Native American Healthcare | On Call with the Prairie Doc | Jan 12, 2017



>> PROVIDING HEALTHCARE TO THE
ORIGINAL DAKOTANS; NATIVE
AMERICAN HEALTH. TONIGHT, "ON CALL WITH THE
PRAIRIE DOC." >> GOOD EVENING, AND WELCOME TO
"ON CALL WITH THE PRAIRIE DOC." TONIGHT OUR SHOW IS ONE WE
RECORDED IN RAPID CITY DURING
THE FALL OF 2016. WE WILL NOT BE ABLE TO TAKE
YOUR CALLS TONIGHT, BUT GET
READY FOR A FASCINATING STORY. THE MISSION OF THE NATIONAL
INDIAN HEALTH SERVICE IS TO
RAISE THE PHYSICAL, MENTAL, SOCIAL, AND SPIRITUAL HEALTH OF
AMERICAN INDIANS AND ALASKAN
NATIVES TO THE HIGHEST LEVEL AND TO ASSURE THAT
COMPREHENSIVE, CULTURALLY
ACCEPTABLE, PERSONAL AND PUBLIC
HEALTH SERVICES ARE AVAILABLE AND ACCESSIBLE TO
AMERICAN INDIANS AND ALASKAN
NATIVE PEOPLE. BUT ARE THEY FULFILLING THOSE
HOPES? TONIGHT WE WILL ADDRESS THIS
QUESTION, ISSUES ABOUT
DIABETES, ISSUES ABOUT
TELEMEDICINE, AND MORE. ABOUT A TON OF VERY IMPORTANT
ISSUES THAT WE'D LIKE TO TALK
ABOUT. JOINING US TONIGHT IS DR. DON
WARNE, M.D.; CHAIR OF THE
DEPARTMENT OF PUBLIC HEALTH, AT
NORTH DAKOTA STATE UNIVERSITY, FAMILY
PRACTITIONER; DIABETOLOGIST;
AND MASTER OF PUBLIC HEALTH. ALSO WITH US IS SANDRA
OGUNREMI, DIRECTOR, NATIVE
AMERICAN COLLABORATION. AT REGIONAL HEALTH WHO HAS A
DOCTORATE IN HEALTH
ADMINISTRATION. WELCOME, DON AN
SANDRA. SO IT'S A GREAT OPPORTUNITY FOR
PEOPLE TO LEARN ABOUT WHAT'S
GOING ON IN OUR STATE, AND
NORTH DAKOTA. DON, TELL US ABOUT YOUR JOURNEY. I MEAN, YOU KNOW, YOU'RE A
MASTER OF PUBLIC HEALTH. YOU'RE
— WHAT IS SPECIAL ABOUT A MASTER OF PUBLIC HEALTH
IN NORTH DAKOTA STATE
UNIVERSITY? >> WELL, ACTUALLY, AT NDSU WE
OFFER THE ONLY MASTER IN PUBLIC
HEALTH IN THE NATION WITH A SPECIALIZATION IN INDIAN
HEALTH. SO THAT'S WHAT — >> THE ONLY ONE IN THE COUNTRY? >> THE ONLY ONE IN THE NATION? >> REALLY? SO YOU'RE A
PHYSICIAN. FAMILY PHYSICIAN.
TELL US ABOUT THAT. >> I'M ORIGINALLY FROM COWLE,
SOUTH DAKOTA, SO NOT TOO FAR
FROM HERE IN RAPID CITY. AND WHEN I WAS IN GRADE SCHOOL,
MY FAMILY AND I MOVED TO
ARIZONA. BUT WE SPENT OUR SUMMERS COMING
BACK HERE TO SOUTH DAKOTA. SO GROWING UP I JUST ASSUMED
EVERY CHILD WENT TO SOUTH
DAKOTA FOR THE SUMMER. >> BUT THEY DON'T. [ Laughter ] >> BUT IN MY FAMILY, THAT'S
WHAT WE DID. BUT IT WAS A WONDERFUL
OPPORTUNITY BECAUSE I HAVE A
LOT OF UNCLES AND OTHER RELATIVES WHO ARE TRADITIONAL
HEALERS AND MEDICINE MEN. SO I WAS ABLE TO LEARN ABOUT
OUR WAYS OF MEDICINE FROM
CHILDHOOD. >> I MEAN, THAT'S FASCINATING.
I THINK THE REAL INDIAN
AMERICAN MEDICINE MAN STORY. >> YEAH, YEAH, AND ACTUALLY, MY
LAKOTA NAME IS — WHICH MEANS
MEDICINE MAN. SO I WAS ACTUALLY
NAMED AFTER MY GRANDFATHER. >> THAT WAS EASY FOR YOU TO
SAY. SAY THAT AGAIN. >> [ SPEAKING LAKOTA ] IT WAS
MY GRANDFATHER'S LAKOTA NAME AS
WELL. AND I WAS DOING WELL IN COLLEGE. BUT DURING THIS TIME I WAS KIND
OF HAVING A STRUGGLE TRYING TO
DETERMINE WHETHER OR NOT I
WANTED TO GO JUST PURELY THE TRADITIONAL CULTURALLY
BASED HEALING ARTS OR EVEN
CONSIDER GOING TO MEDICAL
SCHOOL. BUT I WAS DOING WELL IN SCHOOL,
SO I WAS BEING ENCOURAGED TO
BECOME A PRE-MED. AND I WAS WORRIED WHAT MY
UNCLES WOULD SAY ABOUT THAT. AS
OPPOSED TO THE CULT RATTILY
BASED SIDE. BUT ACTUALLY THE OPPOSITE
HAPPENED. THEY WERE VERY
ENCOURAGING. ONE OF MY UNCLES
TOLD ME, I THINK THIS IS A GOOD IDEA, BUT
IF YOU DO THIS, ALWAYS REMEMBER
WHERE YOU COME FROM. REMEMBER WHO YOU ARE AS A
LAKOTA PERSON AND HANG ONTO
THAT AS THE SOURCE OF STRENGTH
TO LEARN THEIR WAY OF MEDICINE. AND THE ONLY WAY THAT YOU'LL BE
TAKEN SERIOUSLY IN MODERN
MEDICINE IS TO GO TO THEIR BEST SCHOOLS
AND LEARN THEIR WAY OF MEDICINE. SO FOR THAT HE, THAT WAS VERY
INSPIRING. SO I WAS ABLE TO GO TO MEDICAL
SCHOOL AT STANFORD
UNIVERSITY,THEN BECAME A FAMILY
DOCTOR, AND AFTER SEVERAL YEARS WORKING AS A PRIMARY CARE
PHYSICIAN, WENT BACK TO GET MY
MASTER OF PUBLIC HEALTH APT
HARVARD UNIVERSITY. >> AND THEN YOU CAME BACK? >> YEAH. >> AND BECAUSE THEY GAVE YOU AN
OPPORTUNITY TO BE THE HEAD OF
THE PUBLIC HEALTH DEPARTMENT? >> WORKED IN A COUPLE OF AREAS
FIRST. SO I WAS ON FACULTY AT
ARIZONA STATE UNIVERSITY FOR A
WHILE. I ALSO WORKED FOR THE NATIONAL
INSTITUTES OF HEALTH DOING
DIABETES RESEARCH IN ARIZONA. AND THEN I WAS THE HEALTH
POLICY RESEARCH DIRECTOR FOR
INTERTRIBAL COUNCIL OF ARIZONA. BUT DURING THIS WHOLE TIME
FRAME, I HAD WANTED TO COME
BACK TO SOUTH DAKOTA. SO I WAS THE EXECUTIVE DIRECTOR
OF THE TRIBAL PLAINS HEALTH
BOARD. SO I WAS HERE FOR A FEW YEARS,
AND THEN IN 2011, BECAME THE
CHAIR OF THE DEPARTMENT OF
PUBLIC HEALTH AT NDSU. SO KIND OF WORKED IN A NUMBER
OF AREAS. >> NOW, THE — THE STATE OF
NORTH DAKOTA HAS A PUBLIC
HEALTH DEPARTMENT, AND THAT'S
NOT WHAT YOU ARE. YOU ARE A PROFESSOR, TEACHING
AT THE — OR A ASSISTANT
PROFESSOR OR WHATEVER THEY —
AT THE SCHOOL THEN? >> YEAH, SO IT'S A SCHOOL OF
HEALTH PROFESSIONS AND AT THE
SCHOOL IS THE DEPARTMENT OF
PUBLIC HEALTH. I AM CHAIR OF THE DEPARTMENT OF
PUBLIC HEALTH. BUT, YEAH, THEIR PUBLIC HEALTH
DEPARTMENTS AT THE STATE LEVEL. AND I ALSO SERVE ON THE BOARD
OF REGIONAL HEALTH, WHICH ISMY
OTHER CONNECTIVITY BACK TO RAP
AIDE CITY. >> YOU HAVE A BOARD MEETING
TONIGHT — >> EXACTLY. >> SO SANDRA, TELL ME, REALLY
WHAT IT IS THAT YOUR
RESPONSIBILITY IS FOR REGIONAL
HEALTH AT THIS TIME. >> I AM THE DIRECTOR OF NATIVE
AMERICAN COLLABORATION. AND
THAT WAS A ROLE THAT WAS
CREATED OFFICIALLY IN 2015, A YEAR AND A HALF AGO, WHERE WE
DETERMINED THAT IT WAS
IMPORTANT TO BRING TOGETHER
PEOPLE TO FOCUS ON A NATIVE AMERICAN COLLABORATION, AND SO
I WORK WITH A LOT OF EXTERNAL
ORGANIZATIONS, THE INDIAN HEALTH SERVICES HERE IN RAPID
CITY, IN PINE RIDGE, ROSE BUD.
