“Well, what can I get you today?” According to my cousin, this is the first question that Indian Health Service (IHS) doctors ask when you visit the clinic on her reservation in rural Wisconsin.
The question, she says, refers to medication, and unfortunately the answer is often a request for some form of painkiller. She reports that on her reservation in rural N. Wisconsin, nearly every family has been touched by abuse of prescription painkillers. She told me of folks being solicited to sell their drugs in the parking lot outside a health clinic, of people afraid to leave their homes lest drug seekers ransack their houses looking for painkillers, of robberies, beatings and worse, all as drug users seek narcotics. Sick with worry and heartbreak, she tells me of her own daughter’s struggle with prescription drugs. Unfortunately, I am hearing similar stories from friends and relatives throughout Indian Country.
According to a story in the Great Falls Tribune, tribal leaders are describing prescription drug misuse as epidemic. The same story reports some stunning data. According to James Melbourne, medical director for the Ft. Peck Tribes in Montana, the federal government pays an average of $15,000 per individual per year for prescription drugs on Indian reservations. I was unable to get a response from the Indian Health Service’s Press and Public Relations Office regarding this information.
Of course, IHS is not solely responsible for script drug abuse in Indian country. Like many communities, Indian country has its share of doctor shoppers, who receive medications from many sources on and off the reservation.
In defense of IHS, it is a chronically underfunded agency. Part of the Federal Health and Human Services department, IHS has been funded with about half of what it needs to provide quality health care to the 2 million American Indians in the 36 states that it serves. The result is that health care is rationed to American Indians, especially those in rural areas. IHS patients are classed based on the urgency of their ailments. People with chronic back, knee, and hip problems can wait for weeks for an appointment and months for surgery. These folks and kids with problems like chronic ear infections are classed as seeking “elective treatment for disease.” The result is that patients wait, and to help them live with the pain while they wait, the doctors do the best they can within the system. They prescribe pain medication.
American Indians make the top of the list for many health problems in the United States.
In comparison to white Americans, Indians and Alaska Natives show
• 40 percent higher rate of infant mortality;
• 60 percent higher rate of stroke;
• 30 percent higher rate of hypertension;
• 20 percent higher rate of heart disease;
• 100 percent higher rate of diabetes;
• 150 percent higher rate of unintentional injuries;
• 100 percent higher rate of homicide;
• 70 percent higher rate of suicide.
Here’s what Congress has said about the most important funding legislation for the Indian Health service, The Indian Health Care Improvement Act.
Federal health services to maintain and improve the health of the Indians are consonant with and required by the Federal government’s historical and unique legal relationship with, and resulting responsibility to, the American Indian people.
Amazingly, the Indian Health Care Improvement Act, which would address many of the problems underpinning the need to prescribe painkillers in lieu of surgery, has not been reauthorized since 1992. The FY 2011 Tribal Budget recommends a $2.1 billion increase toward the $21.8 billion needed to bring parity in health care for American Indians and Alaskan Natives.
Secretary of Health and Human Services has publicly admitted to the deplorable state of health care available for American Indians and promised to increase the number of doctors sent to reservations through the U. S. Public Health Service Commissioned Corps, according to a story in the Cape Cod Times.
President Obama’s budget includes an additional $454 million to the IHS budget as well as $500 million in stimulus funds. According to the IHS website, most of the stimulus funding will be used for building construction, maintenance and improvements, sanitation facilities construction and health care equipment. We are talking about some pretty basic stuff.
The good news is that President Obama appointed Dr. Yvette Roubideaux, a member of the Rosebud Sioux tribe of South Dakota, to head IHS. Dr Roubideaux has an impressive background. A graduate of the Harvard Medical School, she has done extensive research on Indian health issues, focusing on diabetes, and has worked within the IHS system for several years.
The challenges facing effective delivery of health services to American Indians will take more than these efforts alone. Last year, the National Congress of American Indians declared a state of emergency for Indian health care services.
During his May 19, 2008 campaign visit to the Crow Agency, where he received his Crow Indian name Aw Kooda bilaxpak Kuuxshish, “One who helps people throughout the land,” Barack Obama said, “Let me be clear, I believe treaty commitments are paramount law, I will fulfill those commitments as president of the United States. That’s why I’ve cosponsored the Indian Health Care Improvement Act and that’s why I am fighting to ensure full funding for Indian Health Care Services.”
Our Indian communities have been waiting for a long time for decent health care, enduring the fall-out from the band-aid of pain medications that have only worsened our situation. Let’s hope Congress authorizes the IHCIA in 2009. The pain meds ain’t working.