KAET: Native Visions

Health Care The Native American community has a distinct set of health care concerns. Don Davis, Director of Phoenix Area Indian Health Service, Arizona Division of Public Health Services, and Dr. John Molina, Arizona Health Care Cost Containment System (AHCCCS) Medical Director, provide insight into the problems and possible solutions. The in-studio panel discussion explores the importance of preserving traditional healing practices as a form of prevention and healthcare resources for Native Americans. Guests include: Donald Warne, M.D., Clinical Professor, School of Health Administration and Policy, W.P. Carey School of Business, Arizona State University; Marcus Harrison, CEO, Native American Community Health Centers; Johnson Dennison, Coordinator of Native Medicine for Chinle Hospital and Navajo medicine man. The complete transcript of the health care discussion on Native Visions follows: Ivan Makil: Native Americans are guaranteed healthcare by the federal government, but challenges, such as access to services in rural areas and cultural difference between patients and health professionals can be barriers to treatment. At the San Carlos Apache reservation, a diabetes education program has been developed to help fight a disease that is claiming many Indian lives. Lois Sprengeler: Is Thurlan in here? Thurlan?[ Speaks Native Language ] Reporter: Lois Sprengeler is the quality manager at San Carlos Hospital. She is talking to the patient advocate who takes complaints and provides Apache interpretation for patients. The hospital is located on the San Carlos Apache Reservation. It's run by the Indian Health Service, an agency within the Department of Health and Human Services. Sprengeler has worked at the hospital about 15 years. Five years ago, she suspected she had diabetes. Lois Sprengeler: I just kind of noticed that something wasn't right with me anymore. I didn't feel the way I used to feel. I told the physician that I felt as though my skin had become very, very itchy, and I've never had that before. So I said I want tests done to see if I am now diabetic. My mother was a diabetic, and she had a lot of complications due to her diabetes and ended up on dialysis. So being that I'm in the healthcare field, I knew that I probably would eventually become diabetic, so every year we'd get tested for that to see whether I had become a diabetic. So I was already mentally prepared for that. Lois Sprengeler: This is Lois. May I help you? Reporter: Sprengeler's suspicion was confirmed. She was diagnosed with diabetes. Sprengeler: At that time I was really motivated. I saw the dietitian, learned about carbohydrate counting, learned about how to, you know, watch what you're eating, saw the diabetic educator, Linda Clark. Linda Clark: But again, it's important to check your blood sugar because dizziness can also be that your blood pressure is out of control, or it could be something else. Patient: Oh, okay. Linda Clark: Does that help you out? Patient: Yeah, that kind of help me, but I like to make appointment with you -- Linda Clark: Okay. Patient: -- to learn more about it. Linda Clark: I can certainly do that. Reporter: Linda Clark is the diabetes educator at San Carlos. She's been at the hospital 23 years. Diabetes has reached epidemic proportions in Native Americans. Clark has seen the disease increasingly affect the young. Linda Clark: I've seen the struggles that patients go through. Dealing with a chronic illness, many of our clients are younger and younger. It used to be what I'd call an old person's disease, people would get it in their 50s. Many of my clients are in their 20s and 30s. How do you deal with a chronic condition that's going to be there my entire life? There is a lot of denial. Reporter: Two factors have contributed to the high incidence of diabetes in Native Americans. John Molina: Genetically, Native Americans are more prone to develop diabetes in their adult life. Culturally, the diabetes that we see in Native American people is also a result of lifestyle, you know, the changing lifestyle from a very sort of a hunter-gathering sort of a people, to one that's more sedentary. Clinic Assistant: So on the newly diagnosed patients, we're trying to get them into the IM clinic. Reporter: At San Carlos, Dr. Binoy Chandra says efforts to promote prevention have been successful. Binoy Chandra: Because of our diabetic program, the instance of some of the complications of diabetes has definitely decreased here, and also certain myths about diabetes that was prevailing before, it has also disappeared, though we still face some challenges in that regard. Reporter: One of the lingering myths about diabetes is that nothing can be done to prevent it, treat it or survive with it. Also the tendency toward acceptance sometimes interferes with prevention. John Molina: Native American people have always lived in our world accepting the world as it is. They sort of give themselves to the elements and for whatever might become them, they've learned to integrate themselves into the world, and they've come to respect this world in a very serene, spiritual way. In a sense it's almost like giving themselves to whatever destiny might befall them, and that's what becomes very acceptable. And I think this was sort of what the early colonies found here in the Americas, was a group of individuals, of tribes, who just sort of roamed the earth and lived off the earth and accepted whatever came to them. This is sort of an attitude I think that's not bad in itself, but it's just a different way of looking at the world. It's a way of saying to the world, you know, if I'm healthy, I'm going to accept my healthful state and I'm going to do as much as a can, but if I get sick, well, then that's