by The Associated Press Thursday March 12, 2009, 12:00 PM
SEATTLE -- On the Okanogan plains in northeast Washington, the Colville tribes recently buried a man who died after facing a bleak decision: spend his money on trips into town for dialysis, or buy food for his family.
It was a variant of a fate that has doomed many people on the stark, remote reservation, causing the timber-dependent tribes to increasingly spend their money on burials.
"It's a choice between feeding your family and living," said Andy Joseph Jr., a Colville Confederated Tribes council member. "Our people can't afford to pay for their funeral services."
From isolated reservations across the state to urban pockets around Seattle, Native Americans are dying at higher rates than a decade ago, at a time when most people in Washington are living longer, healthier lives.
A recent state Department of Health report showed that the march against cancer, heart disease and infant mortality has largely bypassed Native Americans. In 2006, the latest year studied, Native American men were dying at the highest rate of all people, with little change since the early '90s. Their life expectancy was 71, the lowest age of all men, and six years lower than that of white men.
The news was just as grim for Native American women. Their death rate had surged by 20 percent in a 15-year period, while the overall death rate had decreased by 17 percent.
But the starkest health disparity was among babies. Native American babies were dying at a rate 44 percent higher than a decade ago, while the overall rate of infant deaths had declined.
"People are suffering," said Marsha Crane, health director of the Shoalwater Bay Tribe in Western Washington. "It's, 'Here's the bad news, here's your diagnosis. But here's the worse news: We can't afford to pay for your drugs, or your surgery.' That's happening every day with tribes across the country."
The trends are a reversal of the progress made in the past century, when the Indian Health Service, a federal agency, made great strides in sanitation, disease control and vaccinations. Deaths nationwide largely fell from the 1950s to the '80s.
"It's astounding what the agency did, in terms of life expectancy," said Joe Finkbonner, executive director of the three-state Northwest Portland Area Indian Health Board. "But what I'm starting to see, in some of the data, is that that progress has either stagnated or is starting to reverse itself."
Health experts say the downward drift, which reflects national trends, stems from entrenched health disparities exacerbated by years of inadequate funding.
Treaty obligations and acts of Congress require the United States to provide health care for Native Americans, but experts say funding chronically falls short of medical inflation.
In 2004, a Civil Rights Commission report found the government spent more on health care per capita for federal prisoners and Medicaid patients than for Native Americans.
Experts say a common myth about tribes is that they're rolling in casino revenue, but the Civil Rights Commission report found that only half of all tribes have casinos, and many casinos barely break even.
"American Indians are an unheard-of political group," said James Roberts, a policy analyst for the Northwest board. "We don't have the political clout."
Many of Washington's 29 tribes don't have money for disease screenings, specialty care, mental health services, substance abuse treatment or dentists. Many triage their funds by invoking a "life or limb" standard, paying for specialty care only in dire emergencies. "If the leg don't have to come off, and if their eye don't have to come out, they won't get referred out," said Joseph, the Colville council member.
Tribes also are running out of medical dollars sooner in their annual funding cycles, which begin every October.
"A lot of tribes used to say, 'Don't get sick after June,'" said Danette Ives, health director of the Port Gamble Tribe. "Now it's like, 'Don't get sick after January.'"
Ives' tiny tribe has managed to stretch its funds by helping members enroll in Medicaid, Medicare or Basic Health plans, and by not paying for glasses or hearing aids. But the tribe, whose members rely on seasonal clam and oyster harvests for work, still struggles with high obesity and diabetes rates. Experts say the tradition of eating high-fat, low-fiber, government-assistance food has rippled through generations, and that fruits and vegetables are out of reach for many people on food stamps.
"People are struggling with so many difficulties in their lives," Ives said. "It's hard to make time to exercise, to get to that mammogram."
A statewide shortage of rural doctors is another barrier to health care, compounded by high gas prices and poorly maintained reservation roads.
Two years ago, Michael Buckingham, a Makah Indian, lost two fingers in a fishing accident in the waters off his reservation, in the isolated coastal town of Neah Bay.
Buckingham needed physical therapy for a third finger that was severely injured, but couldn't afford the 70-mile trips to the closest therapy clinic in Port Angeles.
"If I can't get it fixed, I'm just ready to have it cut off, because it's too painful," Buckingham said. A fisherman since 15, he has struggled to pay his electricity bills in the past, and worries how he'll provide for his four children.
Elizabeth Buckingham, Michael's mother and the tribe's health director, said the lack of federal funds has caused people to live with chronic pain, pregnant women to forgo prenatal care and many people to suffer from untreated depression. And that's in a place already distraught from drug overdoses and an unemployment rate of 50 percent.
"I'm looking at the people I'm serving here," Buckingham said. "They're staying in their houses with the lights turned off, and they're literally hungry."
For the state's 110,000 Native Americans -- less than 2 percent of the population -- health inequities began generations ago, when white settlers spread diseases to Native Americans, and took away their homes, language and culture.
"There's the regular health care factors, but also historical and social factors that have to be looked at, too," said Ralph Forquera, executive director of the Seattle Indian Health Board. Many of his patients are unemployed and uninsured, and move around a lot.
But many are also like LoAnn Rochna, a 56-year-old Alaskan Native, who can trace her sorrows to the day Europeans stepped into her mother's tiny village and spread tuberculosis. cm-bd
Her mother got sick as a child, never recovered and died young. Rochna's older brother later drank himself to death, and her other brother soon followed. Her best friend died the same way, as did her friend's brother, whose body was found in the snow after a night of drinking.
"He died right in front of the welfare office, freezing to death," Rochna recalled.
These days, Rochna lives in Everett and suffers from a painful bone and joint disease, for which she cannot afford surgeries that would improve her quality of life. She has lost most of her molars, making it difficult to eat, because she can't afford dental care.
After the swaths of tribal land ceded to the government, Rochna had expected the government to provide better care for her people.
"Isn't that shameful?" she said.
With the new administration, many Native Americans see glimmers of hope. President Barack Obama, who campaigned in Indian Country, has proposed a $4 billion budget for Indian Health Service, a $700 million increase.
This year, the Northwest health board launched an ambitious five-year "tribal action plan" to reduce suicides -- the second leading cause of death for Native American youths.
Tribes also are relying on their own community bonds to improve their health. The Port Gamble S'Klallam Tribe recently started a fitness challenge, enticing participants to lose weight, attend nutrition classes and get dental checkups, for a chance to win $15,000 or a new car.
One of the participants is Kim Freewolf, 52, who says she needs to lose at least 50 pounds. Her boyfriend, a carver and fisherman, has diabetes and is losing his eyesight. But Freewolf is determined to turn their health around, with more walking, fruits and vegetables, and someday a neighborhood garden.
"I'm really hoping that we'll all work together as a community, into changing the way we are," she said.
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