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On Native American reservation, tradition and medicine face off.
By Aaron Goode |
This September, a San Francisco pediatrician named Nancy Iverson brought two health educators to the Pine Ridge reservation for Lakota Sioux in western South Dakota and put the residents through a grueling weeklong regimen of seminars on healthy eating and diabetes prevention. Their reward: they got to swim from the North End Rowing Club in San Francisco's Marina District to Alcatraz through 1.2 miles of choppy, 56 degree water. Iverson, a member of the club, had calculated that the media might be attracted by the unusual nature of the event, and could be enlisted to provide some much-needed publicity to her health-education nonprofit PATHSTAR (Preservation of Authentic Healings and Tradition), which she had founded in 1999 to promote holistic solutions to adult-onset diabetes and other preventable illnesses on the Pine Ridge Indian Reservation in South Dakota.
She was right. The event was covered by the San Francisco Chronicle and even appeared on the front-page of the California section of the LA Times, a major newspaper for a city as far from San Francisco as Washington DC is from Boston. The media coverage was gratifying, but not nearly as gratifying as finally putting the "Alcatraz Swim" T-shirts that Iverson had been storing in her garage for two years to use.
PATHSTAR had come a long way since its humble beginnings. When Iverson had created the organization, she and her husband were its Executive Director and Treasurer, respectively, and they served on the Executive Board with another San Francisco doctor. When Iverson and her husband Tom separated in 2001, Iverson was left running the organization by herself. The other doctor on the board was verbally and financially supportive, but too busy to help much with the day-to-day administration Ð Iverson describes her recurring mantra as "I'll be less busy next month." Iverson became involved in messy divorce proceedings, and began suffering from severe back problems, which eventually forced her to leave work.
Iverson's support system failed at a bad timeÑ in late 2002, when PATHSTAR's 401(c)3 designation came up for review after a 3-year probationary period, there were hundreds of pages of financial statements and tax documents to sift through and organize. Meanwhile, the California Franchise Tax Board had sent three notices saying the organization was late with its biannual tax filing, and demanding payment of late fees. Iverson had been planning an exchange program with a group of a dozen or so kids from the reservation which would culminate in an Alcatraz swim. She had originally planned the exchange for 2001, but two weeks before the kids were supposed to arrive, 9/11 struck. The swim had to be postponed a whole year not so much because of the kids' scheduling as because of the tides. With the administrative problems and Iverson's disability, the exchange had to be shelved again in 2002.
In 2003, Iverson's divorce was mercifully completed, and her back pain had abated enough that she could work things out with California Tax Board (they had mixed up the dates), and found a nonprofit advisory group to help organize PATHSTAR's books pro bono, so that the organization could retain its 401c3 status.
Iverson had righted the ship. Personal experience told me how important it was to keep PATHStar alive. In 2001, before all the problems began, Iverson, her then-husband Tom, and I collaborated on a diabetes education project at Pine Ridge. Invited by the tribe, we created a 'healthy kitchen' to cook for the more than 200 visitors who came to watch the traditional sundance at the homestead of Pete Catches, son of a famous shaman and one of the people who helped bring back the sundance 25 years ago after it was banned by the federal government in the 1890s. Throughout the weeklong ceremony, which takes place every year at the end of July, the sundancers fast for four days, while their friends and family feast on communal meals. Fresh buffalo, slaughtered at the beginning of the week, is traditionally the culinary centerpiece. In the healthy kitchen we churned out one improvised dish after another: buffalo chili, buffalo stew, and buffalo stir-fry, made with lean meat and all the vegetables we could find in the produce-starved Sioux Nation supermarket, the only grocery outlet "on the rez." Trying to walk a fine line between not being critical of 'traditional' dishes like fry-bread (dough fried in prodigious quantities of 'traditional' polyunsaturated vegetable oils), we tried to keep anxieties about lifestyle change Ð and about white paternalism Ð at bay, while still promoting healthier alternatives.
In the face of (mostly) tacit accusations of paternalism and busybodyness, we did everything possible to encourage healthy eating, exercise, abstinence from nicotine, alcohol, and other drugs. At the end of the week, fatigued from the difficulties of trying to change fixed ways, we met with Harvey Iron-Boy, a youth worker and diabetes educator on the reservation. He advised us not to be discouraged by resentment or ingratitude Ð whenever he tried to educate about healthier lifestyles, he experienced mixed reactions, and he was a full-blooded Sioux who had lived on the rez his whole life.
