Washington State University’s Native American Health Sciences program will soon face some changes as it continues its support of providing resources to young Native students pursuing careers in health and sciences. 

The first change will come about this fall when the program’s longtime director Robbie Paul retires and the university seeks to fill her position. 

The second change may come in the form of increased recruitment of Native American students, as the university moves toward accreditation for the new Elson S. Floyd College of Medicine. Some in the program feel the new school will appeal to Native students in particular because of the health care opportunities it offers for rural communities, including reservations. 

The Native American Health Sciences program at WSU is divided into two sections—a student recruitment and retention program, and Na-ha-shnee, a two-week summer institute for Native American high school students. The two programs are funded through an endowment and various grants, which help to pay for scholarships, activities, and recruitment efforts. 

A member of the Nez Perce tribe, Paul has been at WSU Spokane since 1995, and has served as director of the NAHS program for nine years. In this role, she recruits Native students into the health science programs at WSU, working to address the low numbers of American Indians in the health care professions. 

In her 21 years at WSU, Paul has seen 57 students graduate from the nursing program, including seven master’s of nursing students and one doctor of nurse practitioner. 

“Of those graduates, I would say 70 percent have gone back to serve in the communities, or on the reservations where they grew up,” she says. 

Paul says she currently has four Native undergraduate students working toward a bachelor’s in nursing this year, three working toward a doctorate in nursing practice, and one student working toward a doctorate in nursing. 

She points out that upon graduation, that student will be one of only 19 Native Americans in the country to graduate with a doctorate in nursing. 

“Native Americans make up just 2 percent of the whole U.S. population,” she says. “Eighty-seven percent of nurses today are white, and only 0.4 percent are Native.”

Paul says one reason there are so few Native students in health care is because of the barriers such students face in getting an education. 

“It varies according to what kind of academic preparation they received in high school,” she says. “For many health care careers, chemistry is a necessary background and if that’s not offered as part of college prep, it can be a difficult obstacle to overcome.” 

Paul says many students also lack confidence in their abilities, and have no role models to look to for inspiration. 

 “We first have to establish what their perception of a college education is,” she says. “A big part of it is getting them to believe in themselves. Many of them grow up thinking they’re just not smart enough, or good enough for college.” 

Paul says that because American Indians are such are small population with so few role models, it’s important to give students a place on campus like WSU Pullman’s Native American Student Center, where they can gather with others who share their cultural identity. 

“These students are already making a tough transition, learning to adjust to dorm life, and being away from home for the first time,” she says. “This gives them another place to gather with others who share their identity, and participate in positive activities.” 

Paul says she visits the Pullman campus’s Native American Student Center at least twice every month to share in student activities and gain insight into their needs. 

“It’s important that we get their perspective on what’s working, what’s not working, and areas where they could use more help or supportive input,” she says. 

As a tribal member with a varied education, Paul says she understands the need for continued learning opportunities. Paul grew up in Craigmont, Idaho, on the Nez Perce Indian Reservation and attended high school in Lewiston. She earned a bachelor’s degree in home economics in 1972 at the University of Idaho. From there she went on to earn an associate’s degree in early childhood education at Spokane Falls Community College in 1984. 

Paul then started the Whitworth Presbyterian Church Day Care Center in north Spokane, where she served as the director for seven years. She then went back to school, completing her master’s in psychology at Eastern Washington University in 1994.

Paul joined WSU in 1995 as coordinator for recruitment and retention for WSU’s College of Nursing, and in 2007 began her current role as director of Native American Health Sciences at WSU Spokane. Also that year, she earned a doctorate in leadership studies from Gonzaga University.

“Part of my initial role was about helping to build relationships with tribes, through what we call the memorandum of understanding,” says Paul. “When I started, we worked out a plan to establish good relationships, recruit students, and then address their needs, whether through academic systems or curriculum development.” 

WSU now has a memorandum of understanding with 11 Native American tribes. This memorandum is essentially an agreement to build relationships with tribes, improve the quality of educational services provided to Native students, and increase their access to opportunities and achievements.

