How I wrote my project on Native American health disparities

From the start, I decided I would take as much time as I possibly could – that is the whole year – to complete my project on health disparities affecting Native Americans in the Portland area. I wanted to learn as much as I possibly could not only about Native health, but also about Native cultures, and I would need to do so while juggling a demanding beat covering both health and higher education.  The challenge was to stay focused and not let daily deadlines keep me from regular work on the project.

I set out on three fronts: one, to get the best numbers I could on the status of health among the 30,000 Native Americans living in the Portland area. Secondly, I started making contact with Native organizations, especially the Native American Youth and Family Center or NAYA, which runs a school and social programs that touch on health issues, and the Native American Rehabilitation Association of the Northwest, or NARA, the primary health organization serving urban Indians in the area. Finally, I began talking to NARA about establishing a web site by and for Native Americans that would serve as a virtual longhouse or meeting place to share information on health problems and solutions.

An early version of a detailed report by Portland State University and the Multnomah County Coalition of Communities of Color provided the impetus for this project with startling statistics on Native Americans in the Portland area. I pursued several avenues to check out those numbers and find more. I made data requests to the Urban Indian Health Service and the Multnomah County Health Department, both of which gave me the best information they had. But both made it clear local numbers on Native Americans were unreliable because so many urban Indian were misclassified, especially on death certificates. That fact became a key point in my opening story. I turned to the Oregon Health Authority and the Indian Health Services to get more reliable figures for the state and nation.  Even without precise local numbers, I could show that Native Americans were facing many health problems at two or three times the rate of the general population.

To put faces with the numbers, I started making inroads into Native American organizations, especially NAYA and NARA. Since I am not Native American myself, it took me months. I went to powwows, spent days at a Native American physician’s conference and a NARA conference, and joined a group of elders for several lunches.  Eventually, I found individual Native people willing to talk to me about their health issues and to learn more about their lives. . I interviewed a young man with HIV/AIDS, pregnant teenage Native girls, and many elders. I found many Natives with diabetes, including Michael Teeple, who survived a decade homeless on the streets of Portland. I interviewed people going through treatment for addiction in the NARA rehab program. I found Candida KingBird, 38, diabetic and pregnant with her sixth child.

At the same time, I looked for any Native health organization that might be making headway in tackling the tough health problems in Indian Country. One name kept coming up: Southcentral Foundation in Anchorage, Alaska. Even non-Native health officials in the state referred to it.  I learned that Oregon’s move to coordinated care organizations for its Medicaid patients – the centerpiece of its health care reform  – is based on what health leaders learned from Southcentral.

So Jamie Francis, a photographer on the project, and I headed for Anchorage in early October before the snow began to fly. As with Native health groups in Oregon, Southcentral was cautious about letting us get close to its patients. The organization canceled our first trip the day before we were set to leave. We spent five days with Southcentral, mostly talking to officials. But we did manage to find a few patients.

By late fall, the broad structure of my project took shape. I would open with an overview about the health disparities hitting Native people and the services available to help them.  I would focus in two more stories on the biggest health challenges facing Native Americans, diabetes and drug and alcohol addiction.  Michael Teeple provided the central personal story for diabetes. To look at addiction and the chaos it produces over generations in Native families, I interviewed a young couple in rehab for meth addiction on several occasions. Their three children stayed at the residential rehab center with them. I also wrote about NARA’s cultural director, who had lived through an era when government policies tried to separate Native people from their culture. Through him, I showed that historical trauma continues to affect people today and that traditional culture plays an important role in healing for Native people. After talking to Candida KingBird several times about her risky and dramatic pregnancy, I decided to follow her through to her delivery, knowing I might have to drop the story if things got too rough. But she and the baby made it, and she agreed to let me tell her story.

I completed the series with a story on Southcentral Foundation and the lessons it offers not only for NARA and Native Americans, but all health providers.  

NARA eventually agreed to work with me on setting up a web site. We developed a plan, and the organization found a designer. We would call it Wellness Longhouse, and it would feature on its home page the Wellness Circle divided into four parts: Wellness for physical health and medicine; Wholeness, for traditional healing; Balance for mental health, and Hamony for addiction and recovery. Each of these would open to pages with directories of service, blogs, news, and resources. The home page would also include a forum for interaction among users and tribal health leaders, a portal to the nine reservations in Oregon and a portal for youth health issues.

But as of this writing, the site is still a work in progress and not up and running. I hope it will be taking shape by the end of this month and plan to keep helping NARA develop content for it.

My editor, Joany Carlin, and I decided to roll out the project as an occasional series. I usually prefer running a series on consecutive days, but in this case having the stories come out every two or three weeks kept Native Americans in the news over a period of months for the first time in years.  The first story came out May 3; the next, May 27. The third part ran in June, and part four runs Sunday, July 8. The final piece is scheduled for July 22.

I’ve had lots of positive reaction from readers and the Native American community, but it is hard to say what good will come of this project. I talked to scores of experts, took hundreds of pages of notes at conferences and workshops, read dozens of studies, but I think I was right in writing mostly about the individual lives of Native Americans. That seemed to do more than any studies, facts and figures to help our readers understand their Native American neighbors. And that’s what journalism should do.