my time in life. There is not sort of an apprehension. There is not a sort of fear of death itself. It's something that's very much acceptable. There's that idea of spirituality where we're on this earth for whatever reason, for whatever purpose and then we move on. So that sort of an attitude sort of makes it difficult to try to intrude into that attitude one of health prevention. Reporter: Sprengeler agrees that it's too easy to accept as inevitable things that can be prevented. Lois Sprengeler: You have to have the mindset -- a positive mindset that I can live with diabetes, or I'm not going to get to dialysis or have all of the complications like having an amputation of my foot done, those types of things. Don Davis: If you eat properly, not too many high fat foods and, you know, you follow a healthy diet, low in fat, and you watch your weight, and you do that by exercising -- exercise has to be a part of that -- if you practice that on a regular basis, more than likely you are going to avoid our top three diseases. Reporter: Like many on the reservation, Lois Sprengeler believes the key to solving many of the health problems facing Native Americans is to focus on the children. Lois Sprengeler: I believe that if we're going to make an impact with diabetic care right now or changing the course, we have to start with our children now. We've got to. The Apache people have a lot of capability, ability to problem solve. We have a lot of talent here. It's just that people aren't aware that they have it. And I believe that somehow we've got to get to that point where people see that they have that type of talent and the ability problem solve and the ability to make changes in their lives. Ivan Makil: Joining me to discuss Indian Health issues is Dr. Donald Warne, clinical professor at Arizona State University. Johnson Dennison, Coordinator of Native Medicine for Chinle Hospital. And Marc Harrison, Chief Executive Officer for the Native American Health Center in Phoenix. Welcome. Dr. Warne, we just reviewed, and for our guests, maybe you could give us an overview of Indian healthcare as it has been historically, and as it is today to help get things started this evening. Dr. Donald Warne: Well, looking at it from a policy perspective, when we think of healthcare in the United States, healthcare is actually not a right for people. People don't have a legal right to healthcare in this country, except for American Indians. We are actually the only population of Americans that has a legal right to health services, and that's based on treaties, which are essentially contracts between the tribal nations and the federal government, and in exchange for land and natural resources, the federal government is responsible for providing several social services to tribes, including housing, education and healthcare. The problem has been that the health systems that have been funded by the federal government for American Indians are severely underfunded. When you look at the funding, for example, for Veterans Administration hospitals, they get over $5,000 per person per year, for Medicaid programs, it's over $3500 per person per year, and Indian Health Service it's about $1800 per person per year. So we have very limited resources, and ironically, that's in the population, the only population in the country that has a legal right to healthcare. And when you look at this more from the perspective of Arizona -- I teach American Indian health policy here at Arizona State University, and when you look at the history of the health of the people here locally, the people, especially in the Valley that is now Phoenix and the Gila River Valley south of here, the people were very healthy. They had a year-long supply of water from the rivers, of course, the Salt River going through Phoenix and the Gila River south of here, and the people lived in a very healthy way. They had farming, primarily corn, beans and squash. They had fish in the river and wild game, and there was a lot of physical activity associated with farming, hunting, gathering and fishing, and the food was much healthier. Well, starting in the 1920s, the governments decided to dam the rivers, Salt River and Gila River. And prior to 1930, again, this is just 75 years ago, there was essentially no diabetes among the tribes in the southwest. And by the 1970s, we had among the highest rates of diabetes in the world. And a lot of that has to do with just changes in lifestyle. So we have terrible health disparities when you look at things like diabetes and lifestyle diseases. Unfortunately, we don't have the resources to adequately intervene. Ivan Makil: So the challenges that have evolved is not only in respect to changes in lifestyle but responding to those changes. Is that accurate? Dr. Donald Warne: Absolutely, changes in lifestyle have led to a number of preventable diseases. What I've heard from a lot of the local traditional healers is that not only did damming the rivers cause a change in lifestyle in terms of farming, it also changed the culture. There used to be ceremonies for harvesting and for planting, and if you've ever visited the Casa Grande ruins out by Coolidge, Arizona, they have windows on the walls that align on the summer solstice and on the equinoxes. That was to mark the changes in season, because you need to track those things when you are a farming culture. Well, when the rivers were dammed, all of those things changed. We really didn't need to track the seasons the way we used to, because traditional farming was no longer available. So a lot of issues arose, related to self-esteem and self-identity, cultural identity. And we've seen a resultant increase in things like depression and other spiritually based diseases, and the result has been, we