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Fighting breast cancer; A Native woman's journal; STRIVING TO MEET PATIENTS' NEEDS

When Dr. Jeffrey Henderson wrapped up his residency at the University of
Washington hospital in 1992, he did what young doctors everywhere do when
they want to help their own.

He took a job at home on the Cheyenne River Sioux Reservation in South
Dakota with the IHS.

Although technically still a resident, Henderson was quickly named the
clinical director, driven by the fact that he was the second doctor in a
clinic that should have had five.

Henderson cut his teeth stitching up the pieces after drunk driving
accidents, holding hands after heart attacks and nagging diabetics to clean
up their eating habits. After hours, he recruited three more doctors to
help staff the only 24/7 emergency room in the area. The next closest one
was 90 miles away.

Life-threatening and chronic diseases course like rivers thought tribal
health clinics from" Alaska to Florida. Few diseases have more impact on
tribal families than heart disease, diabetes and cancer, which are fed by
the streams of addiction, poor diet and trauma.

Native doctors, who number in the hundreds, are a rare breed. They are
also, each in their own way, helping to define the future of medicine for
Indian people. Many, like Henderson and Dr. Rex Quaempts of the Yakama
Nation Health Clinic, follow their gut beliefs about what they can give
their people despite limited federal support.

After two years of doctoring, Henderson took a moment to look up from his
medical charts. He realized that he had helped a lot of families, but he
grew worried that he wasn't putting a dent in the underlying problems.

"I came to the sobering conclusion that not only were we not helping,
things were getting worse," Henderson said. "Crystal methamphetamine use
was raging. Car accidents and domestic violence were continuing unabated."

Henderson, a Sun dancer, decided that the skills he needed to really help
the next generation were not the ones he was taught in medical school. So
he went back to the university to learn epidemiology, the study of the
sources of disease, and returned to Rapid City to found the Black Hills
Center for American Indian Health.

In the early 1990s, Quaempts wrapped up his residency at Sacred Heart
Medical Center in Spokane, Wash. Quaempts dreamed of making a difference of
his own and despite his wife's initial misgivings - "working for the feds
you'll make 50 cents on the dollar" - he joined the IHS.

For the last decade Quaempts has tried to be an old-fashioned family doctor
inside the Yakama National Tribal Health clinic in Toppenish, Wash. That's
quite a challenge in a clinic where four doctors are responsible for 5,000
patients each and where, according to the 2002 report "Facing Cancer in
Indian Country," IHS funding covers only about 25 percent of patients'
medical needs.

Still, Quaempts says, "I love the people I take care of. I have patients
who went to Chemawa Indian School with my aunts and uncles, people telling
me where to go pick berries or go fishing.

"Unfortunately, I've had to hospice some of my own family. Medicine says
you shouldn't take care of your own family, but what did we do 100 years
ago?"

Quaempts is known on the Yakama Reservation for more than just doctoring.
He is also a triathlete who trains on his lunch hour by running the RV park
track, according to my 76-year-old uncle who walks at the same time.

Now, working two days a week in a diabetes education program, Quaempts'
personal commitment to physical fitness says more to his patients than a
lecture on the subject. He has time to reflect on patients, like one of the
elders with whom he sweats, who have gotten control of their diabetes.

Even Quaempts, who says he believes in government health care, feels the
financial pressures that are always at the door. IHS's $3 billion budget,
despite Congress' incremental appropriation increases, loses ground
annually because the Native population is growing and the costs of health
care are rising.

"One of the tribal counselors said recently, 'How come docs don't do home
visits anymore?'" Quaempts said "It's kind of hard when my appointments
open on the first of the month, and they're full by noon."

It's also hard, he told the President's Cancer Panel in 2002, to talk to
people about cancer prevention when "you can't keep up with the onslaught
coming in the door." Citing 2000 statistics in the "Facing Cancer in Indian
Country" publication, Quaempts said of the 5,000 women to whom his clinic
should have given pap smears, only 1,100 received the screening. For about
10 months in 2000, the clinic couldn't afford mammograms, he told the
panel.

For Henderson, those kinds of delays are evidence of "the most draconian
types of health care rationing in the country." The typical prison inmate
will get annually twice the dollars spent on health care as a patient of
the IHS, he and many other tribal health care advocates say.

"That would be one thing if the American Indian population were the
healthiest population in the country," Henderson said. "But, in fact,
across the board the American Indian population manifests the poorest
health of any community in this country."

That's why Henderson has dedicated his career to studying disease, work
which over the coming decades could help identify causes of cancer among
tribal peoples, and demonstrate the need for federal dollars to fight and
prevent such diseases.

Henderson's biggest under-taking to date is the EARTH Study, which is
recruiting 16,000 young Native adults, who will be studied for the next 20
years to identify diet, life styles and habits that may contribute to
cancer.

This is a project that seven generations from now some journalist or maybe
an academic researcher will be writing about.

For now, Quaempts said there is more to good medical care than money can
buy.

It comes from a doctor who gives up a potentially lucrative practice to
study the cause of disease among Indian people. Or from another doctor who
calls the tribal housing department to get help for a patient whose home
lacks running water.

"When I was a little Indian kid going to Yellowhawk," Quaempts said of the
IHS clinic on the Umatilla reservation in Oregon, "you were kind of raised
at this health center that was crappy and second-rate. Since then, I have
worked in the private sector. And the patients here get better health care
than they realize."

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.