Native American Culture and Public Health | Dr. Claradina Soto

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Good afternoon, and welcome to the Master of Public Health Online Programs Faculty Spotlight Webinar, with Dr. Claradina Soto, presented by the Keck School of Medicine at the University of Southern California. My name is Kiana Carter, and I am the enrollment advisor here for the Master of Public Health online program. And I’d like to thank you for taking time out of your busy schedule to join us. Before we begin, I’d like to review what you can expect during the presentation. To cut down on background noise, please mute your phone line so as not to disturb the presenters. If you have any questions for our speakers, please type them into the Q and A box in the lower right hand corner of your screen and hit send. Feel free to enter your questions as you think of them, and we’ll answer as many as time allows at the end of the presentation. A copy of this recording and slide presentation will be available shortly after. Here’s a quick look at what we’ll be covering today. First, I will share some information about the Keck School of Medicine of USC. I’ll give you some background information about our program director, Dr. Shubha Kumar, who will be available during the Q and A session for any questions. Then we’ll here from William Jardell who will introduce our speaker, Dr. Claradina Soto. Lastly, we’ll end the presentation with a brief Q and A session. Now, let’s begin.

About the Keck School of Medicine, Keck is the oldest medical school in southern California. It was established in 1885. Today it is a place of dynamic activity and patient care, scientific discovery, medical and bioscience education, and community service. The Department of Preventative Medicine at the Keck School of Medicine of USC is known as a leader in public health and population health sciences. It is organized into six divisions. Disease prevention and global health, bioinformatics, biostatistics, cancer epidemiology and genetics, environmental health, and health behavior research. The Department of Preventive Medicine performs pioneering research in areas such as tobacco control, breast cancer, pediatric obesity, global health, interaction between genes and the environment and others. Some key research institutes include the Institute for Global Health, and the Institute for Health Promotion and Disease Prevention Research. Now Dr. Kumar is the program director for the Master of Public Health online program here at USC. She has a background in social return on investment analysis and has successfully led the design and oversight of several programs in healthcare, disaster relief, and education. Dr. Kumar has also launched an international humanitarian NGO, for which she was the Chief Operating Officer. Her recent projects include capacity building of healthcare, NGO’s, and the developing and strengthening of emergency medical systems in Sub Saharan Africa. Now, I want to hand it off to William Jardell who will introduce our speaker.

– [William] Hi everyone, my name is William Jardell and I’m the Director of Online Student Relations for MASA, or the Master of Public Health Student Association. In doing these webinars it gives us as students a way to learn more about the amazing research our faculty is doing and ways in which we can learn more and get involved. I’m very excited to introduce to all of you Dr. Soto as our speaker for today. Dr. Claradina Soto is a full time assistant clinical professor at the University of Southern California Keck School of Medicine. She received her MPH and PHD from the USC Keck School of Medicine, and she has over 20 years of experience working with American Indian and Alaskan Native populations in public health. She collaborates on several research projects with various organizations to reduce and prevent metal health disparities, commercial tobacco use, and substance use disorders. She teaches courses in the Master of Public Health and Health Promotion Programs at USC and mentors undergraduate and graduate students. Dr. Soto is a long time advocate for American Indian and Alaskan Native communities and other priority populations to advance health equity and reduce health disparities. I urge you to listen closely to the great information being presented today and to take notes on any questions you would like to ask at the end of the presentation. Will you please help me in welcoming Dr. Soto to the presentation


