A Cultural Context for Providing Dermatologic Care to American Indian and Alaskan Native Communities Through Telehealth

Abstract

staging in accurately conveying prognosis in the context of what might be termed prominently invasive T1 melanomas and minimally invasive T2 melanomas. One beauty in the application of CTA is its utter simplicity, because the assessment can be completed in a timely fashion using conventional histopathologic sections. One flaw is that it does include an estimated component, in that the area is precisely determined through measurements of width and thickness but the proportion involved by melanoma cells is gauged by visual inspection. It seems possible if not likely that this factor could lead to poor reproducibility with broader dissemination.There are many reasons why a new paradigm fails to capture the collective imagination and supplant an existing approach. The durability of the Breslow thickness is a testament to its simplicity, teachability, general accuracy, and reproducibility. Slight improvement is probably not enough to supersede an entrenched parameter used daily in laboratories throughout the world. However, if coupled with advances in digital pathology, evaluating melanoma sections with a true measured tumor area (or what could also be termed the Breslow area) could become an invaluable element of melanoma staging.

High Melanoma Rates in the American Indian and Alaska Native Population—A Unique Challenge

“…The difficulties American Indian/Alaska Native patients must overcome to receive dermatology care are considerable . Townsend et al noted that American Indian/Alaska Native patients who lived in metropolitan counties had a higher melanoma incidence.…”

“…We applaud Townsend et al for their careful demonstration that misclassification of race among American Indian/Alaska Native people potentially underreports the burden of disease in the population, especially late-stage melanomas . To enact change that better serves American Indian/Alaska Native patients with melanoma, further work is warranted to understand the limitations of the current health services ecology for American Indian/Alaska Native patients, how public health interventions may be beneficial, and how dermatologists may partner with Tribal and IHS health care systems to provide culturally competent care . Perhaps, then, the Navajo people may no longer speak of cancer as łóód dóó nádzi híí and instead as a sore that will heal.…”

“Our Hair, Our Strength, Our Identity”: Native American reflections and what dermatologists can learn

“…"Students" were compelled to speak English, given White names, and were abused; many never returned home. [7][8][9][10] Importantly, children were forced to cut their hair, considered by many Native peoples as a personal signifier of family and tribal identity and an extension of the soul that should only be manipulated at significant occasions (while mourning, to send on to a loved one's spirit, or in ceremony). 11 This demonstration of violence has occurred even within recent memory: in Albuquerque, NM, there is ongoing litigation involving a teacher alleged to have forcibly cut the braid of a Native student with scissors and called another a "bloody Indian."…”

Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness

“…8 -10 Patient populations who face sociodemographic and clinical challenges (e.g., travel distance to care for rural patients) can benefit from video telehealth. [11][12][13][14][15][16] Other vulnerable populations that have been shown to benefit from video telehealth include older adults, [17][18][19][20][21] African American and Hispanic adults, [22][23][24][25] and Native and Alaskan American adults; 26,27 and patients with mental health conditions such as anxiety and depression 28 or anxiety and alcohol use disorder, 29,30 post-traumatic stress disorder (PTSD), 31,32 substance use disorder (SUD); [33][34][35] or challenges with medication adherence. 36 One VA patient population that could potentially benefit from virtual care is Veterans experiencing homelessness, representing 8% (n=37,085) of all US homeless adults.…”