Skoll World Forum Interviews: Spotlight On Indigenous People’s Day

Host (00:02):
Welcome to Role Models for Change, a series of conversations with social entrepreneurs and other innovators working on the front lines of some of the world’s most pressing problems.

Andrea Garcia (00:13):
My name is Andrea Garcia. On my maternal side, I am from the Mandan, Hidatsa, and Arikara Nation from the Fort Berthold of the reservation in North Dakota. I am a physician specialist. I work with the LA County Department of Mental Health, where I work specifically at the American Indian Counseling Center.

(00:33):
While I am a physician, I only do that a day a week, and the other time I get to spend working on what I like to call the systems change or the structural determinants of American Indian and Alaska Native Health.

Matthew Beighley (00:45):
Day in and day out, what are you focused on? What’s the problem that you’re addressing?

Andrea Garcia (00:48):
Yeah, so as a physician, I truly believe that Indigenous health can flourish where we have our ancestral wisdom. And so what that means to me is even within my mental health practice, bringing Indigenous concepts of wellness into that practice, even though they might not be evidence-based as academia likes us to follow. We know that these ways work with Western ways. So that’s what that looks like in the clinical sense. But also for larger problems that I’m specifically addressing like housing and homelessness, specifically, we know that our community has the answers. We know that we know how to take care of each other. It’s just that from a systemic point of view, we are not a part of the system or the tables. And so specifically bringing resources, partnerships, relationships with Indigenous communities and the systems that be, like the one within which I work, is a way in order to elevate our knowledge, but also give us the resources to be able to take care of our relatives in a way that we know how.

Matthew Beighley (02:08):
Can you give me a case study or an example of what’s an example of something you’re trying to bring in that wouldn’t, in a clinical way, have been recognized before?

Andrea Garcia (02:16):
So specifically in the clinic setting, there are cultural ways of being in practices. Let’s use traditional healers as an example. I work for a county system, and so every service that we do is billable. Specifically because I’m in the county, Medi-Cal is a big reimburser for services. If we were to bring in a traditional healer, there’s no way that we could bill for that service. Or if we’re to bring in other community-defined evidence practices, those also are not reimbursable within our current system. We know that those alternative ways of connecting with our clients is what gets them coming back to us for services. But unfortunately, it’s really hard to do that in a system that’s structured to not embrace those other practices. That’s one example.

Matthew Beighley (03:16):
What are you up against? Can you articulate the obstacles that you have?

Andrea Garcia (03:21):
I think the obstacles that we have, again, particularly working within a local government, is our systems aren’t built to include our ways of knowing and ways of being. That includes, again, use of ancestral knowledge, traditional healers, talking circles, drumming, and what that means in the context of mental health and therapy. Again, we can’t reimburse for that.

(03:50):
In other ways, in some of the larger systemic work that we’re trying to do, we want Native housing. We want to prioritize native people so that they can be together and build community together, to do placemaking together. Our system tells us, “Well, that would be discrimination if able to preference Native people in certain ways. Our system is not built for that. The Fair Housing Act, oh boy, watch out. You’re really going to cause us a lawsuit there.” It’s those very specific laws and policies that we haven’t been able to delve into, even though we know that other places are already doing it, which is the shame of it all, is that LA is far behind other cities within the country that are already doing the things that we want to do. I think it’s an investment of time and finding the correct expertise to bring to the table to allow us to be able to implement the practices that we want to do.

Matthew Beighley (04:56):
Again, I’m imagining someone watching this might be like, “Well, what do you mean by a healer? What are they bringing specifically that they wouldn’t get otherwise?”

Andrea Garcia (05:04):
Absolutely, sure. As Indigenous people, we know that health is mind, body, spirit, and also emotional. We often think of it in the context of the medicine wheel, which is typically four quadrants. It’s physical, mental, spiritual, emotional. Currently, the way that our Western services are structured, even though I am in a mental health clinic, it doesn’t often include the spiritual/cultural component. To everyone, but specifically to Indigenous people, that is a huge way of life. It’s not just something that you do on certain days of the week or certain days of the year. It is fully integrated into your life. Specifically people who live in urban areas have lost that connection along the way. When we say that we really need to incorporate the cultural-spiritual, again, it’s because of our worldview and going back to that medicine wheel, and so having our systems support that worldview would mean everything to truly healing people that work within. We’re not just treating them. Our goal is to find that common ground and to begin to heal so that they can move forward with their lives.

