Budget-Cutting Endangers Indian Clinics

Karen Jester went to a local emergency room several years ago with complications from diabetes. When the doctor asked what the trouble was, she began by saying she had heard her late grandfather talking to her that day.

“They thought I was crazy, of course,” recalled Jester, 46, an Assiniboine Indian. “They said: ‘We think you’re depressed. Here are some pills.’ ”

Jester recalled the incident as a cultural clash: To her, it was natural to invoke the spirit of an elder in describing her condition. It is just the sort of thing she feels comfortable expressing at the Leo Pocha Clinic, a federally financed Indian health clinic, where Jester comes regularly to manage her illness.

The clinic is one of five such facilities in Montana and 34 across the nation intended to serve about 70% of American Indians who live in urban areas, not on a tribal reservation.

But in a budget-cutting proposal that has set off protests and indignation among Indians from Los Angeles to New York and several smaller cities in between, the Bush administration has proposed eliminating funds for these clinics, which served about 106,000 Indians last year.

Under the plan, Native Americans in urban areas would use the already overburdened municipal clinics, hospitals and other health services that most Americans use -- and that many Indians say have no concept of their traditional forms of care and healing, which are often used in tandem with modern healthcare.

Alternatively, under the plan, urban Indians could go to federally funded clinics on the reservation of the tribe to which they are registered. For many Indians, some of whom left those reservations because of crushing poverty and a lack of jobs, the latter option smacks of insult.

“They’re basically saying, ‘Go back to the Rez,’ ” said Donald L. Clayborn, executive director of the Helena Indian Alliance, which runs the clinic here. “There is an absolute sense of frustration over that message. They are trying to balance the budget on the backs of some of the poorest people in the nation.”

Federal budget officials deny that is the case, arguing that the $33-million subsidy for the inner-city clinics provides an unnecessary duplication of services.

“Unlike Indian people living in isolated rural areas,” President Bush’s budget proposal says, “urban Indians can receive healthcare through a wide variety of federal, state and local providers.”

If the cuts are adopted by Congress, at least half of the 34 clinics would face sudden closure, while the rest would have to curtail services, said Greg Fine of the National Council of Urban Indian Health, a nonprofit alliance in Washington.

Eight of the targeted clinics are in California, including United American Indian Involvement in downtown Los Angeles, near Good Samaritan Hospital; the San Diego American Indian Health Center; and American Indian Health & Services Corp. in Santa Barbara.

“In our clinic, we do have that real sense of being in an Indian environment,” said David Rambeau, executive director of L.A.’s United American Indian Involvement, which has served about 15,000 Indians with medical problems over the last decade and receives about $800,000 in annual federal subsidies.

“If a person is diabetic, we not only give them pills, we deal with their emotional part, we deal with the spiritual part,” said Rambeau, a Paiute Indian. “That is definitely part of our program; that is what would be lost if Indian-oriented clinics have to close.”

Here in Helena, the state capital, the Pocha Clinic clearly has more than just a medical function: It is something of a community center built around a clinic, with a food pantry, an after-school program for children to learn about Indian heritage, and meetings for Indians dealing with substance abuse. Indian quilts, buffalo hides and other decorations line the hallways in the small building along Last Chance Gulch, a downtown thoroughfare whose name dates to Helena’s 19th century mining history.

“When you’re Native American, it’s honestly not that easy to express yourself, especially in a crowded place like a hospital,” said Julie Gardipee-Chriske, 49, a Chippewa Cree Indian who deals with chronic pain from diabetes and persistent swelling, welts and cracking in her legs.

“If I lose this place, I’m someone that will probably die,” said Gardipee-Chriske, a former tribal liaison with the U.S. Forest Service, explaining that she wouldn’t go to an emergency room unless she felt horribly sick or someone took her there by force.

Jester, the Assiniboine Indian, left her reservation and took a seven-hour bus ride to Helena when she was 15 and pregnant. She was desperate to find work and a more hopeful place to raise her son, Jester said.

She found work as a cook and a home health aide, but still felt she was living as “a stranger in a strange land.” Here at the clinic, she said, she has not only regained some of her health but has found a way to reconnect with her Indian identity.

“It would be insanity to close a place such as this,” Jester said. “It would be like taking a knife to the Indian community.”

Directors at the four other clinics in Montana -- in Butte, Billings, Missoula and Great Falls -- said they worried that their patients would be swallowed up or ignored by the non-Indian health system.

Indians suffer disproportionately from diabetes, obesity, tuberculosis and alcoholism, said Marjorie Bear Don’t Walk, executive director of the Indian Health Board, which operates the clinic in Billings.

“A lot of our work is targeted at preventing these very problems,” Bear Don’t Walk said. “We have helped a lot of people, but these are the very people we worry about now, the kind of people who could disappear into the system, or perhaps maybe never even make it into the system at all.”