ALASKA NATIVES

I spent 7 months in Alaska and there are about 35,000 people eligible for care. In Alaska, the natives within the scope of the program, are a combination of the Chelans, Shoshone, Haida, and Aleut North American Indians, plus the Alaskan Eskimo. After the purchase of Alaska from Russia the Alaskan native fit into this total responsibility of the Federal Government and was included in the Indian Health program. Senator DwORSHAK. As long as you keep the Indians on the reservations it is not difficult, especially in the case of the Navahos, to provide health for them in their environment. But they have to leave reservations in order to get employment and they become integrated in the population, is that correct?

ECONOMY RELATED TO HEALTH

Dr. CRONIN. I think that is correct, Senator, but I also think first of all, the economy of any people is directly tied up with its health and vice versa. I think when the situation is considered there has to be created in the mind of the Indian an actual need for good health. If you can create that feeling in his mind, and that is our basic job, in other words, we should get his sense of values up in regard to health and then you can follow along with all these other things, such as occupational and vocational training, and all of that. He should be educated so that he can go out and take his place in the community.

HOSPITALS FOR NAVAHOS

Senator DwORSHAK. In the case of the Navahos, are you not building the hospitals in the area with the implication they are going to remain in that section indefinitely?

Dr. CRONIN. No, sir. I think the hospitals are not being built on that basis. They are being built on the basis of where the people are. It is very difficult. I don't think that it would be accepted if we came in for funds for a fleet of helicopters to transport the sick Indians to Albuquerque or Phoenix or some place like that. I don't think it would work. After all, to get a man in an airplane he has to agree to get

into it.

Senator DWORSHAK. I am not arguing. I am just asking on what basis you are planning that program, because it is a little difficult for me to reconcile this building. First, may I say that I am in full sympathy, wholehearted sympathy with what your objectives are, but I am questioning whether, in concentrating all of these advantages in health and education in the areas where the Navahos now reside, whether it will not be more difficult, increasingly more difficult to get them out of that area so they can get employment like other Americans? Would not the tendency be to remain in that area in order to take advantage of all of these fine health and educational opportunities that we have provided for them?

Dr. CRONIN. If that happens, we have failed in our job and I don't think we will fail in the job, because I think our goals are true goals and I think our hospitals are primarily health centers for these communities. They are places where not only are gall bladders removed and sick people are treated but also out of which flows good health education, and good information so the Indians can benefit.

SHIPROCK HOSPITAL

Dr. SHAW. As to specific information on the Navahos, there is the Shiprock Hospital, which is at Shiprock, N. Mex.; it is true it is the center of the desert, but there is also found there terrific oil, gas, and mineral deposits and the San Juan irrigation project is underway. A very large productive community activity is developing.

HOSPITAL AT GALLUP

The other hospital is going in Gallup, which is on a railroad and which will be a center of manufacturing and will have transportation and communications of all types and be a center of employment for the Navahos.

Senator DWORSHAK. Then you envision some agricultural and educational development in the area so that it will not be necessary for the Indians to leave there?

Dr. SHAW. Yes, sir. We have resisted pressures to locate hospitals out in the middle of that terrific reservation. We are meeting the need by cheaper health centers, public health care and the clinic type of operation.

INCREASE IN ADMISSIONS TO HEALTH FACILITIES

Now this shows the increase in admissions to our health facilities, which has been considerable. This will give a better index of the type and extent of service than do the average daily patient figures. Because of the increase in medical services and doctors and so on, we have been able to decrease the length of time it takes to cure them. So the average patient stay is not going up, but the number of patients receiving treatment and cure has gone up very materially. This is the hospital patient load showing the increases that have occurred. (The following charts were submitted:)

Dr. SHAW. This chart shows the outpatient treatments. We feel it is our job to keep them well, keep them working, keep them vertical rather than horizontal, so to speak, so our efforts are directed along those lines, using every opportunity to impart information to them which they can use in an overall situation which will assist them in protecting themselves from the infectious diseases.

(The following chart was submitted:)