From the Dean: Heavy hearts
The UND SMHS family shared in lamenting the unsettling news that some 250 boxes containing the remains of Indigenous ancestors and other sacred objects have been located on the UND campus in Grand Forks. President Armacost spoke about the news on Wednesday and was sincere in his apologies on behalf of the entire UND community. He outlined how the repatriation process will occur and the ancestors’ remains and sacred objects returned to their ancestral homes.
This is a painful discovery, especially for our Indigenous friends, colleagues, and students. While we cannot correct past wrongs, we can ensure that they do not recur. Especially in view of the School’s Indians into Medicine (INMED) and Indigenous Health Ph.D. programs, along with our Department of Indigenous Health, the SMHS family stands ready to assist and support our American Indian and Alaska Native colleagues in any way we can.
One of the common threads all of us have with our Indigenous colleagues is understanding the critical role that the land of North Dakota has played for millennia. To UND’s credit, the importance of that shared use of the land was declared in its Land Acknowledgement Statement that was promulgated in 2020: “Today, the University of North Dakota rests on the ancestral lands of the Pembina and Red Lake Bands of Ojibwe and the Dakota Oyate – presently existing as composite parts of the Red Lake, Turtle Mountain, White Earth Bands, and the Dakota Tribes of Minnesota and North Dakota. We acknowledge the people who resided here for generations and recognize that the spirit of the Ojibwe and Oyate people permeates this land. As a university community, we will continue to build upon our relations with the First Nations of the State of North Dakota – the Mandan, Hidatsa, and Arikara Nation, Sisseton-Wahpeton Oyate Nation, Spirit Lake Nation, Standing Rock Sioux Tribe, and Turtle Mountain Band of Chippewa Indians.”
This statement’s emphasis on not only land but the rural essence of the region speaks to North Dakota’s past and future, and the wellbeing of all of its people. While our sparse population density certainly is attractive compared to the situation in some overcrowded cities, it does present its challenges, especially relating to healthcare delivery. A recent publication in the Journal of the American Medical Association (JAMA Cardiol.doi:10.1001/jamacardio.2022.2774, published online Aug. 31, 2022) has several important implications in this regard. This was a study of the outcomes after serious heart attacks experienced by patients in rural compared with urban areas. Some of the findings were expected – rural patients were less likely to get a stent, and if they did, it took longer for rural heart attack patients to get a stent inserted than an urban patient. What was somewhat unexpected was that the mortality rate was identical in the two groups! This likely was because rural patients were more likely to get a so-called “clot buster” drug (thrombolytic therapy) than urban patients. It turns out that these drugs are quite effective in getting rid of the blood clots that cause heart attacks, and we’ve learned that it is better to give a thrombolytic agent immediately than to wait to transfer the patient to a referral hospital where a stent can be inserted. Important in this regard is the need for a systematic plan for dealing with heart attack patients in a given region, such as we have in North Dakota for prioritizing which treatment (thrombolytic vs. immediate stent) is indicated depending on how close the patient is to a stent-capable hospital.
Thus, the important implication of this study is that while obviously it is crucial to have the same patient outcomes in rural compared with urban areas, the healthcare delivery specifics may differ in the two areas. This concept of equivalent-but-not-necessarily-identical care in rural vs. urban areas will be especially important going forward.
Joshua Wynne, MD, MBA, MPH
Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences