Stop & Talk

Singer 0:00
Stop talk to me.

Crystal Page 0:10
Hello, Grant.

Grant Oliphant 0:11
Hey, Crystal. So today we're going to be speaking with Angelina Renteria, who is COO of the Indian Health Council. And this was a really good interview. I enjoyed speaking with her.

Crystal Page 0:24
And Indian Health counsel, or, as we sometimes shortcut, IHC, is one of our share grantees, right?

Grant Oliphant 0:30
Right. And so you know what they what they are. The easiest way to think of them is as a healthcare clinic that happens to be on tribal lands and serves the tribal community, and so they have a distinctive appreciation for the role of healthcare clinics in our medical delivery system. I really, I really think Angelina brings so much positive energy to this work. She's also very real about it. I think folks who care about how we think about health care will really enjoy this interview.

Crystal Page 1:07
Let's dive in.

Grant Oliphant 1:07
All right. Let's do it.

Grant Oliphant 1:12
Alright, I am here with Angelina Renteria, and it is a delight to welcome you to this conversation. Thank you for joining me today.

Angelina Renteria 1:20
Thank you for having me.

Grant Oliphant 1:23
I've been looking forward to touching base with you. We had we had spoken some months ago, well actually a couple of years ago, with Dr Dan Celac, and we'd spoken about the work of the Indian Health Council then, but we wanted to check in with you, because it feels especially timely right now as we look at two years of the Share program having been in operation in San Diego County. This is, of course, a program where we funded frontline health clinics like yours working to improve the health of people around San Diego County. It also feels timely, because of everything that's going on with the federal government, taking a different and new look at how various services are delivered, and we want to talk about that. So I'm looking forward to this conversation. I just want to thank you again for joining me for it.

Angelina Renteria 2:18
Yeah, thank you, Grant. Likewise, I'm excited to share.

Grant Oliphant 2:21
Great. So would you start off by telling us a little bit about Indian Health Council. And I'm interested particularly in why an Indian Health Council? You know? Why is why is it important and the mission of the organization relevant?

Angelina Renteria 2:38
Oh, absolutely. That's a fantastic question. Thanks you. Thanks for asking so Indian Health Council exists to serve nine consortium tribes within the North San Diego County area. Prior to our existence, here at Indian Health Council, which was established in 1970 there was no organization like ours available to the nine consortium tribal members. Those consortium tribes are Pala, Pauma, Rincon, Inaja-Cosmit, San Pasqual, La Jolla, Mesa Grande, Santa Yisabel and Los Coyotes. Those reservations all exist within the North San Diego County Area Indian Health Council was developed by our founders to ensure that our tribal community members have access to health care that is tribally informed, has an awareness of some of the challenges within reservation territories, then that has the capacity to understand cultural needs specific to the nine consortium tribes. We're governed by our nine consortium tribes. We have two tribal representatives on each representing each of the nine consortium tribes. So we're, we're extremely aware of the needs of the community. That's something that's extremely important to Indian Health Council, is that we listen to the voice of the population that we serve. We currently serve, have about an active patient count of about 6000 that utilize our services. Here at Indian Health Council, we have about 15,000 eligible to receive services. At Indian Health Council, we have two facilities, one located on the Rincon reservation, which, if you're not familiar with where that is, most people know the landmark Harras casino, so we're relatively close to Harras casino

Grant Oliphant 4:23
Which is in North San Diego County.

Angelina Renteria 4:24
It is in North San Diego County, correct. We have a second clinic, satellite Clinic, located on the San Isabel reservation, for those who want a landmark that's memorable for anyone who's ever had a Julian pie the Julian pie shop borders Santa Isabel reservation. So that is relatively close. If you ever go there, you've probably driven past the Santa Isabel reservation, depending on what direction you go. But like I said, we do serve nine consortium tribes. We're the only. Eight tribally run Healthcare Center available within relative close proximity to the nine consortium tribal members

Grant Oliphant 5:09
well, and let's stay with that for a moment. One of the reasons we're doing this by video is that you're up at Rincon, on the Rincon reservation right now, and I'm speaking with you from Little Italy in downtown San Diego. And and people who don't know San Diego may not appreciate just how big this county is, and the the difficulties that can be involved in reliably getting from where you are to where I am, and vice versa. So this is a big County, and part of the reason you're located where you are is simply geography. But for for people who don't maybe understand why it is that they're, you know, maybe, maybe they think, because of the messaging that we're getting today, that healthcare is healthcare, and it doesn't matter what it's informed by or who's delivering it. Why is tribally informed care important?

