By - October 14, 2024
Indigenous peoples have long struggled to access quality healthcare in the United States. While many of the issues related to these barriers cannot be solved in the laboratory alone, those laboratories and hospitals that employ more people who are indigenous to the patient populations being served bring cultural competency that leads to better and higher-quality patient care.
To explore this further in the context of Alaska Native indigenous people, Critical Values spoke with Dr. James J. Tiesinga, MD, Laboratory Medical Director at Alaska Native Medical Center (ANMC) in Anchorage, Alaska.
Understanding the history
To better serve any indigenous population, it is necessary to understand their historical relationship to the American healthcare system. Dr. Tiesinga points out that Alaskan Native people (as well as many others) “have been let down by the American healthcare system time and again which has been very paternalistic, very centralized and out of touch with the people they purport to be helping.”
European settlers brought illness like tuberculosis, which led to the deaths of many Alaskan Native people in the 20th century, and those who were treated did not often receive the best care, he explains. “I think that has created a lot of distrust among indigenous groups towards the established healthcare system, and a reluctance to put trust in Western medicine.”
In fact, he says, the performance metrics have shown that it was only when Alaskan Native people gained self-governance and self-determination over their healthcare system, that morbidity and mortality indicators started to improve.
Laboratories have a responsibility
There are many aspects of healthcare that laboratories cannot directly control, such as the fact that most test manufacturers base their test specifications on studies centering on heterogeneous populations that skew toward non-Hispanic white people in much of the U.S. “So, it’s a real challenge to get accurate reference ranges and performance characteristics for indigenous populations and frankly, other minority groups,” he says.
However, his laboratory makes efforts to perform patient population reference range validation studies and other validations on the Alaskan Native people it serves. That can be challenging, however, because Alaska Native/American Indian people have been mistreated and disappointed so often by the research community, they may shy away from or refuse to participate in this kind of research, Dr. Tiesinga notes.
“The historical trauma created by these breaches in research ethics now keep indigenous people away from participating in the very research that might actually provide new treatments.”
Dr. Tiesinga says that, in discussions of cultural competence, the emphasis is often on the doctor/patient relationship, but there is also significant value in having culturally competent laboratory professionals, as well.
“The laboratory, perhaps more than any other department, has a crucial role to play in almost every process and service that a healthcare organization provides. Whether it’s emergency services, antimicrobial stewardship, critical care, surgery, outpatient services, you name it,” Dr. Tiesinga says.
This, he says, provides a tremendous opportunity for laboratory personnel at all levels to serve on organizational work groups and committees, and contribute in multiple ways to the culturally sensitive delivery and structure of the healthcare system that they work in.
“People should never underestimate the power and influence laboratorians have in their workplace and in how care is delivered across a broad range of healthcare services.”
Cultural competence is key in the laboratory
Alaska Native Medical Center (ANMC) where Dr. Tiesinga works is the largest tribal hospital in the U.S., he says, and it has established an Indian preference policy that offers preferential employment to qualified candidates of Alaska Native and American Indian heritage. As a result, 25 percent or more of their laboratory staff are Alaska Native people who actively engage in hospital work groups, committees, and initiatives that discuss how care is delivered to Alaska’s Native indigenous people as well as other indigenous people living in Alaska.
Alaska Native staff can also provide useful feedback regarding the type and scope of test systems they can implement in indigenous communities in both point-of-care and village testing programs, among other things.
“As another example, Alaskan Native people working in the ANMC laboratory who participate on our cancer committee have developed educational materials that very effectively communicate information regarding screening tests and the explanation of test results that specifically address the cultural needs, lifestyles, and historical circumstances of our patients,” he explains.
Even more reflective of the power of cultural competency was how well the hospital responded to the COVID-19 pandemic’s increased need for testing. “ANMC laboratory’s success during the COVID-19 pandemic was the expression of the Alaska Native values of our staff. They take care of others and share what they have, including their professionalism and their laboratory expertise,” Dr. Tiesinga says.
If anyone was surprised by their success during the pandemic, he says it’s likely because people outside their hospital system are not familiar with the historical circumstances that have shaped the way Alaska Native people respond to such emergencies—such as having their communities decimated by respiratory infections from the earliest days of European colonization.
By having such a significant number of Alaska Native people on staff, Dr. Tiesinga says, “ANMC was able to respond to the pandemic in ways that empowered Alaska Native people and gave them the tools they needed to face their circumstances not in isolation but as part of a strong and culturally cohesive community.”
As his hospital shows, cultural competence requires hiring more than just a couple of cultural representatives.
Laboratories can drive change
For anyone who feels discouraged by the siloed nature of healthcare, Dr. Tiesinga likes to shoot down the myth that laboratory professionals are isolated from influencing patient care. In fact, he says that the work of a laboratory is “very dynamic and corrective work. You have to have leadership that appreciates the role of the laboratory. You need to have laboratory professionals who understand the power and influence that they have in influencing and educating these processes.”
It is often the laboratory professional who has the final say on what a healthcare process is going to look like, he insists. And that’s just another reason why cultural competency and education make such an important difference in patient care.
Contributing Writer