"The Federal government runs three systems: The VA, the Military system, and the Indian Health Service. My expertise is number three.

How the Indian Health service is run is important, for it is an example on how to supply medical care to the uninsured, in areas where it is difficult to recruit physicians and other medical personnel, and who have to follow limited budgets and guidelines.

So one is glad that the New York Times has decided to look at the Indian Health Service’s problems. The article is mainly about the Navajo area, which is actually one of the better areas to work. Yes, it is short of money, and distances are far, but they tend to fill most of their positions, and morale among staff is better than in some other areas that I will not name. So imagine if they visited one of the less favored areas.

The newspapers do an “ain’t it awful” article every year or two about the problems of medical care in Indian country, then move on. Actually, things have improved since my first stint with the IHS in 1977, when I had to deliver a baby in a delivery room heated by space heaters because the heating system broke down and it was 90 miles to the next hospital. No more, thank the Lord and the bureaucrats (all such cases now are referred to hospitals with Obstetricians, so that complications like emergency Cesarean sections can be handled if the problems arise.)

But problems remain, and the main one is lack of money.

The chronic lack of money often meant inadequate older facilities, with limited lab and X ray availability.Because there are “budgetary restraints”, you are supposed to handle the patients in the clinic or hospital. The next level is the local Indian Hospital, if available, which can do most routine specialty care. The level after that is referral to local specialists in the private sector, if the medical problem is severe and no other option is available.

But some areas, there simply are no Indian Hospitals with the specialist you need, so at one hospital we had regular runs to the “cities” for appointments with specialists: Three hundred miles each way: the distances involved are mindboggling for those who live in cities with a hospital on every corner. A lot of the “problems” discussed in the New York Times article are not about lack of money as much as the problems of getting patients from A to B in a sparsely populated area."

Get the Story:
Nancy Reyes: The Federal Government’s Medical system still needs improvement (and money) (Blogger News Network 12/2)

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Indian Country waits for long-overdue health reform (12/2)