Decades of Service in IHS
Martha Duganne, Seminole Creek, is a United States Public Health Service commissioned corps officer who was one of the first American Indian registered physical therapists to serve in the IHS. At the time this article was published she was serving the Gallup Indian Medical Center. Duganne is a member of the Acute Care/Hospital Clinical and Administration Section and a member of the USPHS Commissioned Officers Association. She was raised on the Navajo reservation where her father worked for the Indian Health Service.
What drew you into physical therapy?
When I went to college, I had many interests and didn’t know what field I wanted to enter. Like other people in reservation areas, I hadn’t heard very much about physical therapy. When I was attending Arizona State University, my advisor suggested that I look into the physical education program in which they paired physical education students with students who had a disability, such as a spinal chord injury or very bad rheumatoid arthritis. When I started doing this, I began hearing a lot about physical therapy. I also remembered that a family member who had been in WW II gave high accolades to the physical therapists at the VA Hospital who helped him. I was interested in the science and activities of physical therapy. I had always wanted to work with Native people, so physical therapy seemed like a good choice.
I was involved in track and got my bachelor's of science degree in exercise physiology. I applied to the physical therapy program at Texas Women’s University. We spent about a year in Denton, Texas getting the basics, mostly in the classroom. The next two and a half years were a combination of class work and clinical rotations. They divided us into two groups My group went to Houston. I had never been in such a hub of medical care. We’d start off observing once a week. Gradually we spent more time in clinic. Finally we did three 6-week clinical rotations, one at an acute facility, one at a rehab facility and one at a setting of our choice.
Being in Houston was a big change for me. At that time, the population of Houston was about equivalent to the population of all of New Mexico. At the medical center, all the buildings were skyscrapers. I’d go across the street to Rice University just to see a patch of blue sky.
I imagine that was a culture shock What kinds of clinical experiences did you have?
I did acute care in Methodist Hospital in the neuro-sensory center. I saw patients from all around the world. The PT would do baseline muscle testing on those individuals. Then the individual would see the neurologist and others.
Next I went into the cardiac ICU [intensive care unit] at Methodist and did chest physical therapy on folks who had just come out of heart surgery. PTs used to be involved with the respiratory component. Now respiratory therapists do most of that. At Methodist, I also worked with people who had total hip and knee replacements.
My second experience was at Medical Center del Oro – a rehab center. Once patients were stabilized at an acute care hospital, they were sent to us. We cared for people with traumatic brain injuries – usually young males who had been in motor vehicle crashes. The older individuals were usually CVAs [people with strokes] or folks who had hip fractures and were having a hard time recovering.
My third experience was at an out-patient clinic doing general orthopedics. It was a pretty luxurious private practice associated with a hospital. Very different from where I work now. I also did acute care at Doctors’ Hospital in Dallas.
At that time there were state facilities for children. Once a week we worked with these children. Some had rare neurological problems or developmental problems.
Sounds like a marvelous spectrum of experiences.
Yes, I got a well-rounded education. That prepared me for IHS (Indian Health Service) because here you need to be a generalist. You need to be able to shift gears and work with different patients. That’s what is enjoyable.
I got through school with an IHS scholarship grant. I wouldn’t have been able to get this education if IHS hadn’t been available to me.
One reason I wanted to go into health care field was because health care wasn’t as available to Indian people as it was with the general population. I wanted to work with Indian people, so my first job in 1984 was at Chinle Comprehensive Health Care Facility. We saw in-patients and outpatients.
Were you one of the first PTs in the IHS?
There were a few PTs who were in IHS in the late 60s. It wasn't until the 80s that IHS started developing a therapy component. Now they can justify having a PT in clinics that see 20,000 patients.
After two years in Chinle, I went to work at Phoenix Indian Medical Center. I saw a lot of wound-care patients. At that time that center had the only plastic and hand surgeon in the IHS, so I got good experience with hand therapy. We also did electro-diagnostic testing. It was a good place to learn. It was an urban facility so we saw individuals from different tribes – White River Apache, St. Carlos, people from Tucson and Parker, Nevada, Keens Canyon. I was there 5 years.
I then went to a hospital that served the Acama and Laguna and the Navajos from the Canyoncito area. I helped to start a program there. I was the first full-time therapist there. When we PTs begin working in facilities that haven’t had a PT, we have to justify the need for PTs. We have to be sure that the facility is convinced of the need for a PT so that when one PT leaves, the facility will get someone else. Facilities have tight budgets, so you have to justify that need. Many facilities now have full time therapy services.
