ALBUQUERQUE, N.M. ? As more and more tribes across the country begin handling their own health programs, American Indian hospitals like the one in Albuquerque are beginning to feel the crunch.
Urban Indians find fewer and fewer services available to them at these hospitals in cities across the nation as tribes pick up more of the funding from the government, leaving urban areas in a funding void.
"The reason this is all happening is because of three main issues," Cheri Lyon, chief executive officer for the Albuquerque IHS Service Unit, said. "Issue number one is IHS is not funded per se for people who live in urban population areas. There is a small portion of the IHS budget in Title V that is used for urban health care, a very small portion of the IHS budget. As a consequence Indian Health Service and the Congressional appropriations have not kept up with the reality that over 60 percent of Indian people now live in metropolitan areas. So we haven't kept pace with that.
"Issue number two is that we have had a declining appropriation for Indian Health direct care?we can't afford the same services we had before with this budget.
"The third issue is that this service unit serves about 30,000 people, 20,000 live in the metropolitan area at large, but not within one of the six tribal communities. The six tribal communities have about 10,000 people, so it is about two-thirds to one-third in terms of proportion, but the one-third are the only group that can actually '638' their health care resources, so what that means is as the tribes become ready and capable to have their own health care, their tribal share includes the piece that we are spending on the urban community.
"Therefore there is nothing left in the metro area that IHS is managing as the tribes take their share and manage it. The tribes are willing to serve the urban people, but the reality is the access, the transportation means that people can't get to those sources of care."
At the Albuquerque Indian Hospital, evening clinic hours have been cut. The unit will begin closing on weekends and holidays as well. Mental health services for urban residents are also a victim to slow strangulation of tightening purse strings as counseling services are cut. The reduced services are not only frustrating to patients of the facility, but to staff members as well who often find their hands tied as they try to provide the best care possible for their urban patients.
As services decrease at the Albuquerque Indian Hospital, services are increasing at area tribal facilities, where urban patients are welcomed, but transportation can become a big obstacle for those traveling to the service units in the field.
Also in question is what the units can do for patients if contract health services are needed. In most service units managed by the tribe or IHS, it is difficult, impossible for urban Indian patients to get specialized care through contract health unless they live within specific boundaries set up by the unit.
In Albuquerque for example, dental services once provided by IHS are now being provided by local tribes and because of the lack of funding the tribes receive, dental care is available only to children under the age of 20. An IHS clinic in town allows 10 emergency patients a day to be seen by dentists, but if further dental work is needed the patient is on his or her own to pay for it.
"If you need a root canal or other work, you'd better have a good job," Lyon said. "The problem is that most of our 20,000 patients are 'working poor'. They have jobs, but either can't get or can't afford insurance in the workplace."
Lyon applauds her staff that continued to keep up morale as funding for the hospital slowly dries up. "This service has been blessed with an incredible staff," Lyon said proudly. "We have a very stable, very committed group of people."
Whether the Bush administration will be cooperative in increasing funding for urban Indians is unclear to Lyon.
"Everyone is willing to advocate for the urban community," Lyon said. "The challenge is to get congressional interest and support in recognizing and addressing the needs of Indian people who live in the metropolitan areas."