance of understanding the cumulative burden of trauma and the interconnections among forms of violence and abuse. However, there has been little conceptualization about what these two constructs mean for American Indian and Alaska Native (AI/AN) individuals, families, and communities, and even less attention to the experiences of AI/AN elders. This paper summarizes prior work on adverse childhood experiences and poly-victimization, addresses the limitations of past research on these issues, and expands these constructs to include concepts of historical trauma in order to better understand victimization and trauma among AI/AN elders. We call for the integration of historical trauma into the poly-victimization framework for AI/AN communities in order to more accurately capture the true burden of victimization among AI/AN peoples. Future research, prevention, and intervention can better incorporate historical trauma and we provide suggestions for doing so, including adding items on historical trauma to poly-victimization surveys and creating programs to promote cultural connectedness.

PROTECTIVE FACTORS IN THE CONTEXT OF SUCCESSFUL AGING IN URBAN-DWELLING ALASKA NATIVE ELDERS

Recently, researchers have been exploring successful aging in rural communities of Alaska as it is experienced by Alaska Native Elders. Due to outmigration based on economic, medical, or familial influences, many Alaska Native elders leave their home communities to live in urban settings in Alaska, even though research suggests that most elders would like to remain in their home communities to grow old. Very little is known about the relocation process and how it impacts an elder’s views on successful aging. While established protective factors in rural communities involve family and extended family members, community, subsistence, and traditional activities, there is little knowledge of which protective factors exist in urban settlements supporting successful aging. This exploratory, qualitative study presents the protective factors of successful aging in the context of relocation of Alaska Native Elders from rural to urban dwellings. A life course approach and discourse analysis were used to analyze individual interviews asking how Alaska Native Elders experienced relocation and how successful aging was experienced similarly and differently in rural and in urban settings. A community-based participatory approach allowed for collaboration between researchers and communities as equal partners at all phases of the process, both contributing their expertise to enhance understanding of successful aging and supportive factors. Access to informal supports and meaningful community engagement were more important to rural Elders, and access to health care services and family engagement were important to Elders in urban communities. Challenges remain for Elders in urban environments to establish a sense of community.

Sobriety and alcohol use among rural Alaska Native elders

BackgroundAlthough notable health disparities related to alcohol use persist among Alaska Native people living in rural communities, there is a paucity of research examining drinking behaviour in particular segments of this population, including elders. One explanation for this is the distrust of behavioural health research in general and alcohol research in particular following the legacy of the Barrow Alcohol Study, still regarded as a notable example of ethics violations in cross-cultural research.ObjectiveThe present study reports findings from one of the first research studies asking directly about alcohol abuse among rural Alaska Natives (AN) since the study in Barrow took place in 1979.DesignWe report findings regarding self-reported alcohol use included in an elder needs assessment conducted with 134 Alaska Native elders from 5 rural villages off the road system in Alaska. Data were collected in partnership between academic researchers and community members in accordance with the principles of Community-Based Participatory Research.ResultsFindings showed very high rates of sobriety and low rates of alcohol use, contradicting stereotypes of widespread alcohol abuse among AN. Possible explanations and future research directions are discussed.ConclusionsThis research represents one step forward in mending academic–community relationships in rural Alaska to further research on alcohol use and related health disparities.

Mental health disorders among an invisible minority: depression and dementia among american Indian and alaska native elders.

According to the 2010 Census, 5.2 million people identified themselves as American Indian or Alaska Native (AIAN) in the United States. This was an increase of 39% from the prior Census, making AIANs one of the nation's fastest growing populations. The health and social programs reaching them, however, have experienced documented devastating shortfalls. Decades of inadequate resources have resulted in significant health and socioeconomic disparities. AIANs are often considered an "invisible minority." In 2012, there were 266,000 AIAN elders 65 or older who claimed one race alone. That number is projected to almost triple by 2030-when the nation's baby boomers move into the ranks of the older population. This article provides an overview of two primary mental health issues-depression and dementia-that will confront this emerging AIAN elder population. Although other health and social issues exist, this article addresses depression and dementia because they are hidden from the community and from health care agencies. This paper focuses both on the unique characteristics of the AIAN population and why it is important to address depression and dementia. The conclusion explores pragmatic policy recommendations for improving the health and long-term mental health care status of AIAN elders.

Social Engagement and Physical and Cognitive Health Among American Indian Participants in the Health and Retirement Study

Social engagement has many demonstrated benefits for aging non-Hispanic Whites in the U.S. This study examined data from the U.S. Health and Retirement Study to determine whether these benefits were similar among American Indians and Alaska Natives older than 50 years. Linear regression techniques were used to examine the associations between level of social engagement, scores for memory and mental status, and self-reported health among 203 American Indian and Alaska Native elders who participated in the Health and Retirement Study and had data available between 1998 and 2010. Level of social engagement was significantly associated with memory, mental status, and self-reported health. However, only the association of social engagement with mental status and self-reported health remained significant (p = 0.04 and p = 0.05, respectively) after adjusting for sociodemographic variables, number of known health conditions, and scores on the Center for Epidemiologic Studies Depression scale. Level of social engagement was not associated with patterns of decline across time in cognitive or physical health. Higher levels of social engagement are associated with better physical and cognitive functioning in American Indian and Alaska Native elders. Future studies should examine whether this association acts through cognitive stimulation, increase in physical activity resulting from social engagement, or access to resources that support physical and cognitive health.

