Embracing Diversity in Curricula: Not Seen, Not Heard, Not Spoken, Not Learned

 In Education, Pediatrics

Education

Fraser Smith, MATD, ND

The opportunities for embracing diversity and racism issues in our curricula are limitless and must be met in earnest.  

This spring I was approached by my long-time mentor, colleague, and friend, Dr David Schleich, who has written this column on education for NDNR for many years. Dr Schleich asked if I might be interested in stepping into this role, provided that the publication wanted to use me, and I said that I was. I have been deeply involved in naturopathic medical education since 1997, in my days as a resident at the Robert Schad clinic of the Canadian College of Naturopathic Medicine (CCNM), in my years as clinic and classroom faculty, and in my role since 2005 as program leader for the Doctor of Naturopathic Medicine degree at National University of Health Sciences in Lombard, IL. I’m currently serving in the volunteer position of president of the AANMC (Association of Accredited Naturopathic Medical Colleges) – a rotating position – and I am in weekly contact with my colleagues from AANMC. It is an exciting and momentous time for naturopathic medical education. Dr Schleich has brought many of the issues to life in his previous columns, and I will endeavor to do the same. 

Naturopathic Medical Education & Diversity 

I could not begin this series in good conscience without addressing diversity and inclusiveness in naturopathic medical education. This, of course, brings us up against racism in medicine as a whole, in research and in our own profession, as well as the many societal inequities that often predispose health inequality.  

I cannot summarize or even begin to solve issues for the profession in this brief discussion, nor can I speak for all schools. There are many aspects surrounding racism and bias that I have not experienced firsthand or from the perspectives of some of my colleagues and students. What I do know, however, is the training of naturopathic doctors and how it can help to begin with a look at where we are and what could be improved. 

In the bigger picture, the very fabric of our society is changing. Through great effort, it is beginning to weave itself into something far better. Our small profession, including its flotilla of colleges, has been very much in the center of it all. We have a mission as a profession to bring healing to the world. We have many students of color who wish for their profession to be a leader in health care, and who are rightfully demanding that we as colleagues raise our level of awareness and keep raising it. 

The member schools of AANMC have been in constant communication this summer about how to collectively act to address issues of inequity, racism, and injustice in our own profession and in health care. On our individual campuses, in the light of our own circumstances, there has been constructive action. Some campuses have appointed dedicated Diversity, Equity and Inclusion (DEI) officers, launched new interdisciplinary DEI committees, begun assessment of curriculum, or begun to use the skills of DEI consultants, trainers, and facilitators. This is a beginning, and it is safe to say that no one sees this as a box to check; rather, it is the beginning of a path to the future. 

Curriculum Opportunities 

One thing, among many, that has become clearer to me as an educator these past months is the degree to which there are missed opportunities in the curricula for incorporating topics that support diversity in our profession and an experience of inclusion for all members of the naturopathic educational community. The extension and outcome of this curriculum are skills that the student will bring into practice as a more aware and effective doctor. This is not to say that there aren’t opportunities taken. That would be giving short shrift to our wonderful faculty and education leaders, many of whom have come up through the naturopathic colleges, themselves. But there is so much further to travel. Just taking a simple example of naturopathic history, there are facts, stories and lessons that we are missing. A few weeks ago, one of my students wrote me a brief, clear, and sincere email, which I’ll paraphrase here: “Why don’t we discuss Black physicians more in the curriculum? What about the Black healers who contributed to natural medicine? Where are the non-Europeans? Even Hippocrates studied the works of Imhotep. Why can’t we balance this out?” This stopped me cold in the train of thought I was on. I am used to garnering feedback from students, and I take it seriously. But this query hit me hard. What about those healers? 

