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PROMISES, PROMISES: Indian health care needs unmet

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Barack=20 Obama

BY MARY CLARE JALONICK, = Associated Press=20 Writer Mary Clare Jalonick, Associated Press = Writer=20 =E2=80=93 2 hrs 41 mins ago

CROW AGENCY, Mont. =E2=80=93 Ta'Shon Rain Little Light, a happy = little girl who loved=20 to dance and dress up in traditional American Indian clothes, had = stopped eating=20 and walking. She complained constantly to her mother that her stomach = hurt.

When Stephanie Little Light took her daughter to the Indian Health Service clinic in this = wind-swept and=20 remote corner of Montana, they told her the 5-year-old was = depressed.

Ta'Shon's pain rapidly worsened and she visited the clinic about 10 = more=20 times over several months before her lung collapsed and she was = airlifted to a=20 children's hospital in Denver. There she was diagnosed with terminal = cancer,=20 confirming the suspicions of family members.

A few weeks later, a charity sent the whole family to Disney World so = Ta'Shon=20 could see Cinderella's Castle, her biggest dream. She never got to see = the=20 castle, though. She died in her hotel bed soon after the family arrived = in Florida.

"Maybe it would have been treatable," says her great-aunt, Ada White, = as she=20 stoically recounts the last few months of Ta'Shon's short life. = Stephanie Little=20 Light cries as she recalls how she once forced her daughter to walk when = she was=20 in pain because the doctors told her it was all in the little girl's = head.

Ta'Shon's story is not unique in the Indian Health Service system, which serves = almost 2=20 million American Indians in 35 states.

On some reservations, the oft-quoted refrain is "don't get sick after = June,"=20 when the federal dollars run out. It's a sick joke, and a sad one, = because it's=20 sometimes true, especially on the poorest reservations where residents = cannot=20 afford health insurance. Officials say they have about half of what they = need to=20 operate, and patients know they must be dying or about to lose a limb to = get=20 serious care.

Wealthier tribes can supplement the federal health service budget = with their=20 own money. But poorer tribes, often those on the most remote = reservations, far=20 away from city hospitals, are stuck with grossly substandard care. The = agency=20 itself describes a "rationed health care system."

The sad fact is an old fact, too.

The U.S. has an obligation, based on a 1787 agreement between tribes = and the=20 government, to provide American Indians with free health care on reservations. But that = promise has=20 not been kept. About one-third more is spent per capita on health care = for=20 felons in federal prison, according to 2005 data from the health = service.

In Washington, a few lawmakers have tried to bring attention to the = broken=20 system as Congress attempts to improve health care for millions of other = Americans. But tightening budgets and the relatively small size of the = American Indian = population have=20 worked against them.

"It is heartbreaking to imagine that our leaders in Washington do not = care,=20 so I must believe that they do not know," Joe Garcia, president of the National Congress of American Indians, said = in his=20 annual state of Indian nations' address in February.

___

When it comes to health and disease in Indian country, the statistics = are=20 staggering.

American Indians have an infant death rate that is 40 percent higher = than the=20 rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a = stroke, 30=20 percent more likely to have high blood=20 pressure and 20 percent more likely to have heart disease.

American Indians have disproportionately high death rates from = unintentional=20 injuries and suicide, and a high prevalence of risk factors for obesity, = substance abuse, sudden = infant death=20 syndrome, teenage=20 pregnancy, liver disease and hepatitis.

While campaigning on Indian reservations, presidential candidate Barack Obama cited = this=20 statistic: After Haiti, men on=20 the impoverished Pine Ridge and Rosebud Reservations in South Dakota have the lowest life = expectancy in the=20 Western = Hemisphere.

