Valerie Guimaraes, a patient relations specialist in Executive and International Medicine, shares the story of how she has found her calling to help Native American patients who come to Mayo Clinic.

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Voices of Mayo is a series that highlights Mayo staff and their stories, exploring their diverse backgrounds, the challenges they face, the opportunities they have been given, and their experiences at Mayo Clinic.

Valerie Guimaraes is a patient relations specialist in Executive and International Medicine. She shares how she works to help Native American patients navigate their way through Mayo and meet their needs ― spiritual and otherwise. She also provides safe spaces for those struggling with biases and helps overcome related barriers to patient care.

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What brought you to Mayo Clinic?

I came to Mayo Clinic because of a desire to return to nursing on a more regular basis. I had taken time off to raise my children and was working only on call for 14 years.

Charter House was looking for nurses to work in either their home care or rehab areas, and I applied. The idea of working with seasoned adults, some at the close of their lives, intrigued me. I felt that I could give them the dignity that they deserved.

Later, through Jeff Bolton and the reconciliation efforts with the Dakota Nation, I was elected to become Mayo's first patient relations specialist to work solely with Native American patients.

Tell us a little bit about your background.

I was raised by my grandparents, Henry and Marie Decorah, in St. Paul, Minnesota. My grandfather, a full-blood member of the Ho-Chunk Nation, and my grandmother, a full-blood member of the Dakota/Santee Nation, were very proud of their heritage, and they instilled this in me at an early age.

While growing up, I was surrounded by family and friends who were Ho-Chunk, Dakota or Anishinaabe. I was quite fortunate. Summers were spent going to powwows, visiting relatives across Minnesota, Wisconsin, South Dakota, Nebraska and Iowa.

After high school, I attended the University of Minnesota and University of Minnesota Duluth. While at Duluth, I earned a full-ride scholarship through the Indians into Research Careers program. It was during this program that I became interested in the health sciences, but I just couldn't figure out what it was I wanted to do. It was also at Duluth where I met my husband, Paulo, who is a member of the White Earth Nation.

After graduation from college, Paulo and I were married. He attended Mayo Clinic Alix School of Medicine, and I stumbled into nursing school at Winona State University. Paulo and I raised four feisty children, several dogs, a hamster, some fish and a tortoise.

Paulo works as a hospitalist for Northfield Hospital and heads up two hospice programs, and I happily work at Mayo as a patient relations specialist.

In addition to nursing, I have had a profound interest in social justice issues. I have served as the chair of the Bemidji-Area Race Relations Council; the chair of the Human Rights Commission in Winona, Minnesota; and started the Indian Education Parent Committee in Rochester.

How did you become interested in health care, and how did you learn about opportunities at Mayo?

I believe this interest started when I was quite young and my grandmother became ill. I would pretend to be the doctor, the nurse, the X-ray technician and the lab technician ― all in an effort to help my grandmother get well. This interest continued throughout high school, where I participated in a summer program through the University of Minnesota to introduce students into the health sciences, and throughout college, where I attended University of Minnesota Duluth through the Indians into the Research Careers program headed by Ms. Ruth Myers.

Ruth persuaded me to continue my studies in the health sciences, even though I didn't know where I wanted to focus my energies. I think she would be quite pleased to know that I became a nurse, earned a master's degree at Lesley University, and that I am completing my doctorate of nursing practice at Augsburg University.

What are some highlights of your experience here at Mayo?

I have to say that my work with a special little patient who required a liver transplant ― who continues to do well, despite many challenges ― is one of my highlights of working here at Mayo. I first met her when she was a newborn, and today, she is an intelligent, stubborn and sweet little 2-year-old. She inspires me to be my best at what I do, and that is to help Native American patients navigate their way through Mayo.

Another highlight was the work that I was privileged to do with Mr. Art Owen here at Mayo. Together, he and I helped Native American patients with their spiritual care needs. We shared many tender moments with patients and their families as he led ceremonies of healing and comfort here at Mayo. Art would drop everything to help an infant or child in need of spiritual care.

One day, I contacted Art, crying, because one of the little patients had to go back into surgery. He basically told me get it together. My role would be hard. Everything for us as a people would be hard, and to remember why I was there. I was there for just this reason. This memory still gives me strength today.

