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0:00 - Tell me about your passion for healthcare 0:02 and what steps you have completed. 0:05 - I've gone to places as the IHS director 0:08 that no other IHS director has visited, 0:12 and that set the stage for, i, I would say, one 0:15 of the most transformative approaches from the federal 0:19 government's perspective, that we can work side by side 0:24 with each of the 574 federally recognized tribes 0:28 in their space 0:30 for their travel communities the way they want it. 0:46 - Hello and welcome to the Degrees of Success podcast. 0:49 I'm your host, Frida Richards, 0:51 and today we have the great honor of having Ms. 0:54 Roselyn Tso join us. 0:56 She is the director of Indian Health Services. 1:00 She's also a member of the Navajo Nation. 1:03 She has a great passion for enhancing healthcare 1:06 for all native Americans. 1:09 And of course, she's a ��ɫ��Ƶ alum. 1:12 Help me welcome Ms. Roselyn Tso. 1:14 Tell me how you grew up, Growing Up in Arizona 1:16 what your childhood was like, and where you're from. So 1:18 - I am from a little town in Arizona. 1:21 It's called Page Arizona, north northern part 1:24 of the state of Arizona. 1:26 I grew up there. I grew up on the Navajo Reservation. 1:29 I'm, I am the daughter of a Korean War veteran. 1:33 I am also the daughter of a 1:36 longtime minister on the Navajo reservation. 1:40 And then my father was a rancher 1:41 and he was also a businessman. 1:43 And my mother's role, she was there side by side with him 1:47 for more than 66 years. 1:48 And so I grew up in a home with imagine a rancher 1:53 and a military and businessman. 1:55 You know, you bring up, you, you, you're raised with a lot 1:57 of structure and a lot of discipline. 2:00 So I, I carry that, those with me. 2:02 I cherish those memories 2:05 and the work that my parents did to raise, 2:07 to raise me as they did. 2:10 And then from there, of course, going to high school 2:13 and in small town, 2:14 and then from there just, just keep moving forward. 2:17 - So what was it like growing up in a small 2:20 town in page Arizona? 2:22 - It was great, you know, I mean, it was great. 2:24 But, you know, the, some of the challenges that I still 2:27 worked through today as, as my job 2:29 as the Indian Health Service, for example, the home 2:32 that I grew up in, we didn't have electricity 2:34 and we didn't have water. 2:35 The home that, that is still there today, 2:37 that was our family home, finally got electricity in 2014, 2:42 and then still today, there's no running water. 2:45 So there are still many, many homes on our tribal, 2:48 tribal lands that don't have sufficient sewer and water 2:52 or even electricity. 2:54 So as, as we talk about healthcare 2:57 and as we talk about public health, those are still factors Public Health Challenges 3:00 that, that are fundamental needs 3:03 for our people across Indian country. 3:06 - So you have a great passion for your people, as you said, 3:10 your culture wanting to give back, 3:13 growing up in page Arizona, in a home 3:17 that had no electricity, 3:18 or excuse me, no running water, you've been able 3:21 to experience what you're trying to change. 3:26 Tell me clearly that passion comes from your, your childhood 3:30 and experiencing it, but what, 3:31 what else drives you in getting involved in healthcare 3:34 and making a change in the community? 3:36 - Thank you. So there are many, many parts of that 3:39 that great question. 3:41 First is just the challenges 3:43 that our people still live with today. 3:46 I mentioned earlier diabetes, you know, we, 3:49 we have the highest rates of diabetes across any country. 3:54 We have challenges with regards to just 3:57 public health infrastructure that impact our ability 4:01 to raise, you know, raise up some of our travel communities 4:04 to the level that we would like to see them. 4:07 But part part of that was, again, reinforced just recently 4:11 with the Covid pandemic. 4:13 It just reminds me of how important it's that we continue 4:17 to improve our travel communities with that infrastructure, 4:21 that infrastructure builds success, 4:23 that infrastructure build what we need 4:26 for our travel communities 4:27 to be successful as we move forward. 4:30 So whether it is broadband, whether it is improved roads, 4:34 whether it's housing, whether it's food insecurities 4:38 that many of our travel communities live with, all of that 4:42 is impacts a person's health. 