– [Dr. Soto] Okay, good afternoon everybody. Thank you so much for this opportunity to be able to share with you about Native American culture and health. This presentation is really primarily to just give an awareness and some information about this population because oftentimes it’s not enough information in our courses, even starting from elementary to high school to undergrad, unless of course you have selected some of these historical courses, right. So it really is a great opportunity to provide even just some of the additional perspective you may not have had on this population. And so I get really excited to be able to share some of this with you. I will share some of the projects at the end of just what’s happening in hopes there might be some opportunity for students to be able to be engaged in, but this presentation is just more about the population, about some of the historical events, and giving an example about a public health environmental justice issue that’s happening at hand in the Navajo Nation. But I definitely will look forward to questions at the end of the presentation, so with that I will just say that I am very fortunate to be here at USC and I am very happy to be able to work with this population, because it’s very much an underserved and under resourced community. We’ll see here in the next slide the number of populations that do exist and so for my self I am full blooded Native American. I am half Navajo and half Pueblo. And so, I definitely learned so much in working and partnering and collaborating with a number of tribal communities with a lot of the projects we have here housed at USC. And so with that, I’ll go to my next slide which is just to really share how many there are of American Indians and Alaskan Native populations in the U.S. And so according to the U.S. Census there are about 5.2 million people who identify as such. There are over 570 plus federally recognized tribes in the United States. I do always like to mention that of that there are over 200 plus readily recognized tribes in Alaska, and I always call them the forgotten group because oftentimes people don’t realize there are tribal communities up there, and let alone that there are over 200. And needless to say I always mention not only are they the forgotten group, but some are hard to reach communities because they can be accessed by plane or only by boat or only by snowmobile. Of course you can understand the environment which some of these folks live in, and so it’s just important to be able to recognize these communities up there. And there’s definitely a lot of great work being done as well. Just a note here that the Navajo Nation is one of the largest Indian Reservations. And that of these groups there are over 200 indigenous languages spoken, and so it’s important to know that there’s a lot of culture, there are a lot of unique differences, but a lot of similarities. But it’s great to know that there’s a lot of the culture preservation that exist in many of these communities. And I wanted to just note as well that you’ve already probably heard different terminology, I don’t have the right answer. I often get asked, you know, what do, what is the best way to say Native American, American Indian, it just, it differs. I have learned in different communities I have gone to to use certain terms. Obviously the most appropriate would be to be calling these communities by their tribal names that they prefer to be called by. And so, even to say the Navajo Nations, the folks like to be called which means the people. So you have different terminologies or different ways that tribal communities like to be called, and so just wanted to make note of that as well. A bunch of my work is being done in California, and many often don’t know that there are over 100 federally recognized tribes in the state of California and so there’s a lot of work to be done here. Especially because you also have the Urban Indian population you may question what is an Urban Indian? And these are individuals who are of American Indian ancestry that relocate to an urban area, either to seek employment, to get an education, or it could have been by forced relocation, primarily by the U.S. Government. And so I myself am a product, I always say, of being an Urban Indian. Born and raised in the Bay Area, so Northern California, in Saliendo, near Oakland. And so I am of an Urban Indian, not of a California tribe as I’ve mentioned, my tribes are from the Southwest. But this is really important in terms of when it comes to conducting research and trying to collaborate and partner with the Urban Indian population. And so oftentimes that means go to different Urban Indian agencies and organizations that exist throughout different areas in the Bay Area, here in L.A. Downtown L.A. has the United American Indian Involvement which services the Urban Indian population with behavioral health services, mental health services, medical. They have programs to work with the elders and with the youth, so there’s some great comprehensive programs to reach these populations. My next slide here is just to show a map of some of the more common tribal communities that exist here in the United States, and just by location. And I always like to note that in the U.S., there’s only 35 states that have tribes, and so this kind of can be an indicator in terms of the administration, you know, the U.S. Government and where folks may say that they don’t need to have this community on their radar and trying to create better services, because they don’t have tribal communities in their state. But, that’s not needless to say that there’s a lot of great efforts that’s still needed for various communities that do exist with the over 570 plus federally recognized tribes here in the U.S. Another question that always gets asked is, how can one become a member of a particular community here. And so, this is always a big, this deserves I think a whole session in itself. But, I’ll just take note here that it is, tribes to establish their own criteria for membership, as this really provides the unique character and traditions of each tribe. And so each tribe does, are able to establish their own membership criteria. And so, typically this could be more of the general piece here where a tribe may say that have to show that they are a fourth tribal blood, a descendant of a tribal member. And so usually if you already have your parents or grandparents as an enrolled member to a tribe, you just can indicate that and then the tribe will see that lineage for you to get your tribal membership. It is important to note though as well that you can only enroll in one tribe. And so I myself being full blooded, I can only enroll in either the Navajo side or the Pueblo side and so I actually am an enrolled member in the Navajo Nation, but actually my children are enrolled in the Pueblo. And those are for various reasons, but in any event these just gives you an idea of just kind of that process of what happens and how this membership is actually also important in terms of resources being made available to the American Indian community. The other important piece that’s important to make students aware of and even just the general population is about tribal sovereignty. So with federal recognition, American Indian tribes can self govern themselves as sovereign nations. And so they’re maintaining their own government to government relationship with the United States. And so, I like try and see it as how California is its own state. Well, each tribe is kind of its own state as well because they are able to govern their own tribal members, their own tribal land, and provide their own infrastructure for their own community. But we do have to abide by federal laws in many ways, just as other U.S. states have to do that same thing. But, this part is very important, especially in just the work that I do with some of our research projects because we want to be able to respect the tribal sovereignty of these communities. And so this comes in to, this is a very important piece because when it comes to laws and policies, some of my work is in tobacco control and California has done an excellent job in trying to reduce tobacco, commercial tobacco use in the general population which has reduced, but that has not been the case for our populations here, the Native American population. Because there’s a lot of work to still be done. So the communities here, the tribes, don’t have to abide by state laws, meaning that they don’t. So a lot of the casinos here in California, they allow smoking. And they rightfully should have that right to do so, because they have the right in their government and their laws to be able to do that. And so that does take extra effort for us to make sure that they understand you know, the education and the implications on some of these policies here. But we have to respect that, that’s their laws that they govern by. But the other piece that is important is that any work that’s being done is you have to have the tribe be a part of that process. Because they too have to be in collaboration and in partnership in any work trying to, especially when it comes to public health and health promotion. So, I oftentimes have to start with the tribal leaders and get tribal approval for any work that’s being done in collaboration so that they know that that partnership is happening. So this is just a really important piece to be able to highlight here, especially when trying to work with various tribal communities just throughout the United States. So, with that I’d just like to highlight again when working with tribal communities that you want to be able to respect the sovereignty, develop a relationship. That is so important because you want to be able to nurture that. And so, oftentimes when we have these grants and different projects, these grants, we need a long term grants mechanism, because it takes awhile. If you don’t have an established relationship, it could take three to five years and maybe even more just to develop a trusting relationship in working with tribal communities. And