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through the American Indian Health Clinic, the needs for the urban Indians that have made the transition from the reservation setting into an urban environment.

And at the present time, according to the 1990 census, there are 4,500 American Indians in Ramsey County alone. And what we'd like to do is emphasize the fact that 39 percent of those are below the poverty level. And many times the percentage is approximately 60 percent that have no coverage for health insurance at all. It's really high.

What we're talking about is primarily from Indian Health Service for the urban programs branch. We would like to see some funds increased in this area for operations of programs, such as, the American Indian Health Clinic of St. Paul. That's an urban clinic that can be that can be creating different types of health care systems for preventative measures for all American Indians, no matter what specific tribe they may be. But those that are in need of health care are off the reservation settings.

The last known clinic that has been financed is one that is in Flagstaff that Senator DeConcini helped push through and get funded there. So we'd like to be part of that system and part of those funds that are increased. And we're talking for more than the years prior to 1994-97 and then in 1998. Obviously, you know if something occurs, there will be a new system that we can work at within the urban system and deal with, but we're worried about up until that time.

Senator WELLSTONE. Thank you. And the other thing is that Carol, too, who of course spoke earlier-I do think it is very important that, Richard, that you do emphasize, you know in fact, put a focus on Indian people within urban communities. Otherwise, they could easily be lost.

I really appreciate what you said.

Mr. CARPENTER. They are all enrolled in urban settings. That's my emphasis.

Mr. SEEGER. Carol, do you have some more that you want? Senator WELLSTONE. We might want to let people who haven't spoken-go ahead.

Ms. MARQUEZ-BAINES. It's a totally different area.

Senator WELLSTONE. Okay.

Ms. MARQUEZ-BAINES. I just wanted to underscore a point that Dan Milbridge brought up in terms of traditional health care services, because I think it's a critical component of the cultural sensitivity.

I recently underwent cancer surgery, and I believe that through accessing traditional health care services through the Indian Health Board of Minneapolis, I was able to help promote my own healing. And this has happened just within the last 22 months; and therefore, I'm not able to undergo certain types of other procedures. But I think that that is something we see a growing number of across all the urban Indian health sites, and I'm sure in the tribal settings, as well. That this traditional health care is an important part of preventive and health promotion services that must not be neglected, and incorporated in the wrap-around services. That's the point I wish to make.

Senator WELLSTONE. Well, Carol, I'm really glad. I had no idea that that's what you were going to say. And I'm certainly glad that you did say it. And I appreciate, very much, your comments. Thanks for drawing on your own personal experience, as well.

Ms. MARQUEZ-BAINES. Thank you.

Senator WELLSTONE. Thank you.

Linda Frizzell.

Dr. FRIZZELL. Can I yield this spot? I would still like to speak, but I yield to the chairman.

Senator WELLSTONE. Of course. Absolutely.

Mr. Chairman, thank you.

STATEMENT OF ALFRED JAKE PEMBERTON, CHAIRMAN, LEECH LAKE RESERVATION

Mr. PEMBERTON. Thank you very much, Linda.

First of all, for the record, I'd like to inform you of my name. My name is Alfred Jake Pemberton. I'm the chairman of Leech Lake Reservation located here in the State of Minnesota.

I want to thank Senator Wellstone and his staff for coming here to hear the health care reform and the health care issues here today from all these people who provided information about our health care.

Thank you, Senator, for coming here to Minnesota and to Bemidji.

I also want to make one quick statement in regards to the Senator. He has visited Leech Lake a number of times. He was over there recently on a trip, and he has been a big voice in Washington, for not only the people of Minnesota, but for the American Indians from the State of Minnesota. And he has done an excellent job of carrying out his duty as a Senator in the Indian chambers there at where the lawmakers are located in Washington, DC.

Senator WELLSTONE. Mr. Chairman, that's a good way for you to finish your remarks. [Laughter.]

Mr. PEMBERTON. All right. Thank you very much.

But we'll move on in regards to health care. I was going to take a little more than 2 minutes anyway.

