I Want Them All To Know That I'm Fighting For Them
An In-Depth Interview with Dr. Mary Owen, Director of the Center of American Indian and Minority Health by Kimberly J. Soenen | June 29, 2022
Recently, I spoke at length with Dr. Mary Owen about her lived experience as a Native American woman, physician and citizen.
Dr. Owen is a member of the Tlingit nation. She graduated from the University of Minnesota Medical School and North Memorial Family Practice Residency Program before returning home to work for her tribal community in Juneau, Alaska. After eleven years of full-scope Family Medicine, she returned to the University of Minnesota Medical School in Duluth in 2014, and became the Director of the Center of American Indian and Minority Health. She is the current President of the Association of American Indian Physicians.
The University of Minnesota Duluth is located on the traditional, ancestral, and contemporary lands of Indigenous people. The University resides on land that was cared for and called home by the Ojibwe people, before them the Dakota and Northern Cheyenne people, and other Native peoples from time immemorial.
Ceded by the Ojibwe in an 1854 treaty, the land holds great historical, spiritual, and personal significance for its original stewards, the Native nations and peoples of the region. University of Minnesota recognizes and continually supports and advocates for the sovereignty of the Native nations in this territory and beyond. The University affirms tribal sovereignty and works to hold the University of Minnesota Duluth accountable to American Indian peoples and nations.
Dr. Owen’s leadership role includes the development and management of programs to increase the numbers of American Indian and Alaska Native (AIAN) students entering medical careers. She also directs outreach to local and national Native leaders to ensure University of Minnesota Medical School remains responsive with AIAN healthcare and educational needs. Her program stewards an AIAN educational track for all students interested in providing healthcare to AIAN communities.
She also develops research efforts to address AIAN health disparities across the United States model of shareholder-driven private healthcare and continues to provide clinical care at the Center of American Indian Resources in Duluth, Minnesota.
We discussed her perspective on what’s needed now from physicians and medical students working within the United States medical industrial healthcare complex.
(“I am the change.” Photo by Dr. Chip Thomas.)
Soenen: What did you witness as a child, young woman and adult early on that made you want to become a physician?
Dr. Mary Owen: So many things culminated in my choosing to go into medicine, but if you go all the way back to my early childhood, it didn't take me very long to feel like “other” or “less than” as a kid growing up in the United States.
I think back to kindergarten when I started to realize that there were—well, even before kindergarten—stratifications in society that were based on things like how you dressed, right? I learned in school, very early on, that stratfiications and judgement were based on what grades you got, how you spoke, how you looked, all of that. It didn't take me very long before I realized that skin color was part of that judgmental and dismissive equation.
Soenen: How did that realization at a very early age shape your youth and world view?
Owen: Being a child, and wanting to belong, I knew I definitely was not “in.” I was impoverished. I was born into poverty, I was raised in poverty, and I was brown-skinned. I was also female. All of those factors worked against me.
Soenen: How did you push through those feelings of marginalization and hurt at such a young age?
Owen: Most kids—most adults—just want to belong. So, I went through school trying to make friends with the kids who seemed to be popular rather than making friends with other Native kids. I got a job at age thirteen so that I could buy the clothes that helped me to “fit in.” I did all of those things kids do to make sure that they are part of the mainstream and not standing out. You go through life living with all those factors, but it's all taking a toll on you and you recognize at a very very young age that somethin' doesn't feel right. All of those factors and experiences combined moved me to become a physician.
Soenen: Did any of your childhood experiences and memories plant a seed for your work, focus and motivation today?
Owen: I had experiences happen in school that made me aware I was different. In junior high school I was called a “muck” and “muck” is the equivalent of the “N” word for Native people in Alaska. My teacher didn't do anything about it. It was like that for me as a child, time and time again. Adults in positions of authority, in my experience, did not seem to protect Native kids from feeling “less than” or “other.”
Soenen: How did you navigate that hurt at a young age?
Owen: I had saddening experiences of “othering” over and over and over throughout school. I was on food stamps (Supplemental Nutrition Assistance Program / SNAP to prevent hunger insecurity) with my mom, and I was a member of a family that had a terrible car. All of those things combined to make me feel “less than” as both a Native and an impoverished person. So, I just tried to belong by making friends with the other kids. I chose not to be part of Native Indian Studies, and tried denying that side of myself, even though my family did not encourage denying my own identity.