Local and traditional knowledge regarding the Bering Sea ecosystem: Selected results from five indigenous communities

We documented local and traditional knowledge (LTK) about the Bering Sea ecosystem through interviews with Alaska Native elders, hunters, and fishers in the coastal communities of Akutan, St. Paul, Togiak, Emmonak, and Savoonga. Their observations describe a complex and changing ecosystem, with indications of divergent impacts of change in the south (many species in decline) and the north (a productive ecosystem). Observed changes in species abundance suggest that the marginal zone of maximum (March) sea-ice extent is experiencing the most rapid directional changes, including shifts in distribution of ice-associated species such as bearded seal (Erignathus barbatus). Causes of declines in other species such as northern fur seals (Callorhinus ursinus) and murres (Uria spp.) are harder to identify, and seabird abundance trends appear to vary greatly with location. Connections between the LTK findings and other research under the North Pacific Research Board and National Science Foundation's Bering Sea Project were modest due to mismatches in temporal and spatial scales of reference and the fact that LTK observations were not initially made with scientific relevance in mind. We found, however, the overall observations to be consistent with the emerging picture of high spatial variability in the Bering Sea ecosystem.

Mount Challenges and Solutions For Native Alaskan Objects for a Study Collection in an Earthquake Zone

This article examines mount challenges and solutions for more than 500 Alaska Native objects on loan from the Smithsonian Institution's National Museum of Natural History and the National Museum of the American Indian to the Anchorage Museum for the exhibit "Living our Cultures, Sharing our Knowledge." Housed within the Anchorage Museum's new addition, the exhibit's unique case design and object mounting system make the objects accessible for study, research, cultural consultation, and education in collaboration with Alaska Native elders, scholars, researchers, artists, and educators. By describing specific examples from these two collections, the article focuses on the unique challenges these objects presented in safely mounting study collection objects, many with multiple and moving parts, that will travel on their mounts to Alaska and from the display case to a study area within the center, all housed within an earthquake zone. Considerations explored are choice of suitable materials, mount design and fabrication, aesthetics of mount design vs. safety and stability of the object, and the collaborative approach that evolved among a revolving team of seven to nine mountmakers attempting to satisfy the unique goals set forth by the curatorial, conservation, and design teams.

Health Numeracy and Understanding of Risk Among Older American Indians and Alaska Natives

American Indian and Alaska Native people suffer extreme health disparities and remain underrepresented in health research. This population needs adequate numeracy skills to make informed decisions about health care and research participation, yet little is known about their numeracy skills. Participants were 91 American Indian and Alaska Native elders who completed an anonymous survey that measured numeracy and the correlation between framing of risk and comprehension of risk. The authors measured numeracy by a previously developed 3-item scale that assessed basic probability skills and the ability to manipulate percentages and proportions. Risk comprehension was measured by 3 items on treatment benefits, which were variously framed in terms of relative risk reduction, absolute risk reduction, and number needed to treat. Framing in terms of relative risk was associated with higher odds of correct interpretation compared to absolute risk (OR = 1.8, 95% CI = 1.2–2.9) and number needed to treat (OR = 2.0, 95% CI = 1.2–3.5). This association persisted after adjusting for covariates, including baseline numeracy skills. Our results underscore the need for clinicians to consider how health information is framed and to check carefully for understanding when communicating risk information to patients.

Successful aging through the eyes of Alaska Native elders. What it means to be an elder in Bristol Bay, AK.

Alaska Natives (ANs) view aging from a holistic perspective, which is not typical of the existing successful aging literature. One of the challenges of conducting research with cultural groups (e.g., ANs) is the lack of data, or research, on culture and aging and its impact on how we view successful aging. This research explores successful aging from an AN perspective or what it means to reach "Eldership" in rural Alaskan communities, which is an area of successful aging where there is very little research. Data were gathered from 26 elders aged 61-93 years in 6 Bristol Bay communities in Southwest Alaska. An Explanatory Model approach was used and adapted to gain a sense of the beliefs about aging and establish an indigenous understanding of successful aging or what it means to attain "Eldership." Rather than establishing a definition of successful aging for AN Elders, this study highlights the four elements of "Eldership" or what AN Elders believe are important characteristics to becoming a respected elder. The four elements of "Eldership" are emotional well-being, community engagement, spirituality, and physical health, which are the characteristics of ANs who have reached "Eldership" and become a respected Elder in their community. This research seeks to inform studies on indigenous aging that prioritizes the perspectives of elders to affect positively on the delivery of health care services in rural Alaska.