But, first of all, I think it's important that we all know that InIdian Health Service has been shorthanded here for a number of years, as far as dollars are concerned. Health care, along with health care needs have escalated so high throughout the years, but the budget for Indian Health Service has decreased. I think this has been mentioned a number of times. But it's important that we not only speak for our area, but we speak for the Indians in total throughout the entire Nation that Indian health care has been underfunded.

Mr. Norman Deschampe mentioned that, treaty rights and treaty funds in 1863-64 and 1867, this is when all our land was seeded throughout the entire Indian country to the U.S. Government. This is where we were actually supposed to be provided with our health care needs. And to this day we are kind of getting shorthanded at this point.

I also would like to move along very quickly and mention other health programs that have been underfunded throughout the area, and particularly our area.

Water and sewer has been a big issue here, not only on the Leech Lake Reservation but, I think, other reservations throughout the State of Minnesota. And these dollars have been really short. And where we've lived in a rural community all our lives and we know that people have to have water and sewer systems here, we're not in an urban setting here. We can't just hook up our water and sewer systems to a metro setting here. In other words, we need single units here in the State of Minnesota.

And moving along I'd just like to say one more thing, Senator, before I close here. I'd like to thank you for coming here, once again. And I think the future of the Indian Health Service budget definitely needs a large increase. So hopefully, with the testimony you heard today here, that when you take our message back to Washington, that we'll be looking for a big increase in all areas of Indian Health Service.

Thank you very much.

Senator WELLSTONE. That you, Mr. Chairman.

Doctor, do you want-I'd also like Senator Finn to join me. I notice he just came in. I would very much be honored if he would come up here with us.

STATEMENT OF DR. LINDA FRIZZELL

Senator FINN. Thank you, Paul.

Dr. FRIZZELL. As Mr. Hunt alluded to, I'd like to just briefly mention something about the Leech Lake health status.

We all hear all the figures and numbers and it sort of glosses over what really is the cause. The leading cause of death on our reservation is health disease or, excuse me, heart disease. And one of the contributing factors to heart disease, as it relates to Indian People, they're different. Stress is a major confounding factor that relates to heart disease. Unemployment. Life in an isolated, rural area can certainly lead to stress, diabetes, and poor nutrition.

The second leading cause of death; accidents. Most of the accidents are related to alcohol and drug abuse. Second leading cause of death. Very preventable. Very preventable.

Third leading cause of death; infections from viral and bacterial infections.

And the fourth leading cause of death is cancer.

Now, all these are preventable. The majority of our visits that we see at the service unit are preventable conditions.

Last year there were over 50,000 outpatient visits. That's an increase from 6,000 from the year before.

What we need to concentrate on is, we need to concentrate on seeking funding for three segments of the population. We have certainly the acute problems that we see and that represents the 50,000. We have the chronic problems that are ongoing ones. Many of the acute problems will continue and become chronic. But where we would have to start right now, and we desperately need the funding, is we need prevention. We have to start preventing. We're overrun right now. And the only way that we can solve or we can elevate the health status of Indian people, is to produce preventative measures, preconception through death. So then we use other multidisciplinary type of programs. Education is a prime example.

Community efforts. But it takes a cooperation from everyone in the community to elevate the health status.

Senator WELLSTONE. I know other people want to speak, but just if I could hold you for a second, doctor.

It seems, you know, we've used this talk about-I think I asked, maybe, Kathy earlier about wrap-around services, to describe what is meant; because it's a sort of lingo-but it seems like what you're really saying is that we have to take much more of a public health perspective. We just really have to look at environmental issues. We have to look at it, and we need to, really. So much of it needs to be focused on the sort, if you will, the community.

Dr. FRIZZELL. Certainly.

Senator WELLSTONE. Is that what you were really saying?

Dr. FRIZZELL. The community, in itself, you know, one person's health affects the health of another person in the cooperative. Then things could be changed and worked together.

Senator WELLSTONE. But you don't see anywhere near the resources?

