Indian Country: Covering Native Health Issues with Sensitivity

By Victor Merina

Califiornia Endowment Health Journalism Fellow

Brian Bull recalls the first story he filed for South Dakota Public Radio. The young reporter spent a day with the Yankton Sioux as they sowed sand grapes and choke cherries and tilled gardens planted with other indigenous fruits and vegetables rarely found on grocery store shelves.

Educating themselves about their traditional ways, the Yankton Sioux were turning to the nutritional diets of their tribal ancestors, not only for cultural reasons, but because of health concerns.

"They weren't just trying to turn back the clock," said Bull, a Nez Perce who is now the assistant news director for Wisconsin Public Radio. "They were trying to deal with obesity and diabetes and heart disease."

As Bull and other journalists have found, serious health issues are no strangers to Indian Country. To cope with them, Native Americans are increasingly blending the traditional and the medicinal with the economic realities of hard-pressed lives.

Statistics show that Native Americans experience higher disease rates than other Americans for problems ranging from diabetes and heart ailments to mental illness and suicides, which contribute to their lower life expectancy. Their health problems are compounded by the grueling poverty, soaring unemployment and persistent school dropout rates that characterize many reservations and other Native communities.

"There are indicators that something is seriously happening in Indian country," said Jacqueline Johnson Pata, executive director of the National Congress of American Indians, which monitors federal policy and represents 250 member tribes.

Johnson Pata said studies have shown that there's a health care crisis, and, more importantly, "a health care resource problem in Indian country" because of the lack of adequate funding. Many lawmakers who vote on federal dollars have little personal knowledge of native communities, she noted. However, she added, "Tribal leaders are stepping up to address the challenges of health care."

A number of tribal communities are emphasizing healthy alternatives, such as physical and mental exercises to help prevent illness and combat substance abuse and other health problems.

While the causes of these illnesses are varied, the Western diet is believed to combine with a genetic predisposition to cause the high diabetes rate among the Pimas who live in the Gila River Indian and the Salt River Pima-Maricopa Indian communities of Arizona. Scientists have found that Pimas in Mexico have much lower rates of diabetes than their counterparts in Arizona, and they attribute the Arizona Pimas' higher rate to the less healthful diets they acquired as they ate food supplied by the federal government. In the past, the federal foodstuffs included lard, sugar, white flour, canned fruit in heavy syrup, high-sugar cereals and other processed foods.

Today, a number of programs in the Pima community target diabetes, which afflicts about half of Pimas by the time they turn 65. Profits from three casinos owned by the Gila River Indian Community help fund several community centers and wellness centers, which are stocked with exercise equipment and educational materials and offer exercise and healthful eating classes. Because Pima Indians have 20 times the kidney failure rate of other Americans, the community even has its own dialysis center.

For many tribes, funding remains a key problem in grappling with health issues, especially given the political problems of the Indian Health Service, a branch of the Department of Health and Human Services that helps pay medical expenses for 1.9 million American Indians and Alaska Natives. The agency has been a frequent target on Capitol Hill amid allegations of mismanagement and other woes. The constant battle over IHS funding has come at a price for those in Indian Country.

While casino revenues are helping some tribes, others are less fortunate.

For many tribes, funding remains a key problem in grappling with health issues, especially given the political problems of the Indian Health Service, a branch of the Department of Health and Human Services that helps pay medical expenses for 1.9 million American Indians and Alaska Natives. The agency has been a frequent target on Capitol Hill amid allegations of mismanagement and other woes. The constant battle over IHS funding has come at a price for those in Indian Country.

Cuts to Indian Health Service means fewer surgeries for some

On the Wind River Reservation in Wyoming, lack of funding has meant fewer surgeries and other medical procedures for members of the Northern Arapaho and Eastern Shoshone tribes. Richard Brannan, chief executive officer of the Indian Health Service at the reservation's Ft. Washakie Health Center, said his local agency is operating with little more than half its needed funding, resulting in "a lot of deferred or denied services" for the more than 10,400 tribal members who have used the clinic over the last three years.

