Here are some harsh truths: Native Americans/Alaska Natives frequently face roadblocks—geographic isolation, low income—that prevent them from receiving good medical care. The impact of this is tragic: They die at higher rates than other Americans in many health and disease categories, including liver disease, diabetes, tuberculosis, homicide, and suicide. Their infant death rate is 60 percent higher than that for whites.
And American Indian women are murdered or disappear at 10 times the national average.
If this is all (sad) news to you, you are hardly alone. The poor state of American Indian health historically flies under the radar. It’s rarely reported on, addressed, or discussed outside of the community.
But one woman has dedicated her life’s work to changing this and saving her people: Margaret Moss, PhD, JD, RN, FAAN, who is the director of First Nations House of Learning, The University of British Columbia, Vancouver. A member of the Mandan, Hidatsa, and Arikara Nation, she is one of about two dozen Native American nurses who also have a doctorate and the only Native American to hold both a PhD and a JD. Moss, 61, speaks all over the world, trying to bring attention to the tragedy that is American Indian health.
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Turning on the Spotlight
“Federal policy over 250 years was meant to literally, in their words, exterminate, assimilate, remove American Indians. They have not removed us, but they have removed us from existence in people’s minds,” Moss says. “You never see American Indians ever on CNN, MSNBC, Fox. We’re not on panels. We don’t get to talk about Indian issues like pipelines through our lands. You never see us. You see people talking about us but rarely us speaking for ourselves.”
There are about five million self-identified American Indians. “That’s a lot in number but only 1.2 percent of the population,” Moss says. “We’re statistically insignificant.”
You see people talking about us but rarely us speaking for ourselves.
Moss has been trying for years to get attention for the murdered and missing American Indian women and girls. “The only reason I know about this tragedy is because of the Facebook pages I am on. I hear of instances weekly. It is never covered in the news and there is no research going into it. No one is looking at this, nobody cares. So, if something as stunning and as bold as murder doesn’t hit the news, why would Natives’ heart attack rate make it?” she points out.
When Moss was in nursing school, she was never taught anything about American Indian-specific health needs unless she sought it out. To fight that ignorance, she edited and wrote the only textbook dedicated to the issue, American Indian Health and Nursing, which is divided up geographically and tribally to examine specific cultural and geographic issues. The book has won two awards from the American Journal of Nursing. Co-written with other nurses (only two of whom aren’t Native Americans), the book also tackles what needs to be done about overall health policies. “I told my contributors to think of the subtext of what you never learned in nursing school,” says Moss.
An Unexpected Adoption
Moss’s childhood made her particularly attuned to these issues. She was born in Fargo, ND, before the passing of the Indian Child Welfare Act of 1978, which prevented American Indian children from being taken from their families of origin. Her poverty-stricken biological mother was pressured into placing her for adoption with a white family that had two biological children and a Native American brother and sister, who were from her same tribe. “The way I grew up is against Federal Law now,” she says.
They didn’t want us in their schools, neighborhoods, and churches.
The family moved to Maryland, where Jim Crow still ruled. “My [adoptive] parents showed up with these three brown children. Not only were we considered ‘heathens,’ under Maryland law, we were ‘colored.’ The community was up in arms: They didn’t want us in their schools, neighborhoods, and churches. My brother and sister could never get a handle on it. This just killed them basically,” she recalls.
Her adopted sister eventually died of alcohol abuse; her adopted brother succumbed to HIV/AIDS. Somehow, Moss remained strong: “It takes a lot of energy to face this abuse all the time, but for some reason, I just had it.”
Finding Her Path Forward
After college, Moss went back to North Dakota to meet her biological family, where she found yet more tragedy. Her mother was an alcoholic, and her biological brother was killed in a motorcycle accident. “Watching what happened to my family woke me up to what was going on. I knew I needed to be part of the solution,” she says.
That led to her pursue an incredible amount of education in order to help her people, all while nurturing a strong family. She married college basketball star Willie Moss (who’s one-quarter Cherokee) almost 33 years ago, and they raised four children. “I literally have noooooo idea how I did it!” she says.
In a six-year span, Moss earned several advanced degrees while raising four kids.
From 2000 to 2006, when she had just completed her PhD, she pushed through a logic-defying schedule: “I was on the tenure track at the University of Minnesota, running grants, teaching, publish or perishing and presenting all over, while doing a post-doctorate concurrently at the University of Colorado’s Native Elder Research Center, which required flying to Denver every other month for two years. I was also in law school on weekends 2002 to 2006, worked at the University Hospital on the side as an Administrative Nursing Supervisor,” all while parenting four kids who were five years apart. When asked how she got any sleep, she cracks back, “SLEEEPPP?” as if to say, “What’s that?”
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Changing the Culture
Image: Courtesy of Margaret Moss
But her vision was strong. Moss seeks to encourage more Native Americans to go into the health professions by removing the usual roadblocks. “It’s everyone’s preference to see a healthcare person who understands you, your health issues, your living conditions, and your cultural demands. If the healthcare practitioner is a non-Indian, they don’t even have the most rudimentary understanding of the various issues of being an American Indian in the U.S., so the care they give is not optimal,” says Moss.
Native-American patients can be torn between spiritual and physical health.
For example, If an American Indian comes in with diabetes, they are told, “Here’s your insulin, keep your wounds clean, go for walks.” Moss says, “The clinic thinks it has done everything it is supposed to do when in fact they have done nothing for that patient unless they ask: Do you have refrigeration at home? They might not. Can you keep your wound clean? They might not be able to because they might not have complete plumbing. Can you walk? There might be ten feet of snow around. They didn’t ask any of that and that’s when they really fall down.”
Then there are specific issues from tribe to tribe. Some use sweat lodges, which can cause blood pressure to shoot up. Some require periodic fasts, which are bad for diabetics. The patient is torn between spiritual health and physical health. There are work-arounds, but the practitioner has to be aware and educated.
Does she see anything changing today? Says Moss, “I have a lot of people writing to me, asking questions, which is a healthy sign. No one was even asking the questions before.”
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Beth Levine is an award-winning writer whose work has appeared in Oprah, AARP, Everyday Health, Woman’s Day, Good Housekeeping and many others. She is also a college essay coach. You can find her at Bethlevine.net and on Twitter @BethLevine75.
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