Columns 2017

Alaska Native Health care

Here’s the quote from Health and Human Services Secretary Tom Price that I never thought I’d hear from a Fed. “They (Alaska Natives) know best how to care for their people, and we need to facilitate that.” For someone who came to Alaska as an employee of the Indian Health Service (IHS) in 1972, that statement is mind blowing.

When I arrived in Alaska to serve as a nurse in the IHS Barrow hospital, the entire attitude of the organization was paternalistic in the extreme. It’s not that the people working for IHS were bad people or had some prejudice against Alaska Natives. It’s just that was the prevailing attitude of the day. The belief was that if it weren’t for non-Natives taking care of Alaska Natives, they would all die because they didn’t know how to care for themselves.

I only had to spend a very short time in Barrow to start questioning that belief. Any group that could harvest a twenty-ton whale amide shifting sea ice in small skin boats clearly know how to survive without us. Yes, we brought modern medicine to a place that would otherwise have had none. But we did it in such a way that local voices were never heard. We weren’t partners in health care, we were in charge and would tell them what was best for them.

Then along came the Indian Self Determination Act, which stated that Native peoples across America had a right to have a say in what was done to them. We finally acknowledged, however begrudgingly, that Native people should have a say in those parts of government that affected their daily life. And so was born the movement to take health care out of the hands of DC bureaucrats and put control of that care into the hands of the people on the receiving end.

Let me again state that the people in IHS were good people who, for the most part, wanted only the best for the American Indians and Alaska Natives they served. But many of them had great difficulty in letting go of the control they’d exercised for so long over Native health care. It was not unlike the parent who is terrified the first time their teen drives them around in the family car. Paternalism is not an easy thing to release from our psyche.

I was lucky enough to be the Health Director for the newly formed North Slope Borough Health Department at the time. And so I was knee deep into both the controversy and confusion inherent in transferring a federal system into local hands. And it wasn’t just the federal system that was the problem. Within the Southcentral region there was great concern over their share of federal funds given that they housed the Alaska Native Medical Center and were responsible for caring for Native peoples across Alaska who needed advanced care.

This issued was argued out in the forum known as the Alaska Native Health Board. I was gone before full resolution was achieved but the fact that we now have an Alaska Native Health Consortium that functions so well here in Anchorage is proof, as though more were needed, that Alaska Natives are more than capable of overseeing their own health care and coming together as necessary to make the system work for their people.

I’ve known this for a long time now because I had the privilege of watching it all evolve over the years. But when I read that quote from Tom Price, it was like someone putting the cherry on top of the ice cream sundae. It was a recognition by the feds that Alaska Natives are not only intelligent enough, creative enough and coordinated enough to run a health care system that covers a state bigger that most of the lower 48, but they were right when they said they could do it better because they knew what their needs were.

The system is far from perfect. But is it always moving in that direction as opposed to the relative stagnation of the days of IHS total dominance. Innovations such as the dental health aide program, have come about because local people saw a local problem and came up with a local solution.

So hats off to all my friends, past and present, who helped create the Native health care system in place today from someone who stands in some awe at how far you’ve come from where I knew you’d been.