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Health Services
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1103381
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Health Services
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Bradley H. Patterson Files (Ford Administration)
Bradley Patterson's Native American Programs Files
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Health
Indians of North America
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The original documents are located in Box 3, folder "Health Services" of the Bradley H.
Patterson Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald Ford donated to the United
States of America his copyrights in all of his unpublished writings in National Archives collections.
Works prepared by U.S. Government employees as part of their official duties are in the public
domain. The copyrights to materials written by other individuals or organizations are presumed to
remain with them. If you think any of the information displayed in the PDF is subject to a valid
copyright claim, please contact the Gerald R. Ford Presidential Library.
Digitized from Box 3 of the Bradley H. Patterson Files at the Gerald R. Ford Presidential Library
Allied Health Directory Helps Answer "What To Do Next Year"
A complete directory of all
requirements, length of
College; with the assistance of
upgrade, improve, and
pharmacology and Emergency
Allied Health Training
program, details of the job
the College and under a DHEW
increase training programs
Medical Technician courses
programs in Arizona, New
training prepares you for, cost
contract.
and opportunities as well as the
have been approved for
Mexico, Colorado, and Utah is
and available stipends or
chance of success for Indian
academic credit at Navajo
ready to be distributed to high
scholarships.
Dr. Crook, who came to the
students interested in an Allied
Community College; bilingual-
school counselors and others
It was developed by Dr.
Navajo Reservation last
Health career. Developing the
nutrition training courses have
who might need the
James R. Crook, director of the
summer, is coordinating the
American Indian School of
been developed and the Indian
information early next fall.
Office of Allied Health
development of Allied Health
Medicine, is part of this job.
Health Service medical
The 31-page booklet lists the
Sciences, Navajo Health
Sciences in the four state area
laboratory technical training
programs by occupation and
Authority, assigned to work at
and at Navajo Community
Since he arrived, the
has moved to Navajo
also includes entrance
the Navajo Community
College, and working to
Community Health Medic basic
Community College.
Dine' Bits'íís Baa O'lta'go Bilhaz'á
NAVAJO AREA HEALTH EDUCATION CENTER
POSTAGE
U.S.POSTAGE
NAVAJO HEALTH AUTHORITY
AU527'76
PAID
P.O. BOX 643
€.13
WINDOW ROCK, ARIZONA
86515
ARIZ
PERMIT
NO. 2
BRAD PATERSON
AHEC. 18 a component
Dr. Ted marro
of the Navajo Health
Authority.
special assist and to the President
the White House
AHEC Director
Dr. Alan Goodman
1600 Pennsylvania avenue AW
AHEC
Editor
Washington D.C.
20295
Barbara Lacy
Bithaz
O'lta'go
90
Baa
CENTER
Bits'ils
slip
Bis,
Dine
EDUCATION
HEALTH
AREA
NAVAJO
VOLUME 1 NUMBER 1 JUNE 1976
PARTICIPATING in the groundbreaking of the NHA-AHEC Family Health Center, Shiprock, N.M.,
were: from left: Dr. Donald Megill, Dr. Luverne Husen, Mrs Harriet Goodluck, R.N., Dr. Graham
Watkins, Dr. Taylor McKenzie (with shovel), Dr. Merle Pennington and Mrs. Shirley Lowe.
AHEC Supports
Health Professions
Family Health Center
Training
The goals of the Navajo
The
1970
Carnegie
Keeps Families Well
Health Authority and Area
Commission
on
Higher
Health Education Centers, as
Education recommended that
established by Congress in
health professional education
1971; were practically the
be revised to coordinate with
The empnasis of the Navajo
the entire staff canvased the
to the university of New
same.
changes in existing patterns of
Health Authority Family
area telling the inhabitants
Mexico, Department of
The first goal of NHA was to
delivery of health care. Part of
Health Center, Shiprock, New
about the new center.
Family-Community, and
develop health manpower
that recommendation was to
Mexico, is preventive
Through the cooperation of
Emergency Medicine.
training programs to support
develop AHEC's in medical
medicine: keeping their 560
the Indian Health Service
The academic institutions
the development of the
centers.
families well rather than just
hospital, all Indian patients
involved in the initial planning
American Indian School of
Eleven AHEC's were
treating their episodic
from the identified area are
were a consortium of Family
Medicine.
established across the country
illnesses.
now referred to the Family
and Community Medicine
AHEC's were to improve the
in 1972, under 5-year grants.
The primary goal however, is
Health Center. This includes
Departments from the
quantity, quality and
The Navajo Area AHEC is a
to develop an accredited family
Anglos who live inside or
universities of Arizona, Utah,
geographical distribution of all
subcontract from the
practice residency program on
outside the area but who have
Colorado, and New Mexico.
health personnel. So it was
University of New Mexico
the Reservation.
not had medical services
Other assistance has come
natural that the Navajo AHEC
medical center; the only AHEC
The philosophy behind this,
available in Shiprock before.
from the University of
should become a component of
on an Indian Reservation.
according to Dr. Merle
The patient load is
Rochester, Family Practice
the Navajo Health Authority.
It was natural that an AHEC
Pennington, director of the
purposefully controlled
Department, and Overlook
AHEC's grew from attempts
should be here-the main thrust
center which opened in
because the clinic is a teaching
Hospital-Columbia
to answer the question, "How
of AHEC's is on the production
January, is that doctors who do
center. Although the resident
Presbyterian Family Practice
can medical education be
and distribution of primary
their residency in a rural area
physicians do much of the
Residencies, the University of
designed to better fulfill the
health care personnel for
will be more likely to establish
clinical care, such as taking
Utah, Maternal and Child
health needs of Americans in
underserved areas. Particular
a permanent practice in a rural
medical histories, doing
Health Project, and others.
the 70's and 80's.
emphasis has been placed on
area later.
physical exams, and treating
the development of regional
"The success of our program
patients, the staff doctors must
residency training programs
depends, to some extent on our
give close supervision.
251 Students Helped
and rural clinical practice for
selection process. First, the
"We will arrive at a diagnosis
medical students.
resident physicians must be
together; they may do some
Another AHEC emphasis is
interested in a rural
additional research or library
By AHEC-Kellogg Funds
continuing education for all
placement; and secondly, they
work and they will come up
health care delivery team
must be self-reliant," he
with a treatment plan which we
Two hundred and fifty-one Indian students have received
members as well as patient and
explained, "especially on
will discuss together,"
financial assistance since the Navajo Health Authority Office of
consumer health education.
reservations where specialists
Pennington explained.
Student Affairs opened in 1973; 46 have graduated from a variety of
Again, these goals fit in to the
are not readily available."
Teaching responsibilities will
allied health programs.
overall plan of the Navajo
When the .center is fully
eventually involve not only the
Thus, the Office of Student Affairs, with grants from the
Health Authority.
operational, up to 18
full-time staff but also
Department of Health Education and Welfare and the Kellogg
Since the AHEC was
residents will spend three years
physicians from the Indian
Foundation, is fulfilling one of the basic goals of the Navajo Health
established, many programs
in the program; the first year
Health Service, from private
Authority and the Area Health Education Center.
have been successfully carried
will be spent at the University
medicine in the surrounding
Eight graduates received their master's degree in Public Health,
out in health education.
of New Mexico Medical Center;
communities, and from the
nine received registered nurse certificates or higher nursing
The stories of some of the
the last two at the Family
consortium universities.
degrees, and seven received a bachelor of science degree and have
current programs are told in
Health Center in Shiprock.
The trim 2,900 square foot
entered medical or veterinarian schools. Three are doctors now into
this edition of the AHEC
The first full-time resident
Family Health Center, was
their residency programs.
newsletter. Because the AHEC
began last January; the second
established because several
The others graduated in a variety of allied health programs:
programs are vital to the
resident will start in July; but
agencies cooperated.
nurse midwifery, nurse practitioner, medical records, health
Navajo reservation residents,
to begin with, rotating
First, the Shiprock Health
education, physician assistant, certified laboratory assistant, and
and because community
residents from other residency
Board and the Indian Health
surgical assistants among them.
support is equally necessary to
programs who will spend up to
Service hospital lent their
To keep the dropout rate of the students as low as possible, the
the AHEC programs; the
six weeks at the center, have
support.
Office of Student Affairs offers continuous emotional support to the
Navajo Times was selected as
been scheduled through
The Navajo tribe provided
students, including a yearly visit to each student at school by one of
the delivery medium because
February 1977.
the building and the tribally
the Student Affairs counselors. Although few students needed it, a
of its high readership across
To develop a patient load, Dr.
the reservation.
operated Navajo Health
job placement program assists graduates in finding a permanent
Pennington ran an imaginary
job.
The AHEC Arrow symbol
Authority provides
line around an easily definable
administrative and technical
describes another aspect of
area of Shiprock; from the San
To keep a supply of interested students coming, the Office of
AHEC-people: people learning
assistance.
