The average medical student spends anywhere from 40 to 80 hours a week studying to become the future of health care, not to mention the hours outside of work that include family, community, jobs, volunteering, research, and day-to-day necessities. The average student goes to class, studies, goes home and studies some more.

However, this is not the reality for many Native medical students. We crave the ability to wake up, go to school, and have nothing but studying and getting through medical school on our minds. Instead, we wake up every day and are told our existence does not matter. We wake up to COVID-19 wiping out our elders and memory keepers, even though our communities have impressively high vaccination rates despite the medical distrust. We wake up to hear that yet another pipeline project was approved and will soon be running through our lands which hold our ways of knowing and living. We wake up to frantic texts asking if anyone has seen our missing cousin, with the all too familiar situation that keeps repeating itself. We wake up hearing that more tiny bones have been unearthed from secret graves underneath residential schools and see the lack of recognition of the ongoing genocide of Native American people. We wake up to the Indian Child Welfare Act (ICWA) being challenged by the Supreme Court and sigh in relief with it being upheld despite all of our work to make sure this would never happen in the first place. We wake up to states challenging our sovereignty as Tribal nations and having power over our Nations. It all sums up to the message that our land, sacrifices, and stolen relatives don’t matter. Our aunties that carry on our teachings, language, and culture don’t matter. That our people don’t deserve clean water, education, or health care. Despite everyone else benefiting from our stolen land, culture, and ways of healing, our communities live in poverty and don’t have the autonomy or capital to make it matter.

As Native medical students, the most underrepresented group in health care, we are constantly confronted by the news and the heavy consequences of this kind of messaging, making it exceptionally difficult to simply go to class and study. We don’t have the privilege to learn while shutting out the news/current events in our communities across the nation. Instead, we go to school and occupy what is often a hostile space in an effort to not feel invisible and advocate for our people, which often ends up with us crying on each other’s shoulders in between didactic sessions. We have become so hardened in order to survive that if one of us bursts out in tears from sheer anger, we find ourselves not blinking an eye. We console ourselves and then proceed to the anatomy lab as if it’s not against our teachings, and dismembering a body doesn’t trigger the mental images of the horrors our women and children endured. We have exhausted ourselves by fighting our schools and systems and asking for them to take a stand and show that they care about us and our communities, but with the answer usually being no. It’s hard to be tokenized and praised at an institution of higher education while your relatives at home fight for their treaty rights.

What a lot of people don’t realize is that Tribal nations are just that, Nations. We are a political entity commonly misidentified as a racial category. We have treaties that trade our homelands for economic stability, education, and health care to ensure the prosperity of our future populations. Although, what has happened after those treaties has been quite the opposite. We have and continue to undergo genocide at the hands of the federal government. We still live with the scars of our immediate relatives being dehumanized in boarding schools and having culture violently ripped from their lives. We scrape the Earth and our memories bare for an ounce of our teachings and language. And yet, when we find a song, or a piece of traditional knowledge, we are told that we’re not Native enough to have something sacred like that. Or, if we show up in regalia or ribbon skirts for a special day, suddenly we are too Native. We were not given the lives that we were once promised despite our sacrifices.

In our circles, we have discussions about just how vital the social determinants of health are when considering illness. While we understand that the root cause of many ailments like hypertension is racism, it appears to be a difficult word for our administration to choke out while we are choked by it. Our reality is this: we have willingly signed up to be a part of a system founded upon racism, genocide, and entitlement of colonialism. Most medical systems and educational institutions refuse to acknowledge their own foundational values and how their legacies impact the health of everyone in the U.S.

When someone asks, what’s it like being a Native medical student, or what’s it like being a brown Native student? What’s it like being a light or white-skinned Native student or a multicultural Indigenous student? We will tell you that we are burdened with the responsibility for the health, wellness, and future of our communities. And although all that pressure exists on our shoulders, what people perceive of us is that we are angry and problematic students. We are often told we are wrong about our own communities’ needs. We are told to stop being inflammatory and worrying about these “little” things. We can’t concentrate when our communities can’t have clean water. We can’t keep the Anki streak going when our sovereignty is threatened.

As Native medical students, we tirelessly pursue opportunities in advocacy and policy because we must, not because it’s a passion project. In order to maintain our humanity, we share our cultural teachings with each other and with our patients. We carry our history and medicines with the same importance that we carry our medical knowledge so that Native kids can see their futures clearly. We wear our intergenerational trauma on our white coats as well as our hearts. We say that we matter loudly because we are here to stay. We are here because of the sheer power, bravery, and resilience of our ancestors. We are the answers to their prayers they’ve spoken for generations. And we will not be silenced.

Katlin Wilson and Cailean MacColl are medical students. Amanda Dionne is assistant director, Center for American Indian and Minority Health, University of Minnesota Medical School, Minneapolis, MN.