It was the first positive reinforcement we had encountered all week, but three years later I realize that for Iverson it was unnecessary. Iverson can't be discouraged. She has been doing public health education at Pine Ridge since she was a resident there after medical school two decades ago. She came to Pine Ridge with Tom even after their divorce had become antagonistic; she had traveled to Rapid City in the middle of December for a conference on Indian hypertension and work-related stress; she had been yelled at, spat on, and talked about behind her back by members of the American Indian Movement, sensitive to signs of 'white man's burden'; she had repeatedly fought the IHS and the tribal administration, both of whom want all programs to go through them; she had stayed through all of it, and resolved to keep coming back.
If the obstacles to finding solutions at Pine Ridge are immense, so are the problems. The state of public health on the nation's Indian reservations is in perpetual crisis. Ten years ago fetal alcohol syndrome (FAS) threatened to create a whole generation of physically and mentally handicapped Indian children. The effort to fight the FAS epidemic, highlighted by half-Modoc author Michael Dorris in a poignant 1989 book called The Broken Cord, revitalized the Indian public health community. Educating pregnant women about the risks of drinking was difficult, but a vigorous campaign against FAS by the Indian Health Service and the nonprofit health-education community has largely neutralized the problem. FAS rates on Indian reservations have declined to 1960 levels.
But another epidemic has replaced FAS: adult onset diabetes, a preventable disease closely related to diet. According to the Oglala Community Education Resource Center, the Sioux went from having no incidence of diabetes in the 1950's to having diabetes incidence in 50% of the adult population by 2000. The disease is also affecting people at an earlier age -- adult onset diabetes is now seen in children on the reservation. Research suggests that the Sioux are genetically predisposed to both type-I and type-II diabetes Ð the pervasiveness of artificial and processed foods on the reservation (the main supermarket, Sioux Nation, stocks two aisles of soft drinks and no fresh produce) severely exacerbates the problem.
So does poverty. Indian reservations are often talked about as a kind of domestic third world. The Pine Ridge reservation, home to 38,000 Lakota Sioux, is the poorest of the poor. It encompasses the two poorest counties in the United States. Unemployment hovers around 75%. The life expectancy is below 55 years, about the same as Sudan. The majority of the unemployed barely support themselves on welfare payments Ð a few manage to augment their incomes by selling crafts to tourists. What about casinos? The closest major population center is Rapid City Ð which is less than half the size of New Haven and is two hours away, in good weather. Can they make money from mining? All the minerals are in the Black Hills, which was lopped off the original land concession to the Sioux and remanded to the federal government. The lack of economic opportunity makes any kind of health education an uphill battle.
Pine Ridge is a phenomenally difficult environment in which to make a difference. The success of Iverson's efforts focusing on youth education will only be seen in the future. But making a dent in Pine Ridge's monolithic public health problems requires an approach that engages young people. It also requires the creativity and expertise of people from outside the reservation Ð not only because they bring fresh perspectives but because working on the rez is mentally exhausting. Some people get burnt out when they realize there is never a shortage of problems, or of the need to address them; that the public health effort has peaks and valleys but no foreseeable end. Others, like Iverson, get invigorated.
Just because PATHSTAR made the newspapersÑ while so many other stories of public health heroes don'tÑ doesn't mean that there aren't hundreds of stories like Iverson's. Her great virtue may be persistence, but she is also lucky: she had a good idea for turning the spotlight, for one day, on the diabetes epidemic at Pine Ridge and a handful of people working to combat it. I wasn't surprised when the pictures of Richard Ironcloud and Armando Blackbear emerging from the frigid water of San Francisco Bay got uploaded onto various websites as an inspirational tidbit amidst a spate of gloomy 9/11 remembrances, but I could only hope that I wasn't the only person who understood what had gone into making those images possible.
While Iverson has plans to return to seeing patients, and continues to run various trauma support groups in San Francisco for victims of debilitating illness, she will continue building a network of associates in the health-education field by visiting the reservation, working with the IHS and tribal administration, and attending public health conferences. She is hoping to do another exchange in the future with kids from Pine Ridge. She has already made a list of friends willing to provide housing, and has talked to fellow members of the rowing club about pairing up with the kids to teach them how to navigate the bay's harsh currents and acclimatize to its cold temperatures. Iverson, who swims in the bay every morning, is hoping to get the kids to undertake the Alcatraz swim, because if they can do that, they can do anything. She knows from experience.
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