Juan River east to the hogback
Student Affairs has a Summer Work Experience Program for high
about health care. AHEC
(a rocky ridge descending from
The program is supported by
school and college students. Because of the popularity of the
programs are directed at you-
the Rocky Mountains) and
an Area Health Education
program which places students in the health career field of their
whether you are a consumer or
north to the Reservation line.
Center contract from the
choice for eight weeks, 75 job slots were created for students during
provider of health care.
Then, before the clinic opened,
Bureau of Health Manpower,
the summer of 1976; only PS could be hired in 1975.
People fill the AHEC arrow.
Page 2 Area Health Education Center June, 1976
AHEC Sponsors
Information Desert Shocks
Symposium
Navajo Health Authority Librarian
Programs
It was a medical information
Now, there are small core
Two Area Health Education
desert. The hospitals had little
medical libraries in each
Center sponsored programs
more than a row of old medical
Indian Health Service hospital
will be part of the third annual
journals. The newly developed
and clinic on the reservation;
Navajo Nation Health
Navajo Health Authority had
many thousands of books and
Symposium to be held August
only an empty room designated
journals at the Area Health
9 through 12 at Navajo
as a library.
Education Center Media Center
Community College, Tsaile, Az.
But most important were the
an extensive "Southwest
They are a trauma seminar
health professionals who
Collection," and a tie-in with the
for physicians to be offered by
worked on the 15 million acre
National Library of Medicine's
Navajo Indian reservation.
Regional Biomedical Network.
the Navajo Health Authority
They often complained about
Emergency Medical Services
their isolation and the fact they
and the fourth NHA-OSA Ned
they were so far from medical
Isolated health professionals
Hatathlie health careers
resources. This had a great
can be as medically informed
seminar of the year.
effect on their decision to
as their urban counterparts.
"A Long Walk to Health, a
continue to practice on the
How did it happen?
Look at the Past, Present and
reservation.
First a librarian was found
Future of Indian Health Care"
whose enthusiasm and love of
is the theme of the conference
books radiated to those around
which is sponsored by the
her. Books were so much a part
Ms. Kay Blosser
Navajo Nation Health
of her life that Ms. Elizabeth
Association, the Navajo Tribe,
Hendryson was actually
NCC Offers MLT
the Indian Health Service and
shocked at what she called the
the Bureau of Indian Affairs.
"information desert" of the
reservation.
Plus AA Degree
The four-day session will be
filled with speeches, panels,
As she visited area health
exhibits, demonstrations,
facilities to catalog what was
Ten students will become
background, the instructors'
cultural activities and a film
Navajo Community College's
background, and the content of
NURSING
available, she discovered that
festival; all leading to the
the frequent Indian Health
first class of medical
the courses. We must have an
increase of knowledge and
NOTES
Service budget cuts usually hit
laboratory technicians next
skills of health concepts by
the library first.
fall, according to the director
overall director of the program
health professionals on the
She also asked the National
of the new two-year program,
who is a clinical pathologist."
Reservation.
Library of Medicine for advice.
Ms. Kay Blosser, MT (ASCP).
"The first year will be
equivalent to any freshman
Three of the featured
The plan decided on was
that a core library of certain
After they graduate, the
speakers will be Dr. David
basic reference books called
medical laboratory technicians
year in college with an
Matthews, Secretary of Health
The Third Indian Nursing
the Brandon Core Collection be
will not only have an associate
emphasis on science," she said.
Education and Welfare; Dr.
Education Conference will be
kept in every health care
of arts degree from Navajo
hesecond year will be held
Louis Hellman, director,
held on June 25-26, 1976, at the
institution, plus some journal
Community College but will be
in Gallup, New Mexico. We will
Health Services
College of Ganado, Ganado,
able to do hundreds of
use the Indian Health Service
Administration, DHEW, and
Arizona. The conference is
subscriptions to keep everyone
upon health developments, and
laboratory tests, (such as
training laboratory which is the
Dr. Emory Johnson, director,
sponsored by the Navajo
knowledge of where
matching blood samples,
perfect student setup. The
Indian Health Service.
Health Authority, Office of
information beyond that was
growing cultures, and testing
instructors who worked with
Nursing Education. The
available.
for chemicals or antibodies)
the medical laboratory
Many other well known
conference, "Indian Nurses
that are used by physicians as a
assistant program are staying
Indian-health and educational
Speak Out Why We Need More
The resulting collection has
guide for diagnosis and
on and the laboratory has very
professionals will participate
Nurses," will focus on
been used as a reference
treatment.
sophisticated and expensive
in panels and be available to
identifying the need for more
library for the Navajo Health
equipment in it.
speak informally with
nurses in the Four Corners area
Authority staff as well as health
The program is an expansion
conference participants.
andwill develop
professionals in the area.
"Although the laboratory is
of a one-year Indian Health
recommendations to solve the
Some books were put on loan
close to the Gallup Indian
Special sessions will feature
Service medical laboratory
nursing shortage problems.
in Indian Health Service
Hospital, the students won't
an alcholism workshop, a
assistance training program
The conference is open to all
facilities. Then came a $25,000
work on any patient samples
health professions career
formerly offered in Gallup,
nurses in the Four Corners
Indian Health Service-Navajo
until the last six months when
recruitment workshop, and a
New Mexico.
area. For more information,
Health Authority contract to
they work in a hospital as
health board seminar.
contact the Navajo Health
put an accredited library in
clinical practitioners. After
Consistent with the concept of
New this year will be a
Authority, Office of Nursing
each Indian Health Service
this, they qualify to take the
the Indian Self-Determination
Manuelito Begay distinguished
Education, Window Rock,
service unit. By the end of the
national qualifying
Act, this is one of the first IHS
health services award, in
Arizona. (602) 871-4831.
second year, all the IHS
examination for registered
programs to be taken over by
memory of Begay, a medicine
hospitals met the Southwest
medical laboratory
an Indian-owned institution.
man in the Crownpoint area
Five students received an
Pacific Regional Medical
technicians."
While discussing the program it
who lived to be over 100 years
Associate Degree in Nursing
Library Advisory Board
was decided that the area's real
old and did much to improve
from Navajo Community
standards and the contract was
need was for medical
the health status of the Navajo
College on May 8, 1976. They
renewed for another year.
laboratory technicians rather
people.
are: Diane Bilagody, Roberta
Meanwhile in old book stores
than assistants. Also, students
1976
Evening events include a
Moore, Rita Cowboy, Carol
or from Publisher's Central
in the former program did not
barbecue, a traditional
Todd, and Larry Roanhorse,
and the best seller lists, Ms.
receive academic credit for
Navajo meal, pow-wow,
who completed the
Hendryson was collecting a
their year long course.
modern and traditional music
requirements in December,
wide variety of old and new
POWER
and a demonstration of Navajo
1975. Congratulations NCC
literature on Navajos, other
"The medical laboratory
native healing sciences.
Nursing graduates!
Indians medical uses of plants,
technicians can do more work
6
Food and lodging are
and other subjects that might
with less supervision and thus
A nursing coordinator for the
*
available at NCC; camping
have a bearing on the far flung
are more valuable on the job,"
NCC Nursing Program has
facilities are adjacent to the
activities of the staff of the
Ms. Blosser said.
been hired. Ms. Lydia M.
college.
Navajo Health Authority.
Pourier, R.N., M.P.H.,
So it was with much regret
Ms. Blosser received her MS
Director of the Navajo Health
from the University of
Manpower Registry Completed
that she resigned her position
Authority, Office of Nursing
as librarian when her husband
Oklahoma and previously
Education, has been on loan to
became ill, although she is still
worked there as the assistant
Approximately 1,500 Indian
resources on the reservation.
the NCC Nursing Program
an active consultant to the
supervisor of the Department
and non-Indian health
They can show distribution,
since January, 1976. The new
library.
of Microbiology and Serology,
professionals have been
numbers, turn-over, and other
coordinator, Ms. Linda
Now running the library is
dividing her time between
identified as part of the first
data essential to developing
Robberson, who will arrive in
Ms. Patricia Bradley, a
supervision and teaching. She
health manpower registry of
and maintaining adequate
August, has a master's degree
Navajo, who graduated with
predicts that her new job will
the Navajo Area. This registry
health care levels in an area.
in medical-surgical nursing
honors from San Francisco
be mostly administration which
is being compiled by the Office
In fact, the National Center
and is an experienced associate
State University and received
she finds exciting. "Of course,
of Health Statistics and
for Health Statistics will
degree nursing educator. She
her master's degree in library
starting a new program also is
Research of the Area Health
require all Health Service
has been the Coordinator of the
science from the University of
exciting as well as
Education Center. Name, age,
Agencies to develop a health.,
Cochise College Nursing
Arizona.
challenging," she added.
sex, occupation, job location,
manpower registry which is
Program in Douglas, Arizona.
What is left for her to do?
and @thnicity are part of he
updated regularly.
Effective May 11, 1976, the NCC
The program itself must
"We are still ordering books
information gathered which is
States will develop their own
Nursing Program has received
follow requirements set by the
that need to catalogued,
being coded and computerized.
registries: the New Mexico
continued accreditation from
National Accrediting Agency
delivered, and shelved. Then
"Who wants it?"
