Who is Responsible for Your Healthcare? at Racialicious - the intersection of race and pop culture

Who is Responsible for Your Healthcare?

by Guest Contributor Jessica Yee

One of the best kept secrets in American health administration is the existence of Indian Health Service.

Unbeknownst to many outside the Native community, our healthcare is actually delivered by the military.

Oh sure, they call themselves the “Public Health Service Commissioned Corps” which is just a nice way of saying they don’t carry guns, but you can bet that you will more than likely receive care from someone dressed in full-out camouflage gear who indeed works for the U.S. Uniformed Services.

How did this all get started? Well for lands seized (read: stolen) the government has a federal responsibility to provide healthcare to Native Americans. After assimilating us and annihilating our culture, the War Department had this duty in 1849. Which was then overseen by the Bureau of Indian Affairs who was responsible for the many abuses and mistreatments that occurred under their umbrella until 1955, when the government thought it would then be a good idea to turn it over to the Department of Health and Human Services.

I don’t know about you, but I’m not really comfortable going to see a doctor wearing army boots in a non-war torn country. Last time I checked, they haven’t exactly been our best friends in the Native community (forcible removal to attend Residential Schools, reproductive trauma from military testing anyone?) I’m also less than pleased being the only race whose healthcare comes like this.

Among the numerous other problems that you can already think of that exist with this kind of oppressive set-up, IHS lacks several necessary services and policies that exist in other clinics and hospitals because as sovereign peoples, we aren’t subject to receive the same things as everyone else.

Sovereignty is supposed to mean governing our own people, on our own land, the way we want to, but in reality it means doing what the United States allows us to do, when they want to. I saw a really good example of this recently in Oneida, Wisconsin when I was reading a posted U.S. government bulletin on minimum wage that basically read “as a federally recognized Indian tribe we don’t have to make sure you get equal pay since you are a separate entity”.

Oh, but how dare we ever try to assert our sovereignty and take care of our own people according to our own ancestral traditions!

Missing links at IHS include sexual assault procedures and some 50% of clinics who lack the trained personnel to administer rape kits, which is so very interesting when you consider our people have one of the highest rates of sexual abuse in the country.

This was all detailed in the latest Glamour article by journalist Marianne Pearl entitled “The Land Where Rapists Walk Free“. (I’d also like to add to that article that the Yankton Sioux reservation where the story takes place had their IHS emergency room shut down in the Spring of this year).

What is more, if you live in a major urban centre, or even away from your home territory, good luck trying to find an IHS you can go to. In California, Native Americans account for the largest “ethnic” poverty group, while there are virtually no IHS clinics in existence to service the more than 70% of people who live off reservation.

I was actually at a conference once where IHS personnel were wondering why some Native youth didn’t want to come in to get tested for sexually transmitted infections to which I grabbed the mic and yelled “Maybe it’s because we can’t trust you!” I mean, are we really supposed to have confidence in the same system that is still colonizing us, more than a hundred years later?

But don’t worry, if you belong to a tribe and work for IHS, you don’t have to wear the military garb.

They’ll just separate the “savages” from the “civilized”.

(Photo Credit: Glamour Magazine)

Trackbacks & Pings

Healthcare for Native Americans provided by the military « The Bead Shop on 08 Aug 2008 at 4:16 am

[…] Native Americans provided by the military August 8, 2008 at 9:16 am | In Uncategorized | From Jessica Yee at Racialicious One of the best kept secrets in American health administration is the existence of Indian Health […]
Conversations on Feminism: Domestic Violence Against Aboriginal Women in Australia at Racialicious - the intersection of race and pop culture on 18 Aug 2008 at 10:03 am

[…] conditions. And she is correct - something needs to happen. However, as Jessica Yee beautifully pointed out in her post a few weeks back, government intervention does not always work to alievate the problem, and can actually make things […]

Comments

thesciencegirl wrote:

I spent a week on a reservation in South Dakota last year with some other med students, and we talked to a lot of people on the res about their impression of IHS. They were untrusting and frustrated, and rightfully so. I worked at the IHS ER one night when I was there, and talked to some patients at length. They echoed the same things I’d heard and read elsewhere: the doctors who work at IHS hospitals often go for very short times (2yrs. or less), are not invested in the people there, are only there because because they are putting in time to get their loans repaid, etc. Of course, there are some dedicated doctors who work at IHS, but given that the res I visited was in the middle of nowhere, I met 2 doctors in that whole week who had moved out there long-term to serve the people. The high unemploment and low education rate make it such that people form the commnity itself rarely become doctors, and thus can not come back to serve their own community. I don’t know how that translates to other NA commnities, but for the one I visited, it was very much the case. The ER doc I worked with told me that their pharmacy didn’t even have important common drugs for people. And they didn’t have the means to deliver babies, so people had to drive several hours to Rapid City to give birth. The whole situation was frustrating and sorely needed to be addressed.

Posted 07 Aug 2008 at 8:55 am ¶
Philip Arthur Moore wrote:

Out of curiosity, do you have to pay these medical bills or do they come ‘courtesy’ of the government?