4:45 So when we talk about transportation and, and, 4:49 and if we can't get a person from point A to point B 4:52 to their, to their appointments or whatever, 4:54 and not take into consideration transportation, then, 4:58 then we are not addressing the the person's need. Reconnecting with Traditional Practices 5:01 If we're talking about food insecurities, where many 5:04 of our families today struggle with that across, 5:07 across the nation struggle with food insecurity 5:10 and what do we do about that? 5:11 How do we build sustainability? 5:14 How do we build systems back into our travel communities 5:17 where we're less reliant 5:18 and we go back to some of our traditional practices. 5:21 And so we're seeing this as we move forward. 5:24 We're seeing that progress across Indian country is being 5:29 the most successful places that we see progress. 5:32 It's where travel communities are thriving. 5:35 When they go back to the traditional practices, they go back 5:38 to the traditional foods, they go back 5:40 to the traditional traditions of just, just the, the, 5:45 the practices of customs for dancing and singing 5:49 and those kinds of things 5:50 that are being brought back into their health, 5:52 into their communities. 5:54 There's that, those are the communities 5:56 that are thriving the most. 5:58 And I think that investment that reinvestment 6:00 to tribal communities are, is so important. 6:04 The the flip side of that is also 6:07 that Indian policies of the history, the history 6:11 of Indian policies 6:13 and how they still impact negatively impact tribal 6:17 communities today. 6:19 If you go to just the basic elements 6:22 of Indian policies that were established years 6:26 and years ago, they were to eradicate us. 6:29 They were to do away with the American Indians 6:32 and Alaska native people. 6:33 But as I've traveled throughout, 6:35 particularly over the last 27 months 6:37 to see travel communities thriving, 6:40 to see travel communities say we wanna change the outcomes 6:44 of our, our community so we can be healthier community. 6:47 That has been the best. That has been just an absolute 6:49 rewarding experience. 6:51 And there are other places where, 6:52 and other areas that we still have to work on. 6:56 But I think that we are on the right path to take to, 6:59 to make sure that any country is healthy. Historical Context and Systemic Issues 7:03 - Well, I'm gonna have to agree, you've been at the helm of 7:06 that will for 27 months. 7:07 So I'm confident as we move forward into this conversation 7:10 and hear more about your accomplishments 7:13 with those native tribes, that we will see that. 7:18 But before that, I, I wanna ask this. 7:21 Tell us the why, why 7:25 were Native American 7:29 or the tribal communities placed in this situation? 7:31 Tell me why this is that it, that it's common for them not 7:35 to have running water or for them to have diabetes. 7:39 Tell me the root, the why. 7:42 - So that, that's a very loaded question 7:46 and I don't feel that I can speak for tribes 7:49 or tribal leaders in, in this particular area. 7:53 But we do know that the lands that, that were, that 7:57 that tribal communities were moved from was part of it. 8:02 And what is on that land? 8:04 What is on that land that those precious minerals 8:07 or whatever, that there was, that the government was looking 8:10 for, to relocate American Indian people from their tribal 8:14 lands to different location. 8:17 That's one of them. 8:18 And and so as we look at the why of where, of why we are 8:23 where we are today, you know, you, you look at just 8:26 the boarding school era where many, many, 8:29 many children were relocated, taken from their families 8:33 and placed in, in government led boarding schools. 8:37 There's just, we've just completed through the, 8:40 the Secretary of Interior just completed a, a study on this 8:45 and the impacts. 8:46 And even though that some of those might have ended in the, 8:50 in the mid sixties, they're still impacting 8:55 the relocation of people taken from their tribal lands 8:59 and relocated into other places that were foreign to them. 9:03 Maybe they could grow things in the land that they used 9:06 to live on, and the new land maybe doesn't support that. 9:10 Maybe there's not that infrastructure, infrastructure 9:13 that's in place for that. 9:14 All of these things, you see, those, those 9:18 to me lead up to the why. 9:20 And so when you look at diabetes, 9:22 when you look at these other challenges that we have 9:25 of heart disease, you know, I, 9:26 we've been working very hard at Indian Health Service 9:30 about food is medicine 9:32 and everything that we take in 9:35 impacts our body one way or another. 9:37 And so if they are unhealthy, if they are not good, 9:42 or if that's not what we were traditionally accustomed 9:45 to eating, then those make a change. 