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Shadowing Tribal Doctors in Kotzebue,
Alaska, February 15-16, 2006 I had the good fortune to shadow two tribal doctors at the Maniilaq Associationšs Traditional Healing Program, along with their two regular tribal doctor trainees. Although Alaska has been my home since 1980, I had never been to Kotzebue. My medical training has been purely in the mainstream western medical way, so traditional healing is a new and interesting experience for me. I worked alternately with tribal doctors Evelyn Karmun and Sue Norton, and trainees Steve Osbourne and Nina Ahkpuk, all of whom are Iņupiat from the region. While most of what I observed for two days involved massage and manipulation, there was a great deal of conversational flow between patient and tribal doctors that demonstrated to me a high degree of personal interest and care by the doctor for the whole patient. The tribal doctors attempted to identify the various stress factors, both physical and psychological, that might have contributed to sore muscles or joints, headaches, back pain, and even constipation. One elderly woman, who visits her tribal doctor weekly, complained of her stomach just "not feeling right," and that she felt constipated. She already had an abdominal work-up recently, and was scheduled for an upcoming screening colonoscopy in Anchorage during the following week, but nothing seemed to resolve the complaint. Her massage started at both ends simultaneously, with the tribal doctor working on the hands, head and neck, while the trainee worked on the lower limbs. This was to relax the patient, and "get her blood flowing," as was commonly described. After her hands and feet warmed up with a restored red glow, the tribal doctor then concentrated on the abdomen. She meticulously examined the area with her palms and finger pads, gliding and pressing every square inch, searching for anything out of the ordinary such as pain or tenderness, enlarged organs, unusual firmness, masses of any kind. She detected a segment of bowel with firm stool, and massaged the abdomen in order to stimulate a bowel movement. This practice continued for another 30 minutes or so, and soon the patient was having episodes of passing gas. She giggled and apologized, but said that this was the relief she needed. The patient left smiling, and stated that she "always feels better" after her visit to the tribal doctor. "Aarigaa taikuu," she said in Iņupiaq, which translates to "Wow, thank you." During the course of my two-day visit, the tribal doctors massaged the back of a woman, seven months pregnant, who had muscle strain from lifting boxes during her move to a new place. Another received a massage specific for relief of recurrent migraine headaches, and prefers this method to medically prescribed pharmacological treatment whenever possible. Still others sought relief for chronic low back pain and cramping legs for which no other medical treatments had yet helped. The patients were often referrals from physicians at the nearby health center. These tribal doctors are also called at appropriate times to reposition a fetus that lies breech in the womb. They also engage is health education and disease prevention presentations, conduct field clinics at local hot springs, perform a unique acupuncture-like procedure called "poking," and use medicinal plants on a limited basis. "What did you learn," Evelyn asked me in the final moments of my visit. I realized in those two days the power of feeling from our hands. I watched the tribal doctorsš method of examining the body, especially of the abdomen and musculoskeletal system, and decided that I would incorporate their comprehensive method of touch into my own technique of palpation. Additionally, I learned the importance of partnering with the traditional healings of Alaskašs tribal doctors, and look forward to building such relationships in my own work as a family medicine physician to foster healing among individuals and within communities.
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