Regional Medical Program has
the Arizona State Board of
there is the whole world of
for Clinical Laboratory
Many agencies. Registries
completed its registry except
Nursing and has been approved
audio visual materials we want
Sciences.
are an invaluable tool for
for information on the Navajo
to accept new nursing
to get into as soon as we have
"They want to know my
planning and analyzing health
portion of the area.
students in the fall.
more space."
June, 1976 Area Health Education Center Page 3
Prevention Team Tries
Workers Attend
Animal First-Aid Offered
To Catch Diseases
Nutrition
To Area Residents, Students
Before You Do!
Workshop
Can you castrate a bull,
Her assignment is to train
dehorn a cow, or check an
animal health aids on the
The caller was brief: A suspected outbreak of Salmonellosis at a
Over 100 cooks, food service
injured sheep for his vital
Navajo, Hopi, and Zuni
BIA boarding school near the hospital.
personnel and counselors
signs?
reservations in Arizona and
As soon as possible, the Indian Health Service preventive
received up-to two hours
What veterinary skills do you
New Mexico, as well as develop
medicine team was on the scene. They took water samples, throat
college credit at a nutrition
need to know? A unique course,
an interest in an allied health
cultures, and rectal swabs. This time they'd catch the epidemic.
workshop in early June.
now in its third year, offers
career among the students.
But they didn't. The water samples were pure, although they did
Two courses, taught at
practical veterinary
Because of the Indian's feelings
discover that the chlorine pump didn't work. The cultures were
Navajo Community College,*
techniques, and skills to animal
for their animals, this seemed
negative.
were sponsored by the Arizona
owners
and
future
to be a good starting point to
What caused the outbreak? Over a dozen people had obviously
Department of Eduçation,
veterinarians.
develop health professionals in
been sick, but the team never discovered the cause and everyone
which is holding similar
any field.
quickly recovered.
conferences around the state.
Sponsored by Navajo
The purpose of the program
Several hundred miles away the scene was different. No one was
Community College, the
is to fill a void in vitally needed
notified when the first child came down with measles. Within two
Attending were counselors,
Navajo Health Authority, and
areas of veterinary care and
weeks over 235 people in the small community came down with
food handlers, and cooks from
Colorado State University, the
range livestock management.
rebella, the kind of measles that leaves young children deaf, brain
WIC, public schools, BIA
eight-week course offers six
Since livestock production is a
damaged, or with other permanent disabilities.
schools, private schools and
hours of college credit to
major part of the Indian
"We could have stopped at least half of those cases, if the first
Indian Health Service
eligible college students; yet is
economy and livelihood, a lack
case had been reported," said Dr. Charles Kaltenbach, Director,
Hospitals.
also open to high school
of veterinary services is a
Preventive Medicine, AHEC, who acted as a consultant to the local
students who hope to enter
"Nutrition and Foods" was
cause for concern.
IHS field health operations.
health careers or Navajos who
That's the challenge he likes--preventing a disease before it
taught by Dr. Alan Ackerman,
own livestock.
"If a serious animal health
infects more than the bare minimum of people.
instructor in Anatomy and
problem were to develop on the
Physiology at Navajo
It is a practical course,
Of course, he'd like to change living conditions so that many
reservation, it could reach
Community College. Dr.
because there are only three
diseases never occur at all.
advanced or epidemic
Ackerman is supported by a
veterinarians on the entire
proportions before it is even
But that's another story.
grant to Navajo Community
Navajo reservation, an area of
detected," Dr. Pate said.
Right now he is designing a model community follow-up
College from the Area Health
more than 15 million acres and
Thus, the Animal Health
procedure for The Family Health Center at Shiprock, New Mexico.
Education Center at the Navajo
only limited services are
Science Training Program
His team is the clinic's residents.
Health Authority.
provided by local veterinarians
teaches Indian students how to
"Residents usually only know clinical medicine. We're going to
"Food and Safety and
in towns near the reservation.
recognize and treat common
teach them how to apply it in a community setting.
Sanitation" was taught by Ms.
"We get some false alarms. But even in the first incident I
Dr. Gale Pate is director of
livestock diseases, how to
Susan Foerster, dietitian with
an M.P.H. degree, who works
the program and instructor of
manage sick animals, and how
mentioned, we did a community service by discovering the broken
water filter and showing the community that we cared.
Animal Health Science at
to use the common techniques
with the California Department
and treatments which are
of Health.
Navajo Community College.
"There are two parts to this really. Teaching residents how to
needed in good livestock
work with the community and teaching the community how to ask
management practices.
for help."
The veterinary program at
Who asks first?
NCC is not limited to the
"It should be the hospitals, the doctors, but the method we have
summer session. Three or
now is not responsive enough."
more classes in animal health
"The Ambulatory Patient Care Information cards filled out by the
sciences are offered each
doctors as each tient is examined are premature. They don't tell
semester of the school year.
us what the actual diagnosis is because they don't include
"We also are teaching
laboratory work."
trainees how to react to animal
Hepaused, as if wanting his next words to sink in.
health crisis and to learn when
"There is a possibility that I can develop a weekly 'notifiable
to seek outside assistance," Dr.
disease' report."
Pate said.
He paused again, but with a new glint in his eye.
She pointed out that most
I'm excited by this," the usually mild-mannered Kaltenbach
veterinarians will give medical
advice over the telephone if
admitted.
they cannot reach a distant
The present disease report used by Indian Health Service is a
location. To give advice they
computer printout of APC forms. The report for March arrives in.
must know an animal's
July. "I want to develop a current disease report. I want physicians
symptoms. After the training
to actually see positive results. Right now, I'm working with the
session, trainees should be able
directors of Community Health Services in each Indian Health
to give a veterinarian that type
Facility to develop the mechanics of the report."
of information.
"I'd also like to do a monthly summary and include information
ZONCIE NEZ, herblist from Hunter's Point, talks with Carl
Dr. Pate, a 1969 graduate of
from the four states bòrdering the Reservation. Each state works on
Gorman.
Colorado State University's
a different schedule so I can't incorporate their reports into
College of Veterinary
anything other than a monthly summary."
Hatathlis Talk
Medicine, also provides
"By the way, notifiable diseases are those transmitted from man
veterinary care whenever her
to man; communicable. Some of the ones we'd want to follow are
schedule permits.
To Carl Gorman
strep, reheumatic fever, rubeola, salmonellosis, tuberculosis,
Before coming to the
influenza and syphilis."
Reservation, she was with the
Carl Gorman, Director of
cooperated.
Peace Corps in Kenya, Africa,
Strep, the one communicable disease he has been working on for
Office of Native Healing
The result is a few copies of a
and had a private practice in
several years is showing a definite downcurve. He hopes that it is
Sciences has been talking to
registry listing 550 native
Clovis, New Mexico.
due to the Reservation-wide Navajo Tribal strep-prevention
Hatathlis or medicine men;
practitioners and their
A long-range goal of the
program he has been involved with as a consultant.
herbalists and diagnostitians
specialities such as a certain
program is to set up an animal
"The importance of this program is its effect on the incidence of
the 'Navajo Way,' to get
ceremony or other treatments
disease diagnostic facility and
rheumatic fever on the Reservation. The reported cases have gone
information for the first Navajo
that they perform, for use by
a pre-veterinary curriculum
registry
of
Native
down steadily in the last five years, but it will be five more years
the Navajos.
through Navajo Community
Practitioners.
Now a second more
before we know how significant that is. The incidence curve has
College in Tsaile, Arizona.
varied so much over the years that we can't tell yet if it is our strep
"You don't just go up and say
ambitious study has been
Pate said, "the final step of
that you want an herb for
started: an ethno-medical
the program is to have Indian
program that's done it, or if it is an artificial drop.
cancer or that you want to know
encyclopedia which is funded
students trained well enough to
"The State of Arizona is discontinuing their rheumatic fever
what their specialities are," he
by the National Institutes of
make it through the Doctor of
registry. I hope to have it transferred to the Reservation because
explained.
Mental Health through
Veterinary Medicine Program
most of the patients on it are Indians."
"We don't go too fast. You
Northwestern University.
at a recognized College of
"We are currently following 315 active patients. Most of them will
practically have to live with
Each of the practitioners
Veterinary Medicine.
be on prophlatic medicine for at least 20 or 30 years; if not the rest of
them," he added for emphasis.
listed in the Native
A scholarship, in the memory
their lives."
"First you find out their clan
Practitioners Registry who are
of Dr. Wilson Francisco, the
and tell them yours. Then you
willing to participate are being
first Navajo veterinarian, for a
"We're not talking about large numbers. Our records show that
see if you have any clan
asked sets of 100 or more
Navajo veterinarian student at
the high incidence of new cases of reheumatic fever was 45 in one
relations."
questions on subjects related to
Colorado State University, was
year; the low was 15."
"Later you tell them why you
health: nutrition, disease,
established in 1974 by the
"Once again, we don't know why."
came."
childbirth, pregnancy and
Francisco family and the
"We do know rheumatic fever is caused by lack of medical care
At first the Hatathlis didn't
others.