have high rates of death due to things like diabetes, because the physical lifestyle changed, but also high rates of death due to alcoholism and substance abuse, and a lot of that has to do with the cultural changes that have occurred. Ivan Makil: Speaking of cultural changes, Mr. Dennison, here, could you kind of help us to understand a little more about some of the traditional healing, and when we talk about healthcare, we're really talking about a more holistic concept of healing. Is that accurate? Johnson Dennison: I believe so. That is accurate. As a native practitioner and native healers, who we call medicine men, medicine women, that has been providing healthcare or healing services for thousands and thousands of years that the Native American has been living in North America, especially in the southwest area, where in particular Navajos and other Indian tribes are all the same as well, that the practitioners have always been a source of healers and providers and the teachers. Not until -- it was in the last 40, 50 years that the dominant culture has been introduced more strongly in terms of healthcare. Since then, the traditional practicing of medicinemenship and ceremonials has been fading away and that -- the healthcare system has been developing on the reservations as well, and up to today that we have the state of the art facilities on the reservations, but at the same time, we have thousands and thousands of doctors and nurses that we have now, but then our health is not getting any better within the last 50 years. On the other hand, the medicine practitioners has been fading away. More and more of the ceremonies that we have had are becoming extinct. So very few number of medicine man practitioners that we have was in the Navajo Nations, still providing health services to the patients. Through the ceremonies that we treat patients, through prayers and songs and sand paintings and herbal medications, sweat and ceremonial procedures and processes, in a lot of ways when you look at it, the ceremonies still being practiced a lot more strongly. The issues and the challenge that we have for the native patient is when they are diagnosed with an illness such as diabetes or heart disease, they run around and turn around and go to the native practitioner, and they have a different diagnosis. So in healthcare, we always have dualities. There is the Navajo or native illness, and there's the western perspective of illness. Ivan Makil: Mr. Dennison, speaking of that, if I could, do you think that not as much practicing goes on in the traditional or has over the years, because we've been focusing more on the contemporary new technology, that kind of thing? I think that part of what you've been and the work that you do has been about combining the traditional healing process along with the technology, because the new technology is considered a tool? Is that accurate? Johnson Dennison: Yes, that is accurate. Through the educations and the dominant society of where we are accepting of becoming more -- technologies and new way and style of living and leaving the old concept of healing in the past. However, there is a trend right now, not only Native American, but many people begin to start looking for alternative medicine. They start looking at the native practitioners for healing, and when that comes about, and then that has developed a lot of awareness in such a way, because that native practitioner has always been there, and they are always there, and it's always available. According to the native practitioner, the western medicine is alternative medicine. Alternative practitioners consider as native medicine as alternative medicine. But within our own culture, when you begin to converse and talk with the ceremonial people, the western medicine is alternative medicine. Ivan Makil: That's right. And maybe just one of these days, people will all understand that perspective, that holistic concept of healing is very valuable, and particularly as we move forward, and I know that large portions of the tribal populations are now living in urban areas, and in the urban areas they have other challenges as well, in terms of looking at not only contemporary healing practices but traditional healing practices as well. So we have Mr. Harrison. Mr. Harrison, enlighten us. Marcus Harrison: You're right, Ivan, by saying that there is a large population that now resides in urban areas. Really, what you saw of this trend, historical perspective, is the 1950s was primarily policy oriented, the relocation policy that was part of the overall assimilation policy from the federal government where they provided opportunities for families to move off of reservation communities to urban areas, to provide housing and job and educational opportunities. I think in theory they meant well, but obviously there was some faults with it, but ultimately, that was the precursor for a lot of the urban Indian communities that you see in today's large metropolitan areas. From that standpoint, today, you really see a migration back and forth, but primarily from reservation to large metropolitan areas, primarily opportunity driven for more opportunities for jobs, employment and also for educational training. I think what you find from that standpoint is the development of the urban Indian health programs to help provide access to some type of healthcare or at least some type of patient advocacy or some type patient navigation for American Indians that reside off reservations in large metropolitan areas. So Native American communities, such as the agency I work for, start off as grassroots organizations, like many other urban Indian health programs in the United States, which there are 34 of them, has really grown exponentially in the