Well now, here’s one of life’s more amusing moments. The federal government, that bastion of financial accountability, is questioning whether Alaskan Native non-profit health organizations are making efficient use of their federal dollars and providing quality services. This from the same government that houses the BIA, a group that seems to have misplaced about a gazillion dollars in trust fund moneys they were supposed to be holding for Native American tribes.
And the pundits said that irony would die after 9/11. Clearly they didn’t have enough faith in the feds.
I arrived in Alaska in those faraway days when Alaska Natives had no control over their health care. The Indian Health Service hospital in Barrow at that time had two doctors, about 10 nurses, a medical records department that functioned only occasionally and pre-hospital care that consisted of a pickup truck and canvas stretcher. It serviced the entire North Slope.
Communications with outlying villages were one step above a tin can and string. Medevac services consisted of whatever plane was on the ground or anywhere nearby when the need arose. And medevac equipment consisted of a hope and a prayer.
So I have to figure that if the Native health corporations did nothing else but buy a new stretcher and an ambulance they would be head and shoulders above what the feds considered adequate care.
Health care for Native Americans has always been a hit or miss proposition. There is no mandated bottom line of care that the feds must provide. So the level of care received depends on the amount of funding Congress gives to IHS in any given year. What that meant to Native Americans was that some years cancer could be treated and some years it couldn’t. Or, if it was treated, it was at the expense of another program that had to be cut in order to fund the cancer treatment.
Each year the feds would issue a list of services available that year to Native Americans and that list would be prioritized. You just had to hope that your disease wasn’t too far down on the list.
Not everything about Indian Health Service was bad. I worked with some truly dedicated doctors and nurses in the IHS system. I also worked with some who weren’t. They were the people putting in two years at an IHS facility to pay back student loans and they were doing it with gritted teeth and an attitude.
I still remember one of those doctors showing up in the emergency room late at night to sew up the head of someone who had lost a fight. The patient was quite drunk and not really being cooperative. The doctor came with an attitude that indicated he clearly thought it was beneath him to be called out of bed in the middle of the night to sew up some worthless drunk. He grabbed the suturing equipment off the sterilized tray with his bare hands and said the patient wasn’t worth the bother of sterile gloves. Nothing I said changed his mind. Nor did the look on the face of the Native nurse’s aide cause him the slightest twinge of conscience.
The Native health corporations in this state may charge more for indirect costs than the feds think appropriate. But at least Native people now go to hospitals where they have some control. If they have a complaint about the service received, they have access to a board that listens to them. And the priorities for health care dollars gets set locally, not in Washington D.C.
Perhaps most importantly, if a doctor ever tried to suture a patient in an unsterile manner while making derogatory remarks about the patient and his culture, he’d find himself facing the people he was there to serve to answer for his actions.
The feds should stop worrying about whether or not Native health care services in this state are giving them the best bang for their buck. They are – and they are doing it head over heels better than the feds ever did.