What could have been better, and what did you or others learn from that?

First, since I have come to Mayo, I have been concerned for the cultural safety of my patients. Mayo has spent some time on cultural competence, but it is not enough. It is not enough to be aware of differences.

Now is the time to take it to the next level: cultural safety. Cultural safety requires that health care providers or organizations examine their own biases, beliefs, stereotypes, prejudices and experiences, and learn if there are barriers to providing health care to marginalized communities or people of color.

There have been times that biases or stereotypes about Native American patients have undermined the excellent care that we at Mayo are known for. During these times, depending on the situation, I take a deep breath, assess the most urgent need, which is usually safety for the patient, and attempt to provide a safe space for the health care provider and I to engage in a crucial conversation to help address the situation.

This has not been easy, but if dealt with in a manner commensurate with the offense, all can be enlightened and treated with respect.

For example, a nurse made a disparaging remark about a patient's family member, and the nurse looked at me and said, "I need help." I looked at the situation from the family member's point of view and through a nurse's point of view, and I explained the reason in part why the nurse might feel the way she did. This nurse, an ally in the making, said: "Thank you. I didn't like feeling this way." The nurse threw her arms around me ― this was before COVID-19 ― and we both went about our work.

My takeaway was that I need to engage in more conversations that provide safe spaces for those struggling with biases.

Tell us about the people you've worked with here.

I have enjoyed working with so many people here at Mayo, including Jeff Bolton, a true warriorlike champion who embarked on a journey of reconciliation. It has not been easy, but it's been so worth it.

He boldly made history by going to Santee, my grandmother's reservation, and apologizing to the descendants of Marpiya te najin. It was such a privilege to participate in this historical event.

The chaplains at Mayo ― there is such quiet strength in these good people. We work in concert to help Native American patients continue in their faith traditions while hospitalized here at Mayo.

Ginger Thompson, has helped many Native American patients receive their medications through the Indian Health Service. There are 4.56 million Native American and Alaska Natives, and up to half live on reservations. Since the reconciliation efforts put forth by Mayo, there has been an uptick in the number of Native American patients here at Mayo. I know because I've seen most of them.

Ginger has worked so well with the Indian Health Service pharmacies. When Native American patients come here to Mayo, often they are prescribed medications that are different from their previous medications. Ginger has provided the needed rationale for the Indian Health Service pharmacies so that they can advocate to get the new medication added to their formulary. It takes patience, humility and critical knowledge to do this, and Ginger has been such an advocate to help our Native American patients overcome barriers to medication adherence.

Many of the social workers at Mayo have worked valiantly to help Native American patients while here at Mayo. Eighty-five percent of my patients come to Mayo emergently. Think about this. That means that none of these patients knew that they were coming to Rochester.

The average length of stay is 7.56 days, and many of the patients come from impoverished conditions. It takes ingenuity, creativity and determination to help many of the Native American patients to return home or get transferred to another facility. Lorena Nimke has been so kind to meet with me quarterly so that we might continue to improve on our knowledge base and processes to help Native American patients.

What advice would you have for others following a similar path?

Remember why you chose to do this work. Whatever work you are doing here at Mayo, there will come a time where you will question why you are here and doing what you are doing. Remembering why you chose this work will help rekindle the passion you once felt. Then, get busy.

Do you have one quote or thought you'd share with others?

When I would get lost in the sadness about the illnesses of my patients, or unkind remarks or actions of co-workers, Art would say, "Let culture be the teacher." He never really explained what that meant, but what I have come to understand is that my heritage, culture, traditions ― or as we say, "the ways" ― have provided me with guidance in every situation.

Much like sacred texts and faith traditions, "the ways," which includes the sacred, tell us how we should govern our thoughts, words and deeds. Through the sacrifices of my ancestors down to my grandparents, our culture has been a guiding force throughout my life and will continue to be so.

What inspires you about Mayo Clinic?

What inspires me the most about Mayo is the continual striving toward excellence and the atmosphere of learning. I wish the environment weren't so competitive. However, excellence and learning, for me, mean continued personal growth. We are in the process of becoming our best selves. We are not quite there, but that is our aim.