Many of us do not like to think of our own death, we would much rather focus on living. Still, as I ponder my life and future I have to think of where I want to be when I die. The older we get the more practical it seems to plan ahead. It is never too early to arrange for your final days.

I know the statistics for life on the rez are often somewhat dismal. The life expectancy for Indian men, women, children and infants is generally lower than for other nationalities. Some of our people are here in one moment and gone in the next. Oftentimes we do not get the chance to say goodbye in the way we would have wanted to. Such is life and death.

Many of our people in Indian Country make their journey to the spirit world when they are very young. On Memorial Day I visited the cemetery at St. Francis Mission and was reminded of how many infants, children and young people are actually buried there. When our children die it is often very tragic and filled with great sadness. Still, I always think that their passing saved them from growing old because really there is no stopping the aging process.

Even though many of our people die very young, we do still have elders. Some of our elders live in the tribally operated nursing home in White River, SD. I would bet money that those elders in the health care facility would much rather be at home. I remember several years ago when I attended the elder games in St. Francis and the nursing home residents were there. One of the residents said to me, “Can you get me out of here?”

We also have elders who are sick and need daily care. Illness may be the deciding factor when a family admits an elder to the nursing home. Still, some of the residents in Rosebud’s nursing home are not sick at all. They just do not have anyone in their family can care for them.

We also have many people diagnosed with terminal illnesses. From what I can see many of them die in the hospital. They spend their last days away from the homes and families they love. Even though many of them may be surrounded by family members when they die in the hospital, I believe many of them would prefer to be at home in their own beds when they die.

If my death is to come from an illness or old age I most certainly would want to make my journey to the Milky Way from my own home. The only way I can do this is to prepare legal documents in advance. I also need someone to care for me if I am going to be bedridden in my own home for any reason.

I want to tell all of you who care for family members in your homes that you are providing an invaluable service. Some of you are also caregivers for people whom you are not related to. The life and work of a caregiver is sometimes not appreciated. I have had experience in the caregiver area so I do want to tell you that there are people who pray for you to have strength in the service you provide to the ill or elderly.

Now if you live close to a big town or city you might have access to home health care or a hospice facility to help you live out your final days in as much comfort as possible. Here in South Dakota there are hospice and/or home health care services located in Pierre, Spearfish, Rapid City, Aberdeen, Freeman, Yankton, Winner, Sioux Falls, Watertown, Mitchell, Vermillion and Platte. The closest hospice care center to the Rosebud Reservation is in Winner, which is about 65 miles away from where I live.

Long term or hospice services are sometimes referred to as palliative care. I found an excellent description online which states: “The term ‘palliative care’ refers to any care that alleviates symptoms, even if there is hope of a cure by other means. It is an approach that focuses on the relief of pain, symptoms, and emotional stress brought on by serious illness. In some cases, palliative treatments may be used to alleviate the side effects of curative treatment, such as relieving the nausea associated with chemotherapy.

The site continues: "Hospice is traditionally an option for people whose life expectancy is six months or less, and involves palliative care. . .rather than ongoing curative measures, enabling you to live your last days to the fullest, with purpose, dignity, grace, and support. . .in most cases hospice is provided in the patient’s own home. This enables you to spend your final days in a familiar, comfortable environment, surrounded by your loved ones who can focus more fully on you with the support of hospice staff.”

Recently, I attended “Completing the Circle of Life: The Walking Forward Program’s Palliative Summit” on the Rosebud Reservation. The goal of the summit was to provide information on palliative/hospice care, expertise and resources available in the community and to assist in the development of an action plan to initiate a palliative care program in Native communities in western South Dakota. I was impressed with the presentations offered throughout the summit.

I was not impressed that the majority of our elected tribal leaders did not attend. There was only a handful of Rosebud hospital staff there. I realize people have busy schedules but this was a very important meeting. At Rosebud we have a Health Board comprised of 11 members. Only one of them attended the summit and stayed all day. This demonstrated that palliative and hospice care are not high priorities among our elected tribal leaders.

I pray our people are someday offered the opportunity to die at home with dignity instead of in the hospital surrounded by machines.

Vi Waln is Sicangu Lakota and an enrolled member of the Rosebud Sioux Tribe. Her columns were awarded first place in the South Dakota Newspaper Association 2010 contest. She is Editor of the Lakota Country Times and can be reached through email at vi@lakotacountrytimes.com.

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