“I also want all of my patients to know that I'm there for them and that they matter to me. I want my students to know that they matter to me. I want my family to know that they matter to me.”
— Dr. Mary Owen
Soenen: How did you perform as a student in the midst of all this internal dissonance and strife?
Owen: I was always a very smart kid, but all of those negative experiences impacted me, and I did not excel as much as I was capable of doing in school. I did graduate and I did get accepted into college because my standardized tests scores were outstanding.
Soenen: Where did you want to go to college and where did you attend? Was it a positive experience for you?
Owen: I attended Carroll College, in Helena, Montana, and for the first time in my life I began to hear some true history being told. I had a little inkling of history in high school, but not enough to understand the gravity and scope and scale of racism. Nobody in my family had gone to college, so I didn't know what to expect at college.
At Carroll, I had a few really good professors who taught the truth about who we are as Native people. I started to realize, "Wait a minute, this is how I feel."
You know when our brains mature, and we get the right affirmations and messages about our truth, things start to change. I started to realize that up until that point in my life I had been taught lies and historical inaccuracies. That’s a pretty heavy realization for an 18-year-old to absorb. It makes you rethink everything and everyone. So, college truly opened up a different view of our world for me. That has informed my work with undergraduate and graduate students in the program I direct at the University of Minnesota in Duluth.
Soenen: Teens, especially, channel anger, alienation and frustration in a not-so-healthful direction. Were you able to contain, manage and direct your frustrations, anger and feelings of dissonance in a positive or healthful direction? And, if so, how?
Owen: Well, a lot of it went internal and I ended up havin' pretty bad depression in college. Go figure, right? I returned to Alaska after college to work, and pay off my college loans. Then, unexpectedly, I was accepted into an academic program that allowed me to go to Paris, France, just to learn openly for about ten months. That time in Paris was the first time in my life—ever—that I’d had complete anonymity. It was a new start for me. A new life. Freedom.
Soenen: What influenced you or moved you the most in the context of health, healthcare and Public Health while in Paris as a young woman?
Owen: I found James Baldwin.
I started reading Baldwin and it was profound for me. It allowed me to help to start to piece together what had happened to me earlier in my life. His words validated my feelings about the cruel, barbaric, unjust world we live in. It was the first time as a young woman that I recognized that it wasn't just me being crazy. It was the first time I recognized that other people felt this way about the world, too.
Young people always think they are crazy when they feel organic pangs of injustice. You feel injustice at the gut level. It is primal, especially when you are a kid. You might not have the language as a kid to explain how you are feeling or the historic reasons for it, but you know when you have been wronged, judged, and hurt without reason. I gained a lot of insight and confidence from reading James Baldwin and Doris Lessing.
Soenen: How did you decide what to do with those revelations and experiences?
Owen: After college I worked for the police in Alaska and everything confounded because it's all there within law enforcement—the racism, the power imbalance, the judgment, the oppression. I got a job with the Alaska Alliance for the Mentally Ill, because my soon-to-be mother-in-law worked in Mental Health as a Social Worker for the state of Alaska. She helped me get that job.
Soenen: What did you witness while working with mentally ill Native American persons in Alaska?
Owen: For the Alliance I traveled out to tribal villages and met with people all over the state. It's sad because when Native people develop mental illness in a village, after a while, the villagers can't handle them and the mentally ill persons get lost. Fear-inducing incidents happen to community members who witness mentally ill persons in distress. So, the village elders and leaders would say "You can't be here anymore," and they'd send 'em back to Anchorage where they'd live in the Alaska Psychiatric Institute. Native people would eventually be checked out and get lost in Anchorage floating around like ghosts in the streets. Can’t go home to their tribal village, can’t get care. Literally, the walking dead.
Soenen: What stuck with you most about witnessing how mentally ill persons are treated on the whole by society, and especially in your tribal villages?
