Bell, Lumbee, MD, is a pediatrician who is the medical
director at Pembroke Pediatrics in Pembroke, North
Carolina. He also serves as a preceptor for medical
students from the University of North Carolina School
of Medicine. In 2002, the Association of American
Indian Physician honored Bell as Physician of the
Year. The following are excerpts from an interview of
Dr. Bell that was published in
Winds of Change when
Dr. Bell was President of the Association of American
Indian Physicians. His comments and advice are still
Reflections on American Indian Health
What kinds of health care services are most needed right now by American Indian people?
There are two kinds of services that are needed. One is prevention. Many health care problems are related to life style. Some problems can be prevented. Others problems may not be preventable but the risks associated with diseases, such as diabetes, can be reduced. So we have to think about what we can do to educate our Native people, like how to eat better and exercise more. That’s tough because it’s a lifestyle change. But there have been some very successful programs such as the classic, well-documented diabetes program in Zuni where the Zuni Pueblo people got back to their tradition as runners. That program had a very positive impact, lowering the rate of type 2 diabetes in that community.
Programs that teach young kids to eat better and exercise can reduce the rate of childhood obesity, which puts children at risk for adult obesity and, therefore, type 2 diabetes. In fact it’s becoming more and more common, especially in Native peoples to see teenagers who are already type 2 diabetics.
We also need to focus on AIDS awareness, protected sex, and the use of clean needles. People need to be aware of the risk of fetal alcohol syndrome in the unborn kids of women who drink too much. And we need to prevent injuries by making sure that everyone lives in safe houses with fire alarms and that we take basic safety measures to keep our children safe. Finally, we also need to make sure that even well people come in for preventive check-ups.
The second kind of service our people need is the front-line management of acute problems. This means that systems are in place so that our people have access to good care, and the providers on the front line care about our people and give good care.
What is your assessment of the health care personnel situation in American Indian communities?
Many tribes are working to build strong administrations and recruit and retain good providers. That’s hard because most Indian people live in rural areas, and, in general, all over the U.S. it’s hard to recruit physicians to any rural areas. Also, pay is not as likely to be good. Some tribes are stepping up their recruitment packages with profits from gaming, but the majority of tribes don’t have this kind of substantial income.
Of course right now there are not enough Indian physicians to go around. And the recruitment of Indian students into medical school and into residency and then into Indian communities is a long and tough process.
Given that there are so few Indian physicians in the country you can imagine the demands on an Indian physician who comes back to an Indian community. It’s unreal. The patients want to see you because they know that you are committed and want to improve Indian health care. Also, you are asked to head up programs, be the medical director, and all kinds of other things.
We warn students about burnout. We say, “Be careful. Know when to say no. Pick and choose. Do what you can. Of course you will be appreciated, but a burned-out physician of any race is not good for anybody, not even themselves.”
Is there a shortage in the other health professions?
Sure. We’re short across the board. At AAIP [Association of American Indian Physicians] we push for more physicians, but we also work at getting students in the other health professions.
What about linkages to traditional healers?
AAIP’s mission statement talks about mind, body, and soul and traditional healers and ways. We have to listen to our traditional healers. We have to have links with our traditional healers. We have to work hand in hand with our traditional healers, as Western-trained physicians. We have to do that because we feel that is important, but also our patients feel that is important. If that’s important for them in their health care, then it should be important for us. Our thinking in AAIP is that Western medicine is good, but the best medicine is a blend of the two: Traditional medicine and Western medicine.
What qualities does a physician need to have?
Certainly you need to have empathy for people and for people with health needs. You need to be a good listener and able to put yourself in the other person’s place. You need to have a helping nature and be good with people. It’s good if you don’t mind sharing yourself with other people and have them share themselves with you. You need to be a good student. That doesn’t mean you have to make A’s, but you do need to be a person who likes to learn and doesn’t mind doing some digging to find what you need to know. As a physician you have to keep on top of issues, so it’s important to like learning and be willing to read and do all that’s necessary to keep yourself up-to-date.
How did you get involved in medicine?
I come from a small town, rural Indian community in North Carolina. When I was growing up, there was only one Indian physician in our community. I looked up to that Indian physician. I thought that he must be a genius.
I like working with people and serving people. I love working with children. When I was in high school I had a counselor who told me, “Joey, I know that you’re a bright student. I know that you tell me that you’re interested in medicine, but I’m not sure you can be a physician. Why don’t you be a pharmacist.”
I know that my counselor was basing what he said on the fact that there was only one Indian physician in the whole state. He was just acting on his bias, which I kind of understand, so I went to pharmacy school first. But about half way through I said, “You know this is not what I’ve been called to do.” I’m called to be a pediatrician and so I applied to medical school and got in.
I went to the University of North Carolina at Chapel Hill. After doing my residency I worked in Oklahoma in the Indian Health Service for about four years because I had gone to school on an Indian Health Service scholarship. I’ve been back practicing in my Indian community going on 6 years. I practice about a mile from my house in the community I grew up in. And there are other Indian physicians in North Carolina. So we are making progress.
The article above was originally published in the Summer, 1999 issue of Winds of Change. (The cover artist is Benjamin Harjo Jr., Seminole Shawne. The Harjo studio is in Oklahoma City.)