Posted 07 Aug 2008 at 10:17 am ¶
Elise wrote:

The idea of ’sovereignty’ is just so FUBAR’d that it seems like short of scrapping the system and starting over (or following the definition in the first place!), it will never get better.

I know of the issues involved here from a legal standpoint and it absolutely makes me sick that there’s a) not enough manpower on the reservations to adequately investigate the crimes that occur and b) no trained people to process and collect the evidence at hospitals. But how can any evidence be collected if there’s no emergency room to begin with?

It’s a ridiculously underfunded knot of bureaucracy that no one can navigate - and subsequently no one receives any justice or physical or mental health care.

Does anyone know of any organizations that are working to address these problems, either nation-wide or reservation-specific?

Posted 07 Aug 2008 at 11:16 am ¶
Anonymous wrote:

Thats just sickening. But just wondering what did the IHS personnel say after you called them out?

Posted 07 Aug 2008 at 11:21 am ¶
Alexandra wrote:

Oops sorry comment number four is mine. I forgot to add my name.

Posted 07 Aug 2008 at 11:36 am ¶
jvansteppes wrote:

Wow.
Please keep posting Jessica and thank you.

Posted 07 Aug 2008 at 11:58 am ¶
Rchoudh wrote:

It just seems so contradictory to state that the Native Americans are a sovereign people all the while their health care is being colonially administered by another (greater) sovereign power. This same set of contradictions is also seen with the occupation of Iraq a so-called ’sovereign’ country currently having all its services administered by the (colonial) occupier.

Posted 07 Aug 2008 at 12:08 pm ¶
Tammi Diaz wrote:

We need HR676 SINGLE-PAYER HEALTH INSURANCE PEOPLE NOT PROFIT! The Insurance Companies are out for PROFIT.

Posted 07 Aug 2008 at 3:06 pm ¶
NancyP wrote:

sciencegirl, that’s interesting. I think it will be hard to attract long-term non-NA, non-native-born S/N Dakotans to the Sioux reservations. If you grew up in the Bronx, it’s a foreign lifestyle being outnumbered by the livestock. Getting white native-born S/N Dakotans to take permanent jobs with the INS might be easier, but then there’s the racism history which is harder to deal with when it’s from neighbors than when it’s from someone from LA or NYC.

For non-reservation underserved areas, many states have acted as matchmakers between towns and first-year medical students, and the town and state will subsidize that chosen student’s medical education and practice start-up cost (ie, get an office set up). Student signs a contract requiring repayment if the graduated doc. spends less than X years practicing in the community. That doesn’t sound all that different from the Armed Services or IHS contracts, but there’s a significant psychological difference that is meant to boost long-term retention. Basically, during the first year of med. school, the student visits towns of interest, and both decide if they want to go further with a particular pairing. If a town and student think they would be a good match, the town becomes home-away-from-home for the student and introduces the student to local social circles, clubs, churches, whatever, all of whom put out the welcome mat while learning more about the student candidate. At the end of the year, a contract may be extended. If it doesn’t seem like a good match, student and town try again with other candidates, without penalty.

Lack of access to quality free / full scholarship public education through the entry requirement of the state’s medical school is obviously problem #1 in growing their own docs. Small starting population doesn’t help. Science-smart homebody with people skills and common sense, who also wants to spend a lifetime being a general practitioner and not get a lot of monetary reward compared to other doctors - that’s a small percentage of the population capable of the intellectual part of medicine.

Posted 07 Aug 2008 at 11:12 pm ¶
Katie wrote:

Awesome post.

Posted 08 Aug 2008 at 8:30 am ¶
Jessica Yee wrote:

Thanks everyone for your comments!

Alexandra:
They actually looked at me with a stupified “Oh, is THAT why they won’t come in to get tested?” One woman actually said “I never even considered that the military uniform might be uncomfortable for some people”.
I guess for some people, thinking about the full picture of things just doesn’t happen. They’ve never even been told that so much of the history they’ve learned is wrong, and frankly I think it scares them.

Philip Arthur Moore:

It depends on your tribe and where you are. If you have an IHS on your reservation that you can go to, it’s all fine and dandy. But if you are travelling or don’t live where you are enrolled with your tribe, it depends on the regulations your tribe sets out whether reciprocal billing will happen or not, so to speak.

To add another twist to the story, I live in Canada and although borders were definitely created to separate our people and my reservation literally straddles a border to the US, my status as a Native is not recognized in the US government at all.

Posted 08 Aug 2008 at 10:02 am ¶
Genevieve wrote:

You know, I’ve never been officially considered “Native American” by the government due to the whole CDIB process, so some of this is new information to me. I’ve been knowing about the sexual-abuse related stuff for a while though, and it’s totally outrageous.

I personally don’t trust the US gov’t for shit if I can help it. I’m mixed-race and literally every race/ethnicity that composes my genetic makeup has been fucked thoroughly by the government.

It’s sad that reservations are internment camps, but that’s what they were meant to be from the beginning anyway. I’ve long suspected that the “sovereignty” thing is tacked on for PR reasons.

Posted 11 Aug 2008 at 2:45 pm ¶