Owen: My job was to help deal with the stigma of mental illness. Because villages weren't set up to deal with mentally ill or depressed persons, my job was to educate them and that taught me the extent of the health crisis within the Native American community—mental illness, depression, alcoholism, substance abuse, poor health in general—which was all rooted in the feelings that I was having inside of me. I knew I needed to meld the two—my inner world and what I was witnessing in the actual external world—into action, practice and change. I did not know how I was going to do it, but I knew I had to do something.
Soenen: What decisions did you make for your own life and path after that experience?
Owen: Even as a grown, mature, professional woman it is very hard for me to even put into words. I knew I needed to go back to school to channel my rage and act to change the world as a physician and prevent young people from going through that same process of despair, depression and feeling “less than.” All of those things culminated and I realized I had to go back to school. At the same time, at the Alaska Psychiatric Institute, there was a man named Norwood Knight-Richardson (M.D., M.A., M.B.A, now retired.) He was an African-American physician who went on to become the Vice Chairman of the Department of Psychiatry and Director of the Division of Public Psychiatry at Oregon Health Sciences University. He became a life-changing mentor for me. He was an economist that decided to go into medicine. He also dedicated a considerable portion of his career to Health Equity.
Soenen: What did he teach you and what do you carry with you from his teachings and story today?
Owen: What I learned from Dr. Knight-Richardson is his work lived at the center of Medical Ethics, healthcare and what I value. I thought it would be pretty cool to be able to emulate those values at the intersection of Healthcare Ethics, Native American Values and also represent my community nationally. I wanted to go home, meaning, to my tribe. I wanted to go home to serve my tribe. So that's what drove me to be a physician…that anger, that frustration, but also that knowledge that there are other ways to think about medicine and health that were largely modeled by him as one of the greatest influences during my most formative years.
Soenen: Young people may be interested to learn how you summoned the energy and will to apply to medical school. Where did that will, determination and stamina come from once you made the decision to pursue a career as a physician?
Owen: My dad only had an eighth-grade education, but nevertheless was always down at City Hall pounding on doors and making change politically. He was poor, but knew right from wrong. "The community deserves that, my community deserves this, we deserve ..." he would say. You know, lettin' them know that he didn't care about the status quo. My mom, an Alaskan Native woman, told me about growing up with signs that said, "No Natives or Dogs on the Grass,” and yet she fought.
Soenen: Tell me more about the influence your mom had on you.
Owen: She'd come home from the hospital working as a Licensed Practical Nurse (LPN) and she would share with me the ways in which she was mistreated, patients were mistreated, and how frustrated she would get at work sometimes. But she kept on goin'. She knew that you're either laughin' or you're cryin'. She knew that there was no choice but survival. Survival for some Native people isn't just about survival for yourself, it's about survival for your children. So, she continued the fight. She was always civically engaged and involved with our community. So I had that very early civic engagement and community-building modeling from my parents. Both now have dementia, but they are alive and I carry them with me in my spirit. I only wish I had told them more when their minds were healthy.
Soenen: You have stewarded so many Native students, both undergraduate and graduate level medical students alike, into careers in the medical field and health sciences. Do you remember who guided you when you doubted yourself?
Owen: Talking to people in Anchorage who I respected cinched the deal for me. Other people would tell me the truisms about medicine and medical school, and I would never listen, 'cause I knew that if I did, I wouldn't get to where I needed to be.
Soenen: White Collar Healthcare Crime is at an all-time high in the United States. Rural clinics and hospitals are closing by the day because of financial and staffing distress. Hospitals are filing for bankruptcy by the day. Medical professionals are striking and unionizing coast to coast. Persons in the United States delay and forego healthcare altogether because of hyper-inflated costs caused by the shareholder-driven model of commercial health insurance industry and corporate healthcare. But the Native community suffers the added layers of disregard, bias and cruelty in the context of healthcare access, invisibility, broken treaties and economic marginalization. Can you speak about what that experience has been like for you and your community?
Owen: In school, all of us have learned about populations turning on another population in various countries. Look what we're doing' on the southern border of the United States right now. We have children in cages. Let’s look at the percentage of the United States population that is homeless. We have massive numbers of people that cannot access healthcare. Even with the Affordable Care Act passed and implemented, there's tremendous pain out there. People can’t even afford the Out-of-Pocket costs while fully “insured.” So, people are not accessing healthcare. The question to ask ourselves is: How can we, as physicians, live and work within a system that doesn't afford access to healthcare without barriers?