Overlooked Non-White Natural Medicine Leaders 

Our naturopathic medicine curricula have always included, and still do include, some history of naturopathic medicine. It is the right time for those of us who teach it to ask ourselves some questions. Do we teach examples of Black natural medicine leaders, past and present? Do we need to learn about these healers? In 1979, Dr Frederick Newsome wrote an article for the Journal of the American Medical Association titled “Black Contributions to the Early History of Western Medicine: Lack of Recognition as a Cause of Black Under Representation in US Medical Schools.” Newsome makes a strong case for the overwhelming influence of Egyptian medicine on Hippocrates. He goes on to argue that because many of these Egyptian physicians were from the Black community, the very foundations that were laid for Western medicine have a significant authorship from these African physicians of the Black communities of the kingdom of Egypt.1 We can also start giving credit to David Ruggles. Some of his story is recounted in the 1959 article, “David Ruggles, 1810-1849; Hydropathic Practitioner,”2 published in the Journal of the National Medical Association and authored by Dorothy Porter, supervisor of the Moorland Foundation Library at Howard University.3 [This library is an example of a vast resource from which we could learn.] Ruggles was a Black man and abolitionist (he was very involved in the Underground Railroad) in the 19th century. Suffering from poor health, he acquired a book from the great hydrotherapist, Vincenz Priessnitz, and, much like other water-cure pioneers, he taught himself and healed himself. Ruggles went on to found the first designated hydrotherapy facility in the United States, a facility that was highly regarded.  

Our curricula include medical ethics, and anyone who has done the Health and Human Services training in order to conduct research has had to learn about Tuskegee, where Black prisoners were intentionally infected with syphilis in order to study its latent and tertiary effects. As important as that example is, there are many more. Albert Kligman, an eminent physician who discovered isotretinoin, was involved for years in barbaric experiments at Holmesburg Prison,4 which was majority Black (85% by the late 1960s). Patients were exposed to myriad chemicals, including dioxin, to study its effects. Intentional infection with massive amounts of fungi was another example of the many tests. Patients were not informed of what they were given, and the pay they received went far beyond the limits of proper incentive.  

Although this came to light in years to come, Kligman was not cast out from the medical profession, nor was he criminally charged. His position of power in the medical profession, and his privilege, insulated him from proportionate (if it were possible) consequences for his actions. I read some years ago – and recommend to anyone – the book, The Immortal Life of Henrietta Lacks.5 Lacks died at Johns Hopkins of adenocarcinoma of the cervix, and the cells harvested from her body became the HeLa cell line, used in innumerable cell-line cancer research projects. The book, which involved not only document-derived research, but also time spent with her family, outlines the callous disregard not only for Henrietta Lacks’ body and its tissues, but also for her family – emotionally, financially, and ethically. Many years after her death, members of Congress and, eventually, Johns Hopkins have paid tribute to her legacy; however, this came about after years of efforts to raise awareness about Henrietta Lacks and a fight for justice. Personally, my next read will be Medical Apartheid, by Harriet A. Washington; as a sometimes-teacher of medical history, I need to absorb these lessons.  

Crediting the Massive Contributions  

Signifying a trend toward recognizing the greater authorship of our medicine, First Nations healers and the materia medica have been appearing in the various “World Medicine” courses taught in ND programs (as such, or as part of a systems or principles course). As we broaden our awareness in this area, it becomes immediately apparent that a passing acknowledgement is not enough. We can look at the many contributions to natural medicine (allopathic medicine and laboratory science has its own list) of Black physicians, herbalists, hydropaths, and midwives. The great work of curanderas/curanderos as part of the Curanderismo system of Mexico is another. There are many traditions across the Caribbean and an incredible materia medica.  

But one example, a vast one, which ties directly into naturopathic botanical medicine – a subject I teach and research – is the contributions of First Nations/Native American (this term varies depending on how individuals choose to be named, which may also include their nation/tribe or band). If you look closely at the body of work of the Eclectic materia medica, you will find many herbs that are of North American origin. The Eclectics undoubtedly added great clinical vignettes and chemical analysis and pharmacology to these herb discussions. As a student, I wondered at how they could pick out, from thousands of plants, those that were most useful, and so rapidly, in decades and zero in on the specific medicines. The answer is that they had the work of centuries of First Nations healers on which to capitalize. A simple example is Echinacea species, which were used by the Lakota and others. We are really massively indebted to that tradition.  