last 10 to 15 years in terms of funding, to provide increased access to care as well as to help provide culturally competent care for the American Indian community members. Ivan Makil: So what's happened is a lot of our -- through this assimilation process that was basically forced on the tribes was then a lot of our people were moved into urban areas to become educated, and then the other part of that, I guess is for jobs, because they didn't -there weren't jobs always available on reservations, but along with that goes healthcare; is that correct? What are some of the programs that you all have in place that go to deal with some of those issues? Marcus Harrison: What we've really done, is our primary program or services are related around medical, dental, mental health, senior programs, as well as Aids health and medicine and also we're dealing with youth culture enrichment. From the standpoint of people moving to the urban Indian communities, which we see from that phenomena, I think as well, the mindset has to change regarding overall Indian healthcare delivery system. It's no longer just tribal health programs and also Indian health service programs. Now you have to really take into account the role that the urban Indian health program plays in providing access to care for the American Indian community members. I think more and more, we're playing more of a significant role from that standpoint, and I think the days of the other entities, all three, the Indian health service, Tribal Health Programs and Urban Indian Health Programs being on three separate islands, that can't happen anymore, especially from the advocacy standpoint, because I think what we're seeing here is not only a healthcare, I guess, standpoint of resource -- depletion of resources, but I think from that standpoint, we all need to have a singular voice in creating more access to funding opportunities. Ivan Makil: Thank you. Dr. Warne, you know, as we heard on the tape earlier, too, one of the comments was that tribal people view things in that more holistic way, and as healthcare has changed across this country and changed for tribal people, as tribal people start to move around a little bit, what do you see as the future and some of the challenges that we're going to continue to deal with as tribal people, and how does that work for us in this world today? Dr. Donald Warne: Well, I was very fortunate to grow up in a family with a lot of traditional healers and medicine men. I was able to understand a lot about the holistic approach to healthcare. For many of our tribes traditionally, the approach to health is very different than the modern scientific approach. In traditional ways, we understand that spirituality, the mental and emotional realm, along with the physical realm, are all very important when we're looking at the health of our people. That's not just in the individuals, but it's also in the families and the communities, and the health of the individuals is determined by the health of the families and the health of the communities. And what we need to understand is that it's not just tribal communities, we are also a part of the state. We're a part of this country. We have our tribal nations, our states and our national system we call the United States, but what I would like to see in the future is more understanding, more awareness and more cooperation. Because as we talked about, for example, the urban setting, the desert that we live in here in Phoenix was never designed by nature to support nearly three million people. The only reason we can have this many people in this region and the only reason we have seen such prosperity in this state is because we've dammed the rivers, and from that perspective, we need to recognize as a state and as citizens in this state that the prosperity of Arizona was really built on the backs of the health of the local tribes, and we need to recognize that, and we need to work cooperatively to reduce health disparities. And the local tribes have never been adequately thanked or compensated for their tremendous gifts and sacrifices that they have made to allow Arizona to be as prosperous as it is. Ivan Makil: So it has been the contributions of tribal people to the Valley in terms of understanding. It's that sharing of knowledge, if you will, that I think that is one of the contributions that tribes, I think, throughout the country probably have to make. Well, I know there is so much more to talk about in this area and so much more that I think that we'd like to talk about, so I want to thank you all for spending time with us and sharing your expertise with us and congratulations, and I really am honored to sit with all of you for all of the work that you do do for Indian country and not only for families, communities, tribes, but for all people. Thank you. Panelists: Thank you. Thank you. Ivan Makil: I hope this program has given you a better understanding of who we are as a people, the issues we face and what we all have in common. Thank you for joining us. >> Read the complete transcript for this groundbreaking one-hour special, including the interview with Senator John McCain and the discussion on education. Major funding for Native Visions provided by a grant from the Arizona State University Office of Public Affairs.	Native Visions Native American sovereignty Education Health care About the TV program Ivan Makil Profile From the General Manager Learn more about the Native American communities represented on Native Visions: The Hopi Tribe Inter-Tribal Council of Arizona Navajo Nation Salt River Pima-Maricopa Indian Community San Carlos Apache Tribe Tohono O'odham Nation Related Links Arizona State University American Indian History and Culture Center for Indian Education

