SACATON, Ariz. - Harriett was born in Fort Peck, Mont. and always wanted to work with children. In her early 20s she left home to attend a bible school in Phoenix. It was there she met Wilfred, a Pima Indian. They married in 1955 and worked together as lay ministers in the Presbyterian Church settling in Gila River to raise their family. She fondly remembers the early years, "My house was always filled with children ... I would teach them right in my home. People thought I was crazy to have so many kids around me but I enjoyed it."
Life at Gila River was good for the couple. It never entered their minds that Harriett, a Sioux, living 1,500 miles from home, might experience delays in medical care. Harriett recalls a simpler time, "Anything I needed I went to the Phoenix Indian Hospital. I just walked across the street. Nobody ever fussed ... we just got our treatment."
Today there is a complex method of deciding care. Do you live on a reservation? Is it your native birthplace? Does your tribe contract with this tribe? Are you in a catchments area? The answers determine how you are categorized; direct services, contract services, IHS only, or any combination. Harriett is lucky to live where the community runs its own private hospital at the reservation. But money is tight. Whenever a person is ill questions are answered and information weighed to allocate services. Pattie King, health care advocate explained, "Now as a Native American enrolled in a federally recognized tribe, yes, you are entitled to health care." But she continued, "There are numerous people who live in town outside the reservation who can't even get their prescriptions paid for because they live too far from the nearest IHS facility."
Living on the reservation, but not enrolled, she experiences little differences, "I don't really care about that stuff. I just want my health care covered. I don't want to have to worry things won't get paid. Care at Gila River had always been good."
Harriet, who always took precautions to receive yearly mammograms, admits she was not consistent with her breast self-exams. One day while dressing she felt a lump. Remembering all the warnings to act fast she called for an appointment.
Initial exams showed the lump was the size of a pea, "I don't know how it got that big ? from July when they did the mammogram (to November)." Her first thoughts were, "well mammograms don't do any good" but then a friend said, "That's why you are supposed to do your own exams every month". In 1999, upon biopsy, doctors found the lump and 18 lymph nodes were cancerous. Getting initial treatment was a frustration, "they took a long time ? to get things set up."
Surgery and chemotherapy were not performed in the same location. At each step, paperwork was resubmitted and approved before the next phase. Transportation was an issue. The couple depended upon the medical shuttle service to get them to appointments. She was told a three-day advance notice would ensure her a ride to and from the clinic. However, at the appointed time, the shuttle bus did not arrive. Harriett quickly phoned the doctor. The office told her about a mix up but said another patient would pick her up. She was warned they were closing shortly, "Be ready." She patiently waited when the phone rang again, and she was informed the other patient had something contagious and couldn't pick her up. They promised to reschedule the appointment soon but again were delayed because the doctor was leaving on vacation.
During this time, Huhukam Medical Center called asking why she had not started treatment. She explained her lack of control over the situation and they switched her treatment facility. After that, "I never asked for transportation again."
Harriett explained, "I didn't have any fear or anything." She understood that to some cancer means death, but she realized, "it doesn't have to be (death) if they catch it early enough." Her main concern was getting timely treatment and medical coverage to minimize financial burdens on the couple, now in their 70s. King describes the disparity, "they say an Indian person will take four to six months longer to be diagnosed ? (because) it could take longer before scheduling mammograms and tests like that." This is a hardship people off the reservation may not suffer.
Although Natives learn to live within the system the negative ripple effect could impact health severely. In a report from the American Cancer Society, Breast Cancer Facts and Figures 2003-2004, findings show "a lack of health insurance is associated with lower survival rates among breast cancer patients. Moreover, breast cancer patients with lower incomes are more likely to be diagnosed with later stages of the disease and to have lower five-year survival rates than higher income patients." The Centers for Disease Control report 2002 found death rates for breast cancer in Alaskan Natives and American Indians has risen from 1950-1998. More awareness could help reverse this trend.
Stories like Harriett's teach us to be conscious about our health choices in advance of diagnosis. Receiving the yearly mammogram together with monthly breast self-exams can increase a woman's ability to survive cancer by detecting it earlier. As an elder, walking in faith daily, Harriett understands the prayer; God, grant me the serenity to accept the things I cannot change. Courage to change the things I can, and the wisdom to know the difference. She shares her story with others as a founding member of the Gila River Cancer Survivor Group. Her husband joins her regularly, realizing that his presence gives comfort. Both plan to attend the upcoming conference in Hawaii to exchange cancer survival stories with other Native Americans. Harriett plans to meet every challenge surrounded by her support group, acknowledging that finding a place to "just sit there and talk" gives her strength to face tomorrow.
To donate funds to GRCSP trip or to learn more about the group, call (602) 239-3814.