In memory of Mark Herzog
A tribal leader explained to me that the Lakota word wacinyapi, meaning both dependable and accessible, represents a key virtue of both traditional and Western healers. The conversation took place in February this year, after a student from Harvard Medical School, Mark Herzog, passed away. To the tribe, Mark embodied wacinyapi, which was bestowed upon him posthumously as part of an honorific Lakota name. There is no better way to highlight the centrality of trust in health care than through reflecting on wacinyapi and on Mark’s legacy.
In 2012, the Indian Health Service invited a primary care team from our teaching hospital to partner in Rosebud, South Dakota. Rosebud Sioux Tribe leaders described their goals for an academic medicine partnership to involve clinical care from physicians they could trust. This request has a 150-year history: the 1868 Treaty of Fort Laramie guaranteed the tribe “a physician.” This and other treaties furthermore led the U.S. Supreme Court in 1983 to declare a “trust responsibility,” or a moral obligation of the government, to honor the spirit of its treaties with tribes. However, as history shows and recent federal watchdog reports describe, the government has often failed to make good on that trust responsibility.
Our now eight-year partnership with the tribe has had trust, or wacinyapi, as its foundation. Collaborative efforts include expanding access to care, recruiting high-quality clinicians, and supporting tribal health programs. These efforts ultimately depend on each member of our team embodying wacinyapi, as Mark Herzog did so well. In Mark’s case, he modeled wacinyapi by being a thoughtful listener, demonstrating altruism, travelling multiple times to Rosebud, participating in community-based research, writing a grant with the tribe, assisting with the emergency response after a mass casualty event, and staying engaged whether he was near or far.
Wacinyapi also has been translated as “works for the people.” This sense of dependability – that one is engaged in doing the right thing for a community – captures many of the highest aspirations of the medical profession. Although our profession has lost a role model in Mark Herzog, reflections on his example and on wacinyapi, which will forever be part of his Lakota name, provide opportunities to rededicate ourselves to shaping a better society through our shared work. We remain sincerely grateful to our tribal partners – and to Mark – for all they have taught us about trust and meaning in medicine.
Matt Tobey is the Director of Massachusetts General Hospital’s Rural Medicine Programs and an Assistant Professor of Medicine at Harvard Medical School. He founded and directs partnerships between MGH and both the Rosebud Sioux Tribe and the Indian Health Service. In addition to serving as a primary care and hospital physician in Rosebud, his academic work focuses on addressing health systems gaps in rural, reservation-based communities.