Health Care

Health care panel discussion The Native American community has a distinct set of health care concerns.
Don Davis, Director of Phoenix Area Indian Health Service, Arizona Division of Public Health Services, and Dr. John Molina, Arizona Health Care Cost Containment System (AHCCCS) Medical Director, provide insight into the problems and possible solutions.

The in-studio panel discussion explores the importance of preserving traditional healing practices as a form of prevention and healthcare resources for Native Americans.
Guests include:
Donald Warne, M.D., Clinical Professor, School of Health Administration and Policy, W.P. Carey School of Business, Arizona State University;
Marcus Harrison, CEO, Native American Community Health Centers;
Johnson Dennison, Coordinator of Native Medicine for Chinle Hospital and Navajo medicine man.

The complete transcript of the health care discussion on Native Visions follows:

Ivan Makil:
Native Americans are guaranteed healthcare by the federal government, but challenges, such as access to services in rural areas and cultural difference between patients and health professionals can be barriers to treatment. At the San Carlos Apache reservation, a diabetes education program has been developed to help fight a disease that is claiming many Indian lives.

Lois Sprengeler:
Is Thurlan in here? Thurlan?[ Speaks Native Language ]

Reporter:
Lois Sprengeler is the quality manager at San Carlos Hospital. She is talking to the patient advocate who takes complaints and provides Apache interpretation for patients. The hospital is located on the San Carlos Apache Reservation. It's run by the Indian Health Service, an agency within the Department of Health and Human Services. Sprengeler has worked at the hospital about 15 years. Five years ago, she suspected she had diabetes.

Lois Sprengeler:
I just kind of noticed that something wasn't right with me anymore. I didn't feel the way I used to feel. I told the physician that I felt as though my skin had become very, very itchy, and I've never had that before. So I said I want tests done to see if I am now diabetic. My mother was a diabetic, and she had a lot of complications due to her diabetes and ended up on dialysis. So being that I'm in the healthcare field, I knew that I probably would eventually become diabetic, so every year we'd get tested for that to see whether I had become a diabetic. So I was already mentally prepared for that.

Lois Sprengeler:
This is Lois. May I help you?

Reporter:
Sprengeler's suspicion was confirmed. She was diagnosed with diabetes. Sprengeler: At that time I was really motivated. I saw the dietitian, learned about carbohydrate counting, learned about how to, you know, watch what you're eating, saw the diabetic educator, Linda Clark.

Linda Clark:
But again, it's important to check your blood sugar because dizziness can also be that your blood pressure is out of control, or it could be something else. Patient: Oh, okay.

Linda Clark:
Does that help you out?

Patient:
Yeah, that kind of help me, but I like to make appointment with you --

Linda Clark: Okay.

Patient:
-- to learn more about it.

Linda Clark:
I can certainly do that.

Reporter:
Linda Clark is the diabetes educator at San Carlos. She's been at the hospital 23 years. Diabetes has reached epidemic proportions in Native Americans. Clark has seen the disease increasingly affect the young.

Linda Clark:
I've seen the struggles that patients go through. Dealing with a chronic illness, many of our clients are younger and younger. It used to be what I'd call an old person's disease, people would get it in their 50s. Many of my clients are in their 20s and 30s. How do you deal with a chronic condition that's going to be there my entire life? There is a lot of denial.

Reporter:
Two factors have contributed to the high incidence of diabetes in Native Americans.

John Molina:
Genetically, Native Americans are more prone to develop diabetes in their adult life. Culturally, the diabetes that we see in Native American people is also a result of lifestyle, you know, the changing lifestyle from a very sort of a hunter-gathering sort of a people, to one that's more sedentary.

Clinic Assistant:
So on the newly diagnosed patients, we're trying to get them into the IM clinic.

Reporter:
At San Carlos, Dr. Binoy Chandra says efforts to promote prevention have been successful.

Binoy Chandra:
Because of our diabetic program, the instance of some of the complications of diabetes has definitely decreased here, and also certain myths about diabetes that was prevailing before, it has also disappeared, though we still face some challenges in that regard.

Reporter:
One of the lingering myths about diabetes is that nothing can be done to prevent it, treat it or survive with it. Also the tendency toward acceptance sometimes interferes with prevention.

John Molina:
Native American people have always lived in our world accepting the world as it is. They sort of give themselves to the elements and for whatever might become them, they've learned to integrate themselves into the world, and they've come to respect this world in a very serene, spiritual way. In a sense it's almost like giving themselves to whatever destiny might befall them, and that's what becomes very acceptable. And I think this was sort of what the early colonies found here in the Americas, was a group of individuals, of tribes, who just sort of roamed the earth and lived off the earth and accepted whatever came to them. This is sort of an attitude I think that's not bad in itself, but it's just a different way of looking at the world. It's a way of saying to the world, you know, if I'm healthy, I'm going to accept my healthful state and I'm going to do as much as a can, but if I get sick, well, then that's my time in life. There is not sort of an apprehension. There is not a sort of fear of death itself. It's something that's very much acceptable. There's that idea of spirituality where we're on this earth for whatever reason, for whatever purpose and then we move on. So that sort of an attitude sort of makes it difficult to try to intrude into that attitude one of health prevention.

Reporter:
Sprengeler agrees that it's too easy to accept as inevitable things that can be prevented.

Lois Sprengeler:
You have to have the mindset -- a positive mindset that I can live with diabetes, or I'm not going to get to dialysis or have all of the complications like having an amputation of my foot done, those types of things.

Don Davis:
If you eat properly, not too many high fat foods and, you know, you follow a healthy diet, low in fat, and you watch your weight, and you do that by exercising -- exercise has to be a part of that -- if you practice that on a regular basis, more than likely you are going to avoid our top three diseases.

Reporter:
Like many on the reservation, Lois Sprengeler believes the key to solving many of the health problems facing Native Americans is to focus on the children.

Lois Sprengeler:
I believe that if we're going to make an impact with diabetic care right now or changing the course, we have to start with our children now. We've got to. The Apache people have a lot of capability, ability to problem solve. We have a lot of talent here. It's just that people aren't aware that they have it. And I believe that somehow we've got to get to that point where people see that they have that type of talent and the ability problem solve and the ability to make changes in their lives.

Ivan Makil:
Joining me to discuss Indian Health issues is Dr. Donald Warne, clinical professor at Arizona State University. Johnson Dennison, Coordinator of Native Medicine for Chinle Hospital. And Marc Harrison, Chief Executive Officer for the Native American Health Center in Phoenix. Welcome. Dr. Warne, we just reviewed, and for our guests, maybe you could give us an overview of Indian healthcare as it has been historically, and as it is today to help get things started this evening.

Dr. Donald Warne:
Well, looking at it from a policy perspective, when we think of healthcare in the United States, healthcare is actually not a right for people. People don't have a legal right to healthcare in this country, except for American Indians. We are actually the only population of Americans that has a legal right to health services, and that's based on treaties, which are essentially contracts between the tribal nations and the federal government, and in exchange for land and natural resources, the federal government is responsible for providing several social services to tribes, including housing, education and healthcare. The problem has been that the health systems that have been funded by the federal government for American Indians are severely underfunded. When you look at the funding, for example, for Veterans Administration hospitals, they get over $5,000 per person per year, for Medicaid programs, it's over $3500 per person per year, and Indian Health Service it's about $1800 per person per year. So we have very limited resources, and ironically, that's in the population, the only population in the country that has a legal right to healthcare. And when you look at this more from the perspective of Arizona -- I teach American Indian health policy here at Arizona State University, and when you look at the history of the health of the people here locally, the people, especially in the Valley that is now Phoenix and the Gila River Valley south of here, the people were very healthy. They had a year-long supply of water from the rivers, of course, the Salt River going through Phoenix and the Gila River south of here, and the people lived in a very healthy way. They had farming, primarily corn, beans and squash. They had fish in the river and wild game, and there was a lot of physical activity associated with farming, hunting, gathering and fishing, and the food was much healthier. Well, starting in the 1920s, the governments decided to dam the rivers, Salt River and Gila River. And prior to 1930, again, this is just 75 years ago, there was essentially no diabetes among the tribes in the southwest. And by the 1970s, we had among the highest rates of diabetes in the world. And a lot of that has to do with just changes in lifestyle. So we have terrible health disparities when you look at things like diabetes and lifestyle diseases. Unfortunately, we don't have the resources to adequately intervene.

Ivan Makil:
So the challenges that have evolved is not only in respect to changes in lifestyle but responding to those changes. Is that accurate?