so, for that to happen then you can next be able to work on some of the needs and what are some of the areas of concern that the community wants to be able to work with with your project. So, including them in the process is absolutely key to any type of work. And so many of you probably have learned this in your courses already with community based participatory research. And so that means the tribe, the communities being a part of that process because we just don’t want to be able to take. We want to be able to have that mutual relationship with both academic and with the community as well. So with that, being that a lot of our work here is in public health and there’s a lot of unfortunate health disparities that exist in this community, I’d like to just kind of give a brief history of this and really get us in the mindset of just how to be mindful of some of the traumatic events that have occurred since the time of the so called you know, Columbus had discovered America but you know, in the thousands of years preceding European contact much of our native communities were organized in societies with their own forms of government and their own way of life, right. So once you see these events of just kind of these historical topics here that have happened from 1492 up until the present day, there’s a lot of things that have occurred during that history time that really has an impact and can show some of those correlations into some of the unfortunate health disparities that exist in this community. And so, with that colonial period you know we had this proliferation of European colonies really creating a dominant presence you know on the East Coast of North America, right. So a lot of the Indian lands were forcefully acquired by the Europeans which led into the removal of a lot of tribes and forced migration of these tribes to move west. I mean, this even came to a point where at least 90 million acres of land the Natives were living on were taken from tribes and given to settlers as a surplus, most often without compensations to the tribe unfortunately. So during this time there was a lot of removal and a lot of now putting these communities once living in their way of life onto these reservations now. So not only have you removed them, but you’ve place them on these lands that they now have to be able to adapt in a new environment, new culture and way of life, new sources of food and other things. And this of course is a very resilient community, but you have to think about some of those things that they now have had to adapt to. And currently still too to this day, living with some of those folks being on the reservation. And so you had all of that during that period, and it’s a big piece of this is really this assimilation that happened with the U.S. government trying to assimilate the native communities into mainstream society. Really trying to not only remove them from their land, but remove them from their cultural way of life. And that in and of itself really has an impact and so there’s a lot of things that have happened within that history to be able to do that. But needless to say, in the 1930’s you know, we did have some sort of, this kind of Indian Reorganization to be able to give back and where the federal government began to restore some of this Indian land and creating programs to rehabilitate and the economic life for this community. But, needless to say what happened after that was this unfortunate termination period where the government, the congress decided to terminate at least 100 tribes, really creating an economic disaster for many tribal communities, again resulting of millions of acres of land being lost and of course, the way of life for many of these communities. But as of now, so you have to think of that time, that’s just not too far ago you know from the 50s and 60s. Now we have here this self-determination period which is absolutely happening with our communities, being able to have this kind of resurgence of tribal government involvement with Congress to be able to have not have any additional terminations but to really provide that state recognition and federal recognition to those tribes and develop more policies for self-determination and self-governance as well. So this I just like to kind of point out, as it’s important to be mindful, as this does have an impact on how this creates some of the public health issues in this community. And so with that I wanted to kind of share a little bit more about some examples of this assimilation and how this happened. And so, they had back in the day General Richard Pratt, which he’s famous for his quote, “Kill the Indian and save the man.” And when you think about this quote, this is trying to take away the language, the culture, the way of dress, but to Americanize him basically. And so you can see this picture here of this Navajo gentleman in his traditional wear, but three years later he is now transformed into this kind of militant looking individual. And this really was based on folks being part of this boarding school which the government also had as part of their systematic way of assimilating Native children in the school system, of assimilating them into mainstream society. Right, so just another systematic way of the government. And so, this picture here is of the Carlisle Indian Boarding School. That happened in the late 1880s to early 1990s. And again, these boarding schools were developed to assimilate American Indians. And so this school is very well known in Pennsylvania, which this became the model for at least another 26 boarding schools in 15 states. And also hundreds of private boarding schools sponsored by various religious denominations. And so actually both my parents are products of boarding schools. My mother being taken away from her family at a very young age, I want to say six, seven years of age and living in a boarding school. Being raised by non-Natives and not being able to speak her language. Her mouth being washed out with soap if she was to speak her language when she’s trying to speak to a peer of hers. Which none of them knew English at the time, right, but that was something that they were mandated to do. And if they broke any type of rules or laws within this boarding school they were reprimanded. So there was a lot of physical abuse, verbal abuse, and even sexual abuse that happened in these boarding schools. And so, again this is just another indication of this assimilation practices that occurred by the government that really has a major impact on this community, long standing for sure. Again, even me having my own parents being part of this system, a product of this system. And so you can see that this new terminology, it’s not new, but more of this is coming in to the research of this historical trauma, which really is just showing the experience of the series of traumatic events by the U.S. government and how this has implications to our community in many ways because of this listing that you see here of all these different acts that had happened. So this does now reflect, you know, in our communities the higher than average rates of suicide, homicide, domestic violence, child abuse, substance abuse. And really, because of these attempts to assimilate our communities and our populations by forcing them into these boarding schools. But then also thinking of these others of putting them into reservations now, which then they have changed their diet, their culture, et cetera, et cetera. And so with that you see a lot of these, and so within the research there are questions now that we have to indicate if folks think about these historical traumatic events, what are some of the symptoms that are now occurring. And you really see a lot of these breakdown in our families because of this forced removal of our children, or because of these other historical events that have happened and are reasons for high rates of child abuse now. And you have to think, if these folks that were taken into these boarding schools or raised in these boarding schools, you know, their parenting style can definitely be different, and there’s a lot of even just, a lot of healing that needs to happen because of the abuse and other traumatic things that have happened while being in there. And so, there’s a lot of higher rates now of domestic violence and I think there’s just a lot of anger issues that are still happening that need to be dealt with, and a lot of healing, as mentioned, that needs to happen in this community. And then we also have just a lot of psychological issues happening that are really impacting a persons well being. You know, unfortunately, higher alcohol consumption, substance abuse, unfortunately having low self-esteem. This being because of cultural identity, having a lack of positive role models, excuse me. But then also these other physiological things that are happening as we do have higher rates of heart disease, injuries with diabetes, and other issues at hand which I think are on my screen. Yeah, so in terms of just the health status as well, again being that there’s just, there’s many causes of health disparities that really span the life spectrum within this community with high infant mortality rates, high prevalence of chronic diseases, mental health disorders, and substance abuse. But I do give, but there is a lot of resilience that has happened in this community and culture has definitely been one way to not only heal but also a way to promote the well being in the community. Here, when we compare the American Indian Alaskan Native population comparing them to the overall U.S. they are younger, poorer, and more likely to be unemployed or lack health insurance. Again, suffer from high rates of a number of health related illnesses. And then also too have a lower life expectancy than the general U.S. population. So with that, there are a number of health risks, of course, based on this, you know. And there’s a lot of issues that are related and complicate things. These are just a number of public health issues that need to be addressed and so here is some of my work it’s