Navajo Health Authority.
and overcrowded conditions. It's prevalent among lower social-
want to be interviewed; they
The final project will be over
Presently, over $1,500 is in the
economic areas."
were afraid of giving their
10 volumes of information on
bank, waiting for the first
secrets away. But when it was
how the Navajos feel and deal
recipient. Perhaps the first
You have the feeling that that's the challenge that keeps the
emphasized that the
with their health--from the
student will come from the
former microbiologist excited.
information was to be reserved
creation myths to their
Navajo Community College
You also have the feeling that he's ready to lead the team when
for future generations of
treatment of disease by modern
animal health science
the call comes.
Navajos, the Hatathlie
or native methods.
program.
EMS System Meets Stringent Standards
Do you think that your CB is
still receives AHEC support,
centers. The third tier is 9
publicsuch as security officers,
communications: without this
the latest thing in radio
especially in continuing
equipment?
critical patient transport
teachers, and supervisors of
vital link, nothing operates.
education.
vehicles which the IHS recently
dangerous jobs, have at least 40
Each vehicle has two radios.
It's not. There is a growing
The area covers the Navajo,
added to the EMS system; an
and extremely exclusive
hours-a basic emergency care
One is a police dispatch radio
Hopi and Zuni reservations,
example of the careful
course.
which connects the ambulance
network installed only in
where the highway accident
coordination and planning
The next step will be training
special vehicles that might
to the police station. The
rate is the highest in the nation.
between the two agencies.
some EMT's at the 120 hour
save your life. And it works
second, part of the nationwide
It is an area bigger than West
These vehicles are equipped
level and eventually bringing
precisely because it is so
EMS system lets the EMT keep
Virginia, where a motorist can
to stablilize a patient's
them up to the Para-Medic 480
exclusive.
in constant contact with the
go for 250 miles without
condition as they are
hour level.
Who gets it?
hospital and the physician;
meeting a stoplight or passing
transported to another facility--
Presently, all EMTs receive
Ambulances and hospitals. It
through voice contact the
more than 5 or 6 areas where a
is the 450 mhz-- nationwide
and don't tie up emergency
a refresher course every six
doctor monitors the patients
telephone is available.
vehicles on what are routine
months, for an updating in what
emergency medical system.
vital signs and assists the EMT
Yet, according to director,
runs.
Lincoln calls their hand skills-
In the Navajo Health
in carrying for patient.
Mike Lincoln, the area's EMS
The final tier of the plan
bandaging, cardiopulmonary
Authority region it is installed
Does the system work?
system is "advanced" by the
covers the vast areas left,
resuscitation, applying splints,
in most emergency
That's what five types of
Department of Health,
unpaved roads or roadless
etc.
evaluation will tell.
areas where heavy ambulances
"We do other types of
can't travel.
continuing education," Lincoln
EMS bought, equipped and
added. "We hold classes for
leased to Navajo chapters, red,
doctors, nurses and other
four-wheel drive suburban
emergency room personnel.
Bithaz
vans, called "wolachee', or
The next stop is
"red ants" in Navajo, which
go
are available to carry patients
O'lta'
ambulances and in 16 health
Education and Welfare
to scheduled appointments or
BOD
facilities. Emergency medical
standards.
on emergencies. and are
technicians can be in constant
It's a well thought out plan.
equipped with basic first aid
Bits'iis
lis
CENTER
Bis,
contact with a physician as
For instance, the emergency
equipment.
they transport an injured
vehicles operate on what
This is where training comes
Dine
Lincoln calls tiers.
EDUCATION
person to the hospital.
in. All EMS vehicles must be
Radio communications are
On the top tier are the
operated by 2 certified
one of 15 components of a total
primary responders, or the
emergency medical
HEALTH
INSIDE:
emergency medical system
first vehicles sent to answer an
technicians. This requires 80
designed to save lives, being
emergency call: $17,500, 2-
hours of class work and
AREA
New Family
developed by the NHA-EMS
patient ambulances assigned to
training.
under grants from the
12 Indian Health Service
Since the program started
Department of Health,
two years ago, EMS has trained
NAVAJO
Health Center
facilities.
Education and Welfare and the
Next, at seven facilities in
188 EMT's, 29 percent women.
P. 1
Robert Wood Johnson
heavy accident areas are
They have also trained 145
Foundation. The Navajo Health
slightly older ambulances
others in basic emergency care
GERALD
Stop That Germ
Authority Emergency Medical
which serve as backup units.
techniques.
Services was conceived
Because of the limited
Also, now all Navajo police
FORD
P. 3
originally under the AHEC
specialized health care at many
cadets must pass the EMT
First-Aid For Animals
contract. Now it is its own
IHS hospitals, critical patients
course and EMS recommends
division of NHA althought it
are often sent to larger medical
that others who deal with the
P. 3
CY PROVIDED: J. MITCHELL
B. KILBERG
B. PATTERSON
J. BROWN
THE WHITE HOUSE
E. JOHNSON
WASHINGTON
May 14, 1976
Dear Mr. Means:
FORD LIBRANK
This is in response to your letter of April 13, 1976
to the President regarding the 1976 funding level
for the Indian Health Service.
The President's 1976 budget request contained an
increase of $30 million over the comparable 1975
appropriation for Indian Health Services. The
President's 1977 budget proposed that $5.3 million
added by Congress to the 1976 request be rescinded.
These funds would have provided specific new and
expanded outpatient care and preventive health care
projects as well as services to non-reservation
urban Indians who are already entitled to services
through other federal health services programs.
Congress did not accept the President's proposal
and thus the $5.3 million proposed for recision
was made available to the Department of Health,
Education, and Welfare on March 18, 1976.
I hope this information is helpful.
Sincerely,
Theodore C. Marrs
Special Assistant to the President
Mr. Warren W. Means
Executive Director
United Tribes Educational
Technical Center
3315 South Airport Road
Bismarck, North Dakota 58501
FOR IMMEDIATE RELEASE
OCTOBER 13, 1976
Office of the White House Press Secretary
THE WHITE HOUSE
STATEMENT BY THE PRESIDENT
I have approved H.R. 5546, the "Health Professions
Education Assistance Act of 1976," which will materially
assist in insuring that all Americans throughout the
country will have sufficient access to physicians and
dentists. Last year the Administration submitted to Congress
a legislative proposal based on findings which showed that
while there was no longer a shortage in the total number of
physicians in the United States, there were alarming signs
that this country was facing two growing problems with
respect to these practitioners. There are not enough
doctors in rural and inner city areas, and there is a con-
tinuing decline in the number of doctors practicing primary
care, i.e., the problem of specialty maldistribution.
I am pleased that the bill specifically
GERALD FORD LIBRARY
addresses those issues which we identified as being of
greatest concern. Although the bill contains some undesirable
features, I believe that, on balance, it represents a definite
step toward improving health care delivery, and, accordingly,
warrants my signature.
There are several provisions of this legislation which
will be instrumental in solving the problems of geographic
and specialty maldistribution. The bill continues and ex-
pands a scholarship program which will provide individuals
with financial assistance to attend medical school. In
exchange for these scholarships, each recipient will be
required to serve in a health manpower shortage area for a
period of at least two years. Coupled with this scholarship
program, the bill authorizes the establishment of a Federal
program of insured loans -- a proposal I have supported -- to
assist health professions students. This program virtually
assures that no individual will be denied a medical education
for financial reasons. Also the bill establishes a program
of special assistance to disadvantaged students in an effort
to equalize opportunities among all individuals who wish to
become health professionals.
In order to deal with the problem of specialty maldistri-
bution and increase the number of doctors who deliver primary
care, the bill authorizes the continuation of the existing
program of financial support to health professions schools
through capitation grants. However, a significant new con-
dition is attached to the receipt of these grants. Medical
schools would be required to provide annually an increasing
percentage of residency positions for individuals in primary
care specialties (i.e., pediatrics, internal medicine and
family medicine).
more
2
The bill authorizes funding for numerous special projects
relating to the education and training of physicians and
allied health personnel. Special grants are authorized for
programs in family medicine and the general practice of
dentistry. In addition, grants for programs for the training
of physician extenders and expanded function dental auxiliaries
were authorized. Such programs are designed to enhance the
overall capacity of physicians and dentists to deliver health
care.
Finally, the bill revises and extends the existing National
Health Service Corps Program -- a program which has made
significant strides in alleviating the problem of inacces-
sibility to health care services in medically underserved
areas. This program currently has more than 600 professionals
working in shortage areas. It is estimated that by next
year, this number will grow to almost 700. And, with the
authorizing legislation before me now, we expect the capa-
bilities of this program to increase dramatically during the
following three years.
As I noted, however, the bill is not without some
FORD
defects. Because I am particularly concerned about the
potential impact of some of these troublesome provisions,
I intend to submit legislative recommendations to remedy
LIBRARY
these problems as soon as the Congress returns.