An image from the program Dr. Donald Warne:
Absolutely, changes in lifestyle have led to a number of preventable diseases. What I've heard from a lot of the local traditional healers is that not only did damming the rivers cause a change in lifestyle in terms of farming, it also changed the culture. There used to be ceremonies for harvesting and for planting, and if you've ever visited the Casa Grande ruins out by Coolidge, Arizona, they have windows on the walls that align on the summer solstice and on the equinoxes. That was to mark the changes in season, because you need to track those things when you are a farming culture. Well, when the rivers were dammed, all of those things changed. We really didn't need to track the seasons the way we used to, because traditional farming was no longer available. So a lot of issues arose, related to self-esteem and self-identity, cultural identity. And we've seen a resultant increase in things like depression and other spiritually based diseases, and the result has been, we have high rates of death due to things like diabetes, because the physical lifestyle changed, but also high rates of death due to alcoholism and substance abuse, and a lot of that has to do with the cultural changes that have occurred.

Ivan Makil:
Speaking of cultural changes, Mr. Dennison, here, could you kind of help us to understand a little more about some of the traditional healing, and when we talk about healthcare, we're really talking about a more holistic concept of healing. Is that accurate?

Johnson Dennison:
I believe so. That is accurate. As a native practitioner and native healers, who we call medicine men, medicine women, that has been providing healthcare or healing services for thousands and thousands of years that the Native American has been living in North America, especially in the southwest area, where in particular Navajos and other Indian tribes are all the same as well, that the practitioners have always been a source of healers and providers and the teachers. Not until -- it was in the last 40, 50 years that the dominant culture has been introduced more strongly in terms of healthcare. Since then, the traditional practicing of medicinemenship and ceremonials has been fading away and that -- the healthcare system has been developing on the reservations as well, and up to today that we have the state of the art facilities on the reservations, but at the same time, we have thousands and thousands of doctors and nurses that we have now, but then our health is not getting any better within the last 50 years. On the other hand, the medicine practitioners has been fading away. More and more of the ceremonies that we have had are becoming extinct. So very few number of medicine man practitioners that we have was in the Navajo Nations, still providing health services to the patients. Through the ceremonies that we treat patients, through prayers and songs and sand paintings and herbal medications, sweat and ceremonial procedures and processes, in a lot of ways when you look at it, the ceremonies still being practiced a lot more strongly. The issues and the challenge that we have for the native patient is when they are diagnosed with an illness such as diabetes or heart disease, they run around and turn around and go to the native practitioner, and they have a different diagnosis. So in healthcare, we always have dualities. There is the Navajo or native illness, and there's the western perspective of illness.

Ivan Makil:
Mr. Dennison, speaking of that, if I could, do you think that not as much practicing goes on in the traditional or has over the years, because we've been focusing more on the contemporary new technology, that kind of thing? I think that part of what you've been and the work that you do has been about combining the traditional healing process along with the technology, because the new technology is considered a tool? Is that accurate?

Johnson Dennison:
Yes, that is accurate. Through the educations and the dominant society of where we are accepting of becoming more -- technologies and new way and style of living and leaving the old concept of healing in the past. However, there is a trend right now, not only Native American, but many people begin to start looking for alternative medicine. They start looking at the native practitioners for healing, and when that comes about, and then that has developed a lot of awareness in such a way, because that native practitioner has always been there, and they are always there, and it's always available. According to the native practitioner, the western medicine is alternative medicine. Alternative practitioners consider as native medicine as alternative medicine. But within our own culture, when you begin to converse and talk with the ceremonial people, the western medicine is alternative medicine.

Ivan Makil:
That's right. And maybe just one of these days, people will all understand that perspective, that holistic concept of healing is very valuable, and particularly as we move forward, and I know that large portions of the tribal populations are now living in urban areas, and in the urban areas they have other challenges as well, in terms of looking at not only contemporary healing practices but traditional healing practices as well. So we have Mr. Harrison. Mr. Harrison, enlighten us.