Angelina Renteria 6:07
I really love that question, and I would, I would love to kind of challenge our thought process in how we deliver healthcare in any venue with any culture. I definitely think it's important that we're culturally informed, specifically in Indian Country, based on the territory that our nine consortium tribes exist in, it's extremely important, not only to understand some of the barriers related to just residences, but culturally speaking, how we engage with each other, looks and feels a lot different, but I would say that it likely resonates with other cultures, not it's not significant simply to Native people. Having sensitivity to cultures that don't resonate with yourself or your own culture is extremely important, and that is something that we definitely embrace here at Indian Health Council, that's that's probably the first priority at Indian Health Council, is to make sure that we truly respect our nine sovereign nations, again, those those nine tribes that I referenced earlier, and that we really make it a priority to understand the unique cultural needs of each of the nine tribes. Very important that we understand the territories of those nine tribes and what barriers exist among the nine I'll share with you to kind of give context to just the region itself, in reference to our Paula, Palma, Rincon, sample, Squall reservations, there's relatively close proximity out to areas like Escondido. It's, it's could be anywhere from 45 minutes to an hour to get to town for many and those are the closer tribes to town. Then we have San Pasqual, los coyotes, Mesa grande Santa Isabel, that are are much further up into the mountains. So while down in Rincon, for example, on the reservation here, we may have relatively clear skies, maybe a little chilly while if you travel up the road to to La Jolla or to Santa Isabel Mesa, grande area, los coyotes. They are in snow capped mountains. So the the climate is very different, and so the challenges are also extremely different, as you can imagine getting to your local healthcare facility when you have maybe one car in a multi generational household, and having to travel in the snow can present challenges that we might not necessarily experience when we live in town. And so again, going back to why is it important that we have cultural awareness or cultural information to understand why a patient of ours has a hard time making it, making it to their appointment, to get to your your provider, it takes a lot of work and planning just to drive here, in many cases, let alone driving to a healthcare facility out in town. For those that live in town, it's, you know, you schedule your appointment, and it's maybe, you know, 15, maybe 30 minutes to get into town, you get to drive on paved roads with stop lights and, you know, crosswalks and sidewalks or there's access to public transportation, whereas here that doesn't exist. There are oftentimes dirt roads, no public transportation. Ubers and lifts really are extremely expensive if they even come out to our area, so those types of transportation don't exist. And so it's extremely important that our healthcare providers understand many of those barriers, and also that we understand just cultural differences among tribal people. Here at Indian Health Council,

Grant Oliphant 9:57
you also, in addition to the layer of culture. I guess the question I want to ask, a follow up question I want to ask on that Angelina is, as people try to understand what that concept is, if they're not dealing with it every day, how would that differ from, say, going into medical facility in downtown San Diego? What would they experience that would be different,

Angelina Renteria 10:22
you know, I I've experienced both. I'm a patient here at Indian Health Council, and I've experienced, you know, being a patient at your standard healthcare facility.

Angelina Renteria 10:34
And I think the biggest difference that I'm really proud to say when it comes to Indian Health Council is that Indian Health Council knows you. We use the word womb to tomb. They know you in utero through the end, the end of this life. We know your parents, your grandparents, your aunties and uncles, your cousins. We know where your house is located, and depending on the on the team members role, we know what your living room looks like. We know what is in the refrigerator. So we know. We know if you have slip resistant texture underneath your your throat rugs, if you're an elder, we know what might be present in your home that could be a fall risk. You know, we know our patients really, really well.

Angelina Renteria 11:27
And in my experience as a patient and other healthcare facilities very different from Indian Health Council, I don't have necessarily that relationship with my provider. It's, you know, you come in, you have your visit with your provider. We go through our labs, we do all of the really important components of a visit. But I don't, I would say, at least in my experience and the experience of others that I talk to, they don't have that sort of connection with their provider, right? You know, our providers don't necessarily have time at other organizations to sit and understand what are, what are some of the social determinants of health, and what are some of the barriers of your household that might be preventing one from being successful in achieving the health outcomes that they're that they're aiming for. So so when you come to Indian Health Council as a patient. Of course, you know, if the patient is open to sharing, which, after a period of time, we've established a relationship where we get to know so much about our patients. And oftentimes, you know, we we get to share a bit about ourselves as well, of course, with healthy boundaries, but we literally know our patients. You know they know us by first name, our patients because we've established such a strong relationship. There's also a comfort to describe when they're not satisfied with their service. They are have the ability to speak to myself and to the CEO of the organization and to various department leaders to express when they are not satisfied, or to express when they're extremely satisfied with their service. They can come and talk to any one of us. So we've really made it a point to ensure that our relationships are really, really solid, that we maintain a connection to the people that we serve and that aligns with our the culture of native people. We're all related. Is something that we say in Indian Country, I'm Navajo on my mom's side, Mexican on my dad's side. And having those relationships and connectivity is extremely important that we take the time to get to know each other, understand each other, have empathy for one another, and do what we can to help each other wherever we're at in our health journey.

Grant Oliphant 13:41
Thank you for taking the time to describe that. Because I think the well, that level of trust and and awareness, I think, is extraordinary. And obviously, when you get to know somebody so well that you know who their family members are and what's in their refrigerator, you learn things about them and and that can be helpful in making a diagnosis. In traditional medicine, they talk about, you use the term social determinants of health, and medical professionals try to get to know a little bit about what's going on in the lives of their patients, and they and they talk about community, connected care as you live that through the Indian Health Council, how do you think it changes the health care that you provide?