Primarily, these concerns relate to the levels of
spending authorized by the legislation, provisions which
deal with medical school admission requirements for Americans
returning from foreign medical schools, and payback conditions
for students who do not fulfill their obligations under the
National Health Service Corps scholarship program. I am
convinced that the authorization levels attached to this
program are excessive. I believe that the desired results
can be attained at a much lower cost. I particularly object
to the provision which creates an automatic funding "trigger"
for the scholarship program and which penalizes other programs
authorized in the bill if certain scholarship funding levels
are not met. Not only does this provision impose unwarranted
sanctions, but it distorts the entire Congressional appropria-
tions process.
Furthermore, I have reservations about the capitation
condition which requires medical schools to accept a certain
number of American citizens who have been students in foreign
medical schools and who meet certain criteria. Not only
does this requirement potentially create administrative
problems, but, equally as important, it undermines our
medical schools' admission policies by imposing Federal law
to override an individual school's admission criteria.
Finally, I object to the unduly harsh penalties assigned
to those scholarship recipients who fail to fulfill their
service obligation in the National Health Service Corps.
With respect to these people, the bill requires them to pay
back three times the amount of the scholarship, plus interest
more
3
(with adjustment for any portion of a service obligation
performed), within one year of the breach of this obligation.
In my view, a penalty of twice the amount provided, plus
interest, would be more than sufficient.
As I indicated earlier, I plan to recommend action to
remedy these problems as soon as Congress reconvenes. Despite
the drawbacks of the bill, however, I believe this legislation
is necessary. Many of the programs which are contained in
this bill have been without "authorizing legislation since
June 1974. Furthermore, the bill addresses the important
problems which we identified last year. In weighing all of
these factors, I believe that it is in the best interest of
the American people to sign this measure into law.
####
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
303-641-3790
October 23, 1976
Mr. Bradley H. Patterson, Jr.
Presidential Assistant
American Indian Affairs
abroad phone 11/1/76
White House Office
Washington, D.C.
Dear Mr. Patterson Jr:
FORD LISBARY
I am writing to you about my concern regarding an
Indian health problem. My wife and I are both pediatricians,
retired from active practice in Grand Rapids, Michigan and now
living in Gunnison, Colorado. Since retirement we have been serving
tours of duty as medical officers on volunteer and sometimes
contract arrangements on the Navajo and more recently on the
Hopi Reservation. We have just completed a 12 month tour of duty
at Keams Canyon Hospital on the Hopi Reservation. While
President Ford would probably remember us, I do not want to trouble
him during his re-election campaign. Perhaps you could give me
some advice and help.
When we reported for duty July 1, 1975 at Keams Canyon
Hospital, Mr. Glenn Randolph, the administrator of the hospital,
asked me to try and identify problems and outline ways to improve
the health care service. We found that there were many areas where
we felt improvement was needed, ( see attached report to
Dr. Charles McCammon, Director of the Phoenix Health Area,
Indian Health Services, 801 E. Indian School Rd, Phoeniz, Arizona).
The problem which gave me great concern, in which I
failed to see improvement was in the area of prenatal clinics, prenatal
parent classes, the identification of the high risk mother and baby and
monitoring during labor. I tried to get the staff to identify the small
for gestational age baby and also the baby that is prone to develop
respiratory distress syndrome but the medical officers just refused
to cooperate. As one said, "In no way will we go through such a
routine, we are just too busy. "
Of the seven medical officers that were reporting for
duty on July 1, 1976, two had never delivered a baby and the others
had various obstetrical experiences, but none would have really
qualified for obstetrical priveleges in the average city hospital,
certainly not without supervision. I don't think this is fair to the
doctors that were sent to Keams Canyon and certainly not fair to the
Indian mothers and their babies. I think that every baby has the right
to be well born.
MARK W. DICK, M. D.
308 E. Ohio St.
Gunnison, Colorado 81230
October 23, 1976
Page -2-
GERALD FORD FLBRARY
Mr. Bradley H. Patterson, Jr.
I pointed out this major defect in the health care
at Keams Canyon and the chief of staff was notified by memorandum
and also the administrator of the hospital. I also outlined a plan to
improve the services as quickly as possible. This plan consisted
of obtaining Board Certified Obstetricians through the American
Obstetrical Society as volunteers. Some of my obstetrical friends
have done this and they only ask for transportation expenses and
housing. Most of these volunteers served monthly tours of duty.
The executive officer of the American Obstetrical Society stated
that he would have no difficulty getting very high quality obstetrical
teachers for as long as a year, if it were necessary. These
obstetricians could establish a really meaningful prenatal clinic,
they could help to identify the high risk mother and baby, they could
institute techniques of monitoring during pregnancy and labor. I am
sure the results of such a training for the officers at Keams would
have been very valuable. I saw the letter that the American
Obstetrical Society wrote to Glenn Randolph, the Administrator of
the hospital and Mr. Randolph was really pleased with the idea
of getting this program started. The medical staff, however,
apparently had a meeting, discussed the possibility of having obstetricians
at Keams and they turned the whole plan down. They apparently wanted
to keep Keams Canyon Hospital a "general practice type of experience"
and they didn't want obstetrical specialists telling them what to do.
The result was, more babies were born with problems which will
result in mental retardation, seizure problems, learning problems,
etc. as they get older. This could have been avoided.
I think that the administration could have asked "What
is best for the patient?" Instead the administrator gave in to the
staff and the patient suffered. I know that you realize that during the
past 5 to 10 years, much of the progress in medicine has been in this
area. The area of good prenatal care, monitoring of labor and the
prevention of birth damage at the time of delivery. To me it was like
rolling the clock back 30 years when I entered medicine, when any
Tom, Dick and Harry with an M.D. degree could deliver babies. Iam
sure this isn't what the Health Education and Welfare want, certainly
the tribes deserve something better.
The fact that I was unable to convince the chief of staff
the administrator of the hospital and the nurses that something needed
to be done in this area has weighed heavily on my conscience. As a
citizen of the United States, what government does, at least in part,
is my responsibility and that of other citizens. That is why I am writing
this letter.
MARK W. DICK, M. D.
308 E. Ohio St.
Gunnison, Colorado 81230
October 23, 1976
Page -3-
Mr. Bradley H. Patterson Jr.
I would like to see the Indians have good obstetrical
care and knowing Jerry Ford, I am sure that he would want to help
the Indian mothers. I pointed out a way that at least temporarily,
these mothers could have had good care and the administrator turned
it down. Why?
I am enclosing copies of my letter to Dr. McCammon in
Phoenix and also my letter to you, to be sent to Mr. F. David Mathews,
Secretary of Health Education and Welfare, Office of the Secretary
North Building, 330 Independence Ave., S.W. Washington, D.C. 20201.
I hope that you will send these copies to the Secretary
if you feel that it is appropriate to do so and you feel that he could
do something to help. The letter indicates only a few of the things
I found that could be improved at Keams Canyon but the thing that
weighs heaviest on my mind is the fact that babies were allowed to
be born inappropriately when it could have been avoided.
Sincerely,
Mark W. Dick, M.D.
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
September
1976
FORD
Charles MacCammon, M.D. Director
LIBRARY
Phoenix Area Indian Hospital Services
801 E. Indian School Rd.
Phoenix, Arizona
Dear Doctor MacCammon:
Having completed an eleven month tour of duty at Keams Canyon
Hospital, Mr. Glenn Randolph asked me to write to you about my
impressions of the hospital. My wife, Louise Schnute Dick, also
a pediatrician, worked as a volunteer for the same period.
When I arrived for duty July 1, 1975, Glenn Randolph asked me to
make suggestions whenever I felt medical services could be improved.
Specifically, he wanted a survey of the Children's Center on the Hopi
Reservation. He also stressed the need for helping out with an
in-service nursing program. I was to work in the outpatient department
where at least 50% or more of the patients were in the pediatric age
group and act as a consultant when requested by the commissioned
medical officers.
I don't know why Glenn asked me to write this letter to you, but
suspected he felt maybe an outsider's view might be helpful. At
least these are my impressions and thoughts about Keams Canyon
Hospital. Most of these are on file in my folder in Glenn's office,
unfortunately only a few could be implemented while I was there. I met
a lot of resistance to any change on the part of the nursing staff and the
medical staff.
1.
Maintenance Department. I felt that the physical plant was well
maintained and improvements were being made or planned. The need
for a larger waiting room space was recognized and I felt should have
had a higher priority than doing over the outside of the hospital and
landscaping the grounds. If one has a good waiting room, in a
hospital such as Keams, it can be put to good educational purposes
with films, tapes, etc. on medical subjects, sanitation, how to
handle the ordinary type of illnesses that children are prone to
develop.
During our atay to Keams, the home that we were living in on the
medical complex, was painted and I don't think that I have ever seen
a poorer paint job, much of the paint got on the windows and doors.
Also while we were there, they "insulated the attic. " I am positive
the amount of insulation that was put in would accomplish nothing.
Coming from Colorado where we have rather severe winters, I am
familiar with the types of insulation and the amounts that are needed.