WE HAVE SERVICES IN CHEYENNE
RIVER THAT I OVERSEE. WE WORK WITH THE NATIONAL
INDIAN HEALTH SERVICES. AND SO
MY JOB IS TO ENSURE THAT WE CONTINUE TO BE
INNOVATIVE, WE USE INITIATIVES
AND WE IMPROVE ON WHAT
CURRENTLY IS GOING ON, BOTH WITH HEALTH ORGANIZATIONS AND
WITH NON-HEALTH ORGANIZATIONS. AND, YOU KNOW, WHEN I WAS
OFFERED THIS OPPORTUNITY, I
BEGAN TO THINK ABOUT THE
DEFINITION OF HEALTH, YOU KNOW, BY THE WORLD HEALTH
ORGANIZATION. AND IN 1948, THE
WORLD HEALTH ORGANIZATION
DEFINED HEALTH AS A STATE OF COMPLETE FIGURE,
MENTAL, AND — PHYSICAL,
MENTAL, AND SOCIAL WELL-BEING. AND SO FOR ME, I FOCUS ON THE
ESSENTIALLY WELL-BEING ASPECT
TO SAY, YOU KNOW, WHAT ARE THE
RESOURCES THAT WE NEED? AND IF YOU THINK ABOUT SOCIAL
WELL-BEING, SOME DEFINE IT AS
AN END STATE OF HAVING BASIC NEEDS MET, WHERE YOU HAVE
PEOPLE COEXISTING AND PEACE
WITHIN COMMUNITIES AND ALSO HAVING OPPORTUNITIES FOR
ADVANCEMENT. RESOURCES, BASIC RESOURCES,
WATER, FOOD, SHELTER, HEALTH.
AND SO I FOCUS ON THAT HEALTH
ASPECT, AND US COEXISTING PEACEFULLY WITHIN THE COMMUNITY
WHILE WORKING COLLABORATIVELY,
AND SO IT'S JUST A PRIVILEGE
AND AN HONOR TO BE ABLE TO BRING PEOPLE
TOGETHER FOR THE GREATER GOOD
OF OUR COMMUNITY. >> LET'S TALK ABOUT SOCIAL
WELL-BEING. DON, YOU'RE — I
MEAN, I KNOW YOU KNOW DIABETES. YOU KNOW —
I MEAN, AND SHE GAVE SOME NUMBERS. 800%, THOSE
DON'T MAKE SENSE TO ME. FIRST I WOULD ASK YOU TO TALK
ABOUT THOSE NUMBERS SHE WAS
EXPLAINING, HOW FREQUENT DO WE SEE DIABETES IN THAT
POPULATION? >> YEAH, SO THERE'S DIFFERENT
WAYS TO LOOK AT IT. SO THERE'S NEW CASES WHICH IS
THE INCIDENCE RATE. THERE'S THE NUMBER OF PEOPLE
THAT HAVE THE DISEASE WHICH IS
THE PREVALENCE. BUT THERE'S ALSO THE MORTALITY
RATE. SO WE HAVE MORE PEOPLE WITH
DIABETES, BUT AMERICAN INDIANS
WITH DIABETES DIE AT A MUCH HIGHER RATE SIMPLY BECAUSE WE
DON'T HAVE ACCESS TO THE SOCIAL
CONDITIONS THAT ALLOW PEOPLE TO LIVE WITH DIABETES IN
A HEALTHIER MANNER. SO WE DON'T
HAVE ACCESS TO HEALTHY FOOD. QUITE OFTEN IN YOUR
RESERVATION, THERE'S NOT SAFE
PLACES TO GO OUT FOR A WALK. VERY NARROW ROADS THAT ARE NOT
WELL MAINTAINED. NO SIDEWALKS,
FOR EXAMPLE. AND THEN MANY OF OUR
RESERVATION COMMUNITIES ARE
GOOD DESERTS. SO QUITE OFTEN PEOPLE HAVE TO
DRIVE ALL THE WAY TO RAPID CITY
TO GO TO THE SUPERMARKET. SO THERE'S ALL KINDS OF SOCIAL
CIRCUMSTANCES. SO IT'S MORE THAN JUST THINKING
OF AN OVERALL RATE. BUT THE
WORST DISPARITY BY FAR IS THE NUMBER OF PEOPLE DYING
FROM IT. >> SO I MEAN, THAT BRINGS US TO
THE INDIAN HEALTH SERVICE,
WHOSE RESPONSIBILITY HAS BEEN, AS I STATED EARLIER, YOU KNOW,
TO TRY TO DO ALL THESE GOOD
THINGS. BUT IT'S A — IT'S AN ALMOST
IMPOSSIBLE TASK IF YOU CAN'T
EVEN ENCOURAGE THEM TO GO OUT ON FOR A WALK BECAUSE
THERE'S NO SIDEWALKS AND
THERE'S DOGS AND THERE'S DANGER
OUT THERE. HOW CAN THAT BE CHANGED? >> WELL, IF YOU RECALL, EVEN
FROM YOUR INITIAL INTRODUCTION,
TALKING ABOUT THE INDIAN HEALTH SERVICE, SO
THE INDIAN HEALTH SERVICE IS
LOCATED WITHIN THE UNITED
STATES PUBLIC HEALTH SERVICE. IRONICALLY BECAUSE OF
UNDERFUNDING, INDIAN HEALTH
SERVICE DOES VERY LITTLE IN THE
WAY OF PUBLIC HEALTH. THEY SPEND MOST OF THEIR
RESOURCES ON EMERGENCY CARE AND
DEALING WITH CRISES. EXACTLY. AND A SERIES OF CRISIS
MANAGEMENT AND THAT GOBBLES UP
ALL OF THE RESOURCES SO WE HAVE VERY LITTLE ACTUALLY
TO INVEST IN PUBLIC HEALTH. SO WHEN WE THINK OF THEM, IT'S
ALSO IMPORTANT TO REMEMBER WHY
IT EXISTS IN THE FIRST PLACE. AND THE BASIS FOR INDIAN HEALTH
SERVICE LARGELY IS BECAUSE OF
THE TREATIES THAT WERE SIGNED BETWEEN THE TRIBAL
NATIONS AND THE FEDERAL
GOVERNMENT. AND THE TREYS QUITE OFTEN THE
LANGUAGE INCLUDED THINGS LIKE
PROJECTION OF ALL PROPER CARE AND PROTECTED IN EXCHANGE FOR
LAND AND NATURAL RESOURCES. SO WHEN WE THINK ABOUT THE
UNITED STATES AND ALL OF THE
TREMENDOUS WEALTH THAT WE HAVE HERE IN THE U.S., MUCH OF THAT
WEALTH IS BASED ON OUR NATURAL
RESOURCES THAT WE'VE BEEN ABLE
TO UTILIZE. BUT WE HAVE TO REMEMBER, THOSE
ARE AMERICAN INDIAN RESOURCES. AND WE DIDN'T LOSE THOSE
RESOURCES IN A WAR. WE EXCHANGED THEM THROUGH
TREATIES FOR CERTAIN SOCIAL
SERVICES INCLUDING HOUSING,
EDUCATION, AND HEALTH CARE. SO THAT'S WHY THERE'S THE
B.I.A., THE BUREAU OF INDIAN
AFFAIRS AND A B.I.E., AND THAT'S WHY THERE'S AN
I.H.S., AN INDIAN HEALTH
SERVICE. I LOOK AT THE I.H.S. AS THE
LARGEST PREPAID HEALTH PLAN IN
HISTORY. THE CHALLENGE HAS BEEN,
CONGRESS HAS NOT LIVED UP TO
ITS TRUST RESPONSIBILITY. AND THEY'VE BEEN UNDERFUNDING
INDIAN HEALTH SERVICE FOR
DECADES, WHICH IS WHY IT IS
UNDERPERFORMING. IT'S LARGELY AN ISSUE OF
UNDERFUNDING. SO WE GET LESS THAN $2,000 PER
PATIENT PER YEAR IN INDIAN
HEALTH SERVICE. LESS THAN 2,000. MEDICARE IS OVER 12,000 PER
PATIENT PER YEAR. >> WOW! SO 2,000 PER PATIENT
PER YEAR? >> YEAH. >> SO I THINK PEOPLE DON'T
REALIZE THAT. THEY'RE THROWING
MONEY, MONEY, MONEY, MONEY,
THAT'S NOT THE CASE. >> AND WE'RE ACTUALLY — WE'VE
BEEN STARVING THE INDIAN HEALTH
SERVICE FOR GENERATIONS. AND I HEAR A LOT OF PEOPLE
SAYING I.H.S. IS BROKEN. WELL,
WE DON'T KNOW IF IT'S BROKEN. IT'S BEEN STARVED. WE'VE NEVER
ADEQUATELY RESOURCED IT. SO THE ANALOGY I LIKE TO USE IS
IF YOU HAVE A CAR THAT NEEDS A
FULL TANK OF GAS TO GET TO ITS
DESTINATION BUT EVERY DAY YOU ONLY PUT HALF A
TANK OF GAS IN, ULTIMATELY YOU
HAVE TO BLAME THE PEOPLE WHO ARE NOT PUTTING
IN ENOUGH GAS AND THAT'S
CONGRESS. >> THEY HAVE THE HEALTH
CONTRACT SERVICE DELIVERY AREA,
AND A LOT OF PEOPLE DON'T KNOW
THAT — >> OKAY, CONTRACT — >> HEALTH SERVICE DELIVERY
AREA, AND THE ACRONYM IS CSDA.