Matthew Beighley (06:29):
Is it working? Are you changing hearts and minds and moving the needle in your direction? Or maybe you’re not.

Andrea Garcia (06:35):
Sure, I would say from the systemic lens, we are slowly changing hearts and minds. Working in as large of a government as Los Angeles County is, it’s at glacial speed. But that said, we have been able to get some wins to be able to support some of the larger initiatives. Whether that means creating full-time positions that are specifically stewarding American Indian, Alaska Native homelessness within certain spaces, or having specific representation on certain boards, we’ve made space for that. We’ve made changes within how we collect data for American Indians, Alaska Natives. We’re getting philanthropy to buy in to support our community-based organizations. It’s happening and there’s also a little of impatience, specifically as it relates to homelessness and housing because we know that people are suffering right now every day. Yes, it’s happening, but we also know that those slow changes are going to be more sustainable.

Matthew Beighley (07:42):
Can we focus on the homeless issue?

Andrea Garcia (07:44):
Mm-hmm.

Matthew Beighley (07:45):
How big of a problem is it now and what are the consequences?

Andrea Garcia (07:50):
Yeah. LA as a whole probably is leading the country in homelessness. Unfortunately, the data that we have, which we typically rely on the point in time count, is not representative of the true magnitude of homelessness for American Indians and Alaska Natives. Based on figures we’re able to pull together with our homeless services agency, it seems as if Native people are disproportionately represented at a rate of, I think two to three times their actual population. What the actual numbers look like, allegedly, there’s about 2,400 relatives who are unhoused, but we, again, believe that’s a gross misundercount. We have the largest population of Native Americans in the country residing in Los Angeles County. That small percentage of our population just doesn’t fit with the other risk factors that we know our population carries. We actually think that the true proportion about 15 to 20% of our population. Yeah, that’s where we’re at in terms of numbers.

Matthew Beighley (09:05):
What’s a solution? What can we do about this?

Andrea Garcia (09:07):
Yeah. I think from the top down, our solutions are representation in the homelessness services system. It’s representation in decision-making bodies. I think equally important is having our community-based organizations who know how to reach our communities at those decision-making tables, but also building the capacity within to be a part of the system and to be able to take on the funding, the resources so that we can better serve our relatives. That’s one piece of it. The other piece is having those with lived experience guide those decisions. I think it’s working on this problem of erasure via data. Some people call it data genocide, so making sure that we’re accurately counted so that we can also accurately and proportionately receive the resources that we need. From a larger point of view, I also think it’s a justice issue. We have tribes indigenous to Los Angeles that have been systematically dispossessed of their land. There are zero reservations in Los Angeles County, and that’s not by mistake. There’s a movement now in native communities everywhere, some people refer it to as Land Back, but it’s not just land back for land’s sake. What that means is also access to sacred sites. It’s access to cultural practices. If those communities feel that they want to build a space, whether it’s actual housing or not, that is also bringing them back home.

(10:52):
One thing that a lot of people can’t wrap their heads around is what homelessness means to Indigenous folks in general. That’s not only just literal physical, a sense of being unsheltered, but it also includes spiritual, cultural homelessness, mental and emotional homelessness. It means folks who are also displaced due to climate issues homelessness. Our Canadian relatives have made 12 different definitions of what homelessness means to Indigenous people, and those very much apply to the folks who have been displaced and moved into Los Angeles as well. I think that the recognition of those types of homelessness is also imperative when we think about changing the system. We need our system to understand that those are important in how we conceive it, and accessing lands to do that, to be together, to think about what home means to Indigenous people in urban areas is absolutely necessary.

Matthew Beighley (12:06):
Just the erasure of Native Americans through American history, there’s still consequences today of all that. Do you feel comfortable giving a broad comment about that?

Andrea Garcia (12:16):
Yeah. Native folks have been systematically erased, and clearly it starts with colonization and then the genocides that happened. That’s not named, by the way. Other countries have named and even apologized for that, but the US doesn’t acknowledge it. I think that’s also a sense of erasure. But even through our policies of assimilation, boarding school, literally having mottoes of, “Kill the Indian, save the man,” is a way of erasure. I have grandparents that went to boarding school. I’ve never heard of some of the things that other people talk about, the abuses, but I know my grandpa couldn’t speak his language. That is the root of erasure. After assimilation didn’t work, then there was this idea of relocation where people would go into cities. That’s how my grandparents ended up in Los Angeles and to find jobs. “We couldn’t kill them, but we’re going to try to save the man even more and bring them outside of their home, their homelands.” That’s another way of erasure. If you look at Los Angeles and you think about it, there is no ethnic enclave, if you will, for American Indian, Alaska Native people in Los Angeles That’s not a coincidence, it’s by design.