9:48 Moreover, just the environments that we live in, 9:51 I've traveled several times to the state of Alaska 9:54 and just, you know, again, to understand 9:56 and appreciate their challenges just for transportation, Alaska Visit: Cost and Access Issues 10:00 they have to go, I, I might be able to fly into Anchorage, 10:05 Alaska, but from there to get to any village, this has to be 10:09 by air or by boat. 10:10 There's no roads in Alaska. 10:13 So how do you, how do you, we manage that, 10:15 not just from a healthcare perspective, 10:18 but just the way people live. 10:21 In, in a recent visit that I had, I visited a small village, 10:24 about 500 people, 10:26 and I always like to look in the stores 10:29 of the, the little stores. 10:30 I like to look at how, how their homes 10:32 are and how people live. 10:34 I went into the store 10:35 and it's $14 for a gallon of water, 10:40 14 for a gallon of water, 10:43 and then right next to it, it's maybe a dollar 20 10:47 for a can of soda. 10:49 So you look at those options that people have and, 10:54 and the resources or limited resources that they might have 10:57 if they're choosing the soda because they can afford that. 11:02 The challenge that that creates is 11:04 by the time children are school age, 11:07 they need reconstructive dental work. 11:10 So all of these things that we talk about, 11:13 and that's why I think from a healthcare perspective, 11:16 we have to take a step back 11:18 and really look at those social drivers of health 11:23 and how those impact the health of our community 11:27 because you can't just deal with the, the medical side. 11:31 You can't just deal with the pharmaceutical side 11:33 and say that we've done our part without looking at 11:37 what are these other factors that impact that patient 11:41 and for them to be successful, for them to be 11:44 where we want them to be as healthy tribal communities. 11:48 So it's more than just medical at ihs. 11:52 And when you look at our mission statement, 11:54 we talk about the, the physical, the mental, 11:58 the social and spiritual health of our people. Holistic Health at IHS 12:02 When you look at it, that that's the whole person. 12:05 And so that does take time as we start 12:08 to really think about, you know, you can, 12:10 you can imagine a if there's not sufficient housing in a 12:13 tribal community, what happens? 12:16 Somebody's worried about that 12:17 and somebody's gonna be impacted by that 12:20 and probably less in thinking of their health. 12:24 So that goes to the bottom of the list until it, 12:28 until it came be at the bottom of the list anymore. 12:31 And then of course, that has its own challenges with it. 12:34 So we know that policies across even policies today continue 12:39 to negatively impact our people. 12:41 But the, at the same time, we have many, 12:45 many travel communities that continue to thrive 12:47 because they are taking the approach 12:50 of addressing the whole person and 12:53 therefore building up each tribal community to be healthier. 12:58 - I heard you say that it's very important for, 13:02 or that you have, there's current, there's current tribes 13:04 that are thriving now that they're having the opportunity 13:08 to invest back into their traditions, 13:11 invest back into the food that that was traditionally 13:15 what they ate prior to being introduced to 13:20 others, other food such as soda 13:23 or maybe burgers or something along those lines. 13:25 I wouldn't necessarily be in line with the native 13:31 nutrition that was done in the past 13:33 or that was participated in the past. 13:36 My question to you is, what, 13:40 what are, what are those foods one that you think that 13:44 are helping the Native Americans get back 13:47 to their health and those traditions? 13:49 And then secondly, I wanted to acknowledge 13:52 that I absolutely agree with you 13:55 and I've seen studies, 13:57 I'm currently getting my doctorate right now 13:59 here at ��ɫ��Ƶ. 14:01 And in in those studies I've actually seen that all 14:06 of our bodies are aligned 14:09 to traditional foods. 14:11 Like, so we're not all supposed to be eating the same thing. 14:14 A burger for me is very different. 14:16 Well, my body will handle that very differently than a 14:18 burger for our producer or so on and so forth. 14:21 And so I think that that in itself is very important. 14:25 You're speaking about preventative, eat, eat this food 14:30 to, to prevent having to heal yourself 14:35 or have a medicine save you. 14:39 Tell me more about the food that 14:41 the Native Americans are accustomed to 14:44 that's actually aligning 14:45 with them staying healthy in those traditions. 14:49 - Well, there again, you know, there's over, 14:51 there's over 500, 14:53 actually 574 federally recognized tribes across, 14:58 across the country at the Indian Health Service being the Region-Based Traditional Foods 15:02 18th largest healthcare system. 