Angelina Renteria 14:30
Oh, it's a game changer. We have to know those elements of a person's life. Of course, if they're willing to share, we're always sensitive to that. And I think in order to understand the patient. We do have to, one, establish a trusting relationship, and two, really try to dive into some of the barriers, the social determinants of health. You know, I think often in speaking with many of our medical providers, our dental providers, our behavioral health providers, our pharmacists, here at Indian Health Council, oftentimes the goal is get. Your appointment, get your physical, you know, check off all of the boxes that we need to check off to ensure that you are a compliant patient. Well, yes, those things are really important.

Angelina Renteria 15:09
Oftentimes, we find that some of the barriers related to showing up to your appointment on time, taking medications as prescribed. You know, following your care plan while on paper sounds like it should be easy. I informed and gave all of the guidance that the patient needed. I think taking the time to understand social determinants of health, taking the time to understand health inequities, taking the time to really understand those mental, emotional, spiritual, physical barriers that someone is experiencing really enhances the patient's ability to take that guidance and care plan that's being provided by our healthcare providers and be as successful as as they can be. So that is an extremely important part of the healthcare process. We find that when that is when we when we take the time to prioritize understanding the patient on a deeper level, we see greater success. Again, we're building a trusting relationship with patients. Patients tend to open up more and ask more questions when they know that their provider is sincerely listening to their questions.

Angelina Renteria 16:18
That's also, I think, kind of going back to your previous question, is, what are some of the differences? I will admittedly, our providers are just as busy as providers and other healthcare organizations, so their exam time is also limited to a specific amount of time, and so it isn't always feasible that a provider sits to talk and listen to some of the barriers. What we do have at Indian Health Council is we have an integrated team of healthcare support people. So we have public health nurses, we have community health representatives, we have health educators. We have over 220 staff members here at Indian Health Council, and each member of our team has been purposefully developed and implemented into our care teams to ensure that while our medical provider, our MDS, clinicians in dental, medical, behavioral health, pharmacy, may not have two hours to sit down with a patient to really understand what's happening in their in their lives. The other professions that we have here at Indian Health Council do have that flexibility to travel to someone's home, to really get to know them, to carry in a trusting way, that information back to share with providers in case management and connection with our other providers here at Indian Health Council. So all of that integrative service is extremely key in ensuring the patient is successful in accomplishing their health goals.

Grant Oliphant 17:52
I love your description of that, because it it is a Yeah, I was going to ask you how you managed to cover all of that with your patients. And one of the ways that you do it, as you just said, is you have an integrated team that does it. A naive outsider might say that's a very resource intensive way to approach medicine. However, there's a lot of evidence in medicine that healthcare that uses that type of approach saves a lot of expense on the back end in terms of delivering a better level of care and more prevention. Do you find that in the work of Indian Health Council?

Angelina Renteria 18:28
Yes. So yes, it's very resource heavy. We have a huge team of integrated care providers. And I think this would resonate with all of us in the healthcare profession or helping industry. I think we all get into this work because we want to make a difference, because we want to see that the work that we are doing potentially enhances the quality of another person's life. And so yes, it is resource heavy, and we're proud to say that if it means that we can carry forward work that is purposeful and impactful to the members that we serve, then we are going to continue with this approach. If we strip away our integrated care teams, we will provide the basic care needs to our community, and they would have information, the success rates we feel confident in saying would dip. And we are in this profession. We are providing these services because we believe that the work that we do is going to create positive health outcomes for our communities. In Indian country, we have a high prevalence rate of diabetes, obesity, substance use, unfortunately, now overdose and addiction is taking over in our communities, which is a really hard topic that we're working very hard to address, and so we are out of. That based on our communities need and their health priorities, as well as the data that we look at internally through our EHR system, we are put in these positions to make informed decisions about how best to provide the services that our community members, one are asking for, and two, that our data clearly says needs to happen.

Grant Oliphant 20:22
Andactually that was the that was the point I was raising, which is that in traditional models of Western medicine, the usual rubric is you get 15 minutes of diagnosis with your physician, if that, and then they prescribe you a pill or a treatment or a test, and what what you're describing in your model is you may get a short amount of time with your physician, but you get a lot of time with other people around the physician who are also providing analysis and diagnosis and support, and that that informs the decision about care that follows, and you experience that the level of care is better as a result of that. Is that right?

Angelina Renteria 21:11
That is correct.

Grant Oliphant 21:11
Yeah, so you were touching on a moment ago, why people get into this work, and I didn't ask you that question at the front end, and I, I usually do. So let me ask it. Now, since you raised it, why did you get into this work?

Angelina Renteria 21:26
Oh, how much time do we have? I may ramble on.