trying to reduce mental health, reduce substance use, tobacco use, and some environmental issues as well in this community. But this definitely deserves a lot more attention and oftentimes I do ask that if you are sitting in a table, the representation needs to happen to bring this community their issues to the table. So even if as you’re just learning some of this and you are in a meeting, maybe your job is in a county or you know in some agency and there’s things happening for other communities, I do ask that you pose the question of how are they reaching this community and how are some of the issues being addressed. Especially if it may relate to some of these topics here that you see on this slide. So that’s just kind of that little piece of that health promotion, those things to keep in mind when you think about how, why are there a lot of health issues and health disparities in this community, when there’s a lot of things that have happened through history that absolutely have an impact on this, and so this deserves a lot of additional attention, a lot of additional work to be done and a lot of collaboration and partnership with these communities to be able to address the various needs within these communities. And so, I’ll leave it at that because my next slides are to also provide an example of just kind of the public health issues of high rates of cancer, high rates of other illnesses due to uranium mining. So I’ll go ahead and go to this next slide here. This is something that I was able to do over 20 years ago and that sounds so long ago, but this is still an issue currently on the Navajo Nation where the community is dealing with a lot of high rates of cancer and high rates of black lung disease, other illnesses due to radiation exposure. And these aren’t just folks that worked in the mines, but their families and families that live around abandoned waste sites, abandoned waste that sits on the reservation. So it’s always to great to just increase your awareness about current issues that are happening just here in our own backyard in the United States. And so this map here just shows where the Navajo Nation sits in the Southwest. Most of parts of Arizona, parts of New Mexico and Utah. And so my family’s from Farmingon, New Mexico, right near the four corners. And I had an opportunity to do an internship in my undergrad years. So, it was familiar territory but living there was another interesting aspect in trying to just understand this issue at hand. Because we were trying to increase the awareness of the community that we needed to get congress to take action. To not only help those that were sick but to also remove a lot the waste that was sitting in the community. But this picture here just shows of some documentaries that have been done about this issue, and so this is a picture of just Navajo miners to give you an idea of just their work environment. Because many of these miners were working for two dollars a day and not having much fresh air, where those that were working in the mines had no proper ventilation and so they were being exposed to this radioactive material daily. But little did they know what they were being exposed to, they had no idea at that time. But the companies did, obviously. So this is just showing how uranium is a naturally occurring radioactive element, and so many Navajo men worked in these mines and these mills. Jobs were near their home and was one of the only jobs available at the time, which was during the 40s and 50s. There was many jobs that included different positions. Again, no protective equipment was provided, and so they inhaled a lot of the dust and drank contaminated waters near these mines. This picture here also indicates how the environment has been contaminated, because a lot of the excess waste that they didn’t need they would just shuffle it over the cliff sides, and so that gets into the farm lands, it gets into the animals that graze. And so sheep is a staple in this community. Many families when I would go home to visit grandma, she would butcher a sheep, and we would have a wonderful family feast. But these animals are ingesting contaminated things within the environment and again it’s getting in to a lot of the farming, the communities that farm as well. The picture on the bottom indicates a lot of the abandoned sites that still sit in the community. EPA has done some work, the Environmental Protection Agency, where some places have been considered more hazard than others. But there’s still a lot of abandoned sites that have not been touched because they don’t quite meet that criteria. But needless to say, there’s a lot of exposure still happening in this community. Especially for those with this picture here shows an abandoned mine, so you see how vast the openness is. And this is from some of the work that I did over 20 years ago and I was very thankful to these folks because they told me to stay away. If I wanted to have children, to stay away from these abandoned sites because the question was how much exposure could get you sick. So, I definitely kept my distance. But there was a lot of children that were playing in these mines not knowing, or in piles of the mill tailings. And often time some of the families are taking these chunks of the ore of the leftover sites to build their bread ovens or even have as their own home foundations, or build fire places. Now knowing that they are being exposed to radioactive elements on a daily basis. And so this picture here, if you can see kind of that there’s a dark mountain in the back, but the lighter one in front of that is the actually mill tailings waste that sits in the middle of the reservation near to the city. And so this is covered with cement, but needless to say once this has been dug up and put out still that exposure can exist. So no matter how thick that cement is, that exposure is still radiating out into the community with the beta gamma alpha rays, I don’t know which one of those, but you get my point. I’m sorry I’m not the scientist here on this piece, but this just kind of gives you an idea of how long and how much of this waste sits in this community and still being exposed, where they’ve picked up and collected some of it, but again it still sits in a community exposing a particular community there. And the part about this is that you know you have over time this seepage that this is now getting into the groundwater. And so there’s a lot of research actually being done by the University of New Mexico which I’m really thankful for. And they’re really identifying a lot of contaminated areas and sites. And really I think this is also helpful to ensure that future mining is not going to happen. Because there’s still a lot of high rich deposits of uranium that sits on the Navajo Nation that the government wants their hands on. And we want to make sure that the Navajo Nation government, again who is a sovereign entity and they can make that decision to say yes we’ll allow you. But being more informed and knowing how much harm this has caused this community and the environment that hopefully it will keep the additional mining from happening in this community. And so again, there’s just a lot of diseases now that are happening in this community, with higher rates of lung cancer all because of these exposure to byproducts. You know again in the soil, air, and water. This is something that has been happening in terms of the knowledge of knowing that correlation of being exposed to radiation and the outcomes of cancer and other illnesses that are because of this exposure. And so this really has really created an unfortunate piece for the community. And so real quickly, what’s happening now is that the community has really fought hard in the past 20 years with some good leadership taking it back to congress to at least get compensation, so those miners, former miners, their family, the wives, the children, are able to apply for compensation of up to $150,000, which some folks say is such an insult because this barely pays for their medical bills. And so it’s really a challenge to get that money, because you have to prove, show documentation, that you worked with one of these companies or that you were married to a miner to be able to help pay off those medical bills. There’s just a lot of loops and barriers to this and it’s a very big challenge, but there’s people that are helping people get compensated. But there’s a lot of appeals that have to happen, because you get rejected the first time and then you have to continue to reapply. But it is reaching some but it has missed a lot because there’s been a lot of losses due to this because of the illnesses and deaths related to the cancer from being exposed to all of these materials. And so that’s just something at hand that’s happening in this community. Again, wanted to raise your awareness about this because many of us have no idea that this is happening and it’s still being fought til to this day. And folks trying to remove this contaminated stuff in their community but also help those that are sick. Shifting gears a little bit, I’d just like to share this other story because this is part of the resilience that’s still happens to this day. And this is a story of culture, quick story. But this is the Pubelo Revolt that happened in 1680. And so again, this is not included in our history books and it absolutely should because this is where the Pueblos in New Mexico revolted against the Spaniards who were trying to acquire land. And so this picture here shows the different Pueblos in New Mexico, and Jemez, with is J-E-M-E-Z, right above the Pueblo. But all of these Pueblos were organized by a leader, a Taos Pueblo leader named Popay. And so he is the one that is well known for organizing a rebellion against the Spaniards. And so you see a picture of a statue here that they have up in New Mexico. And in his hand he has a rope of knots. And so he had every Pueblo, he made sure that every Pueblo got this rope of knots because he had said that every morning that the sun comes up to remove a knot. And when we get to that last knot, on