AND WHEN YOU LEAVE THE AREA OF
YOUR CSDA, YOU ARE NO LONGER ELIGIBLE FOR PURCHASED CARE. SO
WHAT THAT THEN MEANS IS THAT IF YOU ARE SUPPOSED TO BE
IN THE CHEYENNE RIVER AREA AND
YOU COME TO RAPID TO VISIT A RELATIVE AND THEN YOU GET ILL,
YOU'RE EXPECTED TO GO TO SIOUX
SAN. BUT IF IT'S CARE YOU HAVE TO
PAY OUT, YOU DO NOT GET THAT
CARE THROUGH AN INDIAN HEALTH SERVICE BECAUSE YOU'VE LEFT THE
AREA WHERE THEY'RE SUPPOSED TO
GUARANTEE YOU OR PROVIDE THE CARE THEY HAVE WITH
FUNDING AT THAT TIME. SO THINK
ABOUT YOU AND I. I'VE NEVER HAD TO STOP TO
THINK, CAN I GO TO MICHIGAN,
KANSAS CITY? I GET ON A PLANE AND A GO
KNOWING MY INSURANCE WILL KICK
IN AND WILL PAY MOST OF IT. BUT THAT'S IT. THAT IS NOT
APPLICABLE TO OUR NATIVE
AMERICAN COMMUNITIES. THEY ARE
FORCED TO RECEIVE CARE WITHIN DEFINED RAZE >> I
DIDN'T REALIZE THAT EITHER. I'VE HEARD SENATOR ROUND SAY
THAT THERE WAS A 40% SOMETHING,
AND THEY'RE GOT — WE'RE GOING TO GO HIGH — WE'RE
NOT GOING TO GO HIGHER THAN
THAT. DOES THAT RING A BELL TO
YOU? >> NO, I'M NOT SURE EXACTLY
WHAT YOU'RE REFERRING TO, BUT I
KNOW THERE'S RELUCTANCE TO ADD
MORE FUNDING TO I.H.S. BASICALLY CONGRESS IS SAYING
WE'RE NOT GOING TO GIVE YOU
MORE MONEY BECAUSE YOU'RE NOT FUNCTIONING WELL, BUT THEY'RE
NOT FUNCTIONING WELL BECAUSE
THEY NEVER HAD ENOUGH MONEY. CONGRESS MAY NOT WANT TO
ACKNOWLEDGE THEIR ROLE BUT
THEIR COMPLICIT IN THE POOR PERFORMANCE OF
I.H.S. THROUGH CHRONIC
UNDERFUNDING. VETERANS ADMINISTRATION
COMPLAINS ABOUT HAVING NOT
ENOUGH RESOURCES. SO IMAGINE CUTTING I.H.S.
BUDGET IN HALF — OR I'M SORRY,
CUTTING THE VETERANS
ADMINISTRATION BUDGET IN HALF — >> AND SEE WHAT THE VETERANS
WOULD BE SAYING ABOUT THAT. >> YEAH. >> WELL, RIGHT HERE IN RAPID
CITY, HEROIC EFFORTS TO HELP
YOUNG PEOPLE ARE BEING SPEAR
HEADED. I WANT TO MAKE SURE THIS IS
CLARIFIED AND WE HAVE AN
INTERVIEW WITH BRUCE LONG FOX.
HIS STORY IS FASCINATING. >> OUR TARGET POPULATIONS
AREPRIMARILY THE ONES THAT COME
FROM THE RESERVATION. AND WE CALL THEM THE
TRANSITIONAL POPULATION. AND WE
TRY TO HELP THEM GET SETTLED
HERE IN TOWN. IN A LOT OF WAYS, WE ACT AS A
BRIDGE PROGRAM TO HELP THEM
ACCESS SERVICES AND TO BE AN
ADVOCATE FOR THEM. MOST OF OUR CLIENTS ARE
ASSOCIATED WITH HEAD START AND
EARLY HEAD START PROGRAMS. THERE'S ABOUT 130 HERE IN RAPID
CITY. AND ABOUT 90 OVER IN CROW
CREEK. WE WANT TO RE– HELP NATIVE
AMERICANS, LOW-INCOME NATIVE
AMERICANS, REESTABLISH FAMILY, AND WE FEEL LIKE THAT'S THE
ANSWER FOR OUR LONG-TERM
CULTURAL SURVIVAL, BUT IT ALSO
PLAYS INTO HEALTH BENEFITS AS WELL. TO HAVE AN IN TACT FAMILY WITH
HEALTHY RELATIONSHIPS MAKES FOR
HEALTHY CHILDREN AND HEALTHY
PARENTS AS WELL. THE DROPOUT RATE AMONG THE
NATIVE AMERICAN POPULATION HAS
ALWAYS BEEN IN THE MID TO HIGH
50%. AND WHEN WE STARTED WORKING AT
CENTRAL HIGH TEN — OR IN 2010,
THE DROPOUT RATE WAS 63%. AND AFTER FIVE YEARS OF
INVOLVEMENT THERE, AND DOING
WHAT WE CALL CULTURAL GROUP
MENTORING, THE DROPOUT RATE IS 41%. AND SO THERE'S BEEN A
SIGNIFICANT DECREASE, AND IN
2015, 93% OF THE SENIORS WHO WERE INVOLVED WITH RURAL
AMERICA INITIATIVES GRADUATED.
AT THE MIDDLE SCHOOL LEVEL THAT
WE'RE DOING IS PROJECT AIM, ADULT, IDENTITY,
MENTORING, AND THE PRIMARY GOAL
OF THAT CURRICULUM IS TO HELP
THE STUDENTS CHOOSE WHAT THEIR GOING TO BE WHEN THEY
GROW UP. IT'S A LONG-TERM GOAL SETTING
PROGRAM. BUT WHAT WE TRY TO DO IS GET
THEM TO BELIEVE IN THAT VISION
STRONG ENOUGH SO THAT THEY WILL
AVOID NEGATIVE BEHAVIORS AND — AND INCREASE THE NUMBER
OF POSITIVE BEHAVIORS THAT THEY
DO. IF THEY CAN ASK THEMSELVES, THE
QUESTION, IS THAT GOING TO HELP
ME BECOME A DOCTOR? OR IS THAT
GOING TO HELP ME BECOME A NURSE? SHOULD I DO IT, OR SHOULD I NOT? AND THE STUDENTS LEARN TO MAKE
MORE POSITIVE, HEALTHIER
CHOICES. AND THE OUTCOMES, FOR INSTANCE,
TO AVOID TEEN PREGNANCY, SO THAT THEY CAN GRADUATE FROM
HIGH SCHOOL AND GO ON TO
COLLEGE. BECAUSE IF YOU LOOK AT THE
REASONS FOR FAILURE, THE NUMBER
ONE REASON IS ADDICTION,
WHETHER IT BE TO METH OR TO ALCOHOL. AND THE PROGRAM THAT WE HAVE,
WHICH HELPS THE STUDENTS TO DO
CHOICE MAKING ENCOURAGES THEM
TO BE DRUG AND ALCOHOL FREE. AND THEN WE ALSO TEACH THEM A
SET OF VALUES THAT THE LAKOTA
VALUES WHICH ALSO ENCOURAGE THEM TO BE DRUG AND ALCOHOL
FREE. ALL OF OUR PROGRAMS HAVE
VOLUNTEER OPPORTUNITIES,
WHETHER IT BE TUTORING AT THE
HIGH SCHOOL LEVEL OR JUST READING TO THE KIDS AT THE HEAD
START AND EARLY HEAD START
LEVEL. THEY'RE WELCOME TO CONTACT US,
AND — AND BECOME INVOLVED THAT
WAY. VOLUNTEER, OR HELP — HELP THE
KIDS TO LEARN READING OR — OR
LANGUAGE. AND — AND ALL PEOPLE ARE
WELCOME TO — TO VOLUNTEER. >> THANK YOU, BRUCE. THAT'S
VERY IMPORTANT INFORMATION. EFFORTS TO HELP THE YOUNG
PEOPLE, THEY SAY THAT, UM, IN A
THIRD WORLD COUNTRY LIKE MIDDLE OF AFRICA, CONGO,
WHATEVER IT MIGHT BE, THE VERY
BEST, MOST POWERFUL WEAPON IS
EDUCATING YOUNG PEOPLE. >> YES. >> HOW DO YOU SEE EDUCATION,
YOU KNOW, HE'S SHOWING US AN
EFFORT THAT IS HAPPENING IN
RAPID CITY. TALK ABOUT EDUCATION ON THE
RESERVATION OR FOR THE INDIAN
POPULATION, DON? >> YEAH, THERE'S A LOT OF
CHALLENGES. SO JUST LIKE INDIAN HEALTH
SERVICES IS UNDERFUNDED. THE
BUREAU OF INDIAN AFFAIRS, BUREAU OF INDIAN EDUCATION ARE
ALL UNDERFUNDED. SO WE TEND TO
HAVE CHALLENGES IN THE
RESERVATION COMMUNITIES. AND WE SEE THAT THERE'S A
STRONG CORRELATION BETWEEN
QUALITY OF EDUCATION IN A
COMMUNITY AND HEALTH STATUS. SO ONE OF THE PREDICTORS OF
HEALTH IS QUALITY OF EDUCATION. SO WE CAN'T CONTINUE TO THINK
OF THINGS IN THEIR OWN SILOS. WE CAN LOOK AT THE GRAIN SILO
OF HEALTH AND THE GRAIN SILO OF
EDUCATION — >> REALLY RUN TOGETHER, DON'T
THEY? >> YEAH. IT'S ALL CONNECTED. SO
I THINK THAT WE NEED TO
RECOGNIZE THAT ECONOMIC DEVELOPMENT, EDUCATIONAL
PROGRAMS, AND SOCIAL PROGRAMS
ARE ALL RELATED TO HEALTH. THAT IS ALL PART OF THE PUBLIC
HEALTH. AND A LOT OF GOOD THINGS GOING
ON HERE IN RAPID CITY AS WELL. >> WELL, RAPID CITY, WHAT, 20%
OF THE POPULATION IN RAPID CITY
IS AMERICAN INDIAN? OR DO YOU KNOW WHAT THOSE
NUMBERS ARE? >> WHEN YOU LOOK AT THE U.S.,
IT SAYS UNDER 10% BUT A STUDY
WAS DONE BY USD AND THEY
DETERMINED THAT AT ANY GIVEN POINT WE HAVE UP TO 25% OF
NATIVE AMERICANS, SPECIFICALLY
LAKOTANS WITHIN RAPID CITY. AND SO THE PERCENTAGES ARE
SIGNIFICANTLY HIGHER THAN WHAT
IS CAPTURED IN THE U.S.
