November 14, 2024 —

During Native American Heritage Month, we celebrate a dedicated champion of health equity. As Chief of Rheumatology and Director of the Arthritis Center at University of Arizona, Dr. Kwoh is devoted to making sure the Indigenous people he treats receive the best possible care for their lupus.  How?  By listening, learning, and incorporating their perspectives into personalized treatment plans and making access to healthcare easier by bringing medical care to where they live and where they are in life.

Personal Connection and Deep Commitment

Dr Kwoh feels a deep connection with Native American communities, drawing from his own experiences of discrimination as an immigrant to the U.S. from Taiwan. This shared understanding of marginalization contributes to his commitment to health equity. He particularly values the stewardship by Indigenous people of the land and recognizes the common ground between American Indian and Chinese holistic practices. This appreciation fosters a respect for diverse healing traditions and highlights the importance of inclusive health approaches that honor all cultures.

Much of that experience in holistic medicine he has gained from his indigenous patients has made him a more effective physician for them, as well as for all his patients, shares Dr. Kwoh. “As a provider, I don’t come in and tell patients what they should do. Combining the mind-body techniques of complementary medicine that many American Indians practice with the advances of Western medicine can be very beneficial for them and any patient.”

“As physicians, we need to negotiate with our patients and in this partnership, put them at the very center of their treatment team. Patients should be free to question and voice their preferences and values.” Dr. Kwoh continued.

Lupus Disproportionately Effects Indigenous People

Dr. Kwoh points to the disproportionate impact lupus has on American Indian and Alaska Native people that makes addressing health inequity so important to address.[i] Dr. Kwoh attributes the high rate of lupus and a higher risk for severe disease to many factors including genetics as well as social stressors like food, housing, and financial insecurity. Difficulty accessing healthcare, particularly specialized care, is another factor, especially for those in rural areas. “Things we take for granted — electricity and running water — may not be easy for individuals in very remote parts of the reservation.”

Bringing Healthcare to Local Nations

Seeing the need to improve healthcare access, Dr. Kwoh’s clinic staff from the Arthritis Center regularly drive 1-2 hours to provide medical attention for two local American Indian nations – the Tohono O’odham and the Pascua Yaqui. “People with lupus can get the specialized care they often need at our Tucson clinic but getting there can be too hard for those who don’t have transportation, and telemedicine can be impossible if things like smart phones and internet availability is too limited. So, we drive and go to them.”

Dr. Kwoh also notes the importance for providers to show regard for patients’ values and cultural heritage.  A little touch Dr. Kwoh adds to put patients at ease – instead of the formal necktie he was accustomed to wearing, he often wears a traditional handcrafted bolo tie of many nations in Arizona. “It sparks compliments and lets my patients know that I appreciate their culture.”

Increasing American Indian Representation in Clinical Research

Another aspect of healthcare is offering equal chances to participate in clinical research, providing patients’ access to the most innovative potential treatments in development and the ability for researchers to evaluate the effectiveness of those treatments in the diverse lupus community.

To that end, Dr. Kwoh is very excited about the opportunities he will be able to bring to his lupus patients as the clinic joins the Lupus Clinical Investigators Network (LuCIN) overseen by Lupus Therapeutics, the clinical affiliate of the Lupus Research Alliance. Three lupus clinical trials are currently underway with Dr. Kwoh serving as the principal investigator.

“Collaborating with the companies investing in lupus treatment and the development of new therapeutics will allow us to bring the next phase of state-of-the-art treatment to lupus patients.”

In encouraging patients to participate in the clinical trials being conducted within LuCIN, Dr. Kwoh stressed the need for honest dialogue, laying out the potential risks and benefits, as well as how participation might benefit them both individually and the community at large. “Patients may have many questions, and you need to be very clear and respectful, knowing that you will need to overcome issues of distrust that understandably exists because of historic mistreatment.”

Conversely, he also recommends that people considering entering a trial ask all the questions they have and express their concerns as well as their beliefs. “We owe a debt of gratitude to the patients who participate in clinical trials, for paving the way for new treatments. We are on the verge of a treatment revolution. There is a really promising future for people with lupus – so many different new treatments in development to not only manage the disease, but hopefully in the future, to cure their disease.”

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[i] Prevalence and Incidence of Systemic Lupus Erythematosus in a Population-Based Registry of American Indian and Alaska Native People, 2007–2009. Available at: Prevalence and Incidence of Systemic Lupus Erythematosus in a Population‐Based Registry of American Indian and Alaska Native People, 2007–2009 – Ferucci – 2014 – Arthritis & Rheumatology – Wiley Online Library. Accessed 10.17.24