CLINICAL DIABETES
VOL. 17 NO. 4 1999

PRACTICE  PROFILES

American Indian Physician
Comes Home to Help Tribes

Claresa Levetan, MD

Editor's Note: In the "Practice Profiles" department of Clinical Diabetes, we spotlight clinicians who have chosen to dedicate a significant portion of their time to the care of patients with diabetes. We welcome suggestions for future interviews.

Tell us about your background.
I am an American Indian. I grew up in South Dakota and am a member of the Rosebud Sioux Tribe.

When did you decide to become a doctor?
I decided to become a doctor when I was in high school. I noticed that my relatives were complaining about the quality of care they received from the Indian Health Service clinic in our town. My relatives would talk about how they wished that there were more American Indian doctors, but I had never heard of or seen an Indian physician.

Almost all of the physicians that provided care to us were physicians who were part of the National Health Service Corps who were only there for a short period of time as pay-back for their medical school education. There was limited continuity of medical care with all of the changing doctors. I recognized the need for American Indian physicians and thought that, as a physician, I could be sensitive to the special health needs of my people.

My interest in being a physician continued to grow, and I realized that becoming a physician would be a wonderful way to help American Indian people get better quality health care. My belief became stronger and stronger that American Indians deserve to have the highest quality physicians and medical providers possible.

Where did you receive your education?
I completed all of my education at Harvard (undergraduate, medical school, internal medicine residency, and later a Masters of Public Health).

When did you get involved with the American Association of Indian Physicians (AAIP)?
While in medical school, I attended a meeting of the AAIP, which was a real inspiration for me. I was at a conference with 200 American Indian physicians, and I had no idea that this group existed. The AAIP helped me renew my commitment to helping American Indians.

When did your interest in diabetes develop?
I became interested in the problem of diabetes in American Indians as I worked as a general internist in the Indian Health Service following my residency. I spent 4 years in Arizona: 3 years on the San Carlos Apache reservation, as both a physician and the clinical director, and 1 year on the Gila River Indian Reservation with the Pima Tribe. During this time, almost all of the patients I saw had diabetes. I saw how severely afflicted Americans Indians with diabetes are and how diabetes affects people in so many devastating ways. I really wanted to help much, much more, not only with providing patients with diabetes education, but by focusing on how American Indians can prevent diabetes.

Why did you go back and earn a Master's in Public Health?
I was frustrated with the lack of care that American Indians were getting, particularly in the area of diabetes. Diabetes disproportionately affects American Indians, and up to half of the adults in some Indian communities have diabetes. The problem I encountered in the Indian Health Service was my frustration that I couldn't do more for my patients. The Indian Health Service is significantly underfunded, and American Indian people are not getting all of the services and the medical care that they need. I decided that I needed to learn more about health policy so that I could help improve things more globally, including learning how to expand resources for the Indian Health System.

I felt that a Masters of Public Health could assist me in helping develop programs for American Indians. I returned to my alma mater, Harvard, and completed my MPH and also completed the Commonwealth Fund/Harvard University Fellowship in Minority Health Policy. During this training, I realized that I could also have a role in public health and health policy efforts in Indian health. I am currently combining both an academic and a public health career.

What type of medical position do you have now?
I am the deputy director of the Center for Native American Health at the University of Arizona. The center helps tribes access the resources of the university as they develop their own health and prevention programs. A Tribal Advisory Council directs the center, and our activities are based on the requests of tribal leaders and tribal health directors. We are involved in technical assistance to tribes in the areas of prevention of disease, public health, epidemiology, health system development, tele-medicine, clinical subspecialty services, and health careers pathway development.

As the deputy director, I help oversee the activities of the center. I am also a clinical assistant professor at the University of Arizona Prevention Center. I am involved in teaching about Indian health issues, research on diabetes in American Indians, quality measurement, and national Indian health program development. I am a consultant for the Centers for Disease Control and Prevention's Division of Diabetes Translation on national projects related to diabetes in American Indians.

What are the unique needs of the population of patients you serve?
American Indians are a challenging group to provide health care for due to many factors. At least one-third of all American Indians live below the poverty level, and Indians disproportionately suffer from chronic diseases such as diabetes, heart disease, and cancer. The incidence of these diseases is rising. American Indians suffer increased rates of morbidity and mortality from chronic diseases. Diabetes afflicts about half of all American Indians in some communities.

The Indian Health Service was created to help meet the government's trust responsibility to provide health care for Indian people, but the system is currently underfunded at only approximately 40% of need. While the Indian health system is doing the best is can with the resources it has, more help is needed. Some tribes are trying to run their own health systems and generate more outside resources, but the disparities remain. In addition, more culturally and linguistically appropriate health care is needed in Indian communities.

Tell me a little about the AAIP.
The AAIP is a 28-year-old, non-profit organization located in Oklahoma City that has a current membership of more than 270 American Indian and Alaska Native physicians. The AAIP is dedicated to improving the health of American Indian people through its efforts to recruit more American Indians into the health professions, educate others about Indian health issues, assist in the development of health care and prevention programs for American Indian communities, respect and educate others about the role of traditional medicine in the care of Indian patients, and collaborate with government, professional organizations, and other groups of all types in efforts to improve the health of Indian people. The AAIP is busy with the National Diabetes Education Program (NDEP) and its special American Indian Campaign.

As a steering committee member of NDEP, what do you feel that you have uniquely brought to NDEP?
I believe that I have brought a unique perspective of someone who works in the Indian health field and who has seen first-hand how this disease disproportionately affects American Indian people and the need for more education about diabetes in American Indian communities that is culturally and linguistically appropriate.

I applaud the NDEP for developing education messages relevant to populations disproportionately affected by diabetes and making every effort to ensure that these messages are appropriate to the American Indian community. The AAIP will have a central role in making sure that the important messages of the NDEP that diabetes can be controlled and its complications prevented are disseminated to American Indian communities.

I know you are very busy, you recently told me you had a backlog of more than 300 e-mails to answer. What do you enjoy most doing in your free time?
I enjoy going home to visit my family and friends in South Dakota.

Claresa Levetan, MD, is director of diabetes education at Medlantic Research Institute in Washington, D.C. She is an associate editor of Clinical Diabetes.

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Updated 11/99
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