Combining Western and Traditional Medicine
Maresca, Mohawk, MD, is a dynamic family physician who
wears many hats. When this article was published, she
was director of the Native American Center of Excellence at the
University of Washington School of Medicine
was, and still is, a clinical associate professor in the
Department of Family Medicine at UWSOM.
teaches medical students and other students at the
medical school, and she supervises residents at
the Seattle Indian Health Board Family Medicine
Maresca has a medical practice with the Snoqualmie Tribe of Washington at the Tolt Community Clinic. Here she combines her Western training with her knowledge of plant medicine. She maintains a medicinal garden at the clinic and is a frequent public speaker on the topic of combining Western and traditional approaches to health care. Maresca is active in the Association of American Indian Physicians (AAIP) and served as its president from 1994 through 1995. She is the medical consultant for the Healthy Hearts Across Generations tribal research project funded by the National Heart, Lung, and Blood Institute, and she is a rare plants volunteer monitor for the University of Washington.
Native American Center of Excellence (NACOE)
“One of our major goals at the center is to improve the recruitment and retention of a Native American workforce for our region,” says Maresca. “We identify students at all levels in the pipe line and try to attract them to our school. We have an Indian Health Pathways program designed for Native and non-Native medical students who are committed to serving American Indian and Alaska Natives and want additional exposure to the issues and to the clinical practice in our communities.” Maresca manages the 4-year long Pathways curriculum that supplements the regular medical school curriculum and teaches an elective in traditional medicine for Pathways students.
Another goal for NACOE is recruiting AI/AN physicians in the region to serve as faculty members and then supporting them in this important work. A few AI/AN physicians are full-time faculty members. Most of the AI/AN physicians are clinical faculty members who supervise medical students in their own practice settings. “These people are tremendous resources,” says Maresca. “We link them with students for mentoring and role modeling, and we help them with their own career development through faculty development seminars and other activities.”
For more information on these programs see School/Programs at this website and/or go directly to the NACOE website.
Maresca has received several teaching awards. She chairs an interdisciplinary course called Indian Health Issues: Past, Present and Future that typically includes undergraduates as well as nursing and law students. “The course is for people who are interested in Indian health in a broad sense and want to know about the history of policies and today’s issues, such as urban Indian policy, fetal alcohol syndrome, and historical trauma.” Until her appointment as director of NACOE, Maresca taught in the required Introduction to Clinical Medicine as well as in several elective courses.
Every week Maresca supervises residents in the Seattle Indian Health Board family medicine residency program. The program is for Native and non-Native physicians who are already committed to working in a Native community. Before becoming director of NACOE, Maresca was director the residency program.
Using Western and Plant Medicine
One of Maresca’s joys is working at the Tolt Community Clinic operated by the Snoqualmie Tribe. When Maresca interviewed for the job 5 years ago, she discovered that the Tribe’s philosophy of medicine was congruent with her own philosophy and with good family medicine. “I was glad to learn that they were open to serving both Native and non-Native people,” says Maresca. “They were also open to maintaining traditional practices. In addition, they had a strong interest in combining mental health and physical health. I was sold!”
For years Maresca had wanted to have a garden as part of a health center. “When I brought up this idea, they smiled” she says. “They already had gotten some funding along these lines.”
In planning the garden Maresca visited with the Elders and the health board. “I invited their participation and support. It was a community effort.” Supporters included Tribal members, friends of friends, people who owned small plant businesses and farmers. There were also high school student from a summer health professions recruitment program. “It was multicultural group of kids, including farm workers who knew a lot about plants. Native youth, and urban African American kids who were new to this kind of experience. We talked about the science of designing a garden and how to use your senses in identifying plants.”
Dr. Maresca with high school students
Maresca gathers some of the plants for the garden by taking Pathways and other interested students with her to sites that are being developed for housing or other uses. “You have half a day to salvage plants. If you know who’s out there, you can dig them up and try to save them.”
Maresca says that her patients, who are mostly Elders, are very supportive of involving students in the garden. They also like the fact that Maresca precepts medical students, and occasionally also residents, at the clinic. “The Elders think it’s important to train our own,” says Maresca. “They see themselves as contributing to the students’ education, and they are acknowledged for that, like at the dinner for the Elders where we give back to the people who support us.”
The garden is surrounded by a cedar fence lined with berry plants. The medicine wheel in the center of the garden is made of different colored salmon tiles. The four zones of the garden contain plants that are used in the different stages of life: birth and infancy, youth, adult, and elder. There is a tea section, with mints, fireweed, and balm, and there is a section with a few of the medicinal plants that Maresca uses in her practice, including the plants that she grew up with in the East, local plants, and crossover plants. A small memorial garden is being developed for Grandma Forgue, a Snoqualmie Elder and herbalist.