that day is when we’re going to revolt against the Spaniards. And so that was a way of them reuniting, getting together, and organizing themselves. Which they of course had a great victory against the Spaniards which is great. So a victory for the Pubelos I should say is why a story of how they still exist today. This next picture is just because I love to share a little bit about Jemez Pueblo and so that is a picture of myself, my father, and my two children. I do need to update this because my son now dances as well. So my daughter and I are both dressed in our regalia for our traditional feast day. It is open to the public, it’s always on August second. And so we dance and it’s a time for our community to come together, and for prayer, for growth, for well being. And so there’s a lot of preparation that happens for this feast day, which one is baking bread because that’s our main tool. Instead of using a fork and spoon, you know, our bread is used to dip in the red chili stew, and the green chili stew. And so this is our oven here that is a fire that’s made and that’s out we remove all the ashes and put all the 70 plus loaves in bread in there, cover it up, and the bread is nice and done in an hour. But you see here, just my children riding their bikes out in the dirt areas, which is just great for the kids to roam because here living in the city it’s a little bit more difficult and letting them around to just roam around free. So, I love showing this picture and just sharing a little bit about the Jemez culture because I often do ask students, you know, what do you picture when you’re thinking of native communities and so it’s great to just share even just the regalia of our community here. I have a few more minutes, but this here is just a slide just showing some of these common values among native communities. And it’s about sharing, generosity. You know, no matter how much has happened in this community or in the communities I should say, there is oftentimes just a lot of sharing and generosity and oftentimes it’s great going to different conferences that are Native specific, because there’s just a lot of sharing and a lot of generosity and just being thankful for the things given. Family is very important, community and tribes. And I always keep that in mind, especially with all the work that we have done because everything we do, and at least with our projects is for the community and for these families and the tribes. And having respect for elders, I’m sure this is very much a common value for many folks in different communities. But we often want to make sure that we respect our elders and go to them for guidance, and making sure that we are doing things in the most respectful way. And again, orientation to present time. You know, it’s great that us here in modern day life, we’re always worried about time and this and that, but it’s always orientation to present time is just in the moment and so, if I have a two o’clock appointment but I’m meeting with a community, we could be talking for another two hours. And you’ve just go to be in that present moment and at that present time and be respectful of that for this community. The other piece that’s interesting is communication, and I wish I had more time because I have so much that I have learned with communication with this community in terms of trying to introduce myself and being a part of different projects and collaborating and partnering. But it is absolutely important to have face time, to be able to introduce yourself to the community, because a phone call is just not going to work. You definitely want to be able to always, these are very general of course, I want to say that. You know but, speak slowly and pause while telling a story because overall with this communication I’ve learned that not all communities but some is that that direct eye contact is important. Where they don’t necessarily look, sometimes the eye contact is looking somewhere else and people can think of it as being rude. And so when I train others to go and help out in the community when we’re trying to gather information, I oftentimes will let them know that it’s not, if they’re not looking at you, don’t take it as being rude. That’s just how it is. But they’re still listening and still paying attention to things. But these are just some of those things that I like to bring up but it doesn’t mean that it’s for everybody, but these are things that I have absolutely learned along the way as well. And that of crust they don’t, there is a lot of distrust of outsiders. And so again that’s part of building that relationship with these communities as well. The other thing that I like to provide is just again with your work being in health promotion, there’s health promotion messages, this is just an example of how trying to reach a specific community with a specific message that absolutely resonates for this community. And so, being in tobacco control and all of this great anti-tobacco messaging that has happened out for the general population, we have to be careful because some of that doesn’t quite resonate with us, where you’re telling our communities, our native communities that all tobacco is bad. Well, it’s not, because tobacco is very sacred to us and it’s used in traditional ceremonial and medicinal ways and so, how do we give back to give that message to show that we must preserve that sacred part, the sacred tobacco. But also knowing that if using tobacco in an abusive way, using recreationally, that this can be harmful to your health and that’s not, we definitely want to provide that message as well. So, back in my work, this was made over 10 years ago, but it’s great that we’ll still see this poster in various clinics and other Native agencies throughout California. This was put together where we were only allowed to provide, to create one health promotion message. And how difficult was that, knowing that we have a beautifully diverse community throughout the state of California. So how were we going to try and reach all. And so we did it to the best of our ability, which then we had to ensure that we were using peripheral strategies. Matching the surface characteristics, meaning the community that you’re trying to reach, right. And absolutely having the number four constituent involving strategies, where you’re involving the community, you’re involving those that can provide that guidance. And so, this really had, with that guidance they said let’s create, let’s try and create something with the four directions in mind, the north, south, east, and west. And so with that in mind, the woman is reflective of the Northern California tribes. Yurok basket is representative of how Southern California tribes weave their baskets. And for the east and west are the tobacco plants that grow to the east and to the west side. And so then you have the messaging that has to be clear, right. I can’t quite read it from here, but hopefully you guys are able to with that message that is supposed to resonate with this community where it’s saying you know, that the Creator gave us tobacco to bless our families and our community right. But if you smoke commercial tobacco and abuse it, it’s going to create harm. So we want to keep tobacco as a gift and not to be abused. And so, I just wanted to provide that example of how use some of those strategies in trying to create public health messaging for this community. So, with that, that ends some of the stuff that I wanted to share with you all. But I also wanted to just share some of the funded grants I currently have. Hoping that if you have an interest in working with some of the projects that I have going on currently, we are looking for students to help with data entry, maybe literature reviews. So folks knowing that many of you are online students and may not necessarily be here, so some may be able to come to the office, but others might be able to work remotely. We are searching for folks for students for some student help. It could either be volunteer or it could also be for credit, and I forget what those class credits are. But other folks on the line from the MPH program can share with that. But we do have a couple of tobacco related programs for smoking cessation. Trying to help Native teens quit smoking or quit using many of these other nicotine products such as e-cigarettes and the vaping, things like that. But then we also have a social media project where we’re training Native youth to develop their own media messages with digital storytelling, photo voice, public service announcements. And they being peer educators back to the Native youth, but also then to tribal councils to create tobacco policy changes. And then we have another that’s looking at community readiness in tribal communities throughout the state of California, where we’re trying to understand if tribes are adopting state policies or state laws. So for example, California just passed a low of having to be the age of 21 to purchase. So are tribes also adopting that law. If they are, we’re asking why. If they are not and choose not to, we’re asking why not, just to kind of learn a little bit more about some of the different policies that are in tribal communities as it relates to tobacco control. And this last one is really addressing the opiod crisis. Native Americans have some of the highest opiod use but also opiod related deaths. And this is a really serious issue happening at hand. And so, there’s a lot of funding being made available to some of the tribal communities and Urban Indian populations in California. So, us here at USC are tasked with the needs assessment to learn more how this funding can be helpful, to create treatment services, prevention, and other services to culturally reach these communities. But also evaluation with a lot of these projects that are being funded and making sure of showing this is how this is creating an impact to reduce opiod use and opiod related deaths. So, with that I want to say thank you, and I know I went a little bit over time, but looking forward to some of your questions. So thank you everyone.