Soenen: How do we break down those barriers to access?
Owen: We do not have a level playing field. None of us as physicians are looking up, because if we were looking up and looking around, we'd say, "What? How is this the reality?”
Soenen: There are many organizations across the United States who advocate for Patients’ Rights, Patient Safety, Quality of Care, Best Practice and healthcare access without barriers. None of these organizations are pure or controversy-free, but their missions are well-intentioned. Physicians for a National Health Program, The Society to Improve Diagnosis in Medicine, MedStar Institute for Quality and Safety; Health Care Council of Chicago; The Bennathan Lecture Series; National Nurses United; Physicians for Human Rights; Partners in Health; Physicians for Social Responsibility, Students for a National Health Program; Doctors without Borders, The Lown Institute, et al. Some are more than 50 years old as organizations. Are they truly moving the dial on Health Equity, Inclusion and Healthcare Access for All? What is your perspective as a Native woman?
Owen: You know, as ethical physicians and medical students, we should be doing more than saying “I'm for Universal Healthcare.” We should each be acting in collaboration to change this barbaric system, and we're not, because I think too many of us are comfortable in getting through the day. It is a lot of work being an ethical physician and it does not leave a lot of time at the end of the day for advocating to change policy and law.
Soenen: Do you think the United States approach to, and model of, healthcare will change?
Owen: I don't know that it's going to change. My question and my push for everybody is to look up and ask yourself, "Is this what we want?" Right now, half the Native kids leave high school before graduation. We are failing them. If they don't get graduate high school, how can they achieve anything that will empower them economically? They are all internalizing that shame I spoke of when discussing my own youth experience. This system is failing them and it's not just them, we are failing many young people.
Soenen: Ethical physicians work 50, 60, 70, 80-hour work weeks. How do you find the time and the energy to fight this system which overwhelms physicians and other healthcare professionals who are experiencing burnout, fatigue and Moral Harm?
Owen: It's true, it's true. We don't have time. It wasn't that long ago that I was working in that dog-eat-dog system. The only way we're going to get that time is if we fight together for it. We gave over our healthcare system to the commercial health insurance industry, and to the financial industry, right? And now we're paying' for it. I'm seeing' the same thing happen with education and higher education. The first step in changing the system is to have physicians organizing together. We need to unionize as physicians to take back control of Do No Harm policies, Best Practice, Quality of Care and Patient Safety.
Soenen: Can we talk a little bit about Moral Harm and not just in the context of COVID, but day-to-day? When you see patients who can't afford healthcare, how does that impact you, as a physician, and how does it impact your patients?
Owen: Well, that’s just it. Many of us don't cope. Look at depression rates among physicians, the burnout rates among physicians, the suicides by medical students and physicians…and they're at a record high. We don't know how to deal with it.
Soenen: Does that frighten or discourage you?
Owen: I'm involved with other people who have the same concerns in healthcare, and who are impacted in the same way that I am by these access and affordability barriers. I can talk to them and know that they're fighting for the rights of others and that helps me not die inside every day.
Soenen: You mentioned that you liked to run a lot as a teenager to exercise some of your anger and stay healthy mentally. Do you still run today?
Owen: I walk to work every day. I've been doing' that for four or five months and it's been fantastic. So that helps with clarity and health. Two years ago, I remember looking out my window in our building and across the street is the Damiano Center, which is the largest emergency meal provider in Northeastern Minnesota for persons who cannot afford homes or housing. They had a day when they were offering winter and sanitary supplies and people who were homeless were lining up to get a meal and sanitary supplies. And it just, it just made you sick to your stomach because this is the richest nation in the world and this is what we have to deal with…why?
Soenen: That said, what advice do you give to medical students who are, for the first time, being exposed to the realities of practicing medicine in the United States of America today and starting to get depressed about it?
