Donald Warne

In pursuit of his goal to help eliminate health disparities in Native American communities, MPH student Donald Warne has trained in several disciplines, including traditional Lakota and classic allopathic medicine.

Warne is also a Commonwealth Fund/Harvard University Fellow in Minority Health Policy at HMS.

As a group, Native Americans have epidemic rates of diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The Pima Indians of the Gila River Indian Community near Phoenix, AZ, for example, have the highest rates of diabetes in the world.

Native Americans also have high rates of heart disease and alcoholism. Alcoholism in particular reveals itself insidiously: Native American babies are at the highest risk in the US to be born with fetal alcohol syndrome (FAS), a leading cause of birth defects. FAS rates vary among tribes.

The health problems result from a number of factors, including low socioeconomic status, said Warne. But more subtle issues color the Native American experience. The loss of culture, traditional lifestyles, belief systems, religious practices and land have all played a role in poor health outcomes, he said.

"Generally, health is a balance within an individual and within a community of spiritual, mental, physical and emotional forces," said Warne. "They are all needed to achieve optimal health."

And that is where classic medicine–the kind usually practiced in hospitals, clinics and doctors’ offices in the US–falls flat, said Warne. Focused on the physical body, modern medicine ignores other aspects of health. Warne has spent his career pursuing a range of medical training to deliver holistic care to Native Americans.

In 1992, Warne was named "pejuta wicasa," or medicine man. He is descended from a line of medicine men, and his grandfather was a traditional healer of the Oglala Lakota Tribe. Warne explained that traditional healers need to be more dynamic than allopathic-trained doctors because they are involved in broader aspects of the patient’s life. In addition to offering herbs or other substances for treatment of the body, a medicine man may also offer prayers, meditation and counseling. And, if warranted, the entire community may gather in special ceremonies to aid someone.

To broaden his training, Warne attended Stanford University School of Medicine, graduating in 1995. Since then, he has become board certified by both the American Board of Family Practice and the American Board of Medical Acupuncture. A license in homeopathy is pending. He has been a fellow in alternative medicine at the Arizona Center for Health and Medicine in Phoenix, AZ.

"No single health system can adequately address all diseases," said Warne. "To me, this is very evident. Sometimes, I feel like I’m pointing out that one plus one equals two."

Warne came to HSPH to broaden his knowledge of community health practices. After he graduates, he will return to the Hu Hu Kam Memorial Hospital in Sacaton, AZ to run a clinic for Native Americans.

One of the biggest differences a patient may find between Warne’s clinic and a more typical clinic is the interaction between patient and doctor, starting with dialogue. Classically trained doctors are taught to ask patients rote sets of questions in a linear fashion to help reach a diagnosis. Warne can quickly spout the list. But he prefers to allow his patients to tell their stories as they see fit, even when they seem to get sidetracked from a modern medicine perspective. Sidetracks can sometimes reveal an aspect of a person’s health that may otherwise go undetected.

For example, a doctor using standard methods may treat a diabetic by focusing on blood sugar levels, offering prescriptions or guidance on diet control. This is fine, said Warne. But as a certified diabetes educator, Warne knows that more goes on within a diabetic than fluctuating blood sugar levels. Patients may feel anger, depression, stress and worry about their disease, which can affect blood chemistry or lead to other harmful habits, such as drinking.

"If all we ever tell them is that their blood sugar is too high, we ignore other factors that may be influencing their health," said Warne.

Warne said he offers varied treatments based on what the patient needs and is comfortable with. He may be as likely to refer a patient to a medicine man as he would to a health counselor or medical specialist.

"Patients who come to the clinic tend to be frustrated with simple, allopathic medicine that doesn’t appropriately address their problems," said Warne. "With offering what we do, I hope to bring a sense of community empowerment and a holistic approach to health. Through this, perhaps health disparities concerning Native Americans will be reduced."

Warne has received the 2002 Dr. Fang-Ching Sun Memorial Award at HSPH, given each year by the Department of Maternal and Child Health to an outstanding graduate dedicated to promoting the health of underprivileged communities.