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General Health

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#400. The Impact of Aids in the Native American Community (Revised)

The report begins with a background on AIDS and methods of transduction, namely sexual contact with an infected person, contact with infected blood or plasma, and in utero infection. It discusses health care issues for those on rural reservations, such as scarcity of medical services, expensive travel requirements, and a lack of education, awareness, and confidentiality within a small community. Optimistically, the author admits that small communities are easier to educate as a whole if an effort is made. Unfortunately, behaviors that increase the risk of contracting HIV, for example early sexual activity, STDs, alcoholism, and drug use, are prominent in Native American populations. Often, Native Americans have a weaker immune system due to poor diet, economics, diabetes, or alcohol. Weakened immune systems lead to a faster progression to AIDS from HIV. The report discusses interesting aspects of culture-specific incidences of transmission, such as through piercings made during religious ceremonies, and the need for access to sterilized equipment. It takes on thorny topics such as injection drug use and needle exchange programs and their ethical implications, as well as the issue of maintaining a woman’s reproductive rights despite the presence of HIV and the potential for in utero transduction of the virus. Because homosexual men make up 67% of the HIV/AIDS infected Native Americans, the report questions why there are so few educational programs directly targeting this cross-section of the population. Statistics comparing the incidence of HIV/AIDS in Native American vs. Caucasian populations and graphs of several specific STDs by race and sex are included. Because a direct relationship between alcohol and HIV/STDs has been associated, the study suggests that controlling STDs would contribute to HIV control as well. The final discussion concerns HIV in prison populations and its implication in relation to the high percentages of Native Americans in prison. A conclusion explores the role of IHS amidst the epidemic.

#402. The Positive Impact of Community Based Self-Help Education among the Native American Diabetic Population of the Yankton Sioux Reservation

It has been estimated that 70% of the Native American population over age 40 is diabetic and that one new patient is diagnosed every week. Related health problems include a poor diet that consists largely of high-cholesterol commodity foods, obesity, and alcohol abuse. Treatment for diabetes is expensive, not to mention time-consuming, and secondary complications such as arteriosclerosis, heart failure, stroke, gangrene, and kidney dysfunction, are common. Diabetes education would help the Native American population manage their own nutrition and basic needs, effectively reducing the cost of treatment as well as the burden on health care providers. This program teaches participants about self-health care, diet, exercise, hygiene, and insulin, and includes individual consultations with physicians and dieticians. The report reviews the effectiveness of the educational program at the Native American Women's Health Education Resource Center in Lake Andes by surveying participants’ general health, improvements, and knowledge. The program was started in 1989, and the participants are taught how to use a glucometer, how to maintain charts, weights, and manage health through exercise and nutrition. They are instructed in foot and eye care, and are given a glucometer and pair of walking shoes to keep. The initial response to the program was enthusiastic and participation high. The report studied effects of the class on three separate groups: men, women over 40 yrs., and women under 40 yrs. It used blood glucose level as indicator of progress and mapped the information in tables and graphs, drawing comparisons by sex and age. Recommendations include coordinating different education programs and networking between tribally based programs as an effort to pool resources.

#000. Current Status of the Wagner Indian Health Service Health Care Facility and the Effects of Indian Health Service Inpatient Service Closure

On November 16, 1992, IHS discontinued their inpatient services, reflecting the government’s failure to honor the 1975 Indian Self Determination and Education Assistant Act by disallowing the tribe to choose the direction of IHS services. IHS claims tribal approval based on the questionable signature of Tribal Chairman Alvin Zephier, and it continues to ignore the countless resolutions passed by the Yankton Sioux Tribe pleading that inpatient services be continued. The report explains funding sources for the Wagner IHS unit; the closure of the inpatient ward was meant to increase revenue but has resulted in severe deficits, which in turn have caused the dismissal of 75% of the day-staff as well as a reduction of the 24hr. emergency room’s staff. If patients require hospitalization for more than 15 hrs, they are referred to Wagner Community Memorial Hospital, which has not met any of the stipulations put forth prior by the Program Justification Document in a letter justifying the initial services closure. However, because the Community Memorial Hospital refuses to treat “alcohol-related illnesses,” over 33% of IHS patients have to travel to Yankton, about an hour and a half away, to receive medical attention. Because IHS has extremely limited hours, Community Memorial Hospital faces a massive influx of patients after hours, and, as many cannot pay for treatment, has to absorb the costs. Understandably, they are not pleased either. The report discusses why IHS simply does not reinstitute inpatient services and how it has become ever more difficult for the facility to attract competent physicians. It includes extensive attachments and copies of the Yankton Sioux Tribe’s Resolutions in the appendix.

