This week on our show we have Dr. Terry Knapp – Founder, Director, and Chief Medical Officer of CareSpan Holdings, Inc.  Dr. Knapp has a storied 50-year record of achievement in health care and business. His company CareSpan provides a comprehensive, integrated digital healthcare “Clinic-in-the-Cloud” solution by creating unfettered access to care for the underserved, with an emphasis on the care of chronic illness. Dr. Knapp has devoted his life to working with native peoples throughout the world and deeply understands the health problems and impediments to better healthcare that afflict Native Americans.  In this episode, he is here to share his views in order to raise awareness for the plight of indigenous peoples in our country who are receiving sub-standard care.

There are some deeply emotional moments in this episode, as he discusses the failures of healthcare delivery as promised by the U.S. government more than 100 years ago. He describes American Indians that are dying a slow and agonizing death.  Their land – a reservation – is a concentration camp where they are treated as third-class “citizens” by receiving medical care that is killing them. He talks about the bureaucracy of the Indian Health Service, the failure of the IHS to provide enough good doctors, the lack of choices by patients, and the lack of respect for Native American ways by a health system that ignores their culture. He discusses the denial of access to modern medical care and posits that the Indian Health system actually makes them sicker by exacerbating psychological trauma and socioeconomic challenges associated with their physical imprisonment (as seen by rates of substance abuse and mental illness). The inhumane treatment that Dr. Knapp has observed firsthand has made him speak out about what he sees as a slow-moving but progressive bureaucratic genocide of our Indigenous peoples.

The Native American phrase Mitakuye Oyasin means “all my relations”.  This is said at the end of every prayer in the Lakota Nation, and it reminds us at all times to honor all of our relations – past, present, and future. This transcends our human relatives and includes our relation to all of creation – the water, the plants, the animals, and the Creator. Indigenous people think intergenerationally as well, by honoring those in the past, present, and future. In thinking of value-based care, how can we consider all of our relations – which includes Native Americans who have suffered irreparable harms from a deeply flawed healthcare system?

Episode Bookmarks:

02:00 Introduction and Background to Dr. Terry Knapp

03:50 Dr. Knapp is speaking out after seeing firsthand the inhumane treatment of our Indigenous peoples by the healthcare system

05:20 The Native American phrase Mitakuye Oyasin (“all my relations”) as a reminder that value-based care must consider all of our relations – including Native Americans who have suffered irreparable harm

07:10 Dr. Knapp discusses his medical training and life’s work to make a social impact as a surgeon, inventor, and entrepreneur

13:00 Insights as a cancer patient led him to develop a “clinic in a cloud” integrated digital care company (CareSpan Health) that leverages technology to enable health equity

14:45 The catastrophically high rate of COVID-19 cases and deaths in the Native American population (and similarities to the 1918 flu pandemic)

15:15 Tribal healthcare facilities are underfunded (in 2017, US healthcare expenditures were $9,207 per capita but only $3,332 per capita for Indian Health Services)

15:50 Unethical medical practices of the past (e.g. Native American women undergoing forced sterilizations in the 1960s and 1970s)

16:20 Dr. Knapp’s early experiences in treating the Yurok and Hupa tribes in California as a medical resident

18:00 Treatment of disadvantaged people in Mexico, Peru, Ecuador, Columbia, Chile, and other parts of Central America

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