The amount used was simply not enough.
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
September
1976
Page -2-
Charles MacCammon, M.D., Director
2. House-keeping. This area was excellent, the hospital was kept
very clean and under very trying conditions, I think they were
to be congratulated.
3. Library. The library was in poor condition when I arrived there,
but suggestions were made. They did have a librarian come and
get rid of a lot of old books that were of no value and outline a
program for getting some new books in all of the different disciplines
along with the current journals which are of value including
"Pediatric Alert" which is edited by Sydney Gillis.
4. Record Room. This department had an excellent filing system and
excellent recall. The records themselves however were
disappointing. This was especially true of the OB and newborn
records. I made every effort that I know how to get the doctors
to improve their records in the newborn area during the neonatal
and delivery periods. I failed completely because as one doctor
stated, "In no way, will we spend time doing that. "
5. Dietary, The facilities seem to be adequate and were well run.
I think they could make more use of dietitians than they were doing.
I found that food handling examinations and stool cultures
were not being done at frequent enough intervals and were only being
done on those that were working in the kitchen. Nurses, nurses aides
and practical nurses are food handlers and no examinations of this
group were being made.
6. Pharmacy. The Pharmacy was excellent. Pharmists were a big
help to busy clinicians. Clinical judgment by the physician would be
questioned but they always respected the doctor's viewpoint. I
tried to get a record established for every mother during pregnancy
and delivery and have this put on a special area of the chart. This could
be easily surveyed by the pediatrician when the baby was born in
trouble. I was a little disappointed that the pharmacy didn't push
this idea.
7. X-Ray Department. Doctor Wood's help in this area was excellent.
I don't think it could be equaled anywhere.
8. The Laboratory. I thought the laboratory was well run, the Chief
Technician complained that he didn't have enough help. Probably
he was right. For this reason, he complained that there were too
many cultures and spinal taps and that we ordered more lab work than
we needed. I think this was not true. If anything, we ordered fewer
cultures than we should have, because we really didn't get much help
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
FORD
September
1976
Page -3-
BERRED
Charles MacCammon, M.D., Director
from them. The cultures from the satellite clinics, after
3 o'clock in the afternoon, were just left standing at room
temperature and were not plated until the next day. Sometimes
there was a lapse of 24 or 40 hours. There was no culture media
for whooping cough and I saw one case during this period of time.
During the year, many new tests were added, such as blood gases,
serum levels for anti convulsive drugs, digitalis levels, etc, all
of this added to the load of the laboratory staff. They probably do
need more help.
9. Nursing. This department showed a wide range of competency or
lack of competency. Isolation techniques were generally disregarded,
a knowledge about keeping intraveous' running was nil, there was no
in-service training of nurses. I gave three lectures in July and the
Director of Nursing then said, she could not spare the nurses from
the floor, not even for 45 minutes a week, "patients needed them
more. " I'm sure it wasn't the quality of the lectures, because none
of the other doctors were giving any lectures to the nurses. Many of
the graduate nurses said that the lectures I did give were exactly
what they. needed. The Director of the Social Service Department said
that when she came, the Director of Nursing was so pleased, that they
would now be able to have lectures but she never arranged for it.
The dietitians don't lecture to the nurses, to keep them posted on
food problems, formulas, etc.
I felt that the Director of Nurses' comments about patients and
parents could not be varified and on some occasions were proven
false. I feel that the nursing situation at Keams Hospital will never
improve until they get a well trained nursing director.
10. Outpatient Department. This department is generally very good,
but there is no facility for isolation of measles, chicken pox or any
other contagious diseases. This could be corrected without too much
changing, but it is being ignored. A very sick child sometimes isn't
recognized during the registration process or in the screening room
and doesn't get seen promptly. For the present staffing, I don't feel
that they have to close up the outpatient department from 12 noon to 1 p.m.
They could stagger the hours for the nurses, LPN's, emergency
technicians, etc. The same could be done with the laboratory, X-ray
and the pharmacy. Some of the specialty clinics, such as diabetes
need re-evaluation. I don't believe they are doing a very good job.
During the year, we did establish a chronic disease clinic, chiefly
to take care of the convulsive disorders so that one person could more
or less supervise it. This has helped a little, but I think it could be
improved. The big problem of chronic diseases, such as diabetes
hypertension, obesity, eye problems, ear problems, etc. are not
given proper follow-up and nobody seems to care whether they return
for rechecks at the proper time or not.
MARK W. DICK, M.
308 E. Ohio St.
Gunnison, Colorado 81230
September
1976
Page -4-
Charles MacCammon, M. D., Director
11. Field Health Nursing. This department functions surprisingly well
in spite of the fact that supervision is poor and the medical
direction for the field work is practically nil. When I requested
that there be a fi eld health survey on salmonella, shigellosis,
otitis media, pneumonias, etc, the nurses in the field were anxious
to carry out these assignments, but they weren't too successful in
remedying problems. In this area again, in-service training is
practically negligible. I think this could be corrected and could have
a very active department that would accomplish a great deal.
12. Medical Education. A few months before leaving, a Director of
Medical Education was assigned to Keams. I think that she, if
given support by the medical staff and the director of nurses and
dietitians will accomplish a great deal for the tribe. I stressed
the importance of prenatal education for mothers and fathers to be
and outlined in detail all of the subjects that should be covered and
by whom and gave them to the medical chief of staff. He turned
them over to the medical education director and as far as I know
nothing has happened.
13. Prenatal Clinics. A real effective prenatal clinic does not exist
at Keams Canyon Hospital. Without a prenatal clinic, the infant
mortality and morbidity rates rise. This is exactly what is
happening at Keams. There is no real effort being made to identify
the high risk mother and baby. At a hospital that does not have the
facility for doing a section, I think it is doubly important to recognize
these mothers and babies early and arrange for their transportation
to Phoenix.
I suggested that it might be wise to have help from voluntary
obstetricians. The Executive Secretary of the American Association
of OB and Gyn, in a letter which he wrote to Glenn Randolph,
agreed to send a board certified OB man to Keams, a different one
every month for a whole year (if needed). The hospital would just
pay for the traveling expenses and provide a house. I was
personally aware that the OB Executive Secretary in Chicago was
anxious to carry through this program. Either Mr. Randolph or
the medical staff disapproved it. Mr. Randolph at first seemed to
be anxious to have this take place until he talked to the staff. I
have a feeling that the staff, who are oriented to a family type of
practice, resented having a board certified man around to tell them
how to deliver babies.
14. Obstetrics. The quality of the obstetric practice at Keams Canyon
Hospital is sub-standard. It reminded me of the obstetrics that
I saw 30 or 40 years ago when every Tom, Dick and Harry and an
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
September
1976
Page -5-
Charles MacCammon, M.D., Director
M.D. would delivery babies. Two of the medical officers,
when they came in July 1976, had never delivered a single
baby. The others had variable training from a few babies
that they delivered to a year in a general hospital. As an
illustration, babies a few days before delivery, the mother's
chart would be labeled a vertex delivery and at the time of
delivery, it was actually a breech delivery. There was no
monitoring during labor. There was no way to tell if the
baby was in distress. Meconium stained babies were much too
common. While most of these babies lived, many of them
will be retarded. During the course of the year, we saw many
of these babies back in the outpatient with seizures. I think
that this is an area that should no longer be tolerated. Much of
the progress in medicine, during the past 5 to 10 years has been
in the field of neonatal care and delivery. Babies have a
right to be well born and they are not being well born at Keams
Hospital. Just from an economic standpoint, it would be
profitable to have an obstetrician supervise the OB department.
One baby that I saw delivered at Keams and in distress at the
time of birth had an Apgar of one or two at 1 minute and only
3 at 5 minutes, was sent directly to Good Samitaritan Hospital
at Phoenix. The baby was there for several weeks and then
was transferred to the Phoenix Indian Hospital. This baby alone
in the neonatal period, ran up a bill of about twelve thousand
dollars according to Glenn. I think the prevention of one or two
of these would justify the expense of a good obstetrician. I
don't think you can justify assigning 7 medical officers,
two of which had no obstetrical experience and expect them to
accomplish a good job. It isn't fair to the doctor. It certainly
isn't fair to the baby. It isn't fair to the tribe. I think this must
be corrected.
15. Newborn Records. The present records are inadequate. I
suggested more complete physical exam forms of the check off
type which would yield much information. This was rejected by
the medical officers. One of the doctors said, "In no way would
he take time to fill out a record of this type. " Examinations
to identify the small for date baby, was also rejected, they simply
wouldn't consider it. They wouldn't do the simple shake test
on the gastric contents to identify the baby that is prone to develop
hyaline membrane disease and could be sent to Phoenix earlier
before it developed.
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
September
1976
Page -6-
Charles MacCammon, M.D., Director
16. Immunizations Records. The present system is inadequate.
Immunizations often didn't get recorded, either at the clinic,
on the clinic sheet or on the mother's card. The cards get
lost, patients change clinics'. The type of material used if not
recorded nor the lot number or manufacturer. All of these
things are important when trouble is found in the child. I
think there is a need for either a manual or a computer type
central recording system. I talked to people that are knowledgeable
in computer techniques and they tell me this could easily done
without too much expense and perhaps along with their social
security data.