#409. Health Survey for the Yankton Sioux Reservation

This survey canvassed eighty-five homes, of which, it found, more than 60% were headed by females. Information was gathered through a questionnaire and interview, a process that lasted from 1-3 hours, and is presented in graphs and tables. Participants were questioned about their satisfaction with hospital services received and the ready availability of these services. The study graphed how many participants actively partook in preventative medical exams, for example pap smears, breast exams, and proctologic exams, and mapped smokers by age and sex. It gathered information on dietary habits, such as the number of meals per day, snack, types of food, and dieting history. Also diagrammed are frequencies of dental checkups, exercise, and blood glucose levels. Although figures about STDs may be a bit skewed due to the personal nature of the question, participants were questioned about their STD history and pregnancy prevention methods, and their reasons for not using condoms were recorded. Charts graph breast-feeding vs. bottle-feeding practices. Other data incorporated into the report concern community knowledge of radon gas. During interviews, the conductor questioned participants on active testing of levels of radon gas in homes and the frequency with which they used their basements. The report concludes with a discussion of its findings and is dotted with recommendations for improving general health and awareness.

#413. Report on and Analysis of the Yankton Sioux Reservation Community Health Fair 1993-1994.

The report initially discusses the background and evolution of local health fairs and goes on to describe the levels of community participation and types of information and tests offered at the fairs. It explains the hardships encountered by rural inhabitants; for example, over 34% use hospitals that are more than 100 miles away and 12% are not affiliated with a hospital at all. High turnover rates for physicians at IHS ensure inconsistent treatment and the need for educated self-monitoring of one’s health is apparent. The information gathered at the fairs on the general health of Native American participants, such as cholesterol levels, diabetes, blood glucose levels, and blood pressure, is graphed and explained. The report concludes by discussing the benefits of health fairs in aiding the Yankton Sioux community with maintenance of general health.

#411. Revictimizing the Battered: An Investigation of the Charles-Mix County Criminal Justice System's Management of Domestic Violence Cases

This report was published in the face of severe inconsistencies on the part of city authorities in treating cases of domestic violence. It begins by defining domestic violence and introduces cycles of violence, dynamics between the batterer and victim, and how violent actions are reinforced in today’s society; it attempts to resolve the ever-present question of why a woman simply does not walk away from the situation. The prevalence of domestic violence cases in Charles Mix County, 95% of which featured a male batterer, is analyzed. It is frightening to note the casualness with which the police treat domestic violence crimes as opposed to crimes committed by strangers. In Charles Mix County, as many as 25% of the criminals were undercharged despite severe injuries to the victim, an action that sends a message of tolerance to offenders. Police failure to gather crucial evidence and take photographs of visible injuries is apparent and the inclusion of irrelevant, even inappropriate, information in the initial police reports create a ready bias for the next examiner of the case. The report discusses the abundance of releases granted to batterers based on personal recognizance without regard to the danger that this leniency could place upon the victim. Native American women, in particular, are often caught in “a bureaucratic net;" while they reside on tribal land, the state police have no jurisdiction to enforce a restriction order, and if the charge was not filed through the Bureau of Indian Affairs courts, BIA police have no right to insist that the order be followed. In the cases where the victim herself requests dismissal of the case or refuses to testify out of fear of retaliation or financial burdens, it is the responsibility of the police to carry out a proper investigation and prevent future attacks. Often, in fact, the woman is ordered to attend counseling sessions more frequently than the male offender, revealing a sexist attitude towards gender roles in a family. The report is well-written, comprehensive, and includes recommendations for change in the conclusion.


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