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Fighting breast cancer; A Native woman's journal; BATTLING CANCER AND BUREAUCRACY

The first time Liz Bahe remembers hearing her mom talk about the lump, she
was the lone teenage daughter of a single mother.

Now a 32-year-old Navajo and Turtle Mountain Ojibwe woman living in
Albuquerque, Liz remembers how her mother, Juanita Thiefaul, went
religiously to the IHS clinic for annual checkups and mammograms. She
remembers the clinic staff saying the lump under her mom's arm didn't feel
like cancer.

Five years ago Juanita realized that the lump had grown into a mass.
Juanita would wait six months to get into the IHS for a mammogram. Even
then, her doctor said that large shadow on the film didn't look like
cancer.

Still, at mother and daughter's insistence, the IHS referred Juanita to a
surgeon in Flagstaff - though getting in to see him on the weak
recommendation that this thing neither "felt" nor "looked" like cancer
would take another four months.

After waiting one full year from her first call for help, Juanita got her
diagnosis: Stage 3 breast cancer. She was 54 years old. Her surgeon, who is
in private practice, rushed her into chemotherapy within two days. Later,
he removed part of her breast and 12 lymph nodes from under her arm.

The IHS operates on an annual budget of about $3 billion, a figure that
keeps the agency treading water against inflation, the rising cost of
health care and the growing American Indian population.

"We are underfunded, and that means we have to prioritize," said Clayton
Old Elk, director of the BIA's division of contract health. "We are
operating at 60 percent of the needs. In some areas, they're operating at
40 percent of the need."

Prioritizing means that regional IHS offices have to decide - based on
their budgets - who they can treat for what conditions. By the end of the
fiscal budget year in September, Old Elk said, even top-priority cases have
to wait for care.

But who gets prioritized? Stroke victims, car accident victims, pregnant
mothers? What if you have a slow-ticking cancerous time bomb in your gut,
your chest or your brain?

Liz, who recruits minorities into doctoral Science, Math and Engineering
programs for the state universities of New Mexico, doesn't know if funding
was the issue behind delays in her mother's initial care.

She only knows, as she said when I first met her via e-mail last April,
that the delays were her mother's death sentence. Still, over the four
years of Juanita's treatment for cancer, mother and daughter hoped as they
counted time in rounds of radiation and chemotherapy.

Juanita would get only 11 months of remission.

"I look at my mother now," Liz wrote. "And I see a shadow of the person she
used to be. She attempts to be normal by doing laundry and other household
chores yet such attempts wear her out, and she spends the rest of the day
sleeping off her exertions."

Liz remembers her mother on the land before the Navajo Hopi Land Settlement
Act forced their family move. She remembers her mom hauling water and
breathing good air. What she can't remember is Juanita's childhood in the
1950s, and the unholy atomic sunrise over the desert that may have planted
the seeds of cancer.

Juanita raised Liz alone in a house full of love, food and ideas. Juanita
supported her daughter through a master's degree, the birth of a
granddaughter, a failed marriage, a new love.

"She still serves as a source of personal strength for me," Liz continued.
"My mother tells me, 'Don't worry babe, I know the radiation will work.'"

But Juanita didn't know that it was working, and by the time desert
wildflowers began to bloom the cancer had advanced to her brain and her
spinal fluid. Pregnant, Liz took a leave from her job and took her
6-year-old daughter out of school so this small matrilineal clan could
approach death together.

One night mother told daughter: "I don't know about this, baby. I don't
feel like I can go through this. My body can only take so much."

Through the ether of the Internet, Liz wrote to a stranger - me: "Is it
selfish to want your mother to live?"

Two weeks ago I told this family's story to retired Sen. Ben Nighthorse
Campbell. The senator took a deep breath. He said running a health care
program like the IHS on government funding cycles doesn't work well because
government money comes and goes. People's need for health care is constant.

More money alone wouldn't fix everything that's wrong with the bureaucracy
called the IHS.

Liz grew frustrated with the young doctors her mother met in IHS clinics,
where they were working to pay off their student loans. They didn't think
her mother's tumor looked like cancer, maybe because they didn't have
enough experience to recognize cancer. The turnover was so high at
Juanita's clinic that no one was aware from one year to the next of her
lump. No one was urging her to get a mammogram the way a family doctor
would.

By May, Juanita's oncologist said it was over. Juanita promptly quit
chemotherapy, saying that she preferred to be able to taste her food and
enjoy it.

Together mother, her daughter and two granddaughters - one big in the womb
and one sitting on the ground - visited family. They asked Juanita's
83-year-old mother and her brothers and her sisters to be with her when she
died. They asked family who had never left a 90-mile radius on the
reservation to travel to Liz's apartment in Albuquerque, N.M.

They came, and they stayed to help Liz dress her mother in turquoise and
silver for her final ride home. Juanita was 58.

Two weeks after her mother's death on June 8, Liz gave birth to a healthy
baby girl.

Now, in spite of her grief, Liz is incubating a plan to use her education
and her love of her mother and her daughters to continue fighting breast
cancer. I hope she follows this dream, because I know Liz will help us win.

Kara Briggs is a Yakama journalist from Portland, Ore., where she is
currently on medical leave from her job at The Oregonian. She chronicles
her battle with breast cancer in this biweekly series. She is a former
president of the Native American Journalists Association and winner of the
2004 Award for Investigative Journalism. She is interested in the
experiences of readers who have had cancer and also remedies, cultural
practices or unusual treatments that have helped them. Contact her by
e-mail at briggskm@gmail.com or by mail through Indian Country Today.