Grant Oliphant 21:31
Well, I'll try and steer you, if you'll let me, if I can,

Angelina Renteria 21:33
you might have to, you know, so I'll share story about about myself. So my my parents again, my Navajo on my mom's side of Mexican on my dad's side. My dad served in the Marine Corps for 26 years, and we traveled to military bases growing up. So I didn't live on our reservation. Lived on military bases. We would move maybe between six months to three years, we'd live on a military base, and we would move to the next one. And, you know, I wasn't as connected to culture. I was connected to great things. You know, we're American and we're patriotic, and I grew up in a really diverse environment with all different races and faces and colors, and really never understood that we were different, that we were just all the same humans that live in wherever we live in the moment, and so I really didn't have The connection to culture in that environment, I had a connection to my my immediate family members and the new kids that I got to meet every time we would move and so my my parents, once my father retired from the military, who moved off base, and I was confronted with, "what are you" I was very confused by that question, What do you mean? What am I? I'm a girl. I don't know,

Grant Oliphant 23:05
right, right, right

Angelina Renteria 23:06
I was in seventh grade and I didn't know my I didn't know and so I started to learn that people really want you to associate with a specific race, and now you know gender and and that it's important that we introduce ourselves accordingly. And I didn't understand that at the young age of, you know, I think 11 and seventh grade. So I started to really dive in deep with my parents and my grandparent, my grandmother, and asked, you know, what what am I and why are people asking me this question? And this is when I learned my culture. I was, you know, 11 or 12 years old, and I started to really experience the differences and being treated differently because of my background, which I'd never experienced before. And so that was my, I would say, at 11 and 12 years old, that was sort of where I realized I really want to do some work with the people that are like me, right again, I didn't experience some of those differences until we lived off off of the military base, so I really started to connect more with my culture. I I immersed myself with my grandmother, who taught me a lot of a lot more information. I started to immerse myself in school and later in college with various clubs and organizations, and really just told myself that I wanted to be an advocate for others, particularly native people in the area Navajo. This is not, you know, where Navajo Reservation exists. That's New Mexico, Arizona, but I was really committed to doing my best to make a difference within native communities. I was extremely interested in movement as medicine from a very young age, and a master's degree in kinesiology and physical education, my focus was ensuring. Or understanding movement in Indian country and how we might integrate movement based medicine within some of our practices. And so I just started to really dive into again, culture and health, and that was really important tome,

Grant Oliphant 23:47
and without even realizing that you were doing it looking at social determinants of health, which is all about where people live, how they how they live, the circumstances under which they live and and how they move. Since that was an interest of yours,

Angelina Renteria 25:31
right, right, I started to really learn again at a young age the importance of four, four components of health, which in culturally speaking, mental, emotional, spiritual and physical well being as part of a medicine wheel, and in many, many cultures, specifically native practice. And I really started to think about, how do we fill each of those buckets? How do we how do we ensure that we're meeting the needs of our mental, emotional, spiritual and physical, well being and so again, this is how I really decided at a young age that this is what I wanted to do. So I've had opportunities to work with so many different places. My heart is here in this work. I love the community that we serve. I love that through Indian Health Council, we can really uplift what we're capable of. What I learned at a young age, which was so almost traumatizing, was that now I'm identifying as a minority person. It was this weird transition where I noticed that I started to experience teachers sort of saying, Well, meet the minimum requirements long as you can.

Grant Oliphant 26:48
Oh, really? So they were dumbing down their expectations of you based on

Angelina Renteria 26:53
that's, yeah, I didn't want to say it that way. Yes, they're dumbing down their expectations of me. And so again, these, these things are sort of like fuel to to push us in a direction. And I thought, You know what I can do way better than that?

Grant Oliphant 27:08
No, thank you.

Angelina Renteria 27:08
You know.

Angelina Renteria 27:09
And so in healthcare as well, I think you know working in the field that we work in, our tribal people are capable of the highest level of of of health, capable of the highest level of mental, emotional, spiritual, physical, well being. And I do think unfortunately, not just in Indian country, but generally speaking across the country, we tend to sometimes stereotype how we provide health to minority groups. And I think that's really an unfortunate I think it's really important that we share information with with all patients, and we let the patient decide what they would like to accomplish in their healthcare journey, rather than dumbing it down and setting the bar really low. I don't think that's fair to to our our people. Setting realistic goals and expectations that are achievable are important, but also here's, here's the here's the end goal. Let's take a look at some of the barriers that a patient or a person is experiencing, and let's find these, these small, achievable goals that ultimately get them get here, that's, that's, that's the best spot again, meeting the patient where they're at. And so I am sharing my personal story because I do think that it's helped me to really understand and empathize with a person's experience in their healthcare journey

Grant Oliphant 28:42
well, and I'm I so I really appreciate you sharing that story, because it is, I mean, first of all, it explains so much about how you came into the work, but it also explains so much about why the work is important, you know, and why the Indian Health Council needs to exist and and the level of care that it can provide. I also very I just want to say, I want to honor the fire that came into your voice as you're talking about how you were being treated at, you know, at the transition that happened after you left the military base environment and came into your early teens and started experiencing being othered because of of certain assumptions about who you were and your identity, and shame on society for doing that to you. On the other hand, the fire that it's produced in you to do better is extraordinary, and I just, I just want to honor that before we before we move on, I need to call out in the environment in which we're operating right now that with all the lazy language that is being used in attacking dei at the moment and concepts of Equity and Inclusion, we use the. Phrase belonging at the Prebys Foundation, because we think what belonging points to is that everybody has a legitimate need and right to exist as the people that they are, and that they should be not only made to feel welcome, but valued as who they are. And the importance of that is called out by work like the work of the Indian Health Council, because we don't all live under the same circumstances, and we don't all experience the same life, life experiences. So the the value of doing this produces better medicine, ultimately, for the whole the whole population. And I just it is important in the present moment not to gloss over a point like you just made in sharing your story with us. So I want to thank you for that.

