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“Taking a History:” Reflections from the Indian Health Services

In elementary school, Indigenous land lived in my imagination as an expansive, beautiful and windy place. Images from storybooks painted pictures of golden plains speckled with horses, an oasis away from my suburban hometown. History is told in stories and these were the stories we were told.

In February 2024, I had the privilege of serving at the Indian Health Services (IHS) in Chinle, Arizona. This land belongs to the Navajo Nation, a sovereign state only recognized by the US government in 1969, but whose people have tended the land for over 1,000 years.

What is the true history of this place? Who is left out of the narrative?

The history of seizing Indigenous land and violently relocating Indigenous populations is hardly the serene image of amicable trading that I was taught in grade school. The trauma experienced by Indigenous populations at the hands of the US government and oil and energy industries led to a cascade of social, psychological, and physical health issues for Indigenous populations. Over 10,000 Navajos were forcibly removed from their homes in the 1974 Navajo-Hopi Land Settlement Act, leading to a massive homelessness crisis that still exists today. It is estimated that one-third of Navajo homes are deficient in plumbing and kitchen facilities. 90,000 Navajo families are presently homeless or under-housed. 

The impact of both displacement and trauma on Navajo families has resulted in poor health outcomes, including a substance use and mental health crisis. The 2021 National Survey on Drug Use and Health reported that the percentage of people aged 12 or older with a substance use disorder in the past year was highest among American Indian or Alaska Natives (27.6%) compared to other racial or ethnic groups. Additionally, American Indians and Alaska Natives reported the second highest percentage of those who expressed serious thoughts of suicide, and the highest percentage of those who attempted suicide in the past year, compared to other racial or ethnic groups.

Trauma-informed care was central to my work on Indigenous land. Trauma-informed care is a compassion-building framework to contextualize interpersonal, societal, historical and generational trauma. It is an ethos that provides practical and philosophical approaches to not simply “take” a patient’s history, but to respect a patient’s history and incorporate it into their care.

One morning in Chinle, I had the opportunity to work at the local high school’s Teen Clinic. Students loomed near the door of the clinic, seeking respite from the bustling halls of the high school. A student I met, who I will call Mikey, was a freshman in high school being seen for a “weight check.” He stared at the tan linoleum floors while we talked, responding to my questions with one word answers or the occasional shrug. I held his depression screening questionnaire in my lap. He had scored 20, indicating severe depression.

“How has your mood been?”

“Fine,” he shrugged.

I showed him the score and explained what it meant. I told him I was worried about him. He shifted his baseball cap and fidgeted in the chair. “Yeah, I guess things have been bad at home,” he said with a shaky voice. He slowly opened up, describing a family torn apart by his father’s addiction to alcohol and a mother who was in and out of abusive relationships. He told me about his sister whose depression had driven her to an addiction to opioids. “Sometimes,” he nearly whispered, “it all becomes too much.”

As a medical student, I have learned that “weight checks” quickly turn into life checks. Trauma-informed care infuses medicine with more humanity. Honoring your own and your patient’s humanity transforms the “doctor and patient” dynamic into two humans connecting. Trauma-informed care teaches us to listen more than we speak and to pay attention to the non-verbal cues of distress and discomfort. By creating this space, we have the opportunity to foster a safe, trusting, supportive, and empowering therapeutic environment.

At 10 am on a Wednesday, with the dramas of high school lurking outside our door, Mikey wept. He said he felt much better after talking to me. We discussed a safety plan, and I provided him with mental health resources. I told him he was brave. He promised to take care.

When history has been stolen from an entire population, medical providers should think critically about what it means to “take” a history. As physicians, we are responsible for learning from our patients and supporting them as they make sense of and reclaim their history. When asking about a patient’s history, it is of utmost importance to understand their entire history. This includes educating ourselves about the history of populations we care for, utilizing cultural humility, and listening more than we speak. Rather than “take” a history, what would it be like if we “received” a history? A patient’s story is a gift that we are privileged to know. By respecting a patient’s lived experiences and utilizing trauma-informed techniques, you ensure you are truly caring for the whole patient.

Image by Eudora Olsen

Eudora Olsen Eudora Olsen (2 Posts)

Contributing Writer

Emory University School of Medicine

Eudora Olsen is an MD/MPH student at Emory University School of Medicine in Atlanta, GA class of 2024. In 2017, she graduated from Harvard University with a Bachelor of Arts in comparative religion and women and gender studies. She enjoys running to her favorite podcasts, trying new restaurants in Atlanta, and traveling. After graduating medical school, Eudora will be an Internal Medicine resident at the University of California San Francisco.