Left: Carrie Fathke, MD, with helper. Right: Polly Olsen (Yakama) braiding sweetgrass in the garden
Using the Garden
One of the ways that Maresca uses the garden is by helping local people identify plants. “Some people are willing to gather plants if I can remind them what various plants look like,” she says. Maresca has also been helpful to traditional practitioners from other parts of the country and Canada who aren’t familiar with local plants.
Some local people want to start their own gardens or grow their own medicine, so Maresca has extra plants that she gives away or swaps for plants from others. “I also make up plant medicines for people to use,” she says. “I try to get people to harvest medicine for themselves. I think that’s part of the connection to the earth, but if people can’t do this for themselves, I’ll do it for them. I don’t charge people for plant medicine.”
Maresca’s path into Western medicine started in an urban Indian community in Brooklyn and then a community in Long Island. Her father was one of many American Indian (mostly Mohawk) men in the 1950s who left the reservation to earn a living as a steelworker. Maresca, who was the eldest of 8 children, remembers how her mother and others were treated when they sought health care, “I was profoundly uncomfortable because people like us didn’t seem to get equitable health care. I didn’t want to be like my own doctor. I remember thinking – we can do better. All people deserve better health care. I didn’t think of it as a Native issue. I thought of it as a human issue.”
Maresca’s frustration with health disparities was deepened when during high school and college summer breaks, she worked for a surgeon in Harlem. The patients often had complications due to diabetes and other conditions. “I wondered how their situations could get so bad. I felt that no one should have to go through this,” she recalls.
Maresca earned her B.A. at Vassar College in Upstate New York. She chose to attend Albert Einstein College of Medicine, in part because it was close to home. When she started medical school, she learned that spirituality and plant medicine were not considered part of Western health care. “Fortunately, I became active in the Association of American Indian Physicians,” she says. “The physicians in AAIP had direct or indirect exposure to these things. It’s part of who we are. They helped me keep these things alive.”
Working as a student leader in AAIP, Maresca was amazed at the wonderful role models, including Dr. Joe Jacobs a pediatrician from her tribe. “I spent a summer with him in Gallup, New Mexico working for Navajo Nation. I had been exposed to another Mohawk community during college when I worked on environmental issues, but this was the first time that I was exposed to another tribe. My experiences that summer convinced me that I wanted to work in a Native setting.”
Maresca had already decided to be a family physician. “I saw family medicine as a way of providing social justice. You have responsibility not only for individuals but for communities.”
Navajo Nation was far from home, but when she graduated from medical school Maresca went even further from home. Maresca says that in doing so she was following her grandmother’s advice to go to the best possible place for her education. Maresca did her internship and residency at Group Health Cooperative of Puget Sound, which is one of the University of Washington’s affiliated residency programs
Her first real job was working as a family physician and clinical director for Indian Health Service on the Rosebud Reservation. She also worked at Kyle at a clinic on the Pine Ridge Reservation. In the Dakotas she met Michael Grijalva, a dentist who was a commissioned officer in the IHS. They married and moved to Tucson where Maresca worked for the Tohono O'odham Nation.
In every community Maresca learned about plant medicines, “Everywhere that I worked, people were using plants from their area or other areas. Our tribes were smart. We traded seeds and ideas. Seeds were precious. If you were from an agricultural tribe and didn’t have seeds, you were dead.”
Maresca realized that many of her patients were using plant medicine. “If you talk with patients about plant medicine, it opens up another door in the relationship,” she says. “It opens up the possibility of healing.”
Next Maresca worked in a community health system in the Tucson area, serving a low income and ethnically diverse population. She also ran a primary care teen clinic for Planned Parenthood that was free to ethnically diverse youth.
Teaching appealed to Maresca. In 1997 she took a staff teaching position at the relatively new Seattle Indian Health Board Family Medicine Residency. It is the only residency program in the country that focuses specifically on the care of AI/AN people. Soon Maresca was made residency director. In addition to her other responsibilities, she taught a class in plant medicine that was open not only to her residents but also to physicians in other family medicine residency programs.
When she joined the residency program, Maresca was given a faculty appointment in the Department of Family Medicine at the University of Washington, which eventually led to her current responsibilities.
How does Maresca juggle her many current jobs? “My work is linked,” she says. “I can care for people. I can influence the workforce by training the next generation to do a better job than we’re doing now. I can also work with other entities that are trying to promote the bigger picture, such as the Robert Wood Johnson Urban Indian Health Commission.” (Maresca was appointed to the commission from 2005 through 2007.)
Maresca helps bring balance to her life with personal interests, such as her beloved peacocks, camping, cooking, travel, and beading and jewelry making.