Tuesday, July 7, 2009

Indian Health Dis-Service

As Obama and Congress, the health insurance industry and the AMA debate about what America’s public health care should be, American Indians and Alaskan Natives are provided health care as part of the government’s trust responsibility for them. However, this health care is not to be envied by non-Indians and hopefully is not to be an example of what Obama has in mind for non-Indian America.

On May 8, 2009, Dr. Yvette Roubideaux was confirmed by a unanimous vote of the U.S. Senate as Director of the Indian Health Service. She will oversee the administration of a proposed $4.3 billion budget. Obama requested a 13 percent increase over the 2009 budget. Despite this hefty dollar amount, the quality of medical care on the reservations the IHS serves has been less than adequate in many cases.

Last month, the Associated Press ran a story about the death of the little girl whose photo graces the top of this blog. Her name is Ta’Shon Rain Little Light. She was a 5 year old little Crow girl from Montana. She died of cancer and her lung collapsed, according to the AP story, which you can read in full
here. The Crow Agency IHS clinic in Montana told Ta’Shon’s parents there was nothing wrong with her except that she was depressed. Obviously, there is a big difference between terminal cancer and depression.

Many health care horror stories have taken place in Indian Country since the advent of Manifest Destiny. After all, it was our government who handed out smallpox-infected blankets in winter so long ago.

Indians have the worst health statistics in America. According to the AP story when Obama was a candidate campaigning on the Pine Ridge and Rosebud Reservations, where Dr. Roubideaux is a member, he cited the statistic that Indian men at Pine Ridge and Rosebud have the lowest life expectancy in the Western Hemisphere after Haiti. That’s Haiti.

Reportedly, American Indians have an infant mortality rate 40 percent higher than whites, twice the rate of diabetes, 60 percent more for strokes, 30 percent more for high blood pressure and 20 percent more likely to have heart disease. Obviously there is quite a need for good health care.

Although the AP story suggests money is the problem, the IHS website for the Crow Service Unit states that its hospital provides health care for the Crow and the Northern Cheyenne and employs 200 plus doctors, nurses, LPN’s, lab technicians, and all service personnel necessary to adequately staff a 24-bed health facility.

But perhaps the problem with health care on the reservations throughout the U.S. is not only with poor quality or lack of money, but with contaminates that cause the diseases for which Indians are receiving less than quality treatment. Between now and August 2011 a study through a grant from the EPA to Montana State University will be conducted on the Crow Reservation to assess the potability of drinking water.

A map of the Crow Reservation shows the heavy amount of surface coal mining on and around the reservation that would affect the drinking water and cause such rapid cancer development in little Ta’Shon Rain Little Light.

A Montana Fish & Wildlife report that states “CBM [coalbed methane] discharged water can contain high levels of ammonia, selenium, boron, iron, radium, and fluoride, as well as the most significant problem— sodium salts. Sodium levels in discharged water render it unsuitable for irrigation. Increased sodium bicarbonate levels in water are lethal to fish and all aquatic and riparian vegetation”.

Radium in drinking water has been known to cause bone cancer. Boron hydrogen compounds are toxic dependent on structure. Hydrogen is two-thirds of water.

Stomach cancer is associated with excessive levels of sodium salts as may be found in CBM discharged water. I’m no toxicologist or doctor, but the possibility that CBM discharge-contaminated drinking water caused little Ta’Shon’s cancer is heightened by the fact that she complained of stomach pains.

This reminds me of the film “Thunder Heart” with Val Kilmer and Sam Shepard, where the character Maggie Eagle Bear discovers that the drinking water is contaminated with uranium due to mining on the res. It also reminds me of is “Erin Brockovich”.

So the story here isn’t ineptitude or under funding at IHS clinics, it’s a story of lax EPA standards and mineral resource exploitation on reservations versus tribal health. It’s an old problem on the reservation. The Indian nation needs income. They have coal or uranium or other minerals. They allow them to be mined to make money. But because of relaxed EPA standards and mining company shyster lawyers, the Indian nation is stuck with the long-term problem of with the mining residue getting into ground water and rivers.

Perhaps the most famous instance was at the Laguna Pueblo Reservation back in 1979 where a hundred million gallons of radioactive water spilled into the Rio Puerco from a Kerr-McGee and United Nuclear Corporation mine. According to Wikipedia, approximately 1,100 tons of uranium mine waste contaminated 250 acres of land and up to 50 miles of the Rio Puerco. There was another
story recently of homes at Navajo built with uranium-contaminated materials which are being torn down and replaced with new homes by the Navajo EPA.

Minnesota’s new Senator Al Franken told reporters last week that he asked to be placed on the Senate Committee on Indian Affairs. I doubt there are many Senators who have requested to be on that committee, so it will be interesting to see what Franken does.

Back in the day, when I was producing Sequoyah, my weekly Native American news program for WBAI, I was also the weekly feature correspondent for the nationally-syndicated weekly half-hour, First Person Radio and the New York-based correspondent for the nationally-syndicated daily five-minute feed, National Native News.

One of the reports I produced was a 1988 interview with Sharon Esotoya, then Executive Director of the Native American Community Board on the Yankton-Sioux Reservation in South Dakota. She spoke about the forced sterilization of Indian women in Indian Health Service clinics.

Esotoya discussed how the forced sterilization practice worked and how the doctors got away with it by not documenting the conversation between doctor and patient, doctors telling the women the procedure could be reversed if they changed their minds and using scare tactics against the young women who didn’t know, saying if they don’t have the procedure they could get cancer, if they had another child they could get cancer.

The use of the contraceptive depo provera on Indian reservations was the subject of Senate Select Committee on Indian Affairs and cited only 35-40 cases. Esotoya disagreed, saying many women were taking depo provera. While it was supposed to be illegal in most states, Esotoya said if you called any HIS pharmacy and asked them if they had depo provera they would say yes.

For that report, I called the Indian Health Service office in South Dakota for a comment about the use of depo provera and the forced sterilization and was referred to a series of IHS personnel until finally being referred to the main IHS office in Maryland where that person was also unavailable for comment.

Esotoya mentioned one woman who changed her mind about having her tubes tied only to have IHS doctors try to wrestle her down onto the table to administer the anesthetic until the anesthesiologist refused.

So, when insufficient health care is combined with poisonous conditions on reservations, a deadly set of circumstances is created like that which allowed little Ta’Shon Rain Little Light to die.

The worst thing for a parent is to lose a child. My heart goes out to Ta'Shon's family.

Obviously not much has much changed at the IHS in twenty years.