Friday, March 10, 2006 | Staff at the San Diego American Indian Health Center – where doctors have heard their patients retell generations-old stories of adversity – are taking the news of President Bush’s plan to cut the clinic’s federal funding as just another hardship after a history of them.
“[American Indians’] understanding of life is that it is a betrayal,” said Dr. Richard Tew, who has practiced medicine at the Banker’s Hill clinic since 1994. “The latest government maneuver is just one more piece in this persistent tradition.”
The Bush Administration has proposed to eliminate $33 million for urban American Indian health clinics, a decision that leaves the future of San Diego’s clinic in jeopardy. Its closure would force 1,500 patients to find new doctors.
It’s familiar ground for the clinic, which survived similar budget cut proposals six times during the Reagan era. This time, the Bush Administration says it wants to redirect the money to treat the increasing American Indian population living in rural areas and on reservations. The administration contends that other community health departments could simply absorb urban patients.
But doctors and nurses at the clinic say American Indians need more culturally sensitive care. Without that, they say, many patients would eschew treatment and simply cope with chronic problems until they required emergency room visits.
“When Indians come from the [reservation] to this environment, there’s a lot of adjustment,” said Ronnie Whitehorse, a registered nurse at the clinic. She is Navajo and was born on a reservation in Arizona. The federal government relocated her parents to Los Angeles in the 1960s.
“It’s a culture shock,” she said. “My parents went through that. I understand what it’s like.”
Whitehorse and others at the clinic sometimes struggled to explain the subtleties of the cultural understanding they have with patients. Some points are obvious: The clinic’s behavior health center has a traditional healer that leads a talking-circle group, supporting those maintaining their sobriety and those coping with HIV-AIDS.
But it is sometimes more complex. Tew remembers one patient’s story vividly. The 23-year-old Navajo man complained of a minor illness. But Tew saw deeper problems. The man had come to San Diego to escape suffering at home. He’d landed in a downtown hotel, with little money and lots of despair. It was his first time off the reservation.
“He talked to me about the sounds assaulting him and the lights and the busyness and the odors,” Tew said. “His only way to escape was to climb to the roof of the hotel and be on top. And he’d get above it somehow.”
Tew treated the illness, but also referred the man to someone with a sweat lodge – part of American Indian tradition. The man needed an anchor back into his world, Tew said.
The clinic acknowledges that both body and spirit sometimes need healing, said Crystal Tetrick, its executive director.
It relies on the federal government to accomplish that. Tetrick said 47 percent of the clinic’s $1.8 million budget comes from federal funding and pays salaries of its eight-doctor staff, which includes a dentist and behavioral health specialists. The remainder of the budget comes from grant sources and insurance reimbursements.
The clinic, which opened in 1979, operates on an already-tight budget. It posted financial losses the last two years – losing $24,000 in 2004 and $158,000 in 2003, according to IRS records. Tetrick blamed the financial trouble on the clinic’s continuing administrative turnover and some lost grants. She was hired in April 2005, and said the clinic’s books are back in the black.
It’s not certain whether a funding cut would require a shutdown of all urban clinics.
“It is difficult for us to tell exactly where they go,” said Grim, who oversees all federally provided American Indian health services. More than 20 of the nation’s 34 clinics could close, he said.
Geoffrey Roth, executive director of the National Council of Urban Indian Health, said urban clinics receive a tiny fraction – 1 percent – of all federally funds, even though 60 percent of the American Indian population lives in urban centers. Nationwide, Roth estimated clinics treat more than 87,000 patients.
“It was a policy of the federal government in the 50s and 60s to relocate American Indians to urban centers. These cities were all relocation sites,” Roth said. “And now it’s a direct contradiction. It’s a blatant slap in the face.”
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