CONFERENCE SUSS. >> SO IF I HAD A HOSPITAL AND A
SICK POPULATION WITH DIABETIC
PROBLEMS FOR EXAMPLE OR
WHATEVER IT IS. OFTENTIMES THEY WILL HAVE
INSURANCE OR THEY'LL HAVE MONEY
WHICH TO PAY. DOESN'T GET REIMBURSED FOR MUCH
OF THAT, IS THAT RIGHT? THE
REGIONAL HOSPITALS? >> WHEN YOU LOOK AT RAPID CITY
SPECIFICALLY, REGIONAL HEALTH HAS ABOUT 33% OF OUR IN
PATIENTS, OUR NATIVE AMERICAN
PATIENTS. AGAIN, THAT COMES FROM AGAIN,
THE INCREASED PERCENTAGE WITHIN
THE COMMUNITY COMPARED TO WHAT
THE U.S. CENSUS CAPTURES. AND THEY'VE LEFT THEIR CSDA
THAT WE TALKED ABOUT EARLIER,
THEN THEY END UP BEING STUCK
WITH THE BILL. WHEN YOU TALK ABOUT A POLICY,
LET'S SAY PINE RIDGE FOR
INSTANCE, WHERE UNEMPLOYMENT
RATES ARE AS HIGH AS 90%, YOU KNOW, THEY DO NOT HAVE THE
RESOURCES. WHEN YOU TALK ABOUT 97% LIVING
BELOW THE POVERTY LINE, THEY DO
NOT HAVE THE RESOURCES TO THEN
HAVE TO PAY FOR THEIR OWN HEALTH CARE BECAUSE THEY GOT
SICK, WENT THROUGH THE E.D.,
GOT ADMITTED. PEOPLE END UP PRESUMING THEY
GOT FREE HEALTH CARE. IT HAS BEEN PREPAID THROUGH
TREATY RIGHTS, AND AS SUCH
THERE IS A DISCONNECT BETWEEN WHAT PEOPLE THINK IS REALLY
OCCURRING AND WHAT IS ACTUALLY
OCCURRING. SO THOSE ARE SOME OF THE THINGS
THAT WE WOULD LOVE TO SEE — >> FIXED. >> FIXED. >> AND THERE WAS AN EFFORT TO
PUT MEDICAID, TO ADVANCE
MEDICAID — YEAH, EXPAND IT.
WHAT HAPPENED WITH THAT? >> WELL, A COUPLE POINTS TOO.
JUST WANTED TO MAKE SURE — THE
TERM TRANSIENT HAS A COUPLE OF
DIFFERENT MEANINGS. PEOPLE MAY HAVE A HOME IN BOTH
PINE RIDGE AND RAPID CITY. SO IT'S CERTAINLY NOT THAT
EVERYONE'S HOMELESS. PEOPLE ARE
KIND OF MOVING BACK AND FORTH. IN MY FAMILY WE HAVE HOUSING IN
KYLE AND IN APP YES, I DID CITY. [Talking at the same time] >> I HAVE A LITTLE CABIN. SO
I'M — >> YEAH, EXACTLY. SO THAT'S
WHAT I MEAN, PEOPLE MOVING BACK
AND FORTH. A LOT OF PEOPLE COME TO RAPID
CITY TO LIVE FOR A PERIOD OF
TIME, SO THEY'RE NOT ELIGIBLE TO GET PAID FOR SERVICES
PROVIDED AT REGIONAL. SO — AND THAT'S A BIG PROBLEM
IS THE CSDA'S. ONE WAY TO FIX IT IS THROUGH
MEDICAID EXPANSION. SO MEDICAID COVERS PRIMARILY
PREGNANT WOMEN AND CHILDREN UP
TO 100% OF FEDERAL POVERTY. NOW, THE FEDERAL POVERTY LEVEL
IS REMARKABLY LOW. IF YOU'RE A FAMILY OF FOUR AND
YOU MAKE $22,000 A YEAR, YOU'RE
ABOVE THE POVERTY LINE. SO IMAGINE TRYING TO SURVIVE AT
22,000. BUT THEN YOU'RE AUTOMATICALLY
OVER THE POVERTY LINE. SO THERE'S FEDERAL POVERTY,
THEN THERE'S TRUE POVERTY,
WHICH IS MUCH GREATER
PERCENTAGE, UNFORTUNATELY. WITH MEDICAID EXPANSION, THEN
EVERYBODY, NOT JUST PREGNANT
WOMEN AND CHILDREN, BUT EVERYBODY, MEN, WOMEN,
CHILDREN, EVERYBODY, UP TO 138%
OF POVERTY WOULD THEN HAVE
MEDICAID. AND IF YOU HAVE MEDICAID, THEN
THE CSDA DOESN'T MATTER BECAUSE
YOU HAVE INSURANCE. >> SO IT WOULD BE A PERFECT
ANSWER. >> IT IS A PERFECT ANSWER. AND
ACTUALLY WE HAVE DONE THIS IN
NORTH DAKOTA, WE HAVE EXPANDED
MEDICAID AND WHAT WE'RE FINDING IS THAT ABOUT 60%
OF THE AMERICAN INDIAN POLICY
IN NORTH DAKOTA NOW HAS
MEDICAID OR MEDICAID EXPANSION. >> SO WHY HASN'T IT OCCURRED? >> YOU'LL HAVE TO ASK THE
LEGISLATORS THAT. >> IT DID NOT PASS OUR
LEGISLATURE? >> NO, AND THERE'S A SENSE
THAT, ONE, MAYBE WE CAN'T
AFFORD IT, BUT THAT'S NOT TRUE
BECAUSE IT'S FEDERAL DOLLARS. >> THE FEDERAL DOLLARS WILL GO
AWAY AND THEN WE'LL BE STUCK
WITH THIS RESPONSIBILITY AND
CAN'T TAKEN AWAY. >> IT'S WRITTEN INTO THE LAW
THAT BASICALLY THE MAXIMUM
WOULD PAY IS 7%, 93% WOULD BE
COVERED BY THE FEDS AND IF THEY EVER DID TAKE IT AWAY,
THEN YOU CAN GET RID OF
MEDICAID EXPANSION. BUT BETWEEN NOW AND WHENEVER
THAT HYPOTHETICAL TIME OCCURS, IT'S AN OPPORTUNITY FOR THE
STATE TO PAY 7 AS AND GET 93 IN
RETURN. SO THE REASONING BEHIND IT,
THEY ALWAYS SAY THEY DON'T WANT
TO FACILITATE ABE-BODIED PEOPLE
FROM, YOU KNOW, GETTING INSURANCE, BUT IN TRUTH WHAT
THEY'RE DOING IS THEY'RE
HARMING THE RURAL HOSPITALS. THEY'RE HARMING — ECONOMY.
SURE. THE ECONOMY IS HARMED BECAUSE
THOSE DOLLARS THEN GO TO THE
PAY FOR MORE PHYSICIANS, MORE
SERVICES, HIRE MORE PEOPLE. IT'S ECONOMIC DEVELOPMENT. SO THERE ARE VERY FEW
OPPORTUNITIES IN WHICH THE PAY
CAN PAY 7 AND GET 93 IN RETURN, BUT THEY'RE THUMBING THEIR NOSE
AT IT TO DATE. >> OUR GOVERNOR IS IN FAVOR OF
IT. >> RIGHT. >> SO THAT WOULD BE AN
IMPORTANT THING. I SENSE,
THOUGH, YOU GAVE A NUMBER OF $2,000 PER
NATIVE AMERICAN, VERSUS $10,000
FOR MEDICARE — >> 12,000. >> 12,000. DO WE HAVE NUMBERS ON INDIAN
EDUCATION? >> YOU KNOW, I DON'T HAVE THE
BREAKDOWN IN TERMS OF PER
STUDENT PER YEAR, BUT I KNOW
IT'S TERRIBLY UNDERFUNDED. ONE OF THE CHALLENGES IS THAT
WHEN WE LOOK AT STATE FUNDED
SCHOOLS, QUITE OFTEN THAT'S
BASED ON THE LOCAL TAX BASES, AND IF YOU HAVE HIGH RATES OF
UNEMPLOYMENT AND NOT A LOT OF
JOBS, YOU'RE NOT GENERATING A LOT OF LOCAL TAXES TO SUPPORT
SCHOOLS. SO THAT'S ONE AREA WHERE WE SEE
A VICIOUS CYCLE OF THE POVERTY
MAKES EDUCATION SYSTEMS WORSE. >> WELL, AND THAT BRINGS UP THE
UNEMPLOYED NUMBERS. THERE'S A
PREJUDICE, OKAY, THEY AREN'T
WORKING BECAUSE THEY DON'T WANT TO WORK. THEY
DIDN'T HAVE I TO WORK. OR WE
DID THIS TO THEM, YOU KNOW, BY MAKING IT TOO EASY,
GIVING THEM SOMETHING FOR
NOTHING AND THEY'RE NOT WORKING. DO EITHER ONE OF YOU HAVE A
RESPONSE TO THAT COMMENT? >> I HAVE A RESPONSE. THE FIRST
TIME I DROVE OUT TO PINE RIDGE
WAS AT THE HEIGHT OF THE COST
OF GAS, WHEN TO FILL YOUR TANK COST OVER $60.
