Terry Maresca
Combining Western and Traditional Medicine
Terry
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
(UWSOM). She
was, and still is, a clinical associate professor in the
Department of Family Medicine at UWSOM.
Maresca
teaches medical students and other students at the
medical school, and she supervises residents at
the Seattle Indian Health Board Family Medicine
Residency Program.
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.
Other Teaching
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.”
Beginnings
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.
Many
Hats
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.