(13:46):
But further, if you think about our educational system, the most that I ever got about American Indian, Alaska Native people was our fourth grade mission projects, which was also very harmful to our relatives who were from those homelands, right?

(14:06):
Including now the system that I work in, we don’t even report the data in a way that is truly representative of the multiple identities that we hold as native people. For instance, I identify as American Indian, Alaska Native and on my paternal side, I’m also Mexican. But according to our system, I would not be classified as American Indian, Alaska Native, even though I’m an enrolled citizen, just by sheer way of reporting and how our systems choose to report data. Erasure is real.

(14:40):
Even if you walk through Los Angeles as opposed to Seattle, for instance. In Seattle, you see Native art, Native spaces, Native places in Los Angeles. There’s not that. If you do find it, you have to look really hard or you have to know what you’re looking for. We’ve done a really, really good job of erasing Native people, specifically in LA.

(15:03):
I will say on that though, the film industry is bringing more representation like with Killers of the Flower Moon, which is great. A couple TV shows that are excellent, and it’s really amazing. That’s our film industry. That doesn’t coincide with our actual services for people, our actual economic support of Native people. It’s an interesting dichotomy of, “Oh, okay, you’re getting representation,” and we like that and we also need more than … Narrative is the beginning of it, but also how we’re able to sustain healthy lives for everyone moving forward. This idea of … It’s not reparations because I know the African-American community uses that term, but reconciliation, I think, and what that means in terms of how we’re actually going to improve the lives of Native people. That’s important and that would be visibility.

Matthew Beighley (16:05):
What’s your vision? What’s the world that you’d like to create?

Andrea Garcia (16:09):
Yeah. A physical, literal manifestation of what I’d like to see in Los Angeles specifically are Native spaces, places that it’s not just housing, but they’re community hubs that are filled with art and culture and social enterprises where we’re bringing in community members, bringing in jobs. We’re supporting them in their love for the arts and bringing back culture. I see partnerships and relationships outside of our community as well, where we realize how exactly interdependent we are with other minoritized communities and we embrace each other’s gifts and contributions. Yeah, I see visibility, and once we have that visibility and those physical spaces and places, then can we have our journeys to healing and becoming fully, holistically the people that we’re meant to be?

Matthew Beighley (17:28):
What’s giving you hope?

Andrea Garcia (17:29):
Ooo.

Matthew Beighley (17:29):
If you have hope.

Andrea Garcia (17:34):
Yeah. What’s giving me hope is the folks in community that I get to work with on the daily. The folks on the front lines of our organizations who are meeting our relatives where they’re at, whether that be in shelters on the street, or even relatives who are recently housed. They bring such a passion to the work, and their voice is so important. That gives me hope because they’re fighting on the daily. More importantly, the people, the patients, the clients that I get to work with, they bring me hope. They’ve gone through it, they’re still going through it, and the fact that they’re able to bring themselves into this county space that I work in and are seeking healing is probably the most powerful thing. It’s a privilege that I get to see. They give me hope.

Introduction (00:02):
Welcome to Role Models for Change, a series of conversations with social entrepreneurs and other innovators working on the front lines of some of the world’s most pressing problems.

Byron Ninham (00:13):
Hey everybody, my name is Niigaanigwaneb in Ojibwe, Byron Ninham is my name in English. And I come from the Red Lake Reservation in Northern Minnesota. So right now I am the Program Director for We Are Healers. We Are Healers as a non-profit, focusing on inspiring, connecting, and advising medical students and medical granting schools, medical granting institutions who also have a larger population of American Indians and, or Alaskan Natives on best practice technical assistance.

(00:53):
But right now, I am currently as Program Director, I work directly with students within our Healers community circle. So we are able to provide networking supports, support financially with their preparatory exams, prep courses. Those that are pre-med, we’re able to support them with their MCAT fees and other preparatory courses necessary to get them to that finish line, and then possibly even into post-BAC programs across the country.

(01:35):
An organization started by one of my mentors, Dr. Eric Brodt [inaudible 00:01:39]. He’s an Ojibwe man from Minnesota and he is a family medicine physician. And my cousin, Dr. Amanda Bruegl, his partner, she is, I believe the only American Indian OB-GYN oncologist in North America or possibly the world. I would assume it’s the world. And they’re over at Oregon Health and Sciences University, currently.