– [Kiana] Thank you, and that’s all right you went over a little bit. That was a lot of great information that you shared with us today. And we are so grateful for you being with us on this webinar. I’m sure we do have plenty of questions, so we are going to open up the Q and A session. I do want to remind students that our program director Dr. Kumar is also on the line available for questions as well. I’d like to go ahead and start off the Q and A session. Actually looking back at some of the research opportunities that you have available right now, and you were talking about some of the roles that you’re trying to fill. What steps do students take to participate in any of your research opportunities, what would they need to do to participate.

– [Dr. Soto] Yeah, so with my information up there it would just be great to just send an email. And sending in email, it would be great for this to start in spring, just to make it easier that way. So again it could be volunteer or it could be for credit. And then we can just touch base. And usually I’ll ask for a CD and just a statement of interest, and then we can take it from there to see how we might make this an opportunity. So, just emailing me and then I’ll probably follow up in November or December and try and figure out how we can best get the help for a number of these projects.

– [Kiana] Okay, great. Thank you so much for sharing that information. Our next question is for you Dr. Soto. Do tribes have their version of public health departments internally that work with federal and non-profit public health workers?

– [Dr. Soto] Yes, they do. Tribes have their own departments, in not all but some. And so some infrastructures are stronger than others. And actually these are some of the entities that we have to go through. And so, like even with our research project where we have our own academic IRB, ensuring that we are not putting any human subjects at risk, we have to get that certification and approval. Well, some of the tribes also have their own departments as such where we have to go through their protocol and IRB process as well, ensuring that we’re not putting anybody at risk as well. So yes, they do. And then some either internally fund themselves or they get the support of government support or that federal funding support their departments.

