Statistics show wide health disparities between American Indians and the rest of the population. For instance, American Indians are six times more likely to die from tuberculosis and twice as likely to die from diabetes than other Americans.
Doctors and others who work with American Indians say using specially designated advocates can improve care for Indian patients while they're in the hospital -- and improve health outcomes once they return home.
It's Aida Strom's job to make sure American Indian patients at Hennepin County Medical Center have everything they need.
She visits patients to ask how they're feeling and relays their concerns to social workers and medical staff. This could mean resolving complaints, arranging for spiritual leaders or clarifying medical information for families.
"My role is, for lack of a better term, like an interpreter's role," she says. "There are some real strong cultural identity issues that Indian people come with in the hospital."
For example, she says hospital staff could get overwhelmed when a patient's extended family holds vigil at the bedside.
[Many] don't have a primary care provider, meaning they don't go to the doctor regularly, they don't have a physician that they have a relationship with.Vikki Howard, Indian health advocate
"I'm from the Sisseton Wahpeton Dakota Oyate, which is in South Dakota. That's a super-cultural thing that we do: your grandma and your aunties and your family members will come, your extended family will be there when you're sick, especially if you may pass," Strom says. "If it's a child everybody will be here."
So Strom tries to make sure communication is smooth.
On one ward, Strom looks in on a 60-year-old man as he finishes dialysis.
"Are you feeling really sleepy right now?" she asks him.
Strom knows Glen Greene, who lives in Minneapolis, from his last stay in the hospital. She referred him to an American Indian diabetes program and says he's been doing better lately.
But a stubborn wound on his foot has landed him back at HCMC, where doctors told him he also has pneumonia. Greene's voice is faint as he tells Strom a podiatrist is coming later for tests.
"Okay, well let me know if there is anything you need and I'll be back in to see you tomorrow," she tells him, "but if you need anything or you need me to call anybody, let me know, okay?"
Greene says he appreciates Strom's assistance and friendly face. "Oh yeah, she's pretty helpful here. I can talk to her about whatever and get some help," he says.
On average, Strom sees about 120 new American Indian patients a month -- equivalent to almost half the non-emergency beds at HCMC at any one time.
A common barrier to regular treatment is poverty.
Vikki Howard, who works as an Indian health advocate at North Country Regional Hospital in Bemidji, says many American Indians have a general mistrust for the medical profession.
"A large number don't have a primary care provider, meaning they don't go to the doctor regularly, they don't have a physician that they have a relationship with," she says.
Dr. Dawn Wyllie, chief medical officer and deputy area director with the Bemidji Area Indian Health Service, says there's no data to show American Indian Patient Advocates directly improve health.
But she says there's strong anecdotal evidence that it helps, especially with chronic conditions like diabetes and cardiovascular disease.
"That individual can advocate for the kind of services, not only while in the hospital but outside, in part of that coordination of aftercare that will be happening and sometimes a patient needs a voice."
Wylie supports the expansion of patient advocate programs, but many programs that serve tribal populations are underfunded.
There are proposals that would boost funding and make changes to the Indian Health Service but in the meantime, many people outside the cities continue to have poor access to care.