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Health issues change little

RAPID CITY, S.D. – Health care in Indian country has been labeled as horrible, abysmal and an embarrassment.

The IHS is chronically underfunded; and each year as budgets are rolled out, money shifts and cuts occur in some areas. Some, as was the case this year, were cut altogether.

To get Congress to meet the needs of Indian country health care, a concerted effort will be needed – and that will require data collection, tribal leaders and health care professionals agree.

The U.S. Department of Health and Human Services has conducted consultation sessions around the country over the past four years. Officials from Region 8, which comprises six states, met recently in Rapid City with state, federal and tribal officials sharing ideas for the future of health care.

“The IHS will never be able to fully accommodate Indian health,” said Doug Black, director of IHS’ office of tribal programs.

Tribes are no longer making unilateral efforts to improve health care: states and federal agencies are getting into the debate.

President Bush’s goal is to cut the budget deficit, Black said, and that forces the IHS to make hard choices to place funds in the areas that best serve health care. The IHS was subjected to some tough Senate hearings on the budget and health care, according to Black.

“The region is dedicated to work with the tribal governments and is willing to sit down and discuss what is important to you,” Region 8 Director Joe Nunez said.

“There is still a long way to go, and much work needs to be done but we are willing to work with you,” he said.

A concerted effort to work with the tribes to set priorities has been a goal in past years, but a new effort by Nunez pleased tribal leaders.

John Blackhawk, chairman of the Aberdeen Area Tribal Chairman’s Board, said he has seen progress and is encouraged by the efforts made to make changes in the health care of Indian country. They are small steps, he noted, and there is improved cooperation.

Blackhawk said he was pleased to hear Nunez commit his office to meetings on every reservation and to meet with each state and tribe to set priorities in health care.

Some issues need to be addressed by the states, such as Medicaid, nursing facilities, Temporary Assistance to Needy Families, social services and other areas the tribes must go through the states to access.

State officials who attended the consultation said that state-tribal relations were improving, some slowly, others made large leaps forward. Colorado state-tribal relations have never been better, said Ernest House Jr., director of the Colorado Commission on Indian Affairs.

North Dakota received praise for the state’s work with tribes in areas of health care, economic development and education. The University of North Dakota is home to INMED, a program that accepts American Indian students into the medical programs. The program works for tribe because many doctors, when they complete their education, will return to their communities, tribal leaders said.

In Colorado, drinking water is a priority and the state negotiates agreements between local governments and tribes as they all work together. “That helps the local communities understand what the issues are,” House said.

Important to many states is the elimination of urban Indian health funding in the president’s fiscal year 2007 budget proposal.

Denver is the hub of Indian country in that region and the most recent count is that 21,000 American Indians from many tribes live in the city. That population is expected to grow to 31,000.

Salt Lake City, Utah, has a population of 14,000 American Indians that will have their health care changed if the UIH cut is allowed to pass. Most attendees were confident that funding would be restored.

The Bush administration’s policy is that urban Indians can receive health care from a wide variety of sources and that the urban Indian health is a duplication of services, according to Black.

Health care is a trust responsibility of the federal government according to treaties, and Jesse Taken Alive, council member from the Standing Rock Sioux Tribe, reminded all officials of that fact.

Taken Alive told government officials at the meeting to have courage and take the message to their bosses that the treaties are living documents, and to also let the states know the American Indian is still here and alive.

“The lands are still being rented,” he said.

Julia Doney, commercial council president of Fort Belknap, told the officials to stop telling the tribes “that’s all you can do, that you can’t do any more.”

All in all, most tribal officials had praise for what the federal and state officials were trying to do, given the resources available.

Emerging priorities in health care in the past are now realities, and priorities such as methamphetamine abuse and treatment and pandemic flu are issues brought to the table by the federal officials.

At latest count, the tribes had some 21 priority issues listed that did not always include diseases.

Increases in funding, increases in contract health care, co-pays by the IHS for private health insurers, urban Indian health funding, facility construction, transportation, solid-waste treatment and preventative medicine were just a few of the priorities set down by the tribes.

“We have a chronically ill population, caused by bad choices,” said Cecilia Fire Thunder, president of the Oglala Sioux Tribe.

“Let’s get real: Are we not going to talk about prevention so children don’t grow up to be chronically ill?” she said.

Fire Thunder said that 20 percent of the funding is spent on health care for young people who make up half the population, but no funding for prevention; and the 80 percent spent on adults will be stretched further because of an aging population.

On the Fort Berthold Reservation in North Dakota, the closest emergency room is 100 miles away. The reservation does not have emergency medical services and has to contract outside for ambulance service. Dental care is lacking at Fort Berthold, as there is no full-time dentist, according to Debra Hall, of the Three Affiliated Tribes.

With the rise of methamphetamine use, auto accidents and an increase in people suffering from post-traumatic stress disorder on reservations, emergency services are almost essential.

Steve Little Bird, Northern Cheyenne, said what he heard at the meeting was very good. “If we all get together we can make a change.”

Nunez said that the IHS was behind the tribes and states, and that his office would review all the comments made at the meeting and address whether the region or the administration or Congress would have to deal with some issues.

“I agree with more meetings with state and tribal officials. I am always ready to meet with tribal leaders,” Nunez said.