– [Kiana] Okay thank you. Our next question is as a student, are there grants or scholarships available for this very important research.

– [Dr. Soto] Yes, there is. I actually ask you all if there are opportunities, I guess I can share that for the MPH to share with the MPH list serve. That might be helpful. I mean, this could be both ways, where students may want to work in this capacity or they may want to get the funding. So this could be either for Native students themselves wanting that additional research experience. Or those that are non-Native but then just wanting to see what other opportunities, they have that available. Things that I have I can definitely share your way too, if that’s helpful.

– [Kiana] Absolutely, absolutely, thank you so much. Our next question is for health care workers is it hard or not an option to conduct studies from afar since in person interaction seems to be of great importance.

– [Dr. Soto] So meaning for public health workers working in tribal communities? Am I understanding that correctly?

– [Kiana] I am going to assume that, yes for public health workers yes.

– [Dr. Soto] It’s important to absolutely have that in person interaction. That is absolutely of great importance to ensure that trust and that mutual respect and that continuance of mutual relationships and building and ensuring that you’re trying to meet the needs of a community. So, yes absolutely.

– [Kiana] Okay. Our next question is actually are there popular blogs that I can follow from either yourself or others concerning awareness on sexual abuse, uranium, and other topics that impact Native American culture?

– [Dr. Soto] There’s a number of them out there, and I think the one I’ll mention is Indian Country. So you can actually get a subscription to Indian Country, it’s very inexpensive. And it really provides current event issues. I think it comes out weekly, I could be wrong. But it comes out often, and there’s a lot of different current events that shares information about various communities throughout the U.S.

– [Kijuana] Okay. Thank you for sharing that information. Our next question actually is a three part question. So how has different eras of government been with working with Native Americans. Is it worse now than it has been in the past? Or was there a time it was best as far as the relationship with the federal government.