Marcus Harrison:
You're right, Ivan, by saying that there is a large population that now resides in urban areas. Really, what you saw of this trend, historical perspective, is the 1950s was primarily policy oriented, the relocation policy that was part of the overall assimilation policy from the federal government where they provided opportunities for families to move off of reservation communities to urban areas, to provide housing and job and educational opportunities. I think in theory they meant well, but obviously there was some faults with it, but ultimately, that was the precursor for a lot of the urban Indian communities that you see in today's large metropolitan areas. From that standpoint, today, you really see a migration back and forth, but primarily from reservation to large metropolitan areas, primarily opportunity driven for more opportunities for jobs, employment and also for educational training. I think what you find from that standpoint is the development of the urban Indian health programs to help provide access to some type of healthcare or at least some type of patient advocacy or some type patient navigation for American Indians that reside off reservations in large metropolitan areas. So Native American communities, such as the agency I work for, start off as grassroots organizations, like many other urban Indian health programs in the United States, which there are 34 of them, has really grown exponentially in the last 10 to 15 years in terms of funding, to provide increased access to care as well as to help provide culturally competent care for the American Indian community members.

Ivan Makil:
So what's happened is a lot of our -- through this assimilation process that was basically forced on the tribes was then a lot of our people were moved into urban areas to become educated, and then the other part of that, I guess is for jobs, because they didn't -there weren't jobs always available on reservations, but along with that goes healthcare; is that correct? What are some of the programs that you all have in place that go to deal with some of those issues?

Marcus Harrison:
What we've really done, is our primary program or services are related around medical, dental, mental health, senior programs, as well as Aids health and medicine and also we're dealing with youth culture enrichment. From the standpoint of people moving to the urban Indian communities, which we see from that phenomena, I think as well, the mindset has to change regarding overall Indian healthcare delivery system. It's no longer just tribal health programs and also Indian health service programs. Now you have to really take into account the role that the urban Indian health program plays in providing access to care for the American Indian community members. I think more and more, we're playing more of a significant role from that standpoint, and I think the days of the other entities, all three, the Indian health service, Tribal Health Programs and Urban Indian Health Programs being on three separate islands, that can't happen anymore, especially from the advocacy standpoint, because I think what we're seeing here is not only a healthcare, I guess, standpoint of resource -- depletion of resources, but I think from that standpoint, we all need to have a singular voice in creating more access to funding opportunities.

Ivan Makil:
Thank you. Dr. Warne, you know, as we heard on the tape earlier, too, one of the comments was that tribal people view things in that more holistic way, and as healthcare has changed across this country and changed for tribal people, as tribal people start to move around a little bit, what do you see as the future and some of the challenges that we're going to continue to deal with as tribal people, and how does that work for us in this world today?

Dr. Donald Warne:
Well, I was very fortunate to grow up in a family with a lot of traditional healers and medicine men. I was able to understand a lot about the holistic approach to healthcare. For many of our tribes traditionally, the approach to health is very different than the modern scientific approach. In traditional ways, we understand that spirituality, the mental and emotional realm, along with the physical realm, are all very important when we're looking at the health of our people. That's not just in the individuals, but it's also in the families and the communities, and the health of the individuals is determined by the health of the families and the health of the communities. And what we need to understand is that it's not just tribal communities, we are also a part of the state. We're a part of this country. We have our tribal nations, our states and our national system we call the United States, but what I would like to see in the future is more understanding, more awareness and more cooperation. Because as we talked about, for example, the urban setting, the desert that we live in here in Phoenix was never designed by nature to support nearly three million people. The only reason we can have this many people in this region and the only reason we have seen such prosperity in this state is because we've dammed the rivers, and from that perspective, we need to recognize as a state and as citizens in this state that the prosperity of Arizona was really built on the backs of the health of the local tribes, and we need to recognize that, and we need to work cooperatively to reduce health disparities. And the local tribes have never been adequately thanked or compensated for their tremendous gifts and sacrifices that they have made to allow Arizona to be as prosperous as it is.

Ivan Makil:
So it has been the contributions of tribal people to the Valley in terms of understanding. It's that sharing of knowledge, if you will, that I think that is one of the contributions that tribes, I think, throughout the country probably have to make. Well, I know there is so much more to talk about in this area and so much more that I think that we'd like to talk about, so I want to thank you all for spending time with us and sharing your expertise with us and congratulations, and I really am honored to sit with all of you for all of the work that you do do for Indian country and not only for families, communities, tribes, but for all people. Thank you.

Panelists:
Thank you. Thank you.

Ivan Makil:
I hope this program has given you a better understanding of who we are as a people, the issues we face and what we all have in common. Thank you for joining us.

>> Read the complete transcript for this groundbreaking one-hour special, including the interview with Senator John McCain and the discussion on education.