Successful Aging through the Eyes of Alaska Natives: Exploring Generational Differences Among Alaska Natives

There is very little research on Alaska Native (AN) elders and how they subjectively define a successful older age. The lack of a culturally-specific definition often results in the use of a generic definition that portrays Alaska Native elders as aging less successfully than their White counterparts. However, there is a very limited understanding of a diverse array of successful aging experiences across generations. This research explores the concept of successful aging from an Alaska Native perspective, or what it means to age well in Alaska Native communities. An adapted Explanatory Model (EM) approach was used to gain a sense of the beliefs about aging from Alaska Natives. Research findings indicate that aging successfully is based on local understandings about personal responsibility and making the conscious decision to live a clean and healthy life, abstaining from drugs and alcohol. The findings also indicate that poor aging is often characterized by a lack of personal responsibility, or not being active, not being able to handle alcohol, and giving up on oneself. Most participants stated that elder status is not determined by reaching a certain age (e.g., 65), but instead is designated when an individual has demonstrated wisdom because of the experiences he or she has gained throughout life. This research seeks to inform future studies on rural aging that prioritizes the perspectives of elders to impact positively on the delivery of health care services and programs in rural Alaska.

Education is Associated with Physical Activity among American Indian Elders

Although educational attainment and physical activity levels tend to be positively associated in majority populations, this relationship has not been investigated in American Indian and Alaska Native (AI/AN) elders. This study examined the association between education and physical activity among AI/AN elders (N = 107) using self-report and behavioral outcomes. Regression models showed that higher education was significantly associated with total caloric expenditure for moderate intensity physical activities and distance traveled during a 6-minute walk test of fitness. Additional research is needed to understand modifiable personal, social, and environmental physical activity barriers in these populations.

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Alaska Medical Center Blends Traditional With Cutting Edge

Back to table of contents Previous article Next article Community NewsFull AccessAlaska Medical Center Blends Traditional With Cutting EdgeJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:21 Nov 2003https://doi.org/10.1176/pn.38.22.0013Top to bottom: The Alaska Native Medical Center, main building; the new building housing mental health, dental, and vision services; a closet crammed with bicycles used for group therapy outings.Anchorage, Alaska, may look like a legendary frontier town to folks from the lower 48 states. But it contains something that none of the lower 48 has—the Alaska Native Medical Center.The center was built by Alaska Natives themselves. They also run it themselves through an Alaska Native nonprofit organization called the Southcentral Foundation.The Alaska Native Medical Center is located in the middle of Anchorage, on Diplomacy Drive. It includes a hospital; a primary care center; a building housing mental health, dental, and vision services, which just opened this past summer; and the Pathway Home Residential Treatment Center for Adolescent Substance Abusers. (In August, Health and Human Services Secretary Tommy Thompson visited the center and announced that $750,000 from the federal Substance Abuse and Mental Health Services Administration would go to the Pathway Home.) The center serves some 46,000 Alaska Natives—mostly from Anchorage, but also from rural areas.Stunning FacilitiesThe Alaska Native Medical Center’s facilities are visually stunning, designed with input from Alaska Native elders to promote spiritual, mental, and physical healing in the Alaska Natives who visit them. According to Alaska Native beliefs, spiritual, mental, and physical health are inseparable. For example, the hospital has been designed to resemble a woven Alaska Native basket. Its reception area contains a circular sitting space where patients and their families can gather. The primary care center and the behavioral health services building, which was designed to let in ample natural light, was constructed with a lot of native wood. The latter is also graced on the outside by a totem pole carved by an Alaska Native from southeast Alaska.The facilities also make it possible to offer the best in Western medicine. For example, the behavioral health services department contains a children’s play-therapy room where clinicians can observe young patients through a one-way window. It also contains a closet full of bikes that teen patients can use during group-psychotherapy outings.Traditional HealingBut probably the most intriguing aspect of the Alaska Native Medical Center is that it also offers non-Western forms of healing, such as acupuncture, and some Alaska Native traditional forms of healing, such as prayer, the laying on of hands, massage, song, dance, and herbal treatment. The center employs two Alaska-Native healers, and the healers have their own herb garden at the center. In fact, a quote posted at the Alaska Native Heritage Center well describes the traditional healing efforts at the Alaska Native Medical Center: “Today we are reclaiming the old ways and healing the mind, body, and spirit of our people. We are discovering a new sense of pride in who we are and where we have come from.”Robert Wald, M.D., a psychiatrist who works in the Alaska Native Medical Center’s behavioral health services department, has referred some patients to the native healers, he told Psychiatric News. Kerry Ozer, M.D., another psychiatrist who works in the department, also refers patients to the native healers from time to time.“Frequently, when I see a patient, I’ll make a diagnosis and then discuss treatment options,” Ozer explained in an interview. “And one of the options that I offer [is] medication. When patients are reluctant or hesitant, or are opposed to the idea of medication, it’s nice that in addition to considering Western counsel, they also have the opportunity to go to the spiritual healing center and see if that is what they are looking for. Sometimes it’s helpful, and sometimes they come back to me and say that it didn’t work and that they would like to reconsider some of the options that I had explored with them. It is just a matter of giving them more choices—and choices that are culturally appropriate for them. That, of course, increases their trust and their comfort level, and sometimes patients take some Alaska-Native healing and some Western medicine and mix and match and find out what works best for them.” ▪ ISSUES NewArchived