After spending several years working as a public health nurse at Indian Health Services in Oklahoma City, Ashton Gatewood, a citizen of the Choctaw Nation, knew she wanted to further her medical training.
She had heard about the first-in-the-country tribal-affiliated medical school at the Cherokee Nation and knew she wanted to make that the next step in her career path.
So Gatewood, originally from Mustang, Oklahoma, enrolled with other students – both Native and non-Native – in 2020 and became part of the first class at the school, a partnership with Oklahoma State University’s College of Osteopathic Medicine.
“I really embraced the mission of IHS, which is to improve patient health and wellbeing, and they look at wellbeing as physical, mental, and spiritual,” she said. “When I saw a newspaper article about the Cherokee Nation campus, I looked into what their goals were and found out that their mission was to train physicians to work in tribal communities. I found that the osteopathic philosophy really aligned with the mission that I had already really embraced.”
While the first cohort of students started in 2020, the $40-million facility in Tahlequah – in the heart of the Cherokee Nation – opened in early 2021.
The OSU College of Osteopathic Medicine at the Cherokee Nation is the first tribally affiliated medical school on tribal land in the country with a focus on educating primary care physicians who have an interest in serving rural and underserved populations in Oklahoma.
“If we think about training physicians, we want to train them in an environment in which we want them to practice,” said Dr. Natasha Bray, interim Dean of the school. OSU had been invested in recruiting rural and Native students for some time, she said.
Conversations around opening a medical school started and accreditation took some time, Bray said.
“We worked through all the accreditation documentation and requirements,” she said, which included showing there was a need for additional physicians in the state. “It’s pretty widely known we need more primary care physicians and even specialty physicians in Oklahoma.”
August 2020 saw the inaugural class of more than 50 students. And the second class recently started.
The curriculum is the same as the Tulsa campus, which includes anatomy, genetics, and biochemistry, among other coursework. Then the students move into learning more in-depth and examining why patients come in, Bray said.
“So patients will come in and say my blood vessels are dilating, so we begin to talk about that dual role of a physician — being able to talk to them and gain their trust but also be a scientist,” Bray added.
Patient populations and the role of historic trauma are also discussed and taught, Bray said. “We really talk about some of the barriers of being a person who lives in a rural community and your access to care is 45 minutes or an hour away and how that will affect how a patient interacts with the healthcare system,” she added.
Most pressing health issues in tribal communities can all be related back to access, said Dr. Janel H. Johnson, a faculty member at the school.
“Whether it’s diabetes, high blood pressure, murdered and missing indigenous women, girls, and two spirits, the systemic lack of access to consistent and culturally competent medical care, food deserts, safe environments to exist, like lighted pathways and decent sidewalks, all contribute heavily to our health issues…We know the health problems; we need investment in equitable and accessible solutions with tribal input and consent.”
One thing Covid-19 brought about was a shift to telemedicine, Bray noted, which worked well in areas with broadband access. “If you’re in a rural community without broadband access and spotty cell service, your ability to access services and do telehealth is going to be very different,” she said.
Cultural competence is high on the list of priorities for the school. This year the school is adding an additional language course – Cherokee – to Spanish and sign language, Bray said.
“We want them to learn the role of the language and culture and even basic phrases,” she said.
Gatewood – the second-year medical student – said the first year was challenging, not least of which was due to Covid-19.
“It’s also because we were the inaugural class,” she said. “It really made us all step up as leaders because there wasn’t anyone ahead of us.”
Less than one percent of physicians are Native American, according to a 2018 study by the American Medical Association.
“It’s challenging when you don’t have anyone in your family or your social network who has done this before,” Gatewood said. “The more students we have from our community that come to the school and become physicians the more it will inspire others to do the same thing.”
The school, Gatewood noted, is trying to recruit Native and rural students so they will train in a Native and rural community and continue their career there.
“We need the physicians here,” she added.
Of the inaugural class, 20% identify as American Indian, according to the school.
Gatewood said another benefit to a tribally affiliated medical institution is cultural context. “If someone comes in who is doing traditional medicine or tribal ceremonial healing practices, and the physician is non-Native and doesn’t recognize that, they may not consider that for the rest of the care plan and they could also be judgemental or negative about something that makes the patient feel uncomfortable.”
Gatewood noted that some of the students have families and come from rural areas, potentially making starting over in a new community a little more challenging. The school has worked with students to overcome any obstacles, she said.
“They’re really adapting to trying to make sure the students are able to live their life while pursuing their dream of becoming a physician,” she said.
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