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ETHETE - Alone or in combination, alcohol, methamphetamine and car keys are deadly and expensive for the residents of the Wind River Indian Reservation.

The tribal health care system is in crisis, say health care and tribal leaders, citing an average life expectancy of 49 years for reservation residents, due to alcohol and drug abuse, drunk driving and non-use of seat belts. The U.S. national average life expectancy is 74 years.

Of the 79 deaths on the reservation last year, 19 - or 25 percent - were attributed to alcoholic cirrhosis of the liver, while close to half of the deaths were due to alcohol-related car crashes and drug-related homicides.

Reservation health care programs, law enforcement, courts and social services are overwhelmed as they deal with the deaths, injuries, illnesses and disabilities of these self-destructive behaviors.

"These deaths from alcoholic liver failure, drug- and alcohol-related illness, car crashes and violence don't have to happen," said Dr. Bill Calder, medical officer for the Indian Health Services program.

The situation is so dire that the reservation's Public Health Service can no longer fund anything other than emergency care, said Cathy Keene, local director for Indian Health Services, in a report this week to the Shoshone and Arapaho Joint Business Council.

That means no referral services for diagnosis or treatment of conditions that are not immediately life- or limb-threatening within 72 hours of onset, she said.

Chronic, life-threatening conditions such as cancer, heart disease and disabling orthopedic conditions cannot be funded for the rest of this fiscal year, Keene said.

Indian Health Services is a federal agency that provides health care for tribal members.

Keene said the social, economic, medical and legal costs of dealing with self-destructive behaviors runs into the hundreds of thousands of dollars on the Wind River reservation. She welcomed the announced intent of the joint council to pass a law on Friday that would require seat belts and child restraints for reservation drivers.

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The Shoshone and Arapaho business councils passed a resolution on Tuesday to target the following priorities in community health:

* Alcohol and drug abuse: The tribes will broaden access to chemical dependency treatment opportunities; revise tribal law codes; increase sobriety patrols and prosecution of drug- and alcohol-related offenses; and increase community education about alcohol and drug abuse.

* Diabetes: Expand outreach services between Indian Health Services and community groups, as well as improve community awareness of how diet and exercise can prevent and help control diabetes.

* Cancer: Tribal leaders want to improve community awareness and access to cancer screening, limit tobacco use for traditional ceremonies and support the Ethete Cancer Center.

Tribal leaders want to enlist schools, public health wellness projects, tribal elders and traditional healing into all of the above efforts.

In a recent radio address to reservation residents, Calder said the four priorities emerged from a January conference. Keene said a Community Wellness Board will be appointed to provide community-based oversight and monitoring of community wellness programs, and to secure the financial, human and material resources needed to support health care services.

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