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Native health needs and federal apathy are told at an IHS conference

DENVER – IHS funding shortfalls and health care cutbacks are identified every year, but nothing is done about it, according to one tribal leader who said “We want better health care for our people and we want to be heard.”

The words were those of Theresa Two Bulls, president of the Oglala Sioux Tribe, Pine Ridge, S.D., but the underlying sentiment seemed to be universal among tribal representatives who attended a two-day summit with federal officials April 15 and 16.

The Health and Human Services tribal consultation included representation from Native nations in Colorado, Utah, Wyoming, South Dakota, Montana and North Dakota and from HHS and IHS regional and national offices.

Although the current IHS budget of $3.58 billion represents a seven percent increase over 2008, it still represents only about 50 percent of need, according to tribal participants.

“They give us peanuts and expect us to accept it,” said Two Bulls, who urged tribes to speak with a unified voice. “Every time a crisis happens on the national level it’s the Indian programs that get cut first.”

The Obama administration has promised change, so “I’m holding that in my heart and my mind for my Lakota people.”

Tribal representatives underscored their concerns with first-hand experiences: The Northern Arapaho man who recalled that “a few counties over they had better treatment (for West Nile virus) for their horses than for the Indians.” Or the woman whose cancer-stricken mother would not take medical marijuana prescribed for her out of fear she would be evicted from federal housing. There was the sign reported at the OB-GYN sign-in at an IHS facility, “You will not be seen unless you are in labor.” The stark reality was recounted of dealing with a reservation’s youth suicides, occurring at an alarming rate.

The IHS budget would be double its present $3.5 billion-plus if it were fully funded, said Dr. Donald Warne, executive director of the Aberdeen Area Tribal Chairman’s Health Board. The additional $3 billion represents less than 1 percent of the $700 billion HHS budget and “would solve a lot of health needs” if it were made available.

Creating an assistant secretary of Indian health position with policy directing authority and awarding block grants directly to tribes would be positive measures, he said.

Doni L. Wilder, of the Rosebud Sioux Tribe, who was named acting deputy director of IHS in February, said the budget includes $7.5 million for domestic violence prevention after a study of the problem by Amnesty International.

Under the American Recovery and Reinvestment Act, $1.3 million each is allocated for two Indian health centers: The Bristol Bay Area Health Corporation in Dillingham, Alaska and the Native American Community Health Center, Phoenix, Ariz., according to conference material.

Other funding areas include $500 million for construction, operation and improvement of health facilities; $5.3 million for urban health clinics and tribal entities; and $153 million to benefit changes in Medicaid and the Children’s Health Improvement Program.

The president’s IHS fiscal year 2010 budget of more than $4 billion “builds on resources provided in the American Recovery and Reinvestment Act.”

Anslem Roanhorse Jr., executive director of the Navajo Nation health division, cited grim but familiar reservation statistics on the Navajos’ West Virginia-size tribal lands: A diabetes death rate three times the national average; alcohol-related deaths at eight times and homicides more than two times the national rates; and 46 percent of residents with one sign or another of obesity.

Among other needs, tribal leaders stressed reauthorization of the Indian Health Care Improvement Act, which has been awaiting congressional action for a decade, and the fulfillment of federal treaty and trust responsibilities.

Marjorie Bear Don’t Walk, Salish/Chippewa, director of the Indian Health Board, in Billings, Mont., pointed out that although nearly 70 percent of Native people live off-reservation, only about one percent of the IHS budget is designated for urban programs.

“A lot of people moved to the city (during the government’s Urban Indian Relocation Program) and were left there without health care. A lot of our kids are lost in the city.” Urging cooperation, she said urban Indian health programs “need all the help they can get.”

Among other perspectives on current Native health needs were those of Ada White, health services director, Crow Tribe (Apsaalooke Nation), who advocated greater IHS support for the Community Health Representative program. Ardys Cook, health commission chair, Cheyenne River Sioux Tribe, said more funds are critical because present support is “not meeting our needs,” while Judy Cranford, health director for the Paiute Tribe of Utah, discussed services and outreach among far-flung Paiute bands that may be hours away from medical care. Others cited shortcomings in contract care.

Lisa Dillon, Oglala Sioux Tribe health administrator, noted that IHS is a small part of the HHS budget, and said more support is needed for youth because, “we’re just overwhelmed” with the effects of historical trauma and oppression, including seven suicides last year and high rates of infant mortality and child abuse and neglect.