Those on reservations qualify for Medicare and Medicaid coverage. But = a=20 report by the Government=20 Accountability Office last year found that many American Indians = have not=20 applied for those programs because of lack of access to the sign-up = process;=20 they often live far away or lack computers. The report said that some do = not=20 sign up because they believe the government already has a duty to = provide them=20 with health care.=20

The office of minority health at the U.S. Department of Health and Human = Services, which=20 oversees the Indian Health Service, notes on its Web site that American = Indians=20 "frequently contend with issues that prevent them from receiving quality = medical=20 care. These issues include cultural barriers, geographic isolation, = inadequate=20 sewage disposal = and low=20 income."=20

Indeed, Indian health clinics often are ill-equipped to deal with = such high=20 rates of disease, and poor clinics do not have enough money to focus on = preventive care. The = main problem is=20 a lack of federal money. American=20 Indian programs are not a priority for Congress, which provided = the=20 health service with $3.6 billion this budget year.=20

Officials at the health service say they can't legally comment on = specific=20 cases such as Ta'Shon's. But they say they are doing the best they can = with the=20 money they have =E2=80=94 about 54 cents on the dollar they need.=20

One of the main problems is that many clinics must "buy" health care = from=20 larger medical facilities outside the health service because the clinics = are not=20 equipped to handle more serious medical conditions. The money that = Congress=20 provides for those contract health=20 care services is rarely sufficient, forcing many clinics to make = "life or=20 limb" decisions that leave lower-priority patients out in the cold.=20

"The picture is much bigger than what the Indian Health Service can do," says Doni = Wilder, an=20 official at the agency's headquarters in Rockville, Md., and the former = director=20 of the agency's Northwestern region. "Doctors every day in our = organization are=20 making decisions about people not getting cataracts removed, gall = bladders=20 fixed."=20

On the Standing Rock Reservation in North Dakota, Indian Health = Service staff=20 say they are trying to improve conditions. They point out recent = improvements to=20 their clinic, including a new ambulance bay. But in interviews on the=20 reservation, residents were eager to share stories about substandard = care.=20

Rhonda Sandland says she couldn't get help for her advanced frostbite = until=20 she threatened to kill herself because of the pain =E2=80=94 several = months after her=20 first appointment. She says she was exposed to temperatures at more than = 50=20 below, and her hands turned purple. She eventually couldn't dress = herself, she=20 says, and she visited the clinic over and over again, sometimes in = tears.=20

"They still wouldn't help with the pain so I just told them that I = had a=20 plan," she said. "I was going to sleep in my car in the garage."=20

She says the clinic then decided to remove five of her fingers, but a = visiting doctor from Bismarck, N.D., intervened, giving her drugs = instead. She=20 says she eventually lost the tops of her fingers and the top layer of = skin.=20

The same clinic failed to diagnose Victor Brave Thunder with congestive heart = failure, giving him=20 Tylenol and cough = syrup when=20 he told a doctor he was uncomfortable and had not slept for several = days. He=20 eventually went to a hospital in Bismarck, which immediately admitted = him. But=20 he had permanent damage to his heart, which he attributed to delays in=20 treatment. Brave Thunder, 54, died in April while waiting for a heart transplant.=20

"You can talk to anyone on the reservation and they all have a = story," says=20 Tracey Castaway, whose sister, Marcella Buckley, said she was in $40,000 = of debt=20 because of treatment for stomach=20 cancer.=20

Buckley says she visited the clinic for four years with stomach pains and was = given a=20 variety of diagnoses, including the possibility of a tapeworm and = stress-related=20 stomachaches. She was eventually told she had Stage 4 cancer that had = spread=20 throughout her body.=20

Ron His Horse is Thunder, chairman of the Standing Rock tribe, says = his=20 remote reservation on the border between North Dakota and South Dakota can't attract or maintain = doctors who=20 know what they are doing. Instead, he says, "We get old doctors that no = one else=20 wants or new doctors who need to be trained."=20

His Horse is Thunder often travels to Washington to lobby for more = money and=20 attention, but he acknowledges that improvements are tough to come by.=20

"We are not one congruent voting bloc in any one state or area," he = said. "So=20 we don't have the political clout."=20

___=20

On another reservation 200 miles north of Standing Rock, Ardel Baker, = a=20 member of North Dakota's Three Affiliated Tribes, knows all too well the = truth=20 behind the joke about money running out.=20

Baker went to her local clinic with severe chest pains and was sent by ambulance to a = hospital=20 more than an hour away. It wasn't until she got there that she noticed = she had a=20 note attached to her, written on U.S. Department of Health and Human = Services=20 letterhead.=20

"Understand that Priority 1 care cannot be paid for at this time due = to=20 funding issues," the letter read. "A formal denial letter has been = issued."=20

She lived, but she says she later received a bill for more than = $5,000.=20

"That really epitomizes the conflict that we have," says Robert = McSwain,=20 deputy director of the Indian Health=20 Service. "We have to move the patient out, it's an emergency. We = need to=20 get them care."=20