Angelina Renteria 30:47
Thank you. Thank you for letting me share. I

Grant Oliphant 30:50
wonder if you know part of what you talked about in that in that story, is the medicine wheel and the physical, the notion of spiritual, emotional, physical, and what was the fourth component, mental well being doesn't come trippingly off my tongue the way it does yours. But the, you know, the, I think one of the challenges with traditional medicine is it doesn't typically look at those four elements in balance, I think we are learning in the core, as healthcare improves over time, that we need to that people are whole human beings, and the medicine wheel that you're describing, does that inherently I wonder if there are a couple of success stories you could share with us that have kept you animated in this work, because it isn't actually easy work. What you're describing, if anybody's ever been to a clinic, the the environment, the days are full and long, and time is scarce, and people are operating on, often, on, on low batteries, and I'm and I just love to hear you share any success stories that you could with us.

Angelina Renteria 32:10
Yes, so one comes to mind. Well, many come to mind, but the one we'll focus on now is we, I shared a little bit earlier that we have a high prevalence rate, unfortunately, of opioid overdose and loss of our community members. So fatal overdoses have unfortunately been a dark cloud over our consortium tribes. And I think, well, I want to say one, I don't think we've been a success. Yet a success would be that there are zero losses by opioid overdose, zero losses by suicide in our tribal consortium areas. I do feel proud of the work that many people are doing to ensure we have zero suicide and zero loss by opioid overdose. And part of that success contributes to a very collaborative approach with many, many organizations, many important people. And that led to a strategic opioid planning meeting. In our strategic opioid planning meetings, we invited all of our nine consortium tribal leaders, all of our board members here at Indian Health Council, several of our directors who oversee programs and services that are designed to prevent, intervene and treat disparities related to opioid use disorder, substance use disorder, mental health challenges and so on. And in our discussions during our strategic opioid planning meetings, I mean, the conversations were difficult. They were very filled with emotion, as you can imagine, sure and very filled with a desire to do better, a desire to find a solution. How do we address this? What do we need to do to ensure that the lives of our people are protected and supported? In addition to those, those people that are experiencing addiction, how do we then support their family members? So the trauma sort of spreads throughout not just that individual, but to their families. And as you can imagine, being that we serve nine consortium tribes. Our community is very, very tight. It essentially spreads to an entire reservation and spreads to entire communities across not just our nine consortium tribes, but it expands out to all of our other neighboring tribes. So the impact is great.

Angelina Renteria 34:50
Through our strategic opioid planning meetings, one of the barriers that we've talked about is when an individual makes that decision to transition. To a life of sobriety, one that's a really hard decision, and we're always so proud of individuals when they make that step. That's a really difficult step to make. It's also a really difficult step to sustain. You know, relapse is real for someone who suffers with addiction, and so in these conversations, our tribal leaders, our board of directors, our team members here at Indian Health Council, really confronted, what are some of the barriers? What are the things that cause relapse? What are some of the issues when someone chooses sobriety and they come back to our communities and are confronted with relapse or reassociating with some of the folks that are still in addiction, how do we what do we do with this? And so one of the things that came up was, you know, finding purpose is really important when you achieve sobriety, finding something outside of of yourself that you can contribute to as a member of your community and feel proud about that is really important in that step of sobriety. So we looked at career development options. We looked at, you know, job opportunities. Job opportunities in this area are not very high. Again, our area, you don't, you can't walk up the road and put it in a job application or apply to some place online and have a job just a couple blocks down the road, so the availability of employment is minimal, and so what we developed, based on all of these conversations, was some career development opportunities. So we have actually established within one of our grants called the tribal opioid response grant, a peer support specialist training opportunity. I'm really happy to say this because this did not exist prior to these discussions. Did not exist here at Indian Health Council prior to these discussions. But what this means is that when someone is has entered recovery, they have chosen a life of sobriety, we now have opportunities for individuals to come and say, Hey, I heard you have this, this opportunity for me, without judgment, in fact, to qualify for the peer support specialist position. The eligibility means that you are a person with lived experience, that you were in darkness of addiction, and that you chose to step out, you chose to break out and free yourself from addiction, and now we need you. We need mentors that our community members can relate to as mentors. We want individuals who have that lived experience again to become educators to others who are suffering in addiction, who again, have that relatability to others. And so we're really excited. Through the tribal opioid response grant, we have opportunities to have, right now, five individuals be trained in peer support, Specialist Certification, programming. It's free to them. And then, in addition to that, we've actually opened up right now, for now, one position as a peer support specialist to come on board Indian Health Council, as a full time team member, which we're really, really excited about, that's just been opened up, and that is as a result of listening to the voice of our tribal leaders, listening to the voice of our community members, those who have gone through lived experience and who have experienced relapse or who have experienced judgment. There's no judgment. In fact, we want to lift you up right and embrace that your experience was not not in vain, that it had some meaning, and now they can be teachers to others who are living in addiction. So that's a that's a big success, and it really resonates across many other programs that we build. They are built with the intention, or intentionally with the voice of community and understanding the barriers that they face, and now we know barrier. Let's find a solution. Here is one. Now let's implement and and move, move ahead. And so we're really excited to support those that are onboarding in this in this program

