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.”