New Mexico News
| HEALTHBITS - Health Care Looking Up For Natives |
| Posted by () on May 21 2008 at 7:04 PM |
YOUR CHILD'S HEALTH: I write to you from Arizona, where I am doing a short "tour of duty" with the Indian Health Service at the Tuba City Indian Hospital. Though I have visited on the Navajo and Hopi reservations many times over the last 35 years, it has been that long since I served the Native American population of this area in one of their hospitals. It has been interesting to me to see the changes over that period of time.
Aside from a quick trip through New Mexico on the Santa Fe Chief in 1961, I had not been in our state until 1970, when I arrived as a very wet-behind-the-ears "general medical officer" at the Gallup Indian Medical Center. The Indian Health Service was only 15 years old when I got to Gallup, having taken over providing health care on the country's reservations from the Bureau of Indian Affairs.
Now the Native Americans' health care system has changed again on parts of the huge Navajo reservation, as well as in many parts of the country: Many of the tribes have taken over their own health care. A Navajo corporation has taken over the Tuba City Hospital, using the authority of Federal Law 93-638. We say that Tuba City has been "638ed," as has care in Jemez and Isleta pueblos and all of Alaska, among many other places.
Both tribal and Indian Health Service facilities continue to be staffed by the Public Health Service— you can see civilians as well as officers in Navy-like uniforms hustling about the hospital campus here, just as you can in Gallup. As a result of treaty obligations in exchange for Indian land, the care in both types of facilities is provided without charge to Native Americans.
In 1970, we young doctors cared for a population that had many diseases that were more typical of a developing country: tuberculosis, severe dehydrating diarrhea, malnutrition, and an occasionally blinding eye condition, trachoma, for example. Other infectious diseases were still very common among the patients we saw in clinic and on the busy hospital wards. Pneumonia and meningitis, a very serious inflammation of the covering of the brain and spinal cord, occupied our thoughts constantly. I became expert at doing a spinal tap, inserting a needle between the bones of the back to obtain fluid to check for meningitis, and I knew the technique for a cut-down, inserting a catheter into a tiny ankle vein in babies too dehydrated to allow us to find a vein from the surface.
I continue to do a spinal tap now and then— meningitis isn't completely gone, but I haven't done a cut-down since I left Gallup. What has changed in these instances? Fortunately, meningitis has been made rare by vaccines, many of them tested out here on the reservations, since meningitis was so common here. This terrible disease, which killed one of every 20 sufferers and maimed many more (making them deaf or mentally retarded or costing them a limb), is now rare. Many of the pediatric trainees at University of New Mexico Hospital have never seen it, and many young PHS officers haven't either. What a wonderful change! Severe dehydration isn't as common anymore either; the roads are better, so Navajo babies get in to get care more quickly, and are cared for expertly when they do.
Tuberculosis is still more common among Native Americans than among others in the Southwest, but trachoma is now consigned to places like Africa. Malnutrition still occasionally occurs— I am caring for one skinny malnourished child right now— but far more common is the opposite, obesity, which is rampant among the entire U.S. population, but especially so among most U.S. tribes. As a direct result of the astounding rise in obesity, tribal and PHS programs are having to deal with type II diabetes at younger and younger ages. For more mysterious reasons, asthma is much more common here now than it was 35 years ago.
Life expectancy for a Native American at birth was 63 years in 1973, eight years less than for the U.S. population as a whole. Twenty years later it had increased by almost 10 years, just two years less than for everyone else in the nation.
The Indian Health Service can be proud of many of the changes that I see. A large part of the credit goes to a far-reaching piece of federal legislation, the Indian Health Care Improvement Act, first passed in 1976. Congress has been dragging its collective feet for the last decade in reauthorizing this bill, but it looks as if it has a chance this year. Four of New Mexico's five representatives and senators in Washington have signed on as co-sponsors of S. 1200 and HR 1328.
As we did 35 years ago, PHS doctors, nurses and many other professions collaborate beautifully to save lives and avoid disability. But they do so under many handicaps. The aging hallways at Tuba City and Gallup are filled with far more patients than in my day; the care there is supported with many fewer dollars than in non-Indian facilities. Despite its advances, Indian Health Care could use an Improvement Act, as I can see from the ground here in Tuba City.
Lance Chilton, M.D., is a pediatrician at the Young Children's Health Center in Albuquerque, associated with the University of New Mexico. He is happy to hear from those with questions at 272-9242 or lancekathy@yahoo.com.
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