Northwest tribal health advocates say the rising cost of fuel is exacerbating budget shortfalls at tribal and IHS clinics, and it is increasing the suffering of Indian people who need health care.
Andy Joseph Jr., the vice chairman for both the Portland Area Indian Health Board and an elected member of the Colville Confederated Tribes business council, believes the time for talk is over.
;'We're not just maintaining status quo,'' Joseph said. ''We're losing ground. We're losing our elders.''
At a July meeting of the tribal delegates to the health board, Joseph was thinking. He was thinking about a Native cancer patient whose family had to choose between paying their bills and buying gas to drive her more than 100 miles each way for cancer treatments.
The patient died because the family couldn't afford the gas.
Joseph was thinking about this while Doni Wilder, the Portland Area director of the IHS, was giving her report to the delegates.
Fresh from a stint as the acting assistant director of the IHS, Wilder, who is Rosebud, was showing slides about the state of federally-funded care for Northwest Indian communities and relating anecdotes from her adventure in headquarters.
Her communication didn't relate to Joseph's growing sense of frustration and grief, or that of others in the room.
''The time for talk is over,'' he said, ''I am thinking of declaring a state of emergency in the Indian Health Service because of fuel prices. They're not only affecting us, they're killing our people.''
Wilder who was still at the microphone, said ''I don't know who you call to declare a state of emergency?''
She mused, ''Do you call the county or the state or FEMA?''
But Joseph was ignoring her. He knew that most of the health board delegates were elected leaders in their nations, who could take a declaration back to their councils for enactment.
''I move,'' he said, ''that a state of emergency be declared because of all the deaths.''
A second came from somewhere in the audience. The vote when called was unanimous. A few delegates made supporting comments, and then the meeting moved on as if nothing had happened.
Three weeks went by.
I wondered, if a declaration of a state of emergency goes unheard, does that mean it didn't count?
I called Joseph at his office in Nespelem, Wash., the capital of the Colville Confederated Tribes.
He hadn't heard anything more about the declaration either. But he hopes that it can in time help to change the direction of federal policy, or at least kick start federal inaction.
The magnitude of the problem is most clear on reservations, where some tribes say the expense of death benefits is rising faster than the budget for health care.
''People are not living longer than they were in the recent past,'' Joseph said. ''Go back 10 years ago, we were given reports where we were starting to live longer lives.''
But Joseph, 48, said people are dying, including many his age and younger.
The role of a state of emergency is clear in cases of a natural disaster.
According to the Web site of the U.S. Federal Emergency Management Agency, states of emergency are declared for the purpose of alleviating hardship and suffering, providing appropriate emergency measures, or for the purpose of identifying, mobilizing and providing necessary equipment and resources.
But can states of emergency be effective when declared by tribal leaders for social issues?
Joseph believes that they can be effective in focusing attention.
The Colville Confederated Tribes had success with a different grim declaration two years ago, Joseph said. It was declared after a series of suicides occurred on the reservation in Central Washington state.
''It had to do a lot with we're only funded in our mental health department at one-third of our need for the size of our tribe,'' he said.
That declaration also might have gone unheard, if not for a statement Joseph made during a U.S. Department of Health and Human Services budget hearing.
Joseph, who I've seen wear his buckskin regalia to meetings where all the other tribal leaders wore business suits, has a way of cutting to the quick of issues.
After that speech, dollars were found to increase mental health services on the Colville reservation. Not enough dollars, but some. Joseph credits these increased services with halting the suicides.
The dollars in that case came from the DHHS, not the IHS. He thinks that the answer to the current problems could include resources from various federal agencies. These resources could, for one example, help rural Native nations to buy hybrid vehicles to transport patients long distances to medical care.
Such declarations from tribal leaders need to be carefully considered by all, even when the status quo suggests that nothing is going to change.
Joseph doesn't blame the IHS employees for the state of Indian health, but he said they can play an increased role in documenting the effect of funding gaps.
He is asking them to document the shortfalls not only on budget sheets but in reports. In these reports, he said, he'd like them to write how many children went untreated, how many elders died and how many treatments were delayed because there wasn't enough money in the budget.
''I'm getting tired of no action from the people who are supposed to save my peoples' lives,'' Joseph said. ''I swore an oath to be responsible for all my people and to uphold the constitution of the United States. They are obligated to look after our health needs. I think every employee from Indian Health Service needs to know that.''
Kara Briggs, Yakama and Snohomish, is a columnist for Indian Country Today and a journalist. She lives at the Tulalip reservation in Washington state.