17. Reporting of Contagious Diseases. Reporting of contagious
diseases was being done only rarely at Keams Hospital. After
I started reporting all diseases required by Arizona law, some
of the doctors did start to report some cases, but it certainly
was in no way a complete record. With my reporting contagious
diseases (and I was seeing most of the children at the clinic)
there was an increase in the number of cases of salmonella,
shigellosis and measles. This seemed to upset Dr. Carlisle at
Phoenix as he felt that we didn't know how to diagnose these
diseases. This is not true. Actually, Dr. Carlisle was quite
well informed as to lack of disease reporting at Keams, but he did
nothing about it.
18. Problem of Gastroenteritis. Year after year, salmonella and
shigellosis ravages the Hopis as well as the Navajos. Little
has been done to prevent this disease. A great deal is talked
about treatment and it is true that we have saved a lot of them
by proper intravenous fluid regulation, but it seemed to me
something sho uld be done in the field of prevention. As an
illustration, there was poor sanitation on the Hopi Reservation.
The out houses were on the edge of the Mesa and the excreta fell
down the side of the cliff. Flies were very bad, there was no
screening, no water except what was carried up and very little
hand washing. It is no wonder we had trouble and I think we know
the answer to control these diseases. It is a question of proper
education and proper facilities.
I understand that a cadre from disease control in Georgia is going
to try and study this problem this summer. When you criticize
what is being done, you become unpopular with the director and
the medical staff and you are also unpopular with the tribe. They
don't want to know how bad their medical problems are in some
areas.
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
September
1976
Page -7-
Charles MacCammon, M.D., Director
19. Lack of Water. Without water the Indian falls prey to many
diseases. The list is a long one. How can you teach sanitation
without water to wash your hands. I don't think we are doing
a very good job of supplying water to the Indians. We go on year
after year and let them have these problems. Yet on the radio,
some weeks ago I heard our Secretary of State on a trip to
Africa, promise some of the countries there, that the USA would
"move the desert back. " I have heard some of the Indians make
the comment, "why can't the federal government roll some of
our deserts back so that we can have some water. " This could
be done. I think we have neglected this area much too long.
20. The Indian Schools and Educational System. During the past year,
I reached the conclusion that most of the education efforts were
poor. From a pediatrician's viewpoint, it is not good to take a
child out of the home to go to kindergarten or first grade and keep
him in a boarding home, cut off all ties with his family for so much
of the year. Children certainly don't learn well and I think the
whole system ought to be re-evaluated by people that are knowledgeable
in this area. We have done a poor job.
21. Social Service Department. I think this department was excellent.
The personnel were knowledgeable, had good programs in all
areas and responded quickly to an emergency situation.
22. Mental Health. I felt this department was excellent, they have
devised alcohol and drug programs. Mr. Percy Povetea, himself
a Hopi, seemed to be well trained. He understood the problems
of both the Hopi and the Navajo and was respected by both tribes.
23. Dental Department. This department is excellent. I find that the
old people were well taken care of. I felt the children however,
needed stronger educational programs, as there was a lot of dental
caries that I think could have been prevented. The amount of
fluoride in the water at Keams seemed to be adequate from all the
information I could get, but I think that there were areas on the
reservation that fluoride with their vitamin drops was indicated.
24. Ophthalmalogy Department. The control of trachoma was
excellent. There was no trouble in getting refractions, I thought
they had a very good program.
MARK W. DICK, M.D.
308 E. Ohio St.
Gunnison, Colorado 81230
September
1976
Page -8-
Charles MacCammon, M.D., Director
25. When I am asked what were my greatest disappointments
during the year I spentat Keams Canon, I would have to say:
A. Rejection by the staff, the chief of staff and the hospital
administrator of the plan, to have
1. A well trained obstetrician come, a different one each
month for a year, to set up an adequate neonatal clinic,
instruct in the proper techniques for monitoring and
identifying the high risk baby and mother during labor.
2. The evaluation of the newborn baby with physical and neurological
examination to identify the small for dates baby.
B. Rejection by the director of nursing, to have any type of
in-service training. I don't think this can be justified.
C. Failure to establish good neonatal, delivery and newborn
records.
D. Failure to establish expectant parent classes.
E. Discovering that doctors, nurses, administrators, etc., when
confronted with a problem, have not yet learned to ask them-
selves "What is best for the patient? and be guided by that
answer.
Sincerely,
MARCH Mark W. Dick, M.D.
TRADITIONAL INDIAN ALLIANCE
of GREATER TUCSON INC.
P.O. BOX 26852
TUCSON, ARIZONA 85726
(602) 882-0555
(602) 791-9913
October 25, 1976
Mr. Brad Patterson
White House
Washington D.C. 20500
TIA
Dear Mr. Patterson:
JEAN CHAUDHURI
DIRECTOR
It is exciting to know that you can do some-
thing to help us keep going in the project we
started, and have maintained for a year and one-half
now.
During the NCAI we met with you personally and
handed you the summary of our program, hoping you
would look at it and find some to facilitate funding
for our Urban Indian Clinic.
way
We certainly need the funds now to continue
operating in the capacity we had been and certainly
even exceed the volunteer work we had done. We
desperately need administrative money.
Enclosed are some copies of our program and
summary of what we have accomplished.
Looking forward to your response soon.
Sincerely yours,
Esperausa Esperanza A. Mopera
Health Co-ordinator
Have applical
to
1H5 these place.
Tulked 10/58; Swd will may treats
Cocileat
Ms. E. Mopara, RN
Traditional Indian Alliance of Greater
Tucson, Inc.
P.O. Box 26753
Tucson, Arizona 85726
Dear Ms. Mopera:
Mr. Brad Patterson of the White House staff has asked me to reply
to your letter of November 1. The newsletter and other materials
you enclosed concerning activities of the Traditional Indian
Alliance of Greater Tucson, Inc. (T.I.A.) are very much appreciated.
In the matte of funding, the situation remains the same as we
discussed. NO additional funds for urban health programs were
allocated in FY 1977. We are now looking toward the possibility
of funding to implement Title V of the Health Care Improvement Act.
This funding would, under the legislation, not be available until
FY 1978.
You will be apprised of developments in this program as they
progress.
Sincerely yours,
FORD LIBRARY & BERALD
Emery A. Johnson
Assistant Surgeon General
Director, Indian Health Service
ce: Mr. Brad Patterson
OTA7IHS
DCID/IHS
HSA/IH/DCID
DDonaldson:bkr 11/30/76
TRADITIONAL INDIAN ALLIANCE
of GREATER TUCSON INC.
P.O. BOX 26852
TUCSON, ARIZONA 85726
(602) 882-0555
(602) 791-9913
November 1, 1976
Mr. Brad Patterson
White House, Washington
D. C. 20500
Dear Mr. Brad Patterson:
TIA
Thank you much for calling us. We were
all excited to hear from someone in the White
NN CHAUDHURI
House.
DIRECTOR
According to Traditional Indian Alliance
director, Jean Chaudhuri, we never received a
letter explaining that we could not be funded.
It was through telephone conversation that we
got the no answer.
Enclosed are the materials we would like
you to look at.
Copies of some literature had been sent
to Dr. De Montegny and Dr. Johnson. Also to
Wes Halsey.
Sincerely yours,
E. Mopera, R. N.
FORD LIDRARY 4
Enclosure
Mrs. Dorothy Matthews
2205 S. 21st Avenue
Birmingham, Alabama 35223
Dear Mrs. Matthews:
Your letter to President Ford concerning the sterilization of Indians has
been forwarded to us for reply.
The account which recently appeared in the news media resulted from
misinterpretations of a Government Accounting Office Report regarding
the Indian Mealth Service. There are no suggestions in the report
that the IHS has undertaken any activities to sterilize Indians
without their knowledge and consent.
The three-thousand four-hundred (3,400) figure referred to in the
newspaper article were surgical procedures performed over a four
year period which could have resulted in sterilization. Many
operations are performed for medical reasons unrelated to the intent
to sterilize but result in sterilization. For example, if a woman
had cancer of the uterus, and received an operation for same, she
would be identified as having been sterilized.
The number (3,400) is overstated and may give an erroneous impression.
For example, one woman could have two procedures which result in
sterilization such as a tubal ligation for sterilization purposes and
a subsequent hysterectomy because of a specific uterine medical
condition. A GAO spokesman states, and IMS agrees, that reliable
national statistics are not available to allow valid and reliable
comparison of sterilization rates. However, the best data available
indicate rates of procedures resulting in sterilization among Indians
are comparable to or somewhat lower than the rates of such procedures
performed for the general public.
It is not the policy of the IHS to sterilize Indians as a means of
controlling population size. Às part of a comprehensive health care
program the IHS provides, within the resources available, a full range
page 2 - Mrs. Derothy Matthews
of family planning services including sterilization. Such sterilizations
are provided only with the full consent of the Indian persons, 21 years
of age or older, requesting this method of family planning.