AND AS I WAS DRIVING OUT THERE
THE FIRST THING THAT HIT ME WAS, OH, MY WORD, THIS IS VERY
FAR. IT'S FAR. YOU NEED MONEY TO GET TO PINE
RIDGE. IF YOU DON'T HAVE MONEY, YOU
CANNOT LEAVE PINE RIDGE TO WORK. AND WHEN YOU GET TO PINE RIDGE
AND YOU REALIZE THEY DON'T HAVE
THE RESOURCES TO HAVE BUSINESSES UP AND FUNCTIONING.
IT IS FAR REMOVED, ISOLATED,
AND SOMEONE SHARED WITH ME THAT
IT'S CALLED THE BADLANDS BECAUSE YOU CAN'T REALLY GROW
CROPS THERE. AND SO YOU HAVE PEOPLE THAT
HAVE PUT IN AN AREA WHERE THEY
CAN'T REALLY FARM, THEY CAN'T
REALLY RAISE A LOT OF LIVESTOCK, AND THEY'RE EXPECTED
TO BE VERY PRODUCTIVE AND
THEY'RE 90 MILES AWAY FROM WHERE THEY CAN HAVE GOOD
GROCERY STORES. IT IS INDEED A
GOOD DESERT. AND TO GET A LITTLE BIT OF
FRUIT IS LIKE $6 SOMETIMES, YOU
KNOW, A FRESH CUT FRUIT. AND SO YOU BEGIN TO SEE THAT
VICIOUS CYCLE, THERE NEEDS TO
BE CHANGE. THERE NEEDS TO BE BETTER
HOUSING. MORE OPPORTUNITIES,
INVESTMENTS NEED TO BE MADE ON
THE RESERVATION. PEOPLE CAN'T GET UP TO GO TO
WORK WHEN THERE ARE NO JOBS
AVAILABLE FOR THEM TO DO. >> JOBS. YOUR COMMENT? YOUR
RESPONSE? >> WELL, WHEN THERE ARE JOB
OPPORTUNITIES, THERE'S MORE
APPLICANTS THAN OPEN POSITIONS. SO THEY'RE A WORKFORCE THAT
WANTS TO WORK BUT THERE'S JUST
LIMITED OPPORTUNITIES. I THINK THERE'S A CHALLENGE
WITH OUTSIDE ENTITIES HAVING
RELUCTANCE TO PUT FACTORIES OR
INVEST ON RESERVATION JOBS BECAUSE THEY'RE LIKE A FOREIGN
NATION. THE RESERVATION
COMMUNITIES ARE THEIR OWN
SOVEREIGN NATION. SO IT'S DIFFERENT THAN BUILDING
A FACTORY IN WALL, FOR EXAMPLE,
WHERE YOU CAN OWN THE LAND. WHEREAS THE COMPANIES CANNOT
OWN THE LAND ON THE RESERVATION. >> AND THAT'S BEEN A
DISINCENTIVE FOR BUILDING A
BUSINESS OR SOMETHING LIKE THAT
ON THE REDS VACATION? >> YEAH, THAT'S ONE OF THE
CHALLENGES. >> LET'S TALK ABOUT THE
RESERVATIONS. WE HAVE A VIDEO
OR A PICTURE OF ALL OF RESERVATIONS IN NORTH
DAKOTA AND SOUTH DAKOTA. WHAT WOULD YOU — HOW WOULD YOU
DESCRIBE THEM, AND — AND
EXPLAIN TO ME THE RESERVATION
SYSTEM. AND THE NATIONS. >> YEAH, IF YOU ARE NOT FROM
THIS REGION, YOU WOULDN'T
REALIZE THERE'S SUCH A
DIFFERENCE BETWEEN NORTH DAKOTA AND SOUTH DAKOTA.
IN SOUTH DAKOTA, WE HAVE NINE
RESERVATION COMMUNITIES AND THEY'RE ALL OYATE, SO ALL NINE
ARE ONE OF THOSE THREE TRIBES
OF LAKOTA, DAKOTA, NAKOTA. SO WEST RIVER, PINE RIDGE, ROSE
BUD, CHEYENNE RIVER AND
STANDING ROCK. MORE TOWARD THE NORTHEAST, THEY
TEND TO BE MORE DAKOTA, SO SIS
TON, WAS PA TON, FLANKED ROE,
CROW CREEK. AND THEN THE RESERVATION
YANKTON. DAKOTA IN SPIRIT LAKE, THERE'S
ALSO CHIPPEWA, TURTLE MOUNTAIN
BAND OF CHIPPEWA. SO THERE'S ACTUALLY FIVE, SIX
TRIBES AND FOUR RESERVATIONS IN
NORTH DAKOTA, WHEREAS THERE'S NINE RESERVATIONS BUT
ESSENTIALLY ONE TRIBE. >> THAT'S SO INTERESTING. AND
THE DIFFERENCE BETWEEN THE
TRIBES AND THEY'RE ALL
INDIVIDUAL NATIONS? >> YEAH, THEY'RE ALL SOVEREIGN
NATIONS. THE IDEA COATS OF THE
THREE ARE THE EASTERN MOST. AND BECAUSE THE WHITE SETTLERS
WERE COMING FROM THE EAST, THEY
ENCOUNTERED THE DAKOTAS FIRST. IF THEY WERE COMING FROM THE
WEST, THIS WOULD BE SOUTH
LAKOTA INSTEAD OF SOUTH DAKOTA.
SO IT'S DAKOTA IS A TRIBE. >> LET'S TALK ABOUT REGIONAL
HEALTH AND WHAT IS REGIONAL
DOING TO HELP WITH ON THE
RESERVATIONS AND OUTSIDE OF THE RESERVATIONS FOR THE
AMERICAN INDIANS. >> THANK YOU. REGIONAL HEALTH
IS ACTUALLY DOING A LOT OF
WONDERFUL THINGS ON THE
DIFFERENT RESERVATIONS. WE HAVE PROVIDERS THAT HAVE
BEEN GOING DOWN FOR DECADES, I
THINK ABOUT DR. LEWIS RAYMOND,
A NEPHROLOGIST HE'S BEEN WORKING IN CHEYENNE RIVER AND
PINE RIDGE SINCE 1994, DR. FRED
BIRCH HAS BEEN WORKING IN ROSE BUD SINCE 1995.
DR. SANDRA OGUNREMI — >> THAT'S YOUR HUSBAND? >> HOW DO YOU SAY HIS FIRST
NAME? >> AYODELE? NIGERIA. ORIGINALLY
FROM NIGERIA AS WELL, BUT HE
WAS BORN IN SCOTLAND. >> NOT SCOTLAND, SOUTH DAKOTA — >> SCOTLAND, SCOTLAND,
EDINBURGH, SCOTLAND. WE HAVE
BETH IVERSON, AN ADVANCED
PRACTITIONER THAT'S BEEN WORKING IN ROSE BUD SINCE
'95 ANOKA COUNTY WELL. WE HAVE
JACKIE GARNER. SHE'S AN ADVANCED PRACTICE
PROVIDER. WE HAVE LEE REPUBLICAN. AND DR.
MASON NEMI THAT'S BEEN WORKING
IN CHEYENNE RIVER FOR THE PAST
FOUR YEARS. SO WE'VE GOT ROSE BUD, CHEYENNE
RIVER, PINE RIDGE COVERED, AND
THEY ALSO GO TO PORCUPINE. AND WHEN DR. BIRCH GOES TO ROSE
BUD, HE SPENDS FOUR DAYS IN
ROSE BUD. THAT'S A LONG-TERM COMMITMENT
FOR 21 YEARS, AND IT'S
SOMETHING WE TAKE VERY
SERIOUSLY. THEY GET UP BRIGHT AND EARLY,
THEY HEAD OUT, BECAUSE THEY
CARE. WHEN YOU HAVE PATIENTS WHO HAVE
DIALYSIS, YOU CANNOT RISK THEM
NOT FOLLOWING UP TO THEM. SO ALL THE PEOPLE THAT I'VE
MENTIONED ARE ALL NEPHROLOGISTS AND ADVANCED PRACTICE PROVIDERS
THAT WORK WITH NEPHROLOGISTS. IN PINE RIDGE WE HAD A
SPECIALTY SERVICES CONTRACT
WITH PINE RIDGE THAT WE STARTED
IN 2008. IT CAME TO AN END IN FEBRUARY.
BUT WE HAD CARDIOLOGIST, DR. — THAT WENT FROM 2008 UP
UNTIL FEBRUARY PROVIDING CARE, AND HE WOULD GET THERE BRIGHT
AND EARLY, STAY, SEE 20
POINTERS. DR. SAM DURR, ANOTHER
CARDIOLOGIST WHO WENT DOWN AND
SERVED WITHIN PINE RIDGE. DR.