(02:19):
But the organization in itself did start out as a media company. So they’re mainly creating content, and this is well before TikTok, Instagram, even YouTube as YouTube is right now, highlighting those stories. As I talked about before, it’s difficult for us to see it, to ourselves doing it if we don’t see, or it’s difficult for us to believe it if we don’t see it. It’s very difficult for us to believe that we are as good or better as our peers, if we don’t see somebody in our profession who cares for us and loves us, and can relate to us on a individual level.

(03:16):
So, that’s where we’re seeing the tides changing. We’re really having an understanding. And I really do believe that I’m able to take my experience not only as an American Indian student, but as a caregiver, as a caretaker, as a programmatic person, as somebody who’s able to work the nuances of tribal relations and university relations to, I just want everybody to win. The only agenda that I have is that we have a healthier community, and that improves incrementally.

(03:59):
I’ve had conversations over the week and possibly over my career, where people say, “Well, how can you measure it?” And I say, “It’s hard for us to measure this within a year or even two years.” And the measures are seeing a healthy child from a healthy mother and healthy father 10 or 15 years down the line, but not letting them stray too far off of their path. But being there to provide that bumper to guide them and to support them through their life. So, I’ve been very fortunate in my life to be able to experience some of those. To be that bumper and to be that guard, that guardrail for young people as they’re going through their path of life. And seeing them being successful, highly successful first-generation college graduates. Even taking it a step further back, first-generation high school graduates moving into college graduates, and now professionals in our community back home in Minnesota. So it’s highly rewarding, highly specialized work that we do. And it’s something that is very, very near and dear to my heart.

Matthew Beighley (05:31):
What’s the problem? Just on a macro level, why is there a need for an organization like We Are Healers?

Byron Ninham (05:38):
So I think the problem with the lack of American Indian and, or Alaska native healthcare providers, systemically, we have the highest of diseases. Our heart disease is high, our diabetes is high, our high blood pressure, our blood pressure is high. Our obesity rates for a population that is less than 3% in the United States of America, the original peoples of this continent and of this space, there’s a high need. There’s a very, very high need.

(06:24):
And I think that mistrust or misrepresentation in healthcare is a very, very big factor because if I, myself, I would much more align myself with and my family with a provider who came from the same space that I did, came possibly from the same community that I did. And had an understanding and wouldn’t just check the box. And would look at me holistically on a case-by-case basis. And wouldn’t just assume, “Oh, you’re pre-diabetic, oh, you have heart disease. Oh, you’re obese.” And then tying those all into, “Well, you’re Indian.”

(07:18):
So just covering broadly, having that understanding that this would… Having people that are more representative of the community that they serve and that they come from would be lifesavers. I mean, it would really change lives and save lives and extend lives. I really do, I believe it to my core, that we’re the ones that are going to save ourselves. And nobody’s going to come in who’s not from there. They may fly in and fly out. They may spend their time and do their time, but they’re not going to lay their roots down and raise their children in our communities. And if they are, it’ll be on guard. So, that’s what I see for the importance of growing our own and having them have the opportunities to come back.

(08:36):
But then it even speaks to a larger concern, ensuring that hospital systems and healthcare systems are equipped to handle new physicians, new physicians that are coming in, so that they can do their best job. So, having these layers and these systems that work in cohesion and together and understanding the changing dynamics of healthcare and representation within healthcare is really… It’s not something that I do particularly, and I feel like I’m unraveling more of an onion. But I do see that as a major accelerator to good things in our communities across America.

Matthew Beighley (09:34):
What’s the world that you’d like to see for your children?

Byron Ninham (09:43):
The vision that I have for my children is for them to completely understand and love their people. And to love our language and to love our ceremony, and to love their relatives. And I really do believe that we are raising great people. And all the credit goes to the generations before me who really had fraught battles, wars that they fought not only in their daily life but systemically.

(10:39):
And I would say that my parents did the very, very best that they could and gave us everything that they could. And then it became our responsibility, my generation’s responsibility, my siblings, and I, and our partners, to take everything that was given to us up to this point and build upon that so that our children are going to have everything and more. And then it’s going to be their responsibility, but not too soon. I think that’s the other part, is we need to really be aware that my generation, we’ve still got a lot of work to do.