Grant Oliphant 39:13
that is such a terrific example. And congratulations to you, and wish you much success with that approach. It it just intuitively seems like the right approach, and I suspect you'll have a lot of success with it. Thank you. I'm curious to know what the what the present funding environment is like for you, and you know what you're experiencing in terms of the turmoil at the federal level, and how that's translating down to the work of the Indian Health Council, sure,

Angelina Renteria 39:46
sure. So we have about maybe 70, 75% of our funds come from the federal level. So we have quite a few grants that are funded by IHS NIH. Uh, CDC, SAMHSA, many of our grants, in fact, are funded by those that are being being reviewed now we we're forging ahead and and again. That relates back to what we do here at Indian Health Council. We develop programs and services so that we can empower our community members to be independent in their health journeys. We ensure that the education and information and the resources that we're providing stick and that they're lifelong and lasting within an individual's life and their family's life now, right now there is, there's a lot of stress around many of our team members, and we're really working hard to, in a sense, fight against, I think, what may be intentionally happening to create fear and anxiety and many, many people that are serving in the best way possible and in the work that we do, and when we think about the Medicine Wheel, mental, emotional, physical and spiritual, well being, it's extremely important that we focus on those elements as as a provider. It's extremely important that we stay grounded in the work that we do. I think probably we all have experienced stress in the workplace, and when we allow that to seep into our core being it can certainly impact the quality of work that you do. It can it can certainly impact how you feel as an individual. So I think right now, more than ever, we've really had to be very grounded in in dealing with the some of the turmoil that we're hearing at the administrative level. Could it impact our programs and services? There is a possibility. And so right now, I think

Grant Oliphant 41:56
you haven't been you haven't been told that, that you're losing any funds. To date,

Angelina Renteria 42:01
we have not been told that we're losing any funds, and we are. We're taking the stance that we're going to continue to apply for the applications that are open. We're not going to stop applying. We're not going to stop writing grants. We're not going to stop, you know, yelling out that these are the resources that our communities need. This is what we're we're here to do, to fight and advocate for the people that we serve. And that said, though we are certainly looking at foundation grants, we're certainly looking at other opportunities to ensure that we can continue to sustain the programs, sure there are no gaps in services, that continuity of cares is a priority. So we're absolutely talking about all of those potential risks that are very real to Indian Health Council right now, right

Grant Oliphant 42:48
when you think about and thank you for being candid about that. I know it's a it's a tense environment, and I think, well, I shouldn't rush past this. You know it is, it is, it is important to acknowledge what your staff members and teams are dealing with in terms of the fear and the uncertainty and and your resolve, which mirrors your resolve from your life story is, you know is evident, and I think will serve you well in This, in these times, I'm curious to know if the experience you've had in reaching populations that traditionally have been hard to reach for traditional medicine have given you insights into healthcare that other healthcare providers are trying to learn from are there innovative models? I mean, I think your example around the around treatment and bringing in people who have themselves been addicted into roles of helping facilitate the care and the journeys of other people who are traveling down that path. That's one great example. But other, are there other examples of how your approach to care is being looked at by other providers in these you know, as they think about how best to deliver health care right now?

Angelina Renteria 44:14
Sure, sure. So, you know, we, I haven't shared that we are also a Native American Research Center for Health, and so we have our own research and Student Development Department here at Indian Health Council. And community based practices are something that we absolutely implement, as well as evidence based practices. Evidence based practices are available to organizations across the country. I think one of the models that we absolutely prioritize is also community based best practice, which, which means that we are listening to the voice of the community that's that's aligns with our approach in developing the strategic opioid planning meeting, we have multiple community based best practice research projects happening, right? Now, and those research projects are developed based on community voice, based on looking at our health data to determine what questions do we have that are unanswered, and how can we develop this into a research project that could inform us in a public health way to essentially, perhaps develop enhanced programs that can truly meet the needs of our community that will be effective.

Angelina Renteria 45:24
We're also really, really embracing an integrative care approach model. So we talked a little bit earlier about how in healthcare, sometimes things can feel very segmented. You talk about medical ailments with your medical doctor at one visit, and then you may go to your dentist and you get your teeth cleaned or a cavity filled or root canal, the procedure that may happen, but those two providers don't talk to each other. Typically correct at Indian Health Council, ours do our medical doctor and our dental clinicians and our behavioral health clinicians and our pharmacists and our research department and our marketing department and our health promotion services department, our tribal Family Services Department, which is a social services department. Essentially, they all talk to each other. That is our integrated care model. That is probably the most important model that we really believe is going to provide quality health care to our communities. We our bodies are not dissected. We're one. Our Medicine Wheel is not dissected. In fact, it's it's a circle, and it's intended to be a circle, for a reason. There's continuity. They're not designed to be again, operated independently or in silos. They're designed to be balanced. And balance is very key in Indian Country, specifically, and I would say all over the world, not just in Indian country. So we want to approach healthcare in a very balanced sense. And so that integrated care model is really, really important to how we deliver services, how we talk to each other, how we relate at our organization, as as colleagues. So we really try to to to adopt that here. I would say that's probably right now the model that we're really focusing on, on enhancing,

Grant Oliphant 47:19
I was going to ask you what your vision is for the future, and it sounds like that is the vision. Is that? Right?