Owen: I don't talk about that a lot with medical students because students have to experience their own lives and decide for themselves what the ethical, most compassionate and humane way forward is for them as healthcare professionals. If they were to ask me though, I would say we need to come together as physicians and medical students to work on changing the philosophy of health in the United States. Profit cannot be the motive for caring for people. The economic byproducts of a healthy society are inherent. So, for me, it's important to emphasize the mission, which is banding together with people who are like-minded and are fighting the existing broken system…or at the least, arresting it somehow, to slow the preventable harm and death that is occurring now.
Soenen: Do you seek out advice from anyone as an experienced physician to keep yourself healthy and mentally healthy?
Owen: What I do not want to hear from someone is advice telling me to go for a run or take another yoga class to deal with the Moral Harm the healthcare model has imposed on us as physicians.
Soenen: What are your thoughts on House Resolution 1976 / National Improved Medicare for All? Is it achievable in the United States? Do you think Universal Healthcare will ever happen in this country?
Owen: Yes. I think it will, but I don't know if it's going to happen in my lifetime. Providers have to get behind it and fight for it with their patients. We know that most all providers do support a Universal Healthcare plan because we are burned out and exhausted by commercial health insurance industry Denial of Care tactics and prioritizing shareholder profits over the health of our patients.
Soenen: With so much political football across the healthcare policy debate, economic upheaval and divisiveness, what do medical students have to look forward to and what is the reason they should be optimistic about the future of healthcare in the United States?
Owen: They should all know that change does happen, albeit slowly, I do know that it happens. It happens at our community level.
Soenen: Is that enough to give them hope?
Owen: Well, the other thing students and patients need to know—especially young Native people—is that we are fighting for them. There are a lot of people out there fighting for you. Know that we don't all think that racism is acceptable, or that marginalization is acceptable, or that economic disenfranchisement is acceptable, or that medical school being unaffordable is acceptable, and so on. We are not OK with what's happening in the world.
They need to hear that.
I also want all of my patients to know that I'm there fr them and that they matter to me. I want my students to know that they matter to me. I want my family to know that they matter to me.
I want them all to know that I'm fighting for them.
Soenen: Are you up for a few non-healthcare related questions?
Owen: Right on, yes.
Soenen: Favorite food or meal?
Owen: Sushi, probably.
Soenen: Favorite band or musician?
Owen: Lately, Michael Kiwanuka.
Soenen: Hero, mentor or influence?
Owen: Definitely it’d be James Baldwin.
Soenen: Recommended reading?
Owen: A book that I'm reading right now is latest one by Jonathan Hari.
Soenen: If you weren't a physician, what would you be?
Owen: Somebody makin' change somewhere.
Soenen: Favorite place to travel?
Owen: Into the woods.
Soenen: Best advice you've ever received and who gave it to you?
Owen: There's so many who have given me great advice.
Soenen: Dr. Mary Owen, what a pleasure speaking with you today. I look forward to following you, your work and your students at the Center of American Indian and Minority Health in Duluth.
Owen: Chi Miigwech. Likewise, you take care.
ADDITIONAL RECOMMENDED RESOURCES
EDUCATION and BETTERMENT
The Center of American Indian and Minority Health was founded on the principle of self-determination. Through Native leadership, they develop Native American physicians, pharmacists, and health professionals. Interested as a student? Reach out.
READING
Stolen Focus, by Jonahtan Hari (Random House / Penguin, 2022)
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Native American and Alaska Native populations were the only Americans to see no increase whatsoever in life expectancy in the two decades preceding the Covid pandemic.
PODCASTS
It Happens Here, Produced by WTIP North Shore Community Radio
Color Code, Produced by STAT News - Racism is America’s Oldest Algorithm: How Bias Creeps Into Healthcare AI
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MENTAL HEALTH RESOURCES FOR MEDICAL STUDENTS AND PHYSICIANS
UPCOMING ENGAGEMENT EVENTS
50th The Association of American Indian Physicians Annual Meeting &
National Health Conference - Washington, DC | July 28 - 31, 2022
Pacific Region Indigenous Doctors Congress (PRIDoC) | July 10 - July 15, 2022
AAMC Workforce Development Summit | July 26- July 27, 2022
AI/AN Academic Medicine Workshop | July 27, 2022