RAPID CITY, S.D. - The acting director of the Indian Health Service (IHS) came to a region that earlier this year gave vent to a full range of horror stories about federal health care and promised a partnership for a better future.
Dr. Charles Grim made the pledge at a workshop of health providers, tribal program directors and IHS officials who gathered here to create a view of the future of health care for Indians. The strategy session listed funding as the number one problem, but it also unveiled problems within and without the healthcare system that participants said improved communications and recruitment and retention of staff would resolve.
Dr. Grim told the gathering that the IHS will cooperate with the Area and tribal program officials in partnering for better health care.
"I am excited about our office being part of this strategy session, it will make a positive impact. We looked at things you want to pursue and we want too implement them at a higher level. We support them, because that's what you want to do, we want to help you pursue your goals," Dr. Grim said.
The current health care system for reservation Indians and in the urban areas has been criticized for years. Long waiting times to see physicians, lack of preventative medicine, little communication between health care officials and the community, understaffing and tribal politics all impact programs.
The idea of the workshop was to form a mission statement and lay out a vision for the future.
"The process is very good and forward-thinking. This is partnership of health care. But, to what degree do these plans have for success? We are so far behind in resources to provide quality health care," said Mike Jandreau, chairman of the Lower Brule Sioux Tribe.
"What is the commitment of the administration to raise resources to provide improved health care. We don't want the end result that says you can't do that because of this or this or that. It is frustrating to go through this process if there is not an objective at the end. It takes a commitment in the beginning to make plans a reality." Dr. Grim and his staff have been to the Aberdeen Area twice in the past two months, first with the Aberdeen Area Chairman's Health Board and then with the strategic planning group. He said his office was committed to the process.
"Now we know which direction you want to go. We may not implement all we want, these are such ambitious goals, but continue to push us," Dr. Grim said.
Many services that could be provided are hindered by regulations imposed at the federal level. More American Indian service providers could be employed if the background checks were not so stringent, officials said.
Also culturally relevant programs are prevented because of the regulations.
Many people in attendance at the planning session said that there were quality staff people at the service units and clinics, but that recruitment and retention was still a major problem. Some suggested that prospective physicians and nurses be assigned to a family on the reservation and given a chance to become part of the community.
Most reservations and communities are isolated, so some prospects with families want to send children to better schools and some need more opportunities that larger cities can provide.
Small communities can recruit physicians trained in foreign countries, but IHS and tribes are not allowed to hire those physicians. Lifting of the ban would help recruit more physicians, officials said. That would take congressional action.
Many health programs are required to share Medicaid and Medicare funding with the states that received the money in the form of block grants. The tribes then have to apply for the money from the state, and in many cases there is a lack of government-to-government relations.
The future of health care may lie in a change from crisis management to prevention. Tribal officials said that health care is always in crisis mode, dealing with the aftermath of the affects of diabetes, alcoholism and accidents.
Elder programs and alcoholism treatment programs need new funding from the IHS participants said.
The key to change and to a new vision for the future of health care is to come up with a document and be dedicated to it, said Roger Trudell, chairman of the Santee Sioux Tribe.
Tribal administrations change regularly and so new appointees are directed to operate the health care of the tribe. Sometimes new people arrive every two years. But if a document is approved, personnel change will not affect the overall commitment to quality health care and its delivery.
There are many obstacles to overcome and they have been on the drawing board for change for many years. Problems such as transportation, the lack of dentists, health education, poor education that means fewer health care providers in the future, cultural awareness and language need to be addressed with funding, planning and cooperation amongst the tribes and with the federal officials, strategists said.
IHS officials said the Aberdeen Area develops more American Indian health care professionals than any other area. The staff of one service unit is more than 80 percent American Indian, yet the problem of recruitment and retention is still grave. Many of the professionals are trained and then go to other areas.
The idea of the strategic planning session is to provide a mission statement and vision that will look five or more years into the future. One of the suggestions was that Indian health care go back to the future because people were healthier 300 years ago.
The planning group provided one statement to sum up the health care that by treaty the federal government is obligated to provide American Indians: "Working together to provide traditional and modern medicine in a culturally sensitive atmosphere."
Another meeting is planned for the Aberdeen Area Tribal Chairman's Board in conjunction with the tribes and the IHS. The meeting will be continuation of the strategic planning sessions.