LIEN PENNAULT. WE HAVE DR. HOLLIS HAS SINCE
RETIRED FROM DAILY PRACTICE. HE
STILL TEACHES AT THE SCHOOL OF
MEDICINE, AN ENDOCRINOLOGIST, WHO WORKED AT
PINE RIDGE FOR AN EXTENSIVE
PERIOD OF TIME. WE JUST HAVE GREAT PEOPLE. WE
CURRENTLY HAVE AN ORTHOPEDIST,
DR. MARK HARE LOW. SO WE'RE
COMMITTED. AND RECENTLY, LAST YEAR AT THE
PEAK OF THE SUICIDE, TEENAGE SUICIDE, 150% ABOVE THE
NATIONAL LEVELS, WE PARTNERED WITH EXTERNAL ORGANIZATIONS AND
PUT TWO HOUSES THERE TO HELP
WITH A SAFE PLACE FOR KIDS TO GO, FOR EDUCATION TO
OCCUR WITH PARENTS. SO WE'RE PARTNERED WITH HABITAT
FOR HUMANITY, WITH SUPERIOR
HOMES, JUST TO CONTINUE MAKING A DIFFERENCE ON
THE RESERVATION, SO WE ARE VERY
PASSIONATE ABOUT MAKING A DIFFERENCE AND COLLABORATING
AND WORKING WITH DIFFERENT
GROUPS TO IMPROVE ACCESS TO
HEALTH. >> LET'S JUST SAY A FEW WORDS
ABOUT SUICIDE. SHE BROUGHT THIS
UP. DON, YOU KNOW, THAT'S — WHY WOULD THAT HAPPEN, AND HOW CAN
WE HELP? >> WELL, IT'S A VERY DYNAMIC
PROBLEM. SO IT'S NOT A SIMPLE
SOLUTION OR ONE SIMPLE BASIS FOR IT. SO
IT'S A VERY DYNAMIC AND COMPLEX
PROCESS AND PROBLEM. SO IT GOES BACK TO HISTORICAL
ISSUES. AND WE SEE, FOR EXAMPLE,
THERE'S AN EMERGING FIELD OF HISTORICAL TRAUMA, AND LOOKING
AT HOW TRAUMATIC EVENTS IN A
POPULATION CAN HAVE A NEGATIVE IMPACT ON THE HEALTH OF
SUBSEQUENT GENERATIONS. WE ALSO HAVE THE BOARDING
SCHOOLS IN WHICH CHILDREN WERE FORCIBLY TAKEN FROM
RESERVATIONS IN SOUTH DAKOTA, AND QUITE OFTEN TAKEN MORE THAN
1,000 MILES, PUT IN BOARDING
SCHOOL WHERE THEY WERE ABUSED, IT'S HORRIBLE TO
EVEN THINK ABOUT, BUT PHYSICAL
ABUSE, SEXUAL ABUSE, EMOTIONAL
ABUSE, NEGLECT. CHILDREN WERE BEATEN. NEXT TO
THE MANY OF THE BOARDING
SCHOOLS ARE HUGE GRAVE YARDS IN
WHICH MANY, MANY AMERICAN INDIAN INCLUDING
PEOPLE FROM HERE IN SOUTH
DAKOTA, THESE CHILDREN BETWEEN AGE 6 AND 12 DIED WHILE
THEY WERE AT BOARDING SCHOOL. AND WE DON'T KNOW EXACTLY WHY
SO MANY DIED. WE KNOW THAT THERE WERE
OUTBREAKS OF INFECTIOUS
DISEASES LIKE TUBERCULOSIS, BUT
WE WILL PROBABLY NEVER KNOW. ONE OF OUR CHALLENGES IS THE
ONGOING HISTORICAL ISSUES AND
SUBSEQUENT ADVERSE CHILDHOOD
EXPERIENCES AND INTERGENERATIONAL TRAUMA THAT
OCCURS. AND MANY CHILDREN GROW UP IN
VERY DIFFICULT SOCIAL
CIRCUMSTANCES. >> WE'RE GOING TO HEAR NOW FROM
THE PRESIDENT OF SOUTH DAKOTA
STATE UNIVERSITY. >> WE'RE KIND OF TRAPPED
OURSELVES INTO A TIME PERIOD
FROM ABOUT 1870 UNTIL NOW, AND WE DEFINE A GROUP OF PEOPLE BY
THAT PERIOD OF TIME. AND SO WE HAVE AN ORAL HISTORY
AND SOME WRITTEN HISTORY OF A
TRANSITION OF A PEOPLE FROM A VERY NOMADIC WAY OF LIFE,
CERTAINLY FOR THE LAKOTA PEOPLE
IN WESTERN SOUTH DAKOTA, TO A
COMMUNITY-BASED PLACE-BOUND
LIFESTYLE. BUT THOSE CULTURAL DIFFERENCES
ARE PROBABLY UNDERSTATED AND
UNDER– UNDERESTIMATED AND
MISUNDERSTOOD. AND THEY REALLY — I THINK
THERE'S A — ALMOST A FUNDAMENTAL COMMUNAL ASPECT TO
CERTAINLY THE LAKOTA PEOPLE
THAT — THAT PROBABLY ISN'T UNDERSTOOD WELL ENOUGH IN TERMS
OF SERVING THEM FROM A PUBLIC
HEALTH PERSPECTIVE OR A — OR SERVING THEIR HEALTH
NEEDS. I AM PERSONALLY A BIG BELIEVER
IN THE IMPORTANCE OF NUTRITION
AND, YOU KNOW, IT IS SO
FUNDAMENTAL. AND SO WHEN — WHETHER THAT BE
FOR THE IMPACT OF THE NUTRITION
OF A PREGNANT WOMAN ON THE UNBORN FETUS AND BABY
TO, YOU KNOW, ALL THE REST OF A
PERSON'S LIFE, NUTRITION IS
JUST SO IMPORTANT. AND NUTRITION ON THE
RESERVATION FOR, I THINK, THE
GENERAL POPULATION, IS HEAVY IN CALORIES, AND LOW IN — IN
SOME NUTRITIONAL VALUE. AND
THAT'S — THAT'S MANIFESTS ITSELF THEN IN OBESITY AND
DIABETES AND HEART DISEASE,
WHICH JUST COMPOUNDS EVERY OTHER CHALLENGE THAT THEY MIGHT
HAVE, A COLD, A FRACTURE, YOU
KNOW, ANYTHING. IT IMPACTS
HEALING. IT IMPACTS LONGEVITY, TRYING TO
TREAT SYMPTOMS BECOMES A VERY
EXPENSIVE AND KIND OF A LOSING
BATTLE. IN 2015, WE WERE — IN 2014,
THE SDSU EXTENSION WAS AWARDED
A FOUR PLUS MILLION DOLLAR GRANT TO WORK ON FOOD DESERTS
NOT ONLY HERE IN SOUTH DAKOTA,
BUT IN SOME URBAN COMMUNITIES. WE WERE THE LEAD AWARDEE ON THE
GRANT. AND SO WE'RE WORKING ON THAT —
THAT ASPECT OF IT. SO OUR — DO
WE HAVE THE COMMITMENT TO TAKE
WHAT WE'VE LEARNED FROM THIS GREAT WORK
THAT SDSU EXTENSION HAS DONE
HERE IN SOUTH DAKOTA AND FOOD
DESERTS AND BUILDING COMMUNITIES ON — THAT REALLY
DO ATTACK THIS CHALLENGE OF
NUTRITION AND FOOD ACCESS? DO WE HAVE THE — KIND OF THE
WILLPOWER TO TAKE THAT TO SCALE
TO MAKE A DIFFERENCE? I THINK THAT'S ALWAYS THE
CHALLENGE. >> THANK YOU, PRESIDENT DON. IT'S REALLY NEAT, YOU KNOW, HE
IS SUCH A GENTLEMAN, SUCH A
GREAT GUY. AND REALLY A HERO FOR MANY OF
US. ME AS A HERO. SO LET'S TALK
ABOUT THE ADVERSE CHILDHOOD EXPERIENCES
THAT YOU WERE TALKING ABOUT
EARLIER, DON. BECAUSE I DO THINK THAT IF A
PERSON HAS A BAD EXPERIENCE AS
A CHILD, YOU CARRY IT WITH YOU
FOREVER. I MEAN, IT CAN BE FIRST TO TWO
AND A HALF, LIKE OUR ADOPTIVE
DAUGHTER, WHO HAD, I THINK, AN ADVERSE EXPERIENCE THAT YOUNG,
AND CARRIES THAT BURDEN NOW YET
EVEN. WHAT IS YOUR KNOWLEDGE? >> WELL, THERE'S EMERGING
SCIENCE THAT SHOWS THE FIRST
1,000 DAYS ARE VITALLY
IMPORTANT. ONE THE CHALLENGES WE SEE WITH
HIGH RATES OF POVERTY AND
UNRESOLVED TRAUMA IN THE COMMUNITY IS WE HAVE
TRAUMATIZED PEOPLE GROWING UP
AND HAVING CHILDREN AND THEN POTENTIALLY TRAUMATIZING THE
NEXT GENERATION. SO ADVERSE CHILDHOOD
EXPERIENCES OR A.C. E.s ARE
CORRELATED WITH HIGHER RATES OF DIABETES, HEART DISEASE AND
CANCER. SO ADVERSE CHILDHOOD
EXPERIENCES, REALLY, THAT'S THE
UPSTREAM AREA WHERE WE NEED TO
PLACE MORE EFFORT. AND IT'S REALLY CONSISTENT WITH
TRADITIONAL LAKOTA MEDICINE IS
TO WORK FURTHER UPSTREAM, AND CHERISH AND HONOR
THE HEALTH OF OUR YOUNG ONES. >> GOSH, THAT JUST RINGS SO
TRUE AND THAT'S A TRADITIONAL
LAKOTA — LET'S HEAR MORE ABOUT
THAT. >> THREE SISTERS WALKING ALONG
THE RIVER AND THEY SEE BABIES AND YOUNG MOTHERS IN THE WATER
STRUGGLING TO STAY AFLOAT. WE NEED TO GET THE BABIES OUT
OF HERE RIGHT NOW. THE SECOND SISTER SAYS NO, WE
NEED TO TEACH THEM HOW TO SWIM AND THE THIRD SISTER KEEPS
WALKING UPSTREAM AND THE OTHER
TWO ASK HER WHERE ARE YOU GOING? SHE SAYS I'M GOING TO FIND OUT WHO IS PUTTING THESE BABIES IN
THE WATER, AND I'M GOING TO
STOP THEM. THAT'S PUBLIC HEALTH. THAT'S
TRADITIONAL MEDICINE. THAT'S LITERALLY WORKING
UPSTREAM AND THAT'S THE
APPROACH WE NEED TO TAKE. >> I HEARD HIM TELL THE STORY
FOR THE FIRST TIME I THINK SIX
YEARS AGO. IT CHANGED MY LIFE. >> WOW. >> BECAUSE I UNDERSTOOD THE
WAY, THE TRADITIONAL LAKOTA
PEOPLE THINK. AND I EVEN USE
THAT STORY NOW. >> GOOD. >> BECAUSE IT'S SO IMPORTANT
THAT WE UNDERSTAND WE HAVE TO
PROSECUTE A FORM OF PUBLIC
HEALTH. WE HAVE TO HAVE THE PEOPLE IN
THE WATER TEACHING THE PEOPLE
HOW TO SWIM, PEOPLE IN THE WATER GETTING THE KIDS OUT AND
PEOPLE FIGURING OUT THE ROOT
CAUSE. >> WONDERFUL STORY. AND IT
MAKES SENSE. IT'S A METAPHOR
FROM WHICH WE CAN ALL WORK. WITH ALL SORTS OF ILLNESSES.