Dr. FRIZZELL. No; there's basically no funding for preventative care, and

Senator WELLSTONE. See, that's

Dr. FRIZZELL. And that's where-look at all the morbidities, you know. Health disease or heart disease. Look at the morbidities that result. And look at diabetes and morbidity.

Senator WELLSTONE. Is there a concensus-I's must looking out in the room now. Is there a concensus that basically there's just very, very little funding for the preventative health care? Is that the way all of you look at it? Because that, to my mind, is clearly one of the bitter ironies that we have to drive home to Washington; because that's what everyone is talking about now. I mean, everybody is saying that that's the most important thing to do, and yet here we have a situation where the, again, the budget directly contradict the rhetoric, if I understand what you're saying.

Dr. FRIZZELL. And preventative is multidisciplinary. that's one key thing that we have to remember. We don't want to band-aid over things. That's what's being done right now. We want-we want to make people have a higher quality of life and have greater life satisfaction.

Senator WELLSTONE. Thank you.
Ms. SEEGER. David Jones, please.

STATEMENT OF DAVID JONES, PRESIDENT, INSTITUTE ON
CULTURAL DYNAMICS AND SOCIAL CHANGES

Mr. JONES. Hello. I'm David Jones, president of the Institute on Cultural Dynamics and Social Change.

I'd like to make a couple of comments. One has to do with my experience as director of the Wings project out of the University of Wisconsin. And that's to say, don't forget the children, particularly children with special needs, chronic illness, or developmental disabilities.

I think one symptom of the fact that there-that programs are so underfunded in Indian country is that we get stuck on the acute problems and don't ever get to the chronic problems, because we can't afford to. That should be a national scandal, I believe. There

are children with great needs in Indian country, and some of them preventable, some not. There's FAS, fetal alcohol syndrome, and the effects, but there's also other developmental disabilities. There's chronic illness from ear infections to whatever.

One of the problems is, we don't even know what a lot of the issues are. There has been so little done with children with chronic conditions under reservations that we don't even know. As far as I know, Indian Health Service has no record of tracking system for these children. So that's my one issue.

The other one is-and that's another problem area, I guess. Another one is a much more positive thing.

Senator WELLSTONE. Can I interrupt you? No tracking system meaning what? That we're not

Mr. JONES. Well, we don't know how many children there are with chronic conditions. We don't know whether there are more or less. I believe, some of us believe, there are many more children with chronic conditions because of the risk factor in Indian country. Poverty, unemployment, isolation, things like that.

But as far as I know there's never been any attempt by Indian Health Service to actually look into how many children there are, what conditions there are, to specifically see how they compare to the general population.

Senator WELLSTONE. Sometimes we don't know what we don't want to know.

Mr. JONES. Right. Yeah.

As I say, the next point I want to make is a much more positive one. Although there is a word of caution that goes along with that, and here I speak as a newly retained consultant to the Mayo Clinic.

I think what we're beginning to see is some entities like the Mayo Clinic bringing its prestige and reputation and its experience to say, "How can we become partners with Indian tribes to bring what we have, our knowledge, our expertise to tribal communities?"

I think that's a very exciting thing that's happening. I guess my word of caution there is, I would hope in health care reform, that that becomes a catalyst to that kind of a partnership and not a barrier to it. Whatever happens to national health care reform enables these kind of new partnerships.

Let me just give some examples. Mayo Clinic has already-it's already a leader in what's called telemedicine, which is like satellite downlinks. They've become experts at that, because they opened their Scottsdale, AZ, clinic and their Jacksonville, FL. The doctors in Mayo can now instantaneously do actual consultations by satellite. So that they can look at an x ray. They can talk to a doctor, even talk to a patient.

One of the things I noted throughout the morning was comments about the isolation. "We lose the doctors. They don't stick around." I think these kind of things can connect those doctors to experts, to some specialists, and help support them so that they stay in rural areas, stay in tribes.

My fear is, I think technology has often gotten in the way with the the expensive technology is often a barrier, itself.

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