Wabanang Kuczek
Wabanang
Kuczek, Yaqui, MPH, PA-C, has provided leadership in
the PA world for many years. In 1995 she was one of
the founders of the First Nations Council of Physician
Assistants. As the first national organization
representing American Indian physician assistants, the
group had caucus status under the American Academy of
Physician Assistants (AAPA). Members of the
organization recruited and supported American Indian
PA students. Their projects included providing health
screening and education at gatherings, such as
powwows. Kuczek was also involved in lobbying with the
American Association of Physician Assistants. When the
following article was published, she was caring for
patients in the department of emergency medicine at
Kaiser Permanente in West Los Angeles.
Preventing
Illness and Honoring Traditional
Knowledge
Wabanang,
what do you regard as some of the key health care issues
facing Indian people?
I’m a Yaqui
Indian from Arizona. As part of the minority populations in
this country, we, like other American Indians, have
experienced the burden of poor health as measured, for
example, by infant mortality rates and disability
levels. There is also a lack of health-related
information and resources.
Cardiovascular disease is one of the leading causes of
death for members of my tribe and for other American
Indians. Diabetes, hypertension, high cholesterol,
morbid [severe] obesity, smoking and inactivity are the
most prevalent risk factors of cardiovascular disease found
among our communities.
That was not our traditional way of life. The findings of
several studies support the theory that the increase in
these risk factors is due to the exposure of our tribe to
Western society. This is something my grandfather knew
without having to do any type of research. For example,
obesity in American Indians was rare at the turn of the
century. It became common around the 1960s and now is
higher among my people than any other U.S. population.
Smoking, hypertension and obesity are significantly more
frequent among the Sioux who have had greater exposure over
time with European-Anglo life styles than the Navajo who
have had less exposure and have been able to preserve their
cultural life style.
All over the country when Indians were pushed into barren
lands on reservations, there was a lack of food because
there was nothing to harvest or hunt. Years later, the
government started sending staple food, like lard, starches
and cans of spam, to reservations, and our diet patterns
were changed. I have much reason to believe that this
contributed to the increase of the cardiovascular risk
factors found among our people.
Traditionally, my tribe did not kill animals unless there
was nothing else to eat. Even then, the killing was done in
a ritual manner with much respect to the four-legged
creatures. My people knew the benefits of a vegetarian diet
and exercise. Like the Tarahaumaras across the Mexican
border, the physical activity of my people was remarkably
higher than the westernized populations.
You may have heard of the outstanding running endurance of
these tribes. The Tarahaumaras have remained healthy
because they have preserved a high level of activity and a
virtually meatless diet. In many ways they refuse to
assimilate into the Western world. However, the Yaquis in
Arizona have not been so fortunate. They have had
greater contact with Western society, and I believe that,
in itself, can be considered part of the problem.
Since becoming a physician assistant I have been fortunate
to work in different settings including internal medicine,
family practice, general and cardiothoracic surgery and
emergency medicine. Even though I have the utmost respect
for what we can do for patients in emergency situations, I
have also come face to face and have been disenchanted with
our present health system and the limits of Western
medicine. For example, almost everyday in the ER, we deal
with patients with heart attacks, and we help them prolong
their lives for some time. But clearly, what those patients
really needed was help, years before, to change their diet
and entire lifestyle.
During all these years, I have never forgotten what I’ve
learned from my grandfather who was a traditional healer.
Whenever appropriate I promote the use of Indian medicine
as an alternative treatment. I do believe that what happens
to the body reflects what is happening in the mind and
spirit. Before a patient can get well, he or she must
undergo a transformation of lifestyle and emotions. I also
believe that we all have a great deal of capacity to heal
ourselves.
I am aware that certain acute emergency problems cannot be
cured with a personal transformation, and traditional
medicine is not designed to deal with certain levels of
complications. However, I am also aware and know that
certain chronic medical conditions have been healed through
ceremonial or traditional practices. Because of that, I
believe that medical providers have much to gain by taking
a look at our traditions.
In practicing medicine, I have not given up my traditional
beliefs. Rather I have tried to blend and teach the best
from traditional and Western medicine. I learned from my
grandfather that illness is caused by a disruption of
harmony, which in turn lowers the body’s ability to fight
illness. He told me that illness is caused by the
disruption of harmony in a person’s circle of life.
