By Taylor Sisk, for The Daily Yonder  

An interest in different cultures led Matthew Mahar to pursue an anthropology minor in college and to subsequently travel extensively. More recently, it’s led him to a hospital in the mountains of Western North Carolina.

Cherokee Indian Hospital sits on the Qualla Boundary, home to the Eastern Band of Cherokee Indians, a 57,000-acre land trust owned by the tribe. The hospital is designed to echo Cherokee history and culture. This is immediately apparent as you enter its main concourse: Imbued with natural light, it depicts a river walk, lined with scenes of Cherokee legend intended to convey a cultural continuum, a source of strength.

In this spirit, a holistic continuum of care is practiced here.

In addition to primary care, pediatrics, and a specialty clinic, the hospital offers dental care, physical and occupational therapy, behavioral health services, nutritionists, and a pharmacy, all within these walls. Each patient’s care is overseen by a case manager.

Cherokee Hospital operates under three guiding principles. “U wa shv u da nv te lv” translates to “The one who helps you from the heart.” “To-hi” is “A state of peace and balance.” And “Ni hi tsa tse li” means “It belongs to you.”

The focus is on community health, toward assuring “the prosperity of the next seven generations of the Eastern Band of Cherokee Indians.”

Mahar was drawn to his current position on the Qualla Boundary by both its culture and this approach to health care. He’s a primary care physician and a faculty member in an internal medicine rural and tribal residency track co-administered by the Cherokee Indian Hospital Authority and the Mountain Area Heath Education Center (MAHEC).

Much of rural America is confronted with a critical shortage of healthcare professionals, such as in rural Western North Carolina. The rural and tribal residency track was launched to address that shortage. It offers comprehensive training and the opportunity to experience what it’s like to practice in rural and historically marginalized communities, and in a model outside the Western tradition.

Mahar certainly knows rural – he was raised in a Nebraska town of 1,000 residents – and the challenges and rewards of practicing medicine there. His experience at Cherokee Hospital has been fascinating. “It keeps me growing and learning,” he said.

He’s now helping impart the virtues of that experience to a new generation of health care professionals.

Residents in the rural and tribal residency track are mentored to gain “an enhanced recognition of the importance of cultural humility and awareness,” said Stephanie Call, director of MAHEC’s Internal Medicine Residency Program, through which the rural and tribal track is offered.

Cherokee Hospital’s values and vision align nicely with MAHEC’s, Call said: an interdisciplinary, comprehensive approach to sustainable quality health care in the region. This partnership, she said, was a natural fit.

“I'm so proud of it,” Call said. “I’ve learned so much.”

Those ‘Smaller-Area Vibes’

The Qualla Boundary is a unique pocket of rural America. Adjacent to the Great Smoky Mountains National Park, it’s an outdoorsperson’s paradise. It’s also home to Harrah’s Cherokee Casino Resort: 150,000 square feet of gambling action and a 21-story hotel. The casino’s opening in 1997 was transformative for the tribe’s economy.

But the Qualla Boundary faces many of the same challenges as the majority of rural America in attracting health care providers: its remoteness, limited housing options, few big-city amenities. A primary objective of the rural and tribal track, Call said, is “to retain at least 50% of our graduates to stay here and work to improve the health of Western North Carolina.”

Sarah Bogan is a resident in the program. She grew up in the small town of Sanford, in North Carolina’s Piedmont region, and has always intended to practice in a like environment. “I enjoy the smaller towns,” she said. “I like the smaller-area vibes, getting to know everybody.”

The rural and tribal track offered a unique experience.

“I think residents having the opportunity to work in a rural area and learn the culture of [the Cherokee people] is so valuable,” said Amy Parker, the track’s site administrator. “They become absorbed in a community unfamiliar to anything most of them have known. Once they get over not having a Trader Joe’s within 60 miles, they find things to love here – hiking, fishing, biking, and maybe even a little gambling.”

But, Parker added, “Getting to know the people is the best bonus.”

Residents are urged to gain insight into what’s important to their indigenous patients. “That can be ceremonies,” Mahar said, “it can be herbal medicines.” They’re urged to encourage their patients “to talk a little bit about their family history and how they were raised.” Such an understanding fosters more comprehensive care.

Bogan’s patients sometimes share their home-remedies, “and it’ll be things that I haven’t heard of before.” She tells them, “‘I should actually do my own research and try out some of this stuff myself.’”

Sarah Taws, another rural and tribal track resident, appreciated the Right Way training she received, in which residents learn of the tribe’s past traumas – most notably, forced removal from their ancestral lands.

Program residents are also trained at the 800-bed Mission Hospital in Asheville, allowing for a rounded workplace experience.

‘Truly Invested’

A second important objective of the rural and tribal track is to instill in its residents the conviction that “selfcare is not selfish,” Call said. “That it is part of our responsibility for making sure that we’re taking care of our strengths, talents, and skills so we can contribute to our communities in a sustainable manner.”

“Our goal is to keep people in this profession by putting a strong emphasis on structures, systems, and training around well-being,” she said.

That emphasis was a major selling point for Taws. “MAHEC advertised a program of wellness,” she said. Its residency programs report a burnout rate 40% below the national average. “That was attractive,” she said.

Practicing in a rural environment, Call said, is a very different experience. “There are different barriers, there are different structures that need to be set up, there are different skill sets for a rural-based internist.” It’s not for everyone.

Taws is from Florida. She initially had some trepidation about Cherokee Hospital’s remoteness. But there was, too, plenty of allure. The mountains beckoned. She and her husband want a small farm; they’re off to a great start: 17 chickens, two ducks, and some bunnies. The idea of staying on post-residency to practice on the Qualla Boundary is enticing, but she acknowledges that a particular specialty, or a fellowship, could take her family elsewhere.

“Time will tell,” Taws said. Regardless, “I hope to work in a rural place.”

Mahar trusts that after having spent a chunk of time on the Qualla Boundary – the residency is a three-year program – many will “fall in love with it and see that there’s a small-town charm and a vision of community that’s a little bit different.”

“The Cherokee people have learned to trust these residents, and welcome them,” Parker said, “and they are rewarded with great care from young doctors truly invested in the community.”

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This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.