15:04 We span about 37 states of where we have those tribes that, 15:08 that live in those 37 states. 15:10 And so, you know, again, taking one 15:13 of those 574 federally recognized tribes and, 15:17 and not layering that we're all like this 15:19 or we're all the same because we're not so 15:22 by regions perhaps. 15:23 So we're different foods that people were, were, 15:25 we're more accustomed to than other regions in Alaska, 15:30 for example, you know, they, they rely on the salmon. 15:34 They, they, that was their choice, that was their food. 15:38 And down in, in the lower 48, they were different kinds 15:41 of foods that that, that were traditionally, 15:45 that our people were traditional accustomed to. 15:47 And those, again, back, back when they were grown 15:52 and then they were utilized. 15:53 And then, so as you, as we, 15:56 so I can't quite answer your question specifically. 15:58 I can talk about maybe this tribe or that tribe, 16:01 but what, what's important to understand is that what I, 16:05 what I experienced as a young child 16:08 and what my parents tried to, what my mother tried 16:11 to prepare for us as, as a young child, 16:13 IWI wouldn't even say we're, we're our traditional foods. 16:17 She was just trying to put food on a table 16:19 that she could put together to, to make sure 16:21 that all all of us ate. 16:23 Children were able to have something to eat 16:26 at any given time. 16:27 So, so I think, I think it's bigger than that. 16:31 And what I see though, 16:33 what I've seen in tribal communities is that each tribe is, 16:37 is making those decisions for themselves. 16:40 What can they, what can they go back to? 16:43 How do they foster that? 16:45 I've been in, in a visiting a tribe in Oklahoma, 16:48 for example, and they have their own little grocery store 16:53 and they put in there what they believe is best 16:57 for their tribal communities they put in there. 17:00 So, so we don't, they don't just go to any grocery store. 17:03 So they're supporting that travel community 17:06 with the healthy choices from, from a a, 17:10 a community perspective. 17:12 And I think that if each community could do that, as opposed 17:15 to what I explained in what I experienced at Alaska 17:18 and what I observed in terms of prices 17:21 and so forth, if those things could be met in each tribal 17:24 community, that's what's gonna drive 17:27 improvement for that community. 17:29 Moreover, coupling that with education today, why it's 17:33 so important that we need to move around, why it's 17:37 so important for us to exercise or walk or whatever it is. 17:41 And many of the services that we do at IHS 17:44 through our diabetes program supports 17:47 that many tribes have taken those resources 17:50 and built wellness centers 17:52 or working on building wellness centers. 17:54 And again, a place, a safe place where people can go 17:57 to do their exercise or to do their walk walking Role of Education and Wellness Centers 18:01 or just to do food lessons. 18:04 How do you, how do you cook with the foods 18:07 that we have today and how do you make them healthier? 18:10 How do you make these, these quick meals? 18:12 Because we're all busy and we're all running from, 18:15 from point A to point B. 18:16 So I see that happening in tribal communities, 18:19 and if they, each tribal community can really invest in that 18:23 for their people, it's gonna make change. 18:26 It's making changes in our, in our tribal communities. 18:30 - That is very powerful. 18:31 And I wanna hear more about your passion for healthcare 18:36 because again, in my studies I've also found 18:39 that there's like in low income African American communities 18:44 there, there's food scarcity, there's less grocery stores, 18:49 but there'll be in like within five to 10 miles, 18:52 there'll be eight McDonald's, 10 Burger Kings, Wendy's, 18:57 pizza Hut, smoke shops, 19:01 the cash advance stores, all of that within a small amount 19:05 of space and maybe two grocery stores. 19:10 That in itself is completely 19:14 destructive for that community. 19:17 And it is only encouraging them to 19:22 spend money recklessly 19:24 and to possibly indulge in 19:29 tobacco or other things from the smoke shop. 19:31 And then the same thing with the food. 19:33 How much cheaper is it to get a Happy meal 19:35 or something along those lines as opposed to going 19:38 to your grocery store where there's only two of them. 19:42 And to your point, soda is substantially cheaper than the 19:45 healthier options. 19:48 You have made some very important moves 19:51 and changes for your community. 19:53 Tell me about your passion for healthcare 19:56 and what steps you have started within this 27 months 27 Months of Leadership 20:02 and, and completed to help move that forward. 20:08 - Thank you. So Indian Health Service is part 20:10 of the Department of Health and Human Services. 20:13 And through many treaty agreements, through many commitments 20:17 of the federal government, the the exchange for land 20:22 or exchange for resources in Indian country was dependent on 20:27 the government providing healthcare 20:29 to American Indians and Alaska natives. 20:31 That's what makes our relationships 20:33 with the federal government, each tribal relationship 20:36 with the federal government unique 20:38 because it is a nation to nation agreements 20:41 that were had way back when. 20:43 And, and many of those agreements, if not all, 20:46 include a component. 20:48 So Indian Health Service is that federal component. 20:51 We are the, the lead organization, if you will, 20:54 the lead government organization that provides 20:57 that healthcare for American Indians and Alaska natives. 21:01 One of the great things about the Indian Self-Determination 21:05 Act that was developed in 1975 provides 21:10 for tribal governments to assume they're part 21:14 of their healthcare system. 21:16 So since that time, tribes have contracted 21:21 or compacted their part of what I, what the government used 21:25 to pro provide for their tribal communities 21:27 in terms of healthcare. 21:29 Again, that self-determination, that self-governance act 21:34 that tribes have taken now has led IHS 21:38 to be about 40. 21:40 Less than 40% of IHS remains as a federal government. 21:45 The rest, or 60 plus percent 21:48 of the tribes have taken their portion 21:51 of the federal government to provide healthcare for them, 21:54 for their own communities. 21:56 That is thriving. 21:58 That is where the change is going to come, 22:01 is when tribal communities take responsibility 22:04 for their own healthcare 22:06 because they know what is best for their tribal communities. 22:09 The government can't say, oh, we should do this here 22:12 for this tribe, or we think that this is gonna work for no, 22:15 because we're not in their space. 22:17 We're not in those tribal communities. 22:20 We don't know how many grocery stores they 22:23 have or don't have. 22:25 We don't know what resources 22:26 that they have or they don't have. 22:28 So I think as we, as the government keeps moving forward 22:32 and fostering this relationship with the, 22:34 with tribal communities 22:36 and tribal governments, that the more 22:39 that tribal communities can take responsibility 22:42 for their healthcare system 22:44 or for their whole community, that that is 22:48 where they're going to make the best decisions. 22:51 And I think as we continue to embrace 22:53 that from the federal government, our role is to assist. 22:56 Our role is to support our role is to foster those steps Rural Health Access and Challenges 23:00 that the tribes choose to take. 23:02 I will say, you know, just the amazing work 23:06 that is happening in Indian country as a result 23:08 of self-governance and self-determination on, 23:11 on in Cherokee Nation. 23:13 For example, in Oklahoma, 23:15 we have the first medical school on tribal land. 23:19 So I wish we could have a medical school in every, you know, 23:23 in every region on tribal land. 23:26 But that's the beginning. 23:27 That's the beginning Out in Arizona, we have one 23:30 of the first cancer centers in a tribal community, 23:33 so people don't have to drive hours 23:36 and hours to get to for cancer care. 23:38 So we're getting there. 23:40 They are small steps and we have a long ways to go. 23:43 But the more that tribal governments can take responsibility 23:47 or when they choose to 23:49 and when they want to, 23:50 then they're going to be the catalyst. 23:52 They are making those changes. 23:54 They are showing that we can do this work as we move along. 23:59 And then most of our care is in rural America. 24:02 Most of our care is in, in, in isolated locations 24:06 where we have to drive four hours. 24:10 When you drive from Fort Peck, Montana to get to Billings, 24:14 Montana, if you need higher level of care, 24:16 it's a four hour drive. 24:18 So you're thinking about somebody that has dialysis, 24:21 you're thinking about somebody that's a cancer patient 24:24 and have to make that drive, you know, maybe two 24:27 or three times a week for dialysis. 24:29 How do we change this? 24:31 How do we really look at creative ways 24:34 that we bring services closer to the people in their, 24:37 in their tropical communities And not just for American, 24:39 Amy Alaska names, names for all, for all Americans, 24:43 that we deserve better healthcare across the nation. 