Paul currently serves on the university’s Institutional Review Board and Native American Advisory Council to the Provost. She also serves on the Northwest Portland Area Indian Health Board Institutional Review Board, and the Southwest Tribal Institutional Review Board.

In addition to her role as director, Paul also teaches one course at WSU every spring titled, “Plateau Tribes Culture and Health.” The course is a cross discipline offering, meaning students from other health fields can also attend. 

As part of the course, Paul teaches students about the effects of intergenerational trauma on Native health. Intergenerational trauma is defined as the transmission of historical oppression and its negative consequences across generations. 

According to Paul, for American Indians, much of this trauma stems from the loss of lives, land, and culture as a result of colonization. Paul first began researching the phenomenon in 1993 during her master’s program and continues to research and speak on the subject today. 

“I’m always surprised at how few people have never heard about historical trauma, or understand very little about it,” she says. “It’s disrupted a lot of family systems and cultural teachings over the years.” 

Through her research, Paul discovered more about her own history and came up with a healing model to help herself and others dealing with historical trauma. 

“I can’t say it works for everyone, but through teaching about it and including it in my courses, I’ve seen a change and it does my heart good,” she says.  “While this is something that does affect us, ultimately it is not what defines us.” 

When considering her achievements at WSU, Paul says she is most proud of three things: the program’s retention of nursing students, the research she’s conducted on how to continue that retention, and the creation of the Na-ha-shnee Native American Health Science Institute, the two-week summer program for students mentioned earlier and that she started in 1995 and that’s held on the WSU Spokane campus annually in June.  

Paul says the Na-ha-shnee camp has served over 340 students since it started, averaging 25 student attendees each year. The course introduces high schoolers to health care careers through labs, and provides them an opportunity for interactions with current students and professionals in various fields. 

Students have access to high-tech equipment, including a talking mannequin that is able to simulate different medical conditions. Camp counselors are usually nursing students, who use the opportunity to practice their leadership skills. 

“It’s a very active and inspiring experience for all the students,” says Paul. “It gives them a clear path, and encourages them to keep getting good grades so they can pursue the next step on that path.” 

Emma Noyes, WSU’s Native American Health Sciences outreach coordinator, who assists Paul in her efforts to recruit Native students, agrees that Na-ha-shnee plays a big role in inspiring students. 

“When speaking to these students, you can see that the idea of making a difference, of getting educated and giving back to their communities really resonates,” says Noyes. “They see that we are going to need culturally aware health workers, and who better than Native students, who have been a part of that culture from the start?” 

Currently a doctorate student in prevention sciences at WSU, Noyes will serve as interim director of the Native Health Sciences program upon Paul’s retirement this fall. 

Paul says the university hasn’t yet discussed any plans to fill the position permanently.

Noyes is a member of the Confederated Tribes of the Colville Reservation, grew up in Omak, and attended Omak High School. She earned a bachelor’s in public health and anthropology from the University of Washington in 2009 and a master’s in public health from the University of New Mexico in 2013.

Looking to the future, Paul says she hopes to see the program continue to support Native students as much as possible, whether through tribal relationships and recruiting, career education, or grants and scholarships.

“Costs only continue to go up, so finding more permanent funding will be especially important moving forward with the program,” she says. 

Both Paul and Noyes say they have been considering the impact WSU’s new medical school might have on Native American students expressing interest in health care careers. 

“It’s structured in a way I think will really appeal to Native students,” says Noyes. “It’s geared toward serving rural areas in need of health care staff and facilities, and there is a huge need in reservation communities right now.” 

While the university can’t move forward with recruitment efforts until the medical school receives accreditation, Noyes says there already has been discussion of how some of those future efforts can be better directed toward interested Native students.  

“The new medical school would provide us that many more options, training and exposure for potential students,” she says. 

Paul and Noyes say the medical school already has received political support from several tribal health organizations, including the Affiliated Tribes of Northwest Indians and the Northwest Portland Area Indian Health Board, a nonprofit tribal advisory organization that serves 43 federally recognized tribes in Oregon, Washington and Idaho.

“Since I started, the program has evolved,” says Paul. “As we go along, we’re working not only to fill health care careers, but also to create a faculty who can continue to teach incoming students.”