Angelina Renteria 47:27
Well, it's interesting that you asked that question. So we do have our mission and vision statement for the organization, and our mission statement is to continually nurture a balance of mental, emotional, physical and spiritual well being. We are actively working on developing as an entire organization and nine consortium community to revisit our mission and vision statement. And you know, we had phenomenal founders who developed our original mission and vision statements. And as we evolve over time, we realize that, let's look at this again. This is our roadmap for how we move into the future, and it's our roadmap to really visualizing who we are, you know, 50 years down the road and so really excited to again. This aligns with the community voice being the strongest voice of all at Indian Health Council is we are. We are actively working with Native staff to build some options for a vision statement. We're also going to take those vision statements and share them with our tribal community members. The most important thing that we see is that we have dual responsibility to achieve this vision doesn't fall just on the individual. We're a team. It falls on how is your healthcare support person helping you to achieve a vision as an individual or a vision as a community and vice versa, doesn't just fall on the responsibility of a provider, there has to be responsibility on the individual side. So we're really excited that we have this opportunity to take the time to talk to, you know, 6000 active patients, to have have the ability to think through what what do we want to be? What is that utopian state that we see for our community 50 years down the road. In fact, we in the meeting that I met you and others from prevista, we had a similar conversation. And so we're having that opportunity to do that with community, and that's extremely key in you know, if we're going to get there, let's, let's, let's document the goal. Let's document the vision, and then let's develop the the activities and the the work that we have to do to ensure that we get to that that place. So integrative care means that we're talking integrative Lee to everybody responsible. For achieving that, that vision so super exciting time, and also comes with with challenges as well. You know, a lot of work from our founders went into developing and instituting this, this organization, and creating the roadmap for for us to carry on that work that was done originally back in 1970 so it's always evolving, and it's always something that we we always want to make sure we're prioritizing tribal community voice. Ultimately, this is all the nine consortium tribal community members home. This is their health care home, and they should be the ones that are talking through what they want to see for themselves and their community. I really love that.

Grant Oliphant 50:46
I'm curious, if you you know, as we wind down, if you have any thoughts you want to share with policy makers as as they think about the work of of Indian Health Council and tribal health care, what you would want them to understand and leave them with

Angelina Renteria 51:06
sure you know, tribal community members have operated and and and existed with medicine prior to the introduction of Western medicine, there's a there's a innate understanding of what one has the potential to achieve, again, through emotional, mental, physical, well and spiritual well being, understanding that traditional practices are medicine and allowing tribes to be the voice the subject matter experts in designing a healthcare system that is culturally informed, that does incorporate traditional medicine in order to sustain, you know, we have, we have the ability to code and and bill insurance. Really excited that now to just some traditional practices are being acknowledged as true medicine, so that could be things like sweat or drum circle or other traditional practices led by traditional healers. We're really excited that that's happening. I would, I would certainly advocate that our western medicine model continue to respect the practices of native people and when native people identify that something is medicinal and healing from a traditional aspect, that we respect that and that we find a way to incorporate that into a western medicine model that allows us to continue to sustain this infrastructure. You know, a lot of discussion has to happen there, specifically with tribal leaders and tribal healers, but absolutely want to ensure that that continues to be a conversation. Next is to really honor the tribal sovereignty of each of the tribes, not just those that we serve, but all tribes across the nation, to ensure that tribal healthcare systems have the capacity to continue to serve the patients that we're here to serve, that funding opportunities are always made available to tribes and tribal organizations. Without that funding, all of the work that we've just described would be really, really difficult to continue to provide to our communities. The other is that oftentimes tribal set asides are extremely minimal, which means that tribes are competing against each other for the same bucket of funds to do the work that needs to be done in tribal communities. There has to somehow be a way to give tribes the ability to serve their communities without competing against one another. If we win an award, we've taken an opportunity essentially from a different tribe that needs to do the same work. So certainly want to make sure that that's continually looked at.

Grant Oliphant 53:59
Well, thank you. I think that is a it's a brilliant set of messages to convey and to wrap up with Angelina, I just want to thank you for the passion that you bring to this work, the enthusiasm and the energy. You know, when I think about the fabric of healthcare in San Diego County, there is no one organization that does everything, and, you know, we have this extraordinary tapestry, and your particular piece of it is, it's just amazing to hear how vital and vibrant you are managing to keep it and that you're leaning into keeping it relevant. You know, I do think what you were talking about a moment ago with with having tribal practices be recognized as part of and alongside traditional medicine, is actually something we probably need to see more of across the spectrum of health care, and not just at Indian Health Council. So you're informing practice for the country, as well as what you're doing through your your work on the nine reservations, and I want to honor that. Is there anything you want to say before we wrap up? To sum up your thoughts here,