24:46 The other thing I would say is that 24:49 over the years we sometimes at Indian Health Service, 24:53 we have made our system more complicated. 24:56 It's navigating the healthcare system today is already 24:59 complicated and we don't need to put more layers on that 25:04 for our American Indians and Alaska native people. 25:07 So dialing it back, simplifying it, going back 25:10 and saying, where do we need to streamline? 25:12 Where do we need to cut out these layers of, of steps 25:17 that maybe our people have to take? 25:19 Those are really important for us to do. 25:21 So as I look at healthcare 25:23 or as I've looked at it while being in this role, 25:26 has really been trying to look at it from that, 25:29 that patient perspective. 25:32 During the last part of my father's life, this is 25:36 my father's a decorated veteran, 25:39 but he chose not to go to the va. 25:42 He chose to go to his, 25:45 his small healthcare facility on the Navajo reservation. 25:49 That was his choice. 25:51 And even though I, I thought you, you have 25:54 the VA owes you this, you, you're entitled to this, 25:57 they're entitled to the best care possible, whether it's IHS Personal Inspiration and Future Goals 26:02 or the VA or however they choose to do it. 26:05 So, and then I had then I also went 26:07 through the same experience of navigating my mother's care 26:10 as, as a cancer patient. 26:12 She had breast cancer and, and navigating that for her. 26:15 But as, as what I saw with her was that was 26:19 during the pandemic 26:20 and that opened the door for, 26:22 even though it was always there for telehealth or, 26:26 or audio health. 26:28 And so she didn't have to drive as far we could take a call 26:31 with her at home and she didn't have to wait in a car 26:35 or drive in a car for hours to get to her appointment. 26:38 So those things are changing 26:40 as we see technology changing us 26:43 as we see these opportunities to make sure 26:46 that we have better outcomes 26:49 or even better experiences 26:50 for our patients is very, very important. 26:53 That's what drives me. 26:55 That's what reminds me that I see that. 26:58 And then I turn and look at my 5-year-old granddaughter 27:02 and I'm thinking, what do I leave for her? 27:04 What do I, what do I want? 27:06 What do I wanna make sure that my children have care, 27:10 the best care that they should be, that they should have. 27:14 And so they're healthy. 27:15 Not just healthy today, 27:17 but healthy 20 years from now, 40 years from now, 27:20 and 50 years from now. 27:21 So I think all of these things 27:23 that we're talking about when we're talking about these 27:25 social drivers of health, what are we eating? 27:28 How, what am my exam? 27:29 What, what is my responsibility to be an example to her 27:33 and to my grandchildren about what I eat? 27:36 Because we give them what we're eating 27:39 and we're, we're, if, if it's healthy, that's great. 27:42 If it's not, then it's not good. 27:44 'cause then we're just fostering this, these behaviors 27:47 as we continue to drive. 27:48 So that's what drives me every single day. 27:51 The work that I do. 27:52 There's a face at the end of every patient experience. 27:57 When I'm looking at policy, when I'm looking at what is it 28:00 that we're gonna work on at IHS, there's a, 28:03 there's a face there, there, there's an, it's meaningful, 28:06 there's a tribe there, 28:07 there's a tribal leader's voice I can hear saying, 28:11 we want this and we want that, 28:13 and this is the way we want it. 28:15 So again, it's not so much that we, we provide the care 28:18 that way, but we provide the care the way 28:21 in this case, our people want it. Tell 28:24 - Me what's up - Next. Closing Thoughts and Appreciation 28:25 Well, I'll take a little bit of time for myself. 28:27 I think there, you know, anyone that has been in these kinds 28:30 of positions, you need time to sort of just step away and, 28:35 and, and decompress, if you will, just the, 28:40 the past that, that we have dealt with. 28:42 So I'm looking forward to that. 28:43 I'm looking forward to getting a little bit of rest, 28:45 and then I'll decide, you know, what my next steps will be. 28:48 - Ms. So thank you so much for joining us 28:51 and even more thank you for the 27 months 28:54 of incredible service. Thank you. 28:56 - Thank you so very much. Thank you. 28:59 - That brings us to the end of this episode 29:01 of Degrees of Success. 29:03 Don't forget to like, subscribe, and comment. 29:06 I'm your host, Frida Richards, reminding you 29:09 that your next chapter might be your best one yet. 29:13 See you soon.