I would heartily recommend the book, The Science of the Sacred: Bridging Global Indigenous Medicine Systems and Modern Scientific Principles, by Nicole Redvers, ND, MPHc.6 This book beautifully and brilliantly explains many of the tenets of traditional medical systems, with many examples from First Nations. Dr Redvers is a member of the Deninu K’ue First Nations Band, or “Dene.” After obtaining her ND degree at CCNM, she returned to Northern Canada (Yellowknife, Northwest Territories) and opened a successful naturopathic medicine center; she also obtained a large federal grant to revitalize wellness services in the North and to preserve the medical traditions with which she grew up. Dr Redvers is now on the faculty at the University of North Dakota, leading the teaching and preservation of indigenous medicine.7 As the book will teach you, there is an incredibly powerful medicine system and wisdom that is dying out as elders die. The systemic racism that attempted to stamp out First Nations culture in Canada also grievously wounded their medical traditions. Would-be healers, identified young by their elders, were forced into residential schools and often beaten should they be caught performing even a simple ceremony. But it survives, and in reading this book, it reminds me that natural healing is deeply scientific. But, unlike the wider project of science on an industrial scale, this branch of science should be championed and expanded.  

The Trim Tab Turns  

Naturopathic medical education is changing on a number of fronts. Diversity is a competency, as stated by the AANMC and in the standards of the CNME. What will happen in the years ahead is that growing knowledge, awareness, and work will elevate this to a strong element in terms of what it means to be trained as a naturopathic physician. We must, and given our mission, we should. Some of my colleagues, who attended naturopathic college in various decades, have shared their experiences of racist encounters. Naturopathic medical education is an enterprise many of us deeply care about, and in order for it to prosper, we need not only funding, research investment, and enrollment, but also to grow in our understanding and practice of these diversity issues to the point of setting an excellent example and leaving a legacy of pride, not disillusionment.  

A corollary topic is in the field of public health. Certainly, health disparities and inequities are part of public health courses in med school. There is so much to unpack in this topic. Access to conventional and naturopathic medicine health care is one. An immediate example is the much higher COVID-19 death rates among African Americans and Native Americans (5-fold) and Latino Americans (4-fold).8,9 A critical and extremely serious aspect of our skill set, as doctors and our student doctors-to-be, is the ability to recognize and address trauma brought on by social upheaval and the long-term and acute effects of violence against Black people and other minorities and a racialized legal system. Another critical aspect is the socioeconomic determinants of health and the effects of racism there. The term “food desert” is used to describe an area, often in a large city, that has no nearby access to produce, healthy foods, etc. This problem disproportionately impacts minorities.10 It is estimated by the USDA that over 23 million Americans live in such a zone.11 Canada has these areas as well.12,13 The term  “food swamps” is used when people living in them are awash in unhealthy food choices; this is sometimes measured by the density of convenience stores. Activists and scholars have criticized the term “desert” in the sense that a desert is a natural phenomenon, like the Sonoran Desert, rather than a byproduct of socioeconomic injustice. So we have plenty of work to do here, ensuring that our students truly engage these issues and become not only literate in them, but capable of constructive action.  

Let’s Add Voices to the Discussion  

As we fearlessly and intentionally move forward to improve naturopathic medical education, one requirement, sine qua non, is that people of color are involved in the discussion, analysis, planning, delivery, and assessment (of success) of these efforts. This could be researchers, faculty, practitioners, students, and patients. We can talk to descendants of great Black, First Nations, Indigenous, Curanderismo, and other healers. There are powerful public health researchers whom we could tap into even more. Discussions and community building will strengthen us, and give our medicine new vigor and purpose. 

Naturopathic medicine is a treasure that must be shared with the world, but we have work to do. There are legacy issues to reckon with as well, and future aspirations to reach for. My wife is an accomplished social scientist, researcher, and practitioner of organizational development. When we discussed this article, and the idea of missed or taken opportunities for learning in naturopathic college, she reminded me of a Maya Angelou quote: “I did then what I knew how to do. Now that I know better, I do better.”14 This is true for both teacher and student. To me, this goes beyond the simple imparting of knowledge to our students. It means that kind of knowledge that sinks deeply into us, and allows us to see new ways to act.  