YOU KNOW, AS A PHYSICIAN AND
CARING FOR PEOPLE, BUT REALLY, PUBLIC HEALTH IS AN IMPORTANT
THING. REALLY, THAT'S PART OF WHY I'VE
GONE INTO SOME TELEVISION AND
RADIO THINGS. YOU KNOW, I CAN ONE ON ONE WITH
MY PATIENT, AND I CAN SAY
YOU'VE GOT TO EXERCISE MORE AND HERE ARE WAYS OF BALANCING
YOUR LIFE AND, YOU KNOW, LET GO
OF THIS FEAR THAT YOU'RE HAVING. >> AND REGIONAL HEALTH DOING A
LOT MORE, WE HAVE COMMUNITY
HEALTH TOO AND I'M EXCITED TO
SEE THAT. >> YEAH, THIS COMMUNITY HEALTH.
IT'S DOING IT IN A LARGER GROUP. TELL US ABOUT WHAT YOU ARE
DOING. >> WE ARE PARTNERING WITH SIOUX
SAN HOSPITAL AND PINE RAGE. AND WITH SIOUX SAN, WE'RE
HAVING COLLABORATIVE MEETINGS
AND COMING TOGETHER AND SAYING THESE ARE OUR PATIENTS. WE
SHARE THE SAME PATIENTS. WHAT
CAN WE DO TOGETHER? AND SO WE'RE DOING A VARIETY OF
THINGS TOGETHER, LOOKING AT
PATIENT INFORMATION, TRYING TO FIGURE OUT A PATIENT WHO WENT
AND PRESENTED IN THE URGENT
CARE WHO SHOULD HAVE GONE TO THE E.D., WHO WAS REFERRED TO
OUR SYSTEM, WHO DIDN'T MAKE IT
THROUGH OUR SYSTEM AND WE MEET EVERY SINGLE WEEK TO HAVE THESE
DISCUSSIONS. AND IN ADDITION TO THAT, WE'RE
DOING COMMUNITY EVENTS. AND
PEOPLE SOMETIMES ASK ME, WHAT'S THE SIGNIFICANCE OF THE
COMMUNITY EVENTS? WELL, GUESS
WHAT. WHEN THERE HAS BEEN HISTORICAL
TRAUMA, AND WHEN THERE'S TRUST
LACKING, YOU BUILD TRUST. BECAUSE IF YOU DON'T BUILD
TRUST, PATIENTS WON'T COMPLY.
YOU THINK ABOUT DISTRUST AND
MISTRUST. WHEN YOU DISTRUST, YOU DON'T
TRUST THE RELIABILITY.
INFORMATION BEAN GIVEN TO YOU. WHEN YOU MISTRUST YOU ACTUALLY
APPROACH IT WITH A SUSPICION.
SO FROM THE GET-GO, WHEN PATIENTS PRESENT, BECAUSE OF
HISTORICAL TRAUMA, THEY'RE NOT
ALWAYS SURE IF THEY SHOULD ACCESS THE CARE, IF THEY SHOULD
TELL YOU ALL THAT'S GOING ON
WITH THEM, IF THEY SHOULD COMPLY WITH THE
TREATMENT PLAN. AND SINCE WE'RE HAVING
COMMUNITY EVENTS, BEING PARTNERS WITH THE RAPID CITY
COMMUNITY CONVERSATION, WITH
THE WELLNESS AND TRANSFORMERS GROUP, HAVING A COLLECTIVE
IMPACT, BY DOING ALL OF THIS,
WE'RE TELLING THE COMMUNITY, WE
ARE UNITED. WE HAD OUR FIRST FOUR
DIRECTION, FIVE KILOMETER RUN
FUN WALK COMMUNITY UNITY DAY,
AND IT — >> I LOVE THAT. >> IT WAS WONDERFUL. WE HAD
OVER 600 PEOPLE COME OUT. AND ONE OF THE POLICE OFFICERS
SAID WE DIDN'T HAVE TO BE THERE
AS PEOPLE ENFORCING. WE CAME AND WE HAD FUN. LAST
WEEK WE CELEBRATED THE NATIVE
AMERICAN PARADE, AND AGAIN, POLICE OFFICERS CAME OUT
AND SAID, WE HAD FUN. THEY WERE
NOT CONCERNED ABOUT TEN TENSION. AND SO WE ARE REALLY MAKES
STRIDES TO SAY WE MUST COEXIST
PEACEFULLY, WHICH IS PART OF
THE ASPECT OF SOCIAL WELL-BEING THAT I DEFINED
EARLIER ON. >> I SENSE THAT MY OWN DIGNITY,
MY OWN SELF-DIGNITY IS ENHANCED
WHEN I GIVE DIGNITY TO — I SEE THE DIGNITY
IN EVERY INDIVIDUAL. >> YES. >> AND I MEAN, O OF COURSE, I
CAN FORGIVE MYSELF FOR MY
PROBLEMS. WHEN I FORGIVE MY — THE PEOPLE
THAT I WORK WITH, AND I KNOW,
AND I DEAL WITH, SO IF YOU GIVE THAT DIGNITY, IF YOU
GIVE RESPECT TO PEOPLE, I THINK
IT ALL COMES BACK TO YOU. WE SHOULD ALL LEARN THAT LESSON. THAT YOU — WHEN YOU GIVE
DIGNITY, IT COMES BACK
FOUR-FOLD. AND THAT THAT'S SOMETHING THAT
I THINK, YOU KNOW, WE — WE — WHEN WE'RE A TRIBE AND WE'RE
NOT GIVING — WE'RE NOT TREATED
WITH DIGNITY, THAT CARRIES WITH
US A LONG TIME. IF WE AS INDIVIDUALS CAN TURN
THE TIDE BY THE WAY WE TREAT
EACH OTHER. >> YEAH, YOU'RE ABSOLUTELY: AND
LOOK AT THIS HISTORICAL TRAUMA
AND BOARDING SCHOOLS, ADVERSE CHILDHOOD EXPERIENCES,
WE ALSO HAVE TOXIC STRESS IN
OUR COMMUNITIES AND ADVERSE ADULT HOOD EXPERIENCES, AND
PART OF THAT IS QUITE HONESTLY
DEALING WITH RACISM. AND UNFORTUNATELY THAT'S ALIVE
AND WELL IN MANY PARTS OF THE
STATE. AND EXACTLY WITH WHAT YOU'RE
SAYING. IF WE THINK ABOUT ALL OF OUR
HISTORICAL TRADITIONS AND
BELIEF SYSTEMS OR WORKING WITH THE POOR AND NOT DOING IT IN A
JUDGMENTAL WAY, I WISH THAT MORE PEOPLE IN SOUTH DAKOTA AND
IN THIS REGION WOULD ABIDE BY THEIR STATED VALUES AND
THEIR STATED BELIEFS, BECAUSE
IF THEY ARE, FOR EXAMPLE, CHRISTIAN, WHAT
ABOUT CHRISTIAN CHARITY? WHAT ABOUT THE BEATITUDES? WHAT ABOUT CARING FOR YOUR
FELLOW MAN? WE SEE A LOT OF THAT DISAPPEAR
WHEN WE FEEL RACIAL TENSION — >> MORE DIVERSE? >> AND MUCH MORE OPEN HEARTED
AND OPEN MINDED. >> BUT EVEN US OLD GUYS SHOULD
BE ABLE TO THROW AWAY OUR
PREJUDGMENT, OUR PREJUDICES, JUST LET GO, AND WE HAVE
NOTHING TO DO BUT GAIN FROM
THAT. >> THAT'S EXACTLY RIGHT. >> AND I TELL YOU, ASK YOURSELF
WHEN YOU SEE SOMEONE WHO IS
DIFFERENT, WHAT ARE THE FIRST THOUGHTS
THAT COME TO YOUR MIND? EXPLICIT BIAS. IMPLICIT BIAS.
EXPLICIT, THE THINGS THAT YOU
SATURDAY. SO HEAR YOURSELF. WHAT ARE YOU SAYING ABOUT THE
OTHER PERSON THAT YOU SEE.