For some clients, that has meant postponing surgeries for knees, hips and shoulders and relying instead on pain medication to help them cope, Brannan said. In addition, cancer tests have been delayed, and contract services for outside medical assistance have been canceled or never scheduled.

"It just seems that Native Americans are always an afterthought" when it comes to health funding, said Brannan.

That oversight also extends to media coverage of Native American health issues, some journalists believe. Cristina Azocar, a board member and immediate past president of the Native American Journalists Association, said problems such as a growing AIDS crisis, domestic violence and sexual abuse, and methamphetamine abuse all need to be reported better.

A member of the Upper Mattaponi Tribe of the Powhatan Nation, Azocar is the director of the Center for Integration and Improvement of Journalism at San Francisco State University, which examines media coverage of people of color, including Native Americans. She said more insightful, fair coverage is needed, including stories that deal with Native Americans' health.

Health coverage that worked

However, there have been some noticeable examples of coverage of Native American health issues over the last decade. In 2007, Laura Sullivan of National Public Radio reported on Native American women who suffer sexual assaults and must deal with the aftermath, which led to Senate hearings and a bill that would facilitate prosecutions. Graciela Sevilla did some of the earliest stories on the diabetes problem among the Pimas in her 1997 series in The Arizona Republic.

Over the years, Kara Briggs, a Yakama journalist, formerly with The Oregonian, has reported on health issues that affect Native Americans and has chronicled her own battle with breast cancer in columns in Indian Country Today, an online news publication. And, in a series of articles in 2007, Judy Pasternak of the Los Angeles Times focused on the decades-long environmental fallout that led to the uranium poisoning of Navajos in Arizona. Pasternak's award-winning series, called "Blighted Homeland," chronicled the impact on the health of Navajos of the 3.9 million tons of uranium ore that were dug and blasted from Navajo soil from 1944 to 1986. She reported how Navajos inhaled radioactive dust, drank contaminated water and used the rocks excavated from mines and mills to build their homes. And she wrote how many, as a result, came down with a mysterious wasting – and incurable – illness that some dubbed "Navajo neuropathy."

For a non-Native American reporter like Pasternak, the reporting and writing of her multi-part series was a challenge. She spent time researching the Navajo culture and then spent months on the reservation talking to people and winning their trust. She navigated the Indian Health Service bureaucracy with the help of Freedom of Information Act filings and willing sources inside and outside the agency. She persuaded family members to sign medical releases and remained persistent in her interviews even as she was mindful of being in an unfamiliar culture with different traditions. "The main key was to be patient," said Pasternak, who left the Times' Washington bureau in 2008 and is turning her series into a book. Pasternak took pains not to pretend that she knew more about Navajo culture than she actually did or to assume that she knew how people felt about their plight and the circumstances that made them and their families ill – a mistake she made once with a tribal member.

"He was right," Pasternak said of the Navajo man who set her straight about assumptions she was making. "That kind of reinforced to me that I was in another country, and I needed to understand that. It's a different culture, and I wasn't going to become an expert just being there a short time."

Brian Bull, the radio journalist of Nez Perce ancestry, notes that non-Native American journalists often unwittingly buy into stereotypes they have seen on television and in other media. They must be careful not to adopt the mindset that views Native Americans as people defined only by their struggles with alcoholism or drug abuse or disease, he says. He advises reporters to look at the efforts being made to cope with or solve those problems. But Bull added that it's not easy, even for a Native American reporter, to tell health stories, especially if they conflict with tradition or culture.

In one radio story, Bull reported on an effort to increase the small number of organ donors in South Dakota's Native American community, even though the push conflicted with long-held Lakota spiritual beliefs that advise against leaving part of one's body on the Earth after death. The smoking story was uncomfortable to do, but necessary, he said.

"What I liked about that story is that it's unique," said Bull. "It was the Native community confronting itself, and the story took a cultural, non-blaming approach."

Victor Merina, a former Los Angeles Times staff writer, is a senior fellow at the USC Annenberg Institute for Justice and Journalism and special projects editor and reporter for Reznet, a Native American news, information and entertainment Web site.