Angelina Renteria 54:10
you know, Grant this, this has been such a pleasure talking with you. I have myself and my colleagues here have really enjoyed working with Prebys. I think you also model the importance of inclusion and belonging and voice of community. In one of the amazing meetings that we had with previs, we talked about gathering community. In fact, something that we discussed was, you know, in the in the height of the conversation, was community block party. And you know, that would resonate in a city where there are blocks in our communities, there's there aren't blocks, but you know, traditional health gatherings are something that I would say are synonymous here. And I definitely just want to point out that, you know, in in healthcare or in health in general, the ability to belong and to commune with each other is so important, and so that's another important element of Indian Health Council is creating opportunity for community to gather

Grant Oliphant 55:24
wonderful

Angelina Renteria 55:31
in the Prebys conversation. Conversation. It was Prebys Block Party, the ability for us to gather and talk about how we can achieve the healthy communities that we want to achieve, one on one conversations or group conversations. And I definitely think especially now, more than ever, this is a time where we have these types of conversations at the dinner table, bonfires, block parties, traditional health gathering. Really important that we continue these conversations at all levels, not just in your job nine to five, but even outside of that. And so I just want to thank Prebys, because I think you really model that you've opened up a conversation with me and others, and I certainly appreciate that you gave us a platform to share more about the work that we do, and just thank you so much for for chatting with me. It was a pleasure to talk with you.

Grant Oliphant 57:13
Well, thank you for all of that, and that's beautifully stated. I don't need to add anything to it. I can, I can. It just underscores for me that we learned from you. So thank you for that opportunity, and I've really enjoyed this conversation. I look forward to visiting soon. I hope,

Angelina Renteria 57:33
yes, absolutely, the invite is open.

Grant Oliphant 57:35
All right,

Angelina Renteria 57:36
thank you, Grant.

Grant Oliphant 57:37
Thank you.

Crystal Page 57:41
So culturally competent care

Grant Oliphant 57:43
and womb to tomb. You know, a lot of phrases there that capture an approach that, you know, I think, what, I think, what, what Angelina was capturing for us was how this clinic approaches medical care through the lens of the distinctive community that they're serving. And when we think what people need, they need, especially in healthcare professionals, people who understand them, and that's what they're modeling at IHC,

Crystal Page 58:13
yeah, and the fact that she said that the primary will speak to the dentist, will speak to the therapist, and you have to know what's in the fridge. I mean, that's the kind of care I think we all probably would aspire to have. Well,

Grant Oliphant 58:25
I'm not sure I want anybody knowing what's in my fridge, but I think that's so important. You know, it's a holistic approach to to medicine, and it also underscores, for me why it's so important to consider things like culture in the delivery of healthcare, because communities are different. They have different access. They have they do have different cultures, they have different practices, they have different ways of relating to healthcare. And I love listening to her talk about this model, because it's a beautiful model,

Crystal Page 59:02
well, and also, when she talked about the Medicine Wheel, right? The physical, mental, spiritual and those cultural practices bringing that in, it seems like it's appropriate. It's informed by what that community already knows as wisdom and healing and connection, which builds belonging.

Grant Oliphant 59:18
It does, it's, it's such a great example. I love the medicine wheel again. It's an illustration of a holistic approach to healthcare, but it's appropriate to the culture, and it really speaks to the clientele who visit the clinic. We need more of that,

Crystal Page 59:40
and we're just so thankful to Angelina, Indian Health Council as a Share grantee, and just to remind folks Share were the grantees that they serve communities directly, so folks don't have to go to a hospital or something. So it's in community, it makes it easier for folks to have access and maintain that care.

Grant Oliphant 59:57
And when we think about what is the frontline health care. Provider. For many people in San Diego County who maybe don't have access to a nearby large healthcare facility, maybe aren't sure they want to go, maybe don't have the means to go healthcare, clinics like this are the place that they turn to, and they really can be a provider that helps them deal in their home environment with the healthcare issues that they're facing.

Crystal Page 1:00:31
Love it. I learned so much on this interview. Thank you Grant

Grant Oliphant 1:00:33
I really did too, and I loved her optimism, so it was an uplifting interview, and I am grateful that we got to talk aboutit.

Crystal Page 1:00:43
Me too. Thanks for listening to stop and talk and have a good one.

Grant Oliphant 1:00:46
Thanks everyone.

Grant Oliphant 1:00:53
This is a production of the Prebys Foundation,

Crystal Page 1:00:57
hosted by Grant Oliphant

Grant Oliphant 1:00:59
co hosted by Crystal page,

Crystal Page 1:01:02
Co-produced by Crystal page and Adam Greenfield,

Grant Oliphant 1:01:06
engineered by Adam Greenfield,

Crystal Page 1:01:09
production coordination by Tess Karesky,

Grant Oliphant 1:01:12
video production by Edgar Ontiveros Medina,

Crystal Page 1:01:16
special thanks to the Prebys Foundation team.

Grant Oliphant 1:01:19
The stop and talk theme song was created by San Diego's own Mr. Lyrical Groove.

Crystal Page 1:01:25
Download episodes at your favorite podcatcher, or visit us at prebysfdn.org.