IMPLICIT, WHAT'S DEEP INSIDE OF YOU THAT HAS NOT YET COME TO
THE SURFACE THAT YOU NEED TO
TRY TO PAY ATTENTION SO THAT YOU CAN GET RID OF IT? REFOCUS AND PAY ATTENTION TO
THE WAY THAT WE THINK AND THE THINGS THAT WE SAY, WE CAN THEN
CORRECT IT. IF WE DON'T PAY ATTENTION, THEN
WE CAN BE IN DENIAL. >> SO WE'VE GOT, YOU KNOW, WE
CAN TALK ABOUT DIABETES AND
CANCER AND ADDICTION. WE HAVEN'T EVEN TOUCHED ON
ADDICTION. I THINK PART OF, THOUGH, THAT
WE'VE TALKED ABOUT IS THAT
ADVERSE CHILDHOOD EXPERIENCE. WE WORK ON THAT, WE CAN FIX
THIS. BUT WE'VE GOT, YOU KNOW, MAYBE
3045 MINUTE — SECONDS LEFT.
SANDRA, IN A 45-SECOND
TAME-HOME MESSAGE. >> I WOULD LOVE TO SEE PEOPLE
COME TOGETHER TO SAY WE HAVE PROBLEMS THAT WE NEED
TO FIX COLLECTIVELY AS
COMMUNITIES. WE HAVE PEOPLE THAT ARE 90
MILES AWAY FROM US WHO HAVE
HIGH PREVALENCE AND HIGH INCIDENCE RATES OF HEALTH
CONDITIONS THAT CAN BE MANAGED,
THAT CAN BE TREATED. IT'S WONDERFUL THAT WE DO
MISSION TRIPS ALL OVER THE
WORLD. BUT WE ALSO HAVE PEOPLE IN OUR
BACKYARD WHO ARE RIGHT THERE
THAT WE CAN POOL OUR RESOURCES TOGETHER AND MAKE A DIFFERENCE
WITHIN THOSE COMMUNITIES, AND
SO MY CALL TO ACTION IS, LET'S ALL GATHER TOGETHER, CHURCHES,
HEALTH CARE ORGANIZATIONS,
NON-HEALTH CARE ORGANIZATIONS, BUSINESSES, LET'S PARTNER AND
MAKE A DIFFERENCE WITHIN THE
COMMUNITIES THAT WE SERVE. >> OKAY. AND, DON? >> AND I WOULD AGREE THAT I
THINK IF WE ARE TRUE TO OUR
STATED BELIEFS, WE CAN GO THE
RIGHT DIRECTION. AND I ALWAYS — AND MY
DISCUSSIONS WAS A PRAYER THAT I
WAS TAUGHT A LONG TIME AGO, AND IT'S LET US REMEMBER THAT
WE ALL DRINK FROM THE SAME
STREAM OF CONSCIOUSNESS. WE ARE ALL CONNECTED BY THAT
SAME STREAM OF CONSCIOUSNESS.
WE ARE ALL RELATED. WHAT WE DO TO EACH OTHER WE DO
TO OURSELVES. ACT KINDLY TOWARD MY PEOPLE FOR
INDEED MY PEOPLE ARE YOUR
PEOPLE. >> THAT'S BEAUTIFUL. WE'LL BE
BACK RIGHT AFTER THESE WORDS. >> ALL AROUND TOWN, FROM STORES
TO PLAYGROUNDS, BABIES ARE ON
THE MOVE. AND THERE ARE DISEASES THAT ARE
ON THE MOVE, TOO, AND SOME OF
THESE SPREAD EASILY. TO BEST PROTECT HIM FROM 14
SERIOUS DISEASES BY THE TIME HE
TURNS TWO YEARS OLD, VACCINATE HIM ACCORDING TO THE
RECOMMENDED SCHEDULE SO HE CAN GO ON ABOUT HIS BUSINESS, AND
OU CAN HAVE PEACE OF MIND. FOR MORE REASONS TO VACCINATE,
TALK TO YOUR CHILD'S DOCTOR, OR
GO TO CDC.GOV/VACCINE. >> THE FIRST DAY I MET AMIEL
REDFISH, PHYSICIAN ASSISTANT,
WE DISCUSSED THE OVERUSE AND OVER-RELIANCE ON MEDICINE
IN OUR MODERN SOCIETY, HOW GREAT CHANGES IN LONGEVITY, THROUGH
THE YEARS, CAME INSTEAD WITH
PROPER SANITATION, CLEAN WATER, AND THE DISCOVERY OF
ANTIBIOTICS. ALTHOUGH THERE HAVE BEEN GREAT
STRIDES IN HEALTH CARE THROUGH
THE YEARS, NONE OF THEM HAVE RESULTED IN SUCH SIGNIFICANT
DROPS IN OVERALL DEATH RATE. REDFISH ALSO EXPRESSED THE
VALUE OF THE VIGOROUS LIFESTYLE
OF THE TRADITIONAL AMERICAN INDIANS AND EATING
CLOSER TO WHAT WAS FOUND IN A
HUNTER-GATHERER'S WORLD, LIKE ROOTS, VEGETABLES, BERRIES AND
FRUIT, EGGS, AND WILD GAME MEAT. MY COLLEAGUE IS A TRUE SIOUX
INDIAN MEDICINE-MAN, A CLASS
ACT AND A DEAR FRIEND. BUT DESPITE THE SAGACITY,
INSIGHT, AND TRADITIONAL
PERSPECTIVE HE REPRESENTS, I DARE SAY THERE ARE THOSE WHO,
NOT KNOWING HIM, WOULD LOOK AT HIS ORIGINAL
AMERICAN INDIAN FEATURES AND
PREJUDGE HIM. PREJUDICE IS A WORD THAT MEANS
PREJUDGING OR MAKING AN OPINION ABOUT AN INDIVIDUAL
USING PRECONCEIVED NOTIONS,
COMING TO AN OPINION BEFORE ONE
HAS THE FACTS. TYPICAL PREJUDICES ARISE OUT OF
ATTITUDES, MOSTLY PARENTALLY TAUGHT, ABOUT
PERCEIVED DIFFERENCES IN RACE,
GENDER, GENDER IDENTITY, NATIONALITY, SOCIAL STATUS,
SEXUAL ORIENTATION, RELIGIOUS
AFFILIATION OR NON-AFFILIATION, AGE,
DISABILITY, HEIGHT, AND WEIGHT. ANTHROPOLOGISTS SPECULATE THAT
STEREOTYPING AND ACTING ON
PREJUDICE, AT ONE TIME, PROVIDED A SURVIVAL ADVANTAGE.
IN UNPOLICED SOCIETIES, PEOPLE
ARE SAFER TRUSTING THEIR FAMILY AND THEIR COMMUNITY,
WHILE BEING CAREFUL WITH
OUTSIDERS. 10,000 YEARS AGO, THOSE LOOKING
DIFFERENT THAN OUR TRIBE HAD A
HIGHER CHANCE OF CAUSING US
HARM. THUS ALL THIS IS HARDWIRED INTO
OUR MIDDLE BRAIN. BUT DISTRUST AND HATING OTHERS
WHO ARE DIFFERENT CAN ALSO COME
OUT OF SELF-DOUBT, JEALOUSY, AND IS DESTRUCTIVE OF
THOSE HATED AND EVEN MORE SO
THE HATER. AS THEY SAY, "IF YOU WANT TO
DESTROY YOUR ENEMY, MAKE HIM
HATE." OTHER RESEARCH SUGGESTS THAT
TREATING PEOPLE WITH RESPECT,
NOT PREJUDGING THEM BY APPEARANCE, ALLOWS AN OPENNESS
TO OPERATE, WHICH IN TURN CHURNS THE WHEELS OF COMMERCE,
COMMUNITY, AND COMMUNICATION. DOESN'T IT RING TRUE WHAT
MARTIN LUTHER KING JR. SAID? "I HAVE A DREAM THAT MY FOUR
LITTLE CHILDREN WILL ONE DAY
LIVE IN A NATION WHERE THEY WILL NOT BE JUDGED BY THE COLOR
OF THEIR SKIN BUT BY THE
CONTENT OF THEIR CHARACTER." IT IS ACCURATE TO SAY THAT
THOSE WHO CAN BREAK FREE OF
PREJUDICIAL STEREOTYPING ARE BETTER ABLE TO MAKE NEW FRIENDS
AND FIND SUCCESS. IT IS A GREAT JOY AND TO MY
GREAT ADVANTAGE TO HAVE FRIENDS
LIKE AMIEL REDFISH. >> WELL, A GREAT BIG THANK YOU
TO OUR GUESTS DR. DON WARNE AND TO SANDRA
OGUNREMI, FOR HELPING US WITH
TONIGHT'S SHOW. AND THAT'S IT FOR TONIGHT. FROM
ALL OF US HERE AT "ON CALL WITH
THE PRAIRIE DOC," UNTIL NEXT TIME, STAY HEALTHY
OUT THERE, PEOPLE. >> MAJOR FUNDING FOR "ON CALL
WITH THE PRAIRIE DOC" IS
PROVIDED IN PART BY :>> AVERA IS A PROUD SPONSOR OF
"ON CALL" ON SOUTH DAKOTA
PUBLIC BROADCASTING. LARSON MANUFACTURING IS PROUD
TO SUPPORT "ON CALL TELEVISION" AS IT CONTINUES TO OPEN DOORS
FOR IMPORTANT MEDICAL
INFORMATION. AND BY THE SOUTH DAKOTA
FOUNDATION FOR MEDICAL CARE,
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR
SOUTH DAKOTA. AND WITH THE ONGOING SUPPORT OF
THESE INDIVIDUALS AND
INSTITUTIONS…

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