A psychiatrist working within a community must understand its history, just
as one who works with a single patient understands what brought that person
into the office, said Roger Dale Walker, M.D., a professor of psychiatry and
of public health and preventive medicine at Oregon Health and Science
University in Portland.
Roger Dale Walker, M.D., is honored as the American Indian Physician of
the Year by the Association of American Indian Physicians at its annual
meeting in Arlington, Va.
Credit: Aaron Levin
Walker is a health services researcher and a clinician who specializes in
substance abuse issues. He also directs the One Sky Center, a national
resource for programs that have helped American-Indian and Alaska-Native
communities prevent and treat substance abuse and other mental health
"You need to understand the background and history and why the
community is the way it is," he told Psychiatric News."
We have to be thorough and careful to establish trust and confidence in
offering help, just as we are when treating an individual."
Decades of work at that intersection of communities and individuals led to
Walker's recognition in July as American Indian Physician of the Year by the
Association of American Indian Physicians at its annual meeting in Arlington,
Va. Walker, a Cherokee, received the same award 20 years ago.
"It's humbling to be selected again," he said. "I'm
honored to be recognized by my peers for our ongoing work."
"Walker has really helped bring attention to the mental health and
substance abuse needs of American Indians and Native Alaskans, so that people
today are fully cognizant of that need," said Daniel Dickerson, D.O.,
M.P.H., an assistant research psychiatrist in the UCLA Integrated Substance
Abuse Programs at the Semel Institute for Neuroscience and Human Behavior of
the David Geffen School of Medicine in Los Angeles. Dickerson is a former
chair of APA's Committee of American Indian, Alaska Native, and Native
Hawaiian Psychiatrists and has known Walker for eight years.
Within APA, Walker has chaired the Council on Advocacy and Government
Relations and the Committee of American Indian, Alaska Native, and Native
Hawaiian Psychiatrists, as well as the Strategic Planning Committee in the
mid-1990s. He served as speaker of the APA Assembly for the 1996-1997
The One Sky Center began six years ago with funding from the Substance
Abuse and Mental Health Services Administration to serve as an advocate as
well as a therapist for communities, said Walker.
"Funding for all underserved communities is fragmented," he
said. "Our job is to help them manage the process of integrating and
allocating those funds."
When one of those 562 groups asks Walker for help, he doesn't just hand out
an off-the-shelf formula.
"A lot of preparation goes into a visit to a community," he
said, speaking from 30 years' experience.
He tells his students to think of the community as the patient. Just as a
physician must integrate the functions and failings of different parts of the
body, a healer approaching a community must know the economic, educational,
legal, and health care dimensions that influence the course of its
Because tribes are independent, sovereign entities under U.S. law, he
begins his discussions with the "ambassadors" from the tribe,
knowledgeable members who provide him with an introduction to others within
"Doing the background work brings you status and trust," he
said. "They know you respect them."
One Sky staff members visit up to 50 tribal communities a year, following
their careful preparation with an intensive two-day stay that sets the stage
for further development of specific plans and still more follow-up.
"When we meet with a community, we don't leave," he said."
They become a part of One Sky and we maintain contact over
The center's Web site includes a searchable database on 134 programs that
have been tried by tribal groups around the country.
Walker helps other American Indians and Alaska Natives in another way,
too. Over the
years, he and his wife, Patricia Silk Walker, Ph.D., M.S.N., a nurse
epidemiologist, have helped mentor more than 50 young American-Indian
scientists on their way to earning a Ph.D., M.D., or master's degree.
Walker took Dickerson under his wing when Dickerson was still a medical
student. He guided Dickerson first toward psychiatry and, once he was in
residency at Loma Linda University Medical Center, urged him to consider
addiction psychiatry as his specialty. As a result, Dickerson completed an
addiction fellowship in psychiatry and research at Yale. Today, Walker and
Dickerson are believed to be the only two certified American-Indian addiction
specialists in psychiatry, according to Dickerson.
Dickerson returned the favor by mentoring undergraduates and residents.
Next year, he will become a mentor for a young researcher.
Expanding that effort has been limited by the lack of a critical mass of
American-Indian scientists and health care educators at any one university. In
response, the National Institute on Drug Abuse granted Walker funds to set up
a national mentor system for American-Indian, Alaska-Native, and
Native-Hawaiian addiction researchers, which now includes eight mentors and an
equal number of protégés.
"We're picking people with a high likelihood of success and helping
them through the sticky patches of graduate school and early career
development," said Walker. Workshops in grant writing and scientific
paper writing have been held or are planned, for example.
Walker's own research path has combined two parallel tracks: substance
abuse among American Indians and general health services and treatment
research. He began by looking at vulnerabilities of American Indians to
alcohol disorders and to prevention and treatment strategies that worked. He
has led one long-term study of 11- to 12-year-old children and their mothers
to document how drug or alcohol abuse arises.
"Dale has helped to engage communities in research and bring a
community-based, culturally relevant approach to research," said
Being named physician of the year is just another chapter in a career
dedicated to helping American Indians. "The award will just motivate me
to keep going," he said.
Information about One Sky Center is posted at<www.oneskycenter.org/>.▪