– [Dr. Soto] Great question. Yeah, that’s a really great question because yeah oftentimes even just when you think of presidents and former administrations. Our current administration, I mean that’s the part that I’m thinking about, right. And how these governments have been, or not working with Native Americans. This really has changed. So I mean I even think of just currently you know, with our former President Obama and really putting a lot of first, or how am I saying this. There’s been a lot of positions having a first time Native American in that position, and that happened a lot with President Obama. Because he really believed in trying to support this community, who again as mentioned, very underserved, very under resourced. And so really working even with youth and having this great, gosh I want to say it was called Generation X and I could be wrong. But he, and it was great that some of my family was part of this where there was just thousands of Native youth that were put together to meet with President Obama and Michelle Obama at that time and things progressed from there, because students were able to share the needs of their community. The things that they wanted to be successful individuals, not only in their own communities but just in our own, and just here today to be successful contributing individuals to society is what I’m trying to say. So, it has changed constantly. Just that quick little history of events of where things were trying to go good, and then all of a sudden you terminate 100 tribes. That again is based on the types of government or who was in government and at the time. So that definitely is scary of where we are currently, and how that is potentially making more harm than good to these communities. And so one example is funding, there’s a lot of funding that’s been taken away that really preserves not only the cultural way of life but education, opportunity for you, but then also for other segments of the population. So, we’re seeing a lot of that unfortunate things happening because of our current administration. So hopefully that answers the question. I’m trying to think of current, past, and how that works with our relationship with the federal government. I mean, there’s a lot that I’ve learned even in our own work here because I think of the huge grant that we got here to learn about the retail environment on tribal lands. And trying to learn about tribally manufactured tobacco products. So, tribes are making their own tobacco products for their own economic infrastructure, right. And so anyways we have some of that work being done to learn more about the retail environment. And we learn that our own community is not using these products, which is a good thing. But we have this federal funding from FDA, and from the National Institute of Health. And so when our communities were learning that we have this funding from the federal government, they definitely did not want, many of them were reluctant in working with us. Because now that’s what the federal government who was trying to put a lot of these retailers, trying to make sure that they were in compliance with the federal rules. Meaning that they should not be selling to minors, which means that they should not be having a vending machine of cigarettes, which means they should not be selling Lucy’s. And so part of our work was to educate tribes of this happening. Because again, they have to abide by federal laws, so then the tribes were worried that federal governments were going to come in to their community and make them do certain things. And so you’ve had some tribes that have had their own tribal police shoo away federal folks that have come on to their own tribal land. So, it gets really tricky. It gets really, that relationship is definitely not a trust one as you can see just with this example I gave. But there’s just a lot of different things that happen and occur that again, that’s why it’s important to understand a little bit about tribal sovereignty and then what does that mean with that federal government relationship. I’ll leave it at that. I could go on and on and on.

– [Kiana] All right, well thank you so much. Our next question is what are your thoughts on current efforts regarding opioids in Native communities.

– [Dr. Soto] Yes, well so I only know of this current. So, I’m really happy that a lot of funding that is coming out from SAMSA to address the opiod crisis in Native communities and populations. So I’m hoping that folks are, tribes and communities are applying for those funds to be able to address it in their own communities. I’m really happy with the state here in California. I’ve worked with a number of state departments before, and so this Department of Healthcare Services has to be one of the most progressive. In the sense that they’re providing funds to Indian Country here in California, to tribal communities to Urban Indian populations to address this. And being, allowing them to have these funds to provide services. So medication assisted treatment services, these MAT programs that they have. That they are trying to address how to best promote training others with naloxone, because many folks have overdoses, and so how we can we try to reverse that right. So by providing naloxone to folks that have overdosed we can save a life. So they’re doing a lot of training with that. And they’re doing a lot of suicide prevention as well. So, the funding is great and I hope that tribal communities are applying for this because I know just here in California it’s a big issue and I know it’s a big issue in other states as well that have the population that are dealing with this issue right now. So, that I know in itself. And there’s a lot of work to be done in figuring out what’s the best way to reach these communities in the most appropriate and the most cultural way in meeting their needs.

– [Kiana] Wonderful. Well thank you so much for sharing that. We’re a little short on time, so I’m going to ask one more question for you Dr. Soto. It’s actually another three part question. But, what online courses do you teach? Do you teach about this topic in your online course, and what other topics do you cover?

– [Dr. Soto] So online course I used to teach the PM501, right, the theory course. But it’s been awhile because with all of this great funding that we have, less time to teach. So I just do more guest lectures in terms of just trying to address certain topics like these. So yeah. I mean, we are trying to, I’d love to have our own class, you know, that’s related to this topic in the Masters in Public Health. But I also know that I’m working with the School of Social Work and so we have a course there. So I don’t know if anybody is a dual degree with MPH and MSW but we have an immersion program that takes graduate students to the Cheyenne River Sioux Indian Reservation and giving them the opportunity to make an impact in this population. So, that’s where a lot of other topics are definitely addressed and you get a whole semester of different issues regarding and how to best reach these communities in public health efforts.

– [Kijuana] All right. Well thank you so much again, Dr. Soto, for sharing with us today. I definitely want to think our speaker Dr. Soto. Dr. Kumar who was also on the line, as well as William Jardell. And I want to thank everyone who participated in today’s webinar. I do want to let you know a copy of this recording and slide presentation will be available shortly after. This concludes today’s webinar. Thank you again everyone, and have a wonderful rest of the day.

– [Dr. Soto] Great, thank you, have a wonderful day.