Budget cuts hurt Indian health

Health Features

By Olga Pierce
Feb 18, 2006, 19:00 GMT

WASHINGTON, DC, United States (UPI) -- President Bush`s 2007 budget proposes to eliminate the entire $33 million budget for the nation`s 34 Urban Indian Health Centers, on the grounds that the Centers` Native American patients can receive treatment at community health centers that already exist to serve the general population.

But opponents of the cuts say the end of the centers would leave a gaping hole in healthcare for the nearly 70 percent of Native Americans who live in urban areas, and may not even save that much money.

'We are a social and economic center for Native Americans here,' Crystal Tetrick, executive director of the San Diego American Indian Health Center, the only primary care urban Indian clinic in southern California, told United Press International. 'The cuts put our entire program into jeopardy.'

Federal funds currently supply 47 percent of the budget for the San Diego center that provides basic medical and dental care, in addition to referral and advocacy services for 1,500 people each year, 75 percent of whom are Native American.

Their services are crucial, Tetrick said, in encouraging the city`s Native American population to seek treatment from a medical system that many inherently distrust.

'We provide culturally competent and culturally appropriate care,' she said. 'Many of these individuals are reluctant to navigate the mainstream medical system.'

In addition to general services, the center has developed preventative programs targeted directly at problems that most frequently afflict Native Americans.

The diabetes rate in the ethnic group is more than twice as high, for example, than in the general population, and so the center has launched a series of preventative measures including a weekly support group for diabetics and a walking group to prevent related health problems before they become acute.

Without the help of the centers, many of the patients will simply not seek care until they end up in emergency rooms with more acute conditions, she said.

Unlike other community health centers, which serve general low-income populations, urban Indian health centers are non-profit organizations governed by board members who are Native Americans themselves.

In the 1950s and 60s, the federal government pursued a deliberate policy of relocation, encouraging and sometimes pressuring Indians to leave reservations and move to cities, particularly on the West Coast, regardless of the cultural impact, and many of those who moved joined the ranks of the urban poor.

The connection to the reservation has not been severed, however, and many tribal members lead semi-nomadic lives, considering reservations home but traveling to cities to work.

Urban Indian health centers are the only organizations involved enough to be able to ensure continuity of care despite the mobile nature of this relationship, Donna Polk-Primm, executive director of the Nebraska Urban Indian Health Coalition, told UPI.

From its base in Nebraska, the center serves a population spread out over three states, spending tens of thousands of dollars every year on transportation to make sure there is adequate access to the center`s services.

The trip is worth it, Polk-Primm said, because of the additional services the clinic can provide.

At the center, where 15 of 28 staff members are Native Americans, interpreters are available for the Lakota and Navaho languages, and an effort is made to integrate cultural traditions into medical care.

The center offers a 12-step recovery program for alcoholics called Red Road that is similar to Alcoholics Anonymous, but incorporates aspects of native spirituality.

A medicine man often comes from Pine Ridge to perform traditional religious ceremonies and periodic trips to a 'sweat lodge' are provided to take care of the overall wellness of a population that also suffers from high rates of drug abuse and depression.

The high diabetes rate means that many patients at the center face amputations, a practice that is not always in accordance with Native American culture. A podiatrist who is familiar with these cultural concerns drives 89 miles to the center both to help prevent the need for amputation, and to serve as a go-between to help make sure the procedure is not performed unless it is absolutely necessary.

'The use of herbs, prayer and sweat lodges--if those are things important to them in terms of healing, the U.S. government has an obligation to provide them,' she said.

To further serve the needs of its clients, the center conducts training for doctors and nurses about the special needs of Native American patients, especially surrounding hospitalization and end-of-life issues.

'They need to understand the rituals that go along with this time of hardship for the family,' she said, 'and we know these things.

The community at the center also allows personal attention for patients. If patients miss appointments, representatives go on home visits to find out what the problem is.

If the cuts go through, the program, which has served 14,000 people over the last ten years, will probably close.

'We feel we have thousands of patients who would not have access to care,' she said.

Urban Indian centers are a critical part of the Indian Health Service, a set of government programs the federal government must provide due to treaty obligations, said Greg Smith, attorney for the National Council of Urban Indian Health Organizations.

In exchange for their moving to reservations, the federal government promised tribes that their basic needs would be provided for.

'Legal deals were struck,' Smith said.'It`s pretty clear the treaties as a group oblige the U.S. government to provide services, especially when it comes to things like education and health care.'

In the budget, the Bush administration points out that funding for Indian Health Services--99 percent of which goes to services provided on reservations--is slated to increase overall by 4 percent. Indians who live in urban areas, it argues, can get health care at other community health centers which have also received a moderate budget increase.

But representatives of those health centers aren`t so sure.

On Feb. 10, Daniel Hawkins Jr., the vice president of the National Association of Community Health Centers, wrote a letter addressed to Bush saying community health centers are complementary to their Indian counterparts and cannot offer the same important services.

Increases in other funding to Indian Health Service and community health centers are not enough to offset the cuts, Hawkins said, and all community health centers will be hurt.

The cuts may also not save money, Tetrick said, because patients will seek care at reservation hospitals that are much less efficient than clinics and do not offer preventative services.

In order for reservation health systems to absorb the additional costs, their budget would need to increase by more than twice as much as the $125 million built into Bush`s budget, according to a study by the Northwest Portland Area Indian Health Board.

Funding for the health centers has been threatened in the past, only to be restored later by Congress. Sen. John McCain, R-Ariz., chairman of the Committee on Indian Affairs, has said he thinks that could happen again.

Sen. Tim Johnson, D-S.D., also a member of the committee, called Bush`s budget priorities 'backwards' and said he will work to get the funding restored.

Reps. Heather Wilson, R-N.M., and Jim McDermott, D-Wash., have asked their Congressional colleagues to sign a letter to Jim Nussle, R-Iowa, chairman of the House Budget Committee calling on him to restore the funding.

'It is unlikely that community health centers will be able to match the service and cultural expertise that urban Indian centers have been providing, and we are worried that these urban Indians living off-reservation may be deprived of appropriate care,' the letter says.

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February 2006 Reports

Last updated on February 24, 2006