In the past few days..

This is our fifth day in Cherokee and our third day within the Cherokee Healthcare System and some of the most prevalent issues within the community are substance abuse, diabetes, and domestic abuse. I would say that the diabetes can be related to genetics and deficient health maintenance/knowledge. The resources within reservation are more sparse, there are not any chain stores, there are local restaurants, gas stations, and at least 1 grocery store. There is also one fruit stand that we have seen and stopped at to get some fruit, but the prices are somewhat high which could make it difficult for some individuals to purchase if they have limited funds. Along with this, within households there have been generations that have developed poor eating habits that can lead to the development of diabetes and can continue for generations. Substance abuse among the Native American population can be partially due to historical trauma and grief, also within the rural community there is a lack of entertainment so it is common for younger generations to fall within the same habits of their elders. It was described to us earlier this week by one of the healthcare professionals that in this region it is common that individuals will feel "stranded" in their own community because it is so rural, and there are not as many resources available to leave the area. While attending a rehabilitation meeting I heard addiction described as "fate" for the Cherokee population living within the area because that is what their relatives and everyone has fallen into over the years. Along with that, the leader within the group asked how many individuals grew up with addiction in their home, to which all individuals raised their hand. Growing up in that environment creates a whole other of issues because most children are like there parents in some way, some for the good and some for the worse, and unfortunately although there are many wonderful traits, there are also issues like addiction occurring. Domestic abuse goes along with substance abuse and poverty on so many levels. A lot of these issues also stem from the grief and trauma felt by the Native American population due to having their culture stripped away by the "white people." There are many programs and therapy programs available to the population in Cherokee, one of the best thing the healthcare systems is doing is providing behavioral health services, and in most cases behavioral health conditions are their primary diagnosis, followed by their medical diagnosis. Based on their model of care behavioral health is the root to the health problems occurring and because of this the nurses and healthcare workers within the CIHA network are all trained to handle the care for these individuals on a high level. I think the center of the healthcare system are definitely the customers of the health services. The individuals of the community vote for the members of the tribal council that make decisions regarding care, and pay to provide care for all. This is definitely different than the way healthcare is ran outside of Cherokee, generally it is ran by a system that the customers have to follow, where here it is catered to the people who receive the healthcare. The system they have here is unlike anything I have observed anywhere else, and the amount of consideration and level of care they take to provide the best outcome for their population is on a completely different level than any healthcare system I have ever learned about. There really is pride in this community, and they are all working together to create the best outcome and to recreate and bring to life their culture again, and it is definitely a beautiful thing to be able to see.