American Indian healthcare

by Sophie Two Hawk, MD; Arna Mora, MD; Carol Whitman, MD

American Indians face some unique challenges when it comes to caring for their health. Culturally, we view health in a Holistic manner as a balance of our bodies, mind and spirit that allows for good health. Historically, the women would have knowledge of herbs and men would be spiritual healers.

Healthcare was one of the items guaranteed under the treaties. Initially, healthcare was overseen by the Army and the Bureau of Indian Affairs. Then Indian Health Service was formed in 1955 to oversee healthcare. Funding for Indian Health Service varies from one year to the next and only provides part of what is needed. Therefore, patients need to enroll in programs such as Medicare, Medicaid and Private Insurance which allows the facilities to be able to fully function. Separate limited funding is given to pay for Purchase Referred Care, i.e. those services that cannot be provided at an IHS hospital or clinic. The referrals are only covered if you meet certain criteria, such as living within the reservation boundaries. If you live in three other cities in SD then there are Urban Indian Health clinic which are able to provide some limited health care.

American Indians face unique challenges to attaining healthcare as well.  There are language, knowledge, and trust issues that impact seeking out healthcare. There is an inherent mistrust by American Indians of IHS and other government agencies due to many historical abuses and mistreatment over the years. This in turn has led to decline in overall individual wellbeing. We were not made citizens of this country until 1924.  We were not legally allowed to practice our Native religion until 1978.  Many were taken from their families at young ages and sent to boarding schools. They faced many abuses during their time in these schools. In addition, there were other issues such as forced sterilization and studies done without consent or knowledge in the past.  These historical traumas continue to affect current generations. 

There are current economic issues such as lack of employment, housing, and transportation which negatively impact health. We see differences in types of diseases, age of onset of diseases, and ways that treatments need to be given as well.  We see higher rates of conditions and deaths due to conditions such as Diabetes, Liver disease, Infectious Diseases, Injuries, and Suicides.  Some of these rates are higher than any other racial or ethnic group in the United States.  

American Indian Healthcare can be improved by increasing funding, increasing the numbers of tribal members who become healthcare providers and improving the education of those who provide healthcare.

Dr. Sophie Two Hawk practices internal medicine in Sioux Falls, SD and is Lakota. Arna Mora, MD is an enrolled member of the Cheyenne River Sioux Tribe and is currently a 2nd year Family Medicine Resident at the Center for Family Medicine in Sioux Falls and will complete her residence in June of 2024. Carol Whitman, MD is an enrolled member of the Cheyenne River Sioux Tribe and is currently a 3rd year Psychiatry Residence at the USD Psychiatric Residency Program in Sioux Falls, SD.  She will complete her residency in Psychiatry with a Fellowship in Adolescent and Child Psychiatry in 2025.

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