My students, who have done a little history with me, know of my fondness for describing the obvious in Greek or Latin. That is something of a long-term effect of studying medicine. The term “education” comes from the Greek, Edukos: “To draw forth from within.” I believe that, fundamentally, we and our students know what is true, and what is healing and just. So, an immense opportunity lies ahead for us to create an awareness of the real problems of our world and in ourselves. Having found our own understanding of these issues, we can act to bring healing where it is needed. 

References: 

  1. Newsome F. Black contributions to the early history of Western medicine: lack of recognition as a cause of black under-representation in US medical schools. J Natl Med Assoc. 1979;71(2):189-193. 
  2. Porter DB. David Ruggles, 1810-1849; Hydropathic Practitioner. J Natl Med Assoc. 1957;49(1):67-72. 
  3. Howard University. Moorland-Spingarn Research Center. Available at: https://dh.howard.edu/msrc/. Accessed June 29, 2020. 
  4. Goodman H. Studying prison experiments Research: For 20 years, a dermatologist used the inmates of a Philadelphia prison as the willing subjects of tests on shampoo, foot powder, deodorant, and later, mind-altering drugs and dioxin. July 21, 1998. Baltimore Sun. Available at: https://www.baltimoresun.com/news/bs-xpm-1998-07-21-1998202099-story.html. Accessed June 28, 2020. 
  5. Skloot R. The Immortal Life of Henrietta Lacks. New York, NY: Broadway Books; 2011.  
  6. Redvers N. The Science of the Sacred: Bridging Global Indigenous Medical Systems and Modern Scientific Principles. Berkeley, CA: North Atlantic Books; 2019. 
  7. University of North Dakota School of Medicine & Health Sciences. Indigenous Health News. [Blog]. July 29, 2019. Available at: http://blogs.und.edu/indigenous-health-news/2019/07/welcome-to-dr-nicole-redvers/. Accessed June 28, 2020. 
  8. Centers for Disease Control and Prevention. COVID-19 in Racial and Ethnic Minority Groups. Last updated June 25, 2020. CDC Web site. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. Accessed June 28, 2020. 
  9. Bendix J. African Americans with COVID-19 More Likely to be Hospitalized than Whites. June 3, 2020. Medical Economics. Available at: https://www.medicaleconomics.com/view/african-americans-covid-19-more-likely-be-hospitalized-whites. Accessed June 28, 2020. 
  10. Dutko P, Ver Ploeg M, Farrigan T. Characteristics and Influential Factors of Food Deserts. August 2012. United States Department of Agriculture. USDA Web site. https://www.ers.usda.gov/webdocs/publications/45014/30940_err140.pdf. Accessed June 28, 2020. 
  11. Let’s Move. Obama White House. Healthy Communities. [Blog]. https://letsmove.obamawhitehouse.archives.gov/healthy-communities. Accessed June 28, 2020. 
  12. Luan H, Law J, Quick M. Identifying food deserts and swamps based on relative healthy food access: a spatio-temporal Bayesian approach. Int J Health Geogr. 2015;14:37.  
  13. CBC News. Canadian cities have ‘food deserts’: study. Last updated April 22, 2008. Available at: https://www.cbc.ca/news/canadian-cities-have-food-deserts-study-1.773896. Accessed June 28, 2020. 
  14. Oprah.com. The Powerful Lesson Maya Angelou Taught Oprah. October 19, 2011. [Interview]. Available at: http://www.oprah.com/oprahs-lifeclass/the-powerful-lesson-maya-angelou-taught-oprah-video. Accessed June 28, 2020.  

Fraser Smith, MATD, ND, is Assistant Dean of Naturopathic Medicine and Professor at the National University of Health Sciences (NUHS) in Lombard, IL. Prior to working at NUHS, he served as Dean of Naturopathic Medicine at the Canadian College of Naturopathic Medicine (CCNM) in Toronto, Ontario. Dr Smith is a licensed naturopathic physician and graduate of CCNM. 

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