It was too late for Harriet Archambault, according to the chairman of = the=20 Senate Indian Affairs Committee, Democratic Sen. Byron Dorgan of North Dakota, who has = told her=20 story more than once in the Senate.=20

Dorgan says Archambault died in 2007 after her medicine for hypertension ran out and = she=20 couldn't get an appointment to refill it at the nearest clinic, 18 miles = away.=20 She drove to the clinic five times and failed to get an appointment = before she=20 died.=20

Dorgan's swath of the country is the hardest hit in terms of Indian = health=20 care. Many reservations there are poor, isolated, devoid of economic = development=20 opportunities and subject to long, harsh winters =E2=80=94 making it = harder for the=20 health service to recruit doctors to practice there.=20

While the agency overall has an 18 percent vacancy rate for doctors, = that=20 rate jumps to 38 percent for the region that includes the Dakotas. That region also has a 29 percent = vacancy=20 rate for dentists, and officials and patients report there is almost no = preventive dental care. = Routine=20 procedures such as root canals are rarely seen here. If there's a = problem with a=20 tooth, it is simply pulled.=20

Dorgan has led efforts in Congress to bring attention to the issue. = After=20 many years of talking to frustrated patients at home in North Dakota, he = says he=20 believes the problems are systemic within the embattled agency: = incompetent=20 staffers are transferred instead of fired; there are few staff to handle = complaints; and, in some cases, he says, there is a culture of = intimidation=20 within field offices charged with overseeing individual clinics.=20

The senator has also probed waste at the agency.=20

A 2008 GAO report, along with a follow-up report this year, accused = the Indian Health Service of = losing=20 almost $20 million in equipment, including vehicles, X-ray and = ultrasound=20 equipment and numerous laptops. The agency says some of the items were = later=20 found.=20

Dorgan persuaded Senate Majority=20 Leader Harry Reid, D-Nev., to consider an American Indian health improvement bill = last year,=20 and the bill passed in the Senate. It would have directed Congress to = provide=20 about $35 billion for health programs over the next 10 years, including = better=20 access to health care services, screening and mental health programs. A similar bill died = in the=20 House, though, after it became entangled in an abortion dispute.=20

The growing political clout of some remote reservations may bring = some=20 attention to health care woes. Last year's Democratic presidential primary played out = in part in=20 the Dakotas and = Montana, where=20 both Obama and Democrat = Hillary=20 Rodham Clinton became the first presidential candidates to = aggressively=20 campaign on American = Indian=20 reservations there. Both politicians promised better health care.=20

Obama's budget for 2010 includes an increase of $454 million, or = about 13=20 percent, over this year. Also, the stimulus bill he signed this year = provided=20 for construction and improvements to clinics.=20

___=20

Back in Montana, Ta'Shon's=20 parents are doing what they can to bring awareness to the issue. They = have=20 prepared a slideshow with pictures of her brief life; she is seen = dressed up in=20 traditional regalia she wore for dance competitions with a bright smile = on her=20 face. Family members approached Dorgan at a Senate field hearing on = American Indian health = care after=20 her death in 2006, hoping to get the little girl's story out.=20

"She was a gift, so bright and comforting," says Ada White of her = niece, whom=20 she calls her granddaughter according to Crow tradition. "I figure she = was=20 brought here for a reason."=20

Nearby, the clinic on the Crow reservation seems mostly empty, aside = from the=20 crowded waiting room. The hospital is down several doctors, a shortage = that=20 management attributes recruitment difficulties and the remote location.=20

Diane Wetsit, a clinical coordinator, said she finds it difficult to = think=20 about the congressional bailout for Wall Street.=20

"I have a hard time with that when I walk down the hallway and see = what=20 happens here," she says.=20

___=20

On the Net:=20

Indian Health = Service: http://www.ihs.gov/=20

U.S. Department of Health and Human Services Department's office of = minority=20 health: http://tinyurl.com/l9qzuq=20

National Congress of = American=20 Indians' health care issues: http://tinyurl.com/krs986=20

Senate Indian Affairs Committee: http://indian.senate.gov=20

GAO reports: http://tinyurl.com/ljq6fb, http://tinyurl.com/n7kdpa

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