Disruption of harmony includes practicing everyday habits
that do not promote a healthy and peaceful life. I believe
that, in most cases, health is a reflection of how we
choose to live.
One of my greatest difficulties in practicing Western
medicine is that, every day I deal with people who see
their illness as something physical, without considering
the mind and spirit, without considering the surroundings
or disruption of harmony in which they live. Many times, I
am disappointed to deal with people who have chosen to live
in disharmony or abuse their minds and bodies for many
years. Then they come to the emergency room expecting to be
fixed in one day.
Because of my traditional beliefs coupled with my medical
education, I always advocate preventive medicine, including
the significant benefits of a healthy diet and exercise.
Our ancestors advocated these basic ideas many years ago.
How
did you get involved in the PA profession?
My grandfather,
who I consider the wisest man I ever met, was a traditional
healer. He was known by his works and by the testimonials
of the people. He was well respected by our community. He
was a runner and a very healthy man. He predicted that I
was going to be a midwife, which is something I did before
becoming a physician assistant. Because he was a healer who
I admired very much, I wanted in a way to follow his steps
and help people heal.
I initially obtained a bachelor’s degree in criminal
justice because in those years I wanted to go to law school
and help my people with their legal problems. I also
thought that it was possible to combine the fields of law
and medicine. However, the field of preventive medicine
interested me a great deal, so instead I went to UCLA and
got a master’s degree in public health and became a health
educator at the same time that I was a lay midwife.
One day I met a physician assistant who was taking care of
a rural area near Gilroy, California. He was the only rural
provider in that community. I was very impressed with his
medical knowledge, so he was a great influence in my
decision to apply to the physician assistant program.
I have been privileged to work in different settings.
Presently I’m working for Kaiser Permanente in West Los
Angeles in the Department of Emergency Medicine.
Do
you care for Indian people at Kaiser?
Sometimes, I
see urban Indians. Outside Kaiser though, I am involved
with the urban Indian community and participate in
different health projects regarding health screenings and
health education in preventive medicine.
What
kinds of opportunities are available to readers who might
be interested in a career as a physician assistant?
The need for
more medical providers among our Indian communities is
unquestionable. I earnestly believe that anyone interested
in the health field shares the responsibility of improving
the health of our Indian communities. Diseases that
traditionally were not found among our people cause many of
our deaths among Indians. As a strong advocate of
preventive medicine we have to find ways to reach our
communities and impart the education needed to prevent many
of our people’s present medical problems.
Whether a physician assistant works for Indian Health
Services or other settings, there is the need for helping
Indian people by mentoring, educating, delivering the best
care, and working with IHS leadership to continue the
tradition of dedicated lifelong service. We have several
physician assistants working for IHS who deliver the finest
care sometimes under harshest conditions in remote areas.
The
article above was originally published in the Summer, 1999
issue of
Winds of Change. (The cover
artist is Benjamin Harjo Jr., Seminole Shawne.)
Update
October, 2007
Wabanang Kuczek was recently hired to provide full-time
emergency medicine care at the Physicians Medical Center in
Santa Fe, New Mexico. From 2004-2006 she provided health
care in the Health Services Center at the College of Santa
Fe. Kuzcek believes that health care providers are
responsible not only for taking care of medical problems
but also for encouraging patients to develop healthy
lifestyles. Consequently, when she realized that a large
number of students were smoking cigarette, she created a
successful for-credit course for students on smoking
cessation that included lectures, videos, nicotine
replacement therapy, and individual and group counseling.
In addition, she developed an individualized program for
students who could not take the class due to time
conflicts.
For many years, Kuczek has actively participated in
distance running. In the last few years, she has focused on
the Indian Pueblo races around Santa Fe. Kuczek says, “I
believe that as medical providers, we need to be role
models to the people. In my case, I hope I can do that
for Indian women. More and more, it is pleasing to see
Indian women involved in distance running. I think
that is a great example to others, especially with the high
incidence of diseases, such as diabetes, obesity, and other
associated illnesses. Although we are already seeing a
trend toward improvement in the lives of Indian people, we
can do much more. An important way of helping is through
our own example.”