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Mending the broken circle of health care

The war in Iraq directly impacts the health of Indian people. Events
occurring these past few years have relegated the treaty obligation to
tribes to the back burner. These events occurring continents away create an
imbalance, particularly in funding to tribes. The situation can be compared
to a household budget where a family is forced to replace meat with Spam,
replace chicken with bologna sandwiches. The family will survive, but will
not be nutritionally sound.

Homeland security has taken on a whole different meaning for American
Indians. Personal security is now the major issue facing this country,
particularly the way business is conducted within and outside of America,
shifting health priorities for tribes. Tribal health organizations such as
the Aberdeen Area Tribal Chairmen's Health Board (AATCHB) must rethink and
redefine strategies to meet the health needs of their constituencies.

Tribal people have made enormous transitions in the past 100 years, from
living in tipis to building housing developments; from communicating
through smoke signals to global communications through the World Wide Web.
Even with these changes, it is critical for tribes to make even greater
strides in economic self-sufficiency and self-determination.

Tribes know they must find creative and innovative ways to meet the health
needs of their people and are acutely aware that they can no longer rely
solely upon the government-to-government relationship for sustenance and
support for their people. The winds of political change have shifted in the
Supreme Court and the executive branch, and tribes must also shift to
accommodate these changes.


The break in the circle of health care has cost millions of Indian lives.
The AATCHB was established in 1986 by tribal chairs who felt the critical
need for greater advocacy for health care and to involve the community in
solutions to the complex health issues facing tribes. Aberdeen Area
includes the tribes residing in the states of North Dakota, South Dakota,
Nebraska and Iowa: a total of 17 tribes and two health service units.

AATCHB's philosophy is expressed by the Lakota phrase "Hecel Oyate
kinipikte," which means "so that the people may live." It is taken from the
Sun Dance ceremony still practiced by tribes in the area and founded in the
fact that children are held sacred, reflecting the certainty that the
future of the people is assured through healthy children and thus healthy
families. The bulk of the work is advocating for quality health care,
increasing communication to and about tribes, keeping tribes informed about
funding trends, networking, developing collaborations and monitoring the
health status of tribal people.

Throughout its 14 years of existence, the Health Board was insured by 10
years of funding through federal grants, primarily the Healthy Start grant
from Health Resources Services Administration within the Department of
Health and Human Services. Understanding the strength in numbers concept, a
core group came together and organized the tribes to apply for a grant to
HRSA whose criteria was a population of 100,000 and 10 baby deaths per
year. One tribe alone did not meet that criteria; however, the natural
formation of the Aberdeen Area tribes met the population criteria and
exceeded the baby deaths by four.

The Health Board grew through the development of other programs important
to tribes, such as two tobacco programs, an alcohol program, and an
Environmental Protection Agency grant. The AATCHB has been very successful
in the acquisition of federal and private grants to support programs that
align with the Strategic Long Range Plan. The AATCHB grew from a staff of
five to 60 housed in Rapid City, S.D.


Indian people residing on the Aberdeen Area's 18 reservations continue to
struggle against many long years of economic frustration and stark poverty
conditions, overcrowded housing, high unemployment, institutionalization
and the removal of Indian children to non-Indian families through adoption,
foster care and myriad jurisdictional dilemmas. Few social and economic
opportunities exist on the reservations.

There continues to be a breakdown of families not in keeping with the
teachings and practices of previous traditional Indian family values. The
pervasiveness of alcoholism and family dysfunction associated with complex
social problems leads to the neglect of newborn babies and children, and a
high incidence of family violence. Contributing to that picture are a
rural, sparsely populated area and the harsh environment of the Northern
Plains. Other not uncommon factors contribute to stressful living
situations, such as homes lacking complete plumbing, no sewage disposal, no
telephone, and having no vehicle. Dependable transportation and great
distances, coupled with the high poverty rate, remain the greatest
obstacles to adequate medical attention.

Amenities most people take for granted are not available on the
reservations. There are few, if any, restaurants, grocery stores, movie
theatres, clothing stores, car lots, or youth recreation centers. Very few
full-service hospitals and clinics may be found on reservations.

The recently-released report, titled "Broken Promises: Evaluating the
Native American Health Care System," found that "today in Indian country
health-related problems and the lack of adequate health care are the enemy
of Indian people." According to Michael Bird, "when you dispossess people
of their land or labor, their culture, their language, their traditions and
their religion, you set in [motion] powerful forces that impact in a very
negative and adverse way ... dispossession which promotes and creates
health disparities for indigenous populations."

Many statistics can be cited describing the health conditions of the
Northern Plains tribes. One that astounds many is that American Indians
comprise only 8.3 percent of the South Dakota population but account for 28
percent of its motor vehicle fatalities in 2003, according to John Weaver
of Aberdeen HIS. In North Dakota, American Indians comprise only 4.9
percent of the population but account for 26 percent of motor vehicle
fatalities in 2003. Unintentional injuries are the leading cause of death
in the age group of 1 - 44, led by motor vehicle crashes.

Carole Anne Heart, is the executive director of the Aberdeen Area Tribal
Chairmen's Health Board. She can be reached at (605) 721-1922 or Visit for more information.