Martha
Duganne
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.)