Then I came to the hospital here in Gallup. It’s a referral hospital, so we get people from all over the Navajo and Zuni reservations. We have surgery, orthopedics – the specialty services. We’re small (99 beds) but we see lots of folks before they are sent back home. And we have about 200,000 outpatients on a yearly basis.
We rotate through the various services, except pediatrics. Because special competencies are needed in pediatrics we have a core group of PTs that cares for children. Our multi-disciplinary team has diabetic clinic days. We work as a team with dieticians, patient educators, physicians, nurses, and others. We do foot evaluation and screening. We also have a clinic for people who need braces and special shoes, and we follow amputees long term.
What has it been like to work with the Indian Health Service?
I enjoy IHS because it’s not-for-profit. You’re providing health care. The private settings I worked in were so geared toward making money. They were controlled setting where you could only see patients a certain number of times. In IHS we PTs have had more autonomy in developing our profession.
We’ve had PTs in IHS who were pioneers in physical therapy. Some have done a lot of diabetic foot casting. We tested monofilaments for testing/screening patients. We worked with EMGs [electromyography] and nerve conduction. Historically not many therapists did that, but we did that work at IHS.
What kinds of opportunities are available to readers who want to become physical therapists?
Physical therapy is such a diverse profession. PTs work in school systems, rehab facilities, outpatient clinics, private clinics, and hospitals. Now we are getting more into wellness facilities. In the private sector, there are PTs at some wellness centers. Out here we PTs are the ones who are developing and managing the wellness facilities.
Within PT we have specialties, but PTs working by themselves in an IHS facility usually have to be able to provide general care. We prefer putting experienced PTs rather than new graduates in facilities that only have room for one therapist. However, there are other openings for new therapists.
Now as tribes are getting money to take on their health care, hopefully they will set up clinics with PTs, occupational therapists and speech therapists. Hopefully we’ll see more vacancies.
Are Indian physical therapists needed?
When I came into IHS I was only the second Indian PT working with IHS at that time. There was one other therapist a year ahead of me. Now about one-fourth of the therapists working among Native Americans are Native Americans themselves. Many of these Native American PTs were IHS scholars.
If we want students to go into health care and other scientific fields, we have to provide strong programs in science and math at the local level. In the past, everyone’s mindset was that if you went into health care, you became a doctor or a nurse. Now our profession is becoming more visible. With our aging population, younger folks have grandparents who have received physical therapy, so they think it’s a neat profession.
You’re able to see the results. You’re not just promoting health, you’re developing quality of life, so people retain dignity and have quality. That’s one of the things I most enjoy.
Are there special needs that Native therapists might be more attuned to?
Each tribe has its own cultural identity and traditions. You need to be culturally sensitivity when you approach individuals and explain things. We orient everyone to that.
It’s always good to have Native therapists in settings where you have individuals who carry their traditional backgrounds. It puts the individual at ease and makes for better communication.
If a Native therapist knows the language, that’s a real asset. Many people are very proud that at our facility we have Navajo therapists, including one who speaks Navajo. Some of the Elders are still only Native speaking.
In PT school we were taught to work with the whole person. When you’re working with Native people, that issue is magnified. You have to consider their spiritual and traditional beliefs and incorporate that into how you are able to help them. We do a lot of teaching. You want the person to understand how what you’re doing with them can be carried over into their home and work. They need to understand the rationale. This translation has to occur even with English-speaking individuals.
You can’t just issue out wheel chairs. You have to be mindful of where people live. Is it rocky? Is there any pavement? For a while, when folks went to rehab facilities in the city, they would come back with inappropriate chairs. We need kind of a 4-wheel drive chair that has tires that can handle the little thorns we have around here.
Do some patients want traditional healers and ceremonies?
Yes, some in-patients will have a medicine individual come in. (Different tribes call that person something different.) We’ll step out while they have a prayer or something. Sometimes patients go home and then come back in. Patients will come in and talk about how they had a ceremony done for them at home, and they’ll talk about how they feel in relation to that. So it’s a matter of respecting that. Acknowledging what’s helpful to that person.
Each facility educates their new people. Here in Gallup, we’ve had a medicine man come in for several noon hour rounds. He’s Navajo speaking. Through a translator, he has talked about different cultural aspects.
Someone who is Native is likely to be more attuned to these issues. But you can educate new people.
The services of physical therapists are greatly needed. It sounds as if it’s a rewarding field for practitioners. Thanks for sharing your experiences and advice.
This article was originally published in the Spring 2003 issue of Winds of Change. (The cover artist is Burgess Roye, Ponca.)