Your concern for the welfare of the Indian people is appreciated.
Sincerely yours,
Enery A. Johnson, M.D.
Assistant Surgeon General
Director, Indian Health Service
cc:
Brad Patterson, The White House
FORD LIBRARY is GERALD
use
Concern re: Indians and
evil
nov 29,1976
Pres gerold Ford
White House
Wash. D.C. 20500
BP
Dear President Ford
know you are terribly busy, but the
emblosed great horrified me, and I am
having you will brow who in contor
to look into this shomeful thing.
How are we ony better than the
german nazis in their persecution
and destruction 7 the jews?
Clease ty to find the time to look
into this showsful matter - and wire
christians? These, tw, are americans
thank you
Sincerely
Has Dorothy monther
2205-21 are South
Birmingham, also 35223
The Birminghon 11/25/76 Pnews
Thousands of Indians sterilized
WASHINGTON (AP,
to sterilization nor did
Abourezk said 30 per
were performed outside
- A federal study has
they contain a written no-
cent of the sterilizations
IHS facilities on a con-
confirmed that the Indian
tice of such rights.
covered by the GAO study
tract basis.
Health Service has steri-
lized thousands of Indian
women without obtaining
the proper consent from
them.
The General Account-
ing Office said Monday
that a survey of Indians in
just four areas found that
3,400 were sterilized dur-
ing a four-year period.
The total among all
American Indians was
probably much higher,
the GAO said.
The files on the opera-
tions indicate the women
often were not told the
sterilization operation
was optional, not manda-
tory.
The GAO report cover-
ed four of the 12 IHS serv-
ices areas: Albuquerque,
N.M; Phoenix, Ariz.;
Aberdeen, S.D., and Okla-
homa City, Okla. Sen.
James Abourezk. D-S.D.,
asked for the survey in re-
sponse to complaints
about the operations.
The GAO said the steri-
lization consent forms
found in the files of the
health service "were
generally not in com-
pliance with the IHS regu-
lations."
The most widely used
consent forms gave no in-
dication whether the pa-
tient had been informed
of her right not to consent
ANALYSIS OF
GAO REPORT/PRESS REPORTS ON
INDIAN STERILIZATIONS AND RESEARCH
The information contained in this report is in response to recent publicity
regarding the Government Accounting Office report on research and sterilization
among the Indian people. The information is intended to clarify any misunder-
standings or misinterpretations which may have resulted from press reports on
the subject.
The recommendations of the GAO are generally acceptable to the Indian Health
Service and many of these recommendations have currently been implemented by
the Service. The GAO recommendations regarding sterilization are as follows:
"We recommend that the Secretary of HEW direct the Indian Health
Service to
--expedite its efforts to have a standard consent form which
provides for full disclosure of the information required
by the regulations (enc. IV shows a form that could serve
as a guide to counsel patients and which details all the
basic elements of informed consent),
--provide training to their physicians and administrators
so that they fully understand the requirements concerning
(a) sterilization of persons under 21 and persons who are
mentally incompetent and (b) obtaining informed consent,
-include in the contracts with non-Indian Health Service
physicians and facilities, provisions to insure that
contractors comply with HEW sterilization regulations,
FORD
-continue to monitor compliance with the moratorium on
is
sterilization of persons under 21 years of age, and
--develop monitoring procedures to assure compliance with
GERALD
LIBRARY
the regulations by contract physicians and facilities."
IHS action to date includes:
At a 11/18/76 session between the Director, IHS; Area Maternal
and Child Health Consultants and others, it was agreed that an
approved PHS developed narrative "Booklet" consent will be used
on an interim basis in addition to the approved HSA-83 form
which has been used since March 1975. Efforts will continue to
develop an IHS sterilization consent form which is sensitive and
responsive to unique Indian needs. The Area MCH Consultants
promised enhanced efforts to provide training to administrators
and physicians regarding the HEW requirements for obtaining
informed consent and the moratorium on sterilization of persons
page 2
under 21 years or mentally incompetent. Activities to assure
that all contracts with non-IHS health service providers
include provisions to stipulate compliance with HEW sterilization
regulations and additional mechanisms to monitor compliance with
such provisions will be conducted. Data regarding current
activities as concerns contract provisions and monitoring was
requested from IHS Areas on 11/26/76. Most IHS Areas have
responded and initial reports indicate much current activities
in this respect although definite improvements are necessary.
IHS will continue its strict monitoring of all sterilization of
persons under 21 years and mentally incompetent and will investigate
indepth any potential violations.
We have observed nothing in the report suggesting that the IHS has undertaken
any activities to improperly sterilize Indian men and women. A GAO spokesman
stated, and the IHS agrees, that reliable national statistics are not
available to allow valid and reliable comparison of sterilization rates.
However, the best data available indicates rates of procedures resulting in
sterilization among Indians are quite similar to the rates of such procedures
performed for the general public, i.e.:
Bilateral Tubal Ligations and Hysterectomies Rates per 100,000
Among the Female Population, 15-44 Years of Age, for Women
Discharged From IHS and U.S. Short-Stay Hospitals
Tubal
Total
Ligations
Hysterectomies
U.S. short-stay
hospital
1,606.8
698.3
908.6
IHS Total
1,103.8
700.1
403.7
Four IHS Areas
Studied 2/
1,154.5
720.7
433.8
GERALD FORD CLARANT
1/ CY 1974 - NCHS Unpublished Data
2/ FY 1975 - IHS data
We have found the GAO report basically fair, constructive and responsive to
the issues, however, we have observed the following inaccuracies and mis-
interpretations by some media regarding what the report allegedly states.
Allegation: "Indian women are being sterilized as a birth-control
procedure without their consent or knowledge." "
Facts:
The IHS can find no basis at all for this statement.
The GAO report makes no such statement.
page 3
Allegation: "3,001 sterilizations were performed by the IHS on
women of child-bearing age between 15 and 44."
Facts:
This is stated incorrectly. Three-thousand and one
(3,001) procedures were performed during a four-year
period which could have resulted in sterilization.
Many operations are performed for medical reasons,
unrelated to the intent to sterilize but result in
sterilization. For example, if a woman had cancer.
of the uterus, and reçeived an operation for the
same, she would be identified as having been
sterilized.
The number is overstated, and may give an erroneous
impression. For example, one woman could have two
procedures which result in sterilization, such as a
tubal ligation for sterilization purposes and a
subsequent hysterectomy for uterine prolapse.
Allegation: "Thirty-six (36) women under the age of 21 were
sterilized during this (3 year) period despite a
court-ordered moratorium on sterilizing persons
under the age of 21."
Facts:
All but 13 of the 36 procedures were performed prior
to the date of the issuance of specific Departmental
regulation including the moratorium on sterilizing
persons under 21 years of age or mentally incompetent.
These regulations were promulgated in April 1974.
Furthermore, GAO notes that 7 of the 13 procedures
performed after this date were "performed for
legitimate serious medical reason."
Allegation: "The report indicated that there may not have been
informed consent by the patients as required by law
and that the consent forms in the IHS medical files
were generally not in compliance with IHS regulations.'
Facts:
The GAO report states, "We found no evidence of IHS
sterilizing Indians without a patient consent form
on file, although we did find several weaknesses in
complying with DHEW's sterilization regulations."
Allegation: "Thousands of American Indians sterilized are used as
medical guinea pigs in violation of Federal safeguards."
Facts:
There is nothing in the GAO report to substantiate this
statement.
page 4
Allegation: "Thirty-six sterilizations also violated the provisions
of a 1974 Court Order which prohibited the operations
except under certain specific conditions.'
Facts:
The Court Order stated that one cannot sterilize a
minor. The Court Order did not apply to the IHS,
and therefore, technically whatever was done was
not in violation of the Court Order. In addition,
all of the 36 procedures were performed on individuals
over 18. The age of consent for medical treatment in
most states is 18 years or less.
Violations occurred in regard to the Departmental
regulations promulgated in April 1974 which imposed
on IHS an absolute prohibition on sterilization of
women 21 years of age or younger. Only 13 of the
36 procedures were performed after this date.
Allegation: "Patients were not adequately informed of their rights."
Facts:
Nowhere in the GAO Report is this statement made.
Allegation: "Fifty-six medical experiment projects used Indians as
subjects."
Facts:
The GAO Report stated, "We reviewed 56 proposals for
research projects and of the 36 projects entailing a
service or treatment to Indians, we concluded that
none appeared to expose participants to serious risks."
"Our review of patient consent forms at selected projects
did not indicate any significant inadequacies. "
The GAO Report points out that IHS policy promotes research
projects and activities provided (1) the projects are
directed toward improving the health of Indians and that
(2) projects have the approval of, and are understood by
the tribal groups involved. The report briefly discusses
research projects carried out within the IHS and cites
significant benefits achieved through the projects in
prevention and treatment of illness among the Indian
people.
Indian Health Service
December 8, 1976