Visual aphasia is the loss of the power of expression. Ordinarily, it is a quick evaluation. Are words slurred? Do sentences make sense?  These are critical clues in evaluating whether or not a patient has had a stroke.  Easy to assess if the patient speaks English -  but what if the patient only speaks Navajo?

“A case that stands out for me was of a Navajo elder who had asked to be taken to an ER.  By the time we saw him, he clearly was not functioning well.  But there was no translator available and no way to tell if he had had a stroke or if it was something else," Dr. Anthony Fleg, a physician with the Native Health Initiative (NHI), told a group during a recent presentation at UNM Hospital. 

“When family members began coming in, it then became quickly obvious from the way he interacted with them that his speech was fine.”         

Yet language is only one potential barrier to providing medical care to diverse groups, he said. Cultural and historical factors can always come into play.

 “Sometimes my job seems more like that of a journalist,” he said.  “It is the act of putting clues together.”

The Native Health Initiative (NHI) is a partnership of health, indigenous, social justice and youth organizations, along with tribes and individuals of all backgrounds who are working together to address inequities in health in indigenous communities. Working with the UNM Health Sciences Center Office of Diversity and other HSC and UNM Hospital organizations, the Native health Initiative is sponsoring a number of programs throughout the HSC.

“My observation as a teacher of medical students is that out of fear of saying the wrong thing, they are often afraid to ask questions in the realms of culture and health,” Fleg said.

Yet, they are hungry for knowledge in how to treat patients from diverse backgrounds.

“We don’t do a good a job teaching about health cultures. Students are eager to learn but they don’t have enough places to learn.  We are trying to create more of those forums for them,” Fleg said.

At the same presentation, three medicine men spoke to the group. They talked of how they see their work as a partnership with western medicine and how their roles differ. 

“You have to be very confident in working with these illnesses. You have to take on the illness from the patient,” one told the audience of students  and providers at UNM Hospital.  They spoke of the need for empathy and compassion in order for the healing process to become complete.

The Native Health Initiative began in North Carolina in 2004 and moved into New Mexico in 2008. Fley completed a Family Medicine residency at UNM in 2011 and is currently family physician with the initiative.

With the Health Sciences Center Office of Diversity and the Committee of Interns and Residents, the group also co-sponsors a “Health Through a Native Lens” – lunch time talks for interested faculty, staff and students.

“The 'Lunch through Native Lens' community has been really interested in looking at spirituality and health ,” said Fleg. “We think we can do more things that are ‘out of the box’ through a more community-centered approach for education.”

Other Native Health Initiative programs include a number of mentorships and student internship projects throughout the year as well as grants and collaborations that can improve health in native communities.

One of the unique traits of the initiative is that it is predominately driven by volunteer efforts with 95 percent of the projects funded though ‘loving service” and only five percent in monetary donations.

As an example, the group sponsored summer ‘Health Justice Internships’ in New Mexico and Arizona that brought health professions students to work in tribes and indigenous organizations on community-driven health projects. In total, the work generated 6,000 hours of “loving service," while using less than $2,000 of funding.

“We have said from the beginning that we don’t believe a lack of money is what is causing injustices, so the solutions to those problems will be found where the decision-making process is more from the heart and through creating partnerships based on loving service.  If you look at our budgets, we only spend a few thousand dollars a year but there are lots of layers to that spending," Fleg said. "More than degrees and titles, we believe that in order to honor our core indigenous values, it really does lie in how you treat your neighbors

For more information about the Native American Initiative or to join their list serve, go to  www.lovingservice.us.