Doctors find a way to bridge cultural gap
By Judy Nichols
The Arizona Republic
July 21, 2002
Reach the reporter atjudy.nichols@arizonarepublic.comor (602) 444-8577.
SPECIAL REPORT - PART 2
Doctors find a way to bridge cultural gap

Mark Henle/The Arizona Republic
Dr. James Galloway talks with Thomas Tsosie about the serious condition of his heart during an appointment at the hospital in Chinle. An echocardiogram showed that his heart was pumping about 10 percent of the blood it collected.
By Judy Nichols
The Arizona Republic
July 21, 2002
Reach the reporter atjudy.nichols@arizonarepublic.comor (602) 444-8577.
SPECIAL REPORT - PART 1
Indian health care: Separate, unequal

Photos by Mark Henle
Maxine Gould, a Navajo, and her one-month-old son, Isiah, listen while a public health nurse advises her on child care. The health system has decreased infant mortality but problems remain.
Federal care spending low, death rates high for tribes
By Judy Nichols
The Arizona Republic
April 14, 2002
Native Americans are dying at shocking rates. Of alcoholism, tuberculosis and diabetes. From accidents, suicide and homicide. At rates up to seven times higher than other Americans.
In Arizona, the average age at death for Whites is 72, compared with 55 for Native Americans. That's younger than for residents of Bangladesh.
The federal government, which promised in treaties to provide health care for Native Americans, spends less than half as much per tribal member as it does for programs covering other Americans. Private health plans spend more than twice as much per person.
"If this were happening in any other part of America, there would be Senate hearings, commissions," said Sergio Maldonado Sr., an Arapaho who is a program coordinator in the American Indian Studies program at Arizona State University.
They would be asking, 'Why are these people dying? Is it the water? The air? Anthrax? But because it's Arapaho, Sioux, the border towns around reservations, no one blinks an eye."
Maldonado said the lack of health care and differences in life span are a sign of continuing discrimination.
The leading causes of death for Native Americans are heart disease and cancer, the same as for other populations. But while those rates are closer to the norm, they are increasing as other populations are seeing improvements.
Native Americans die in accidents at more than three times the rate of other Americans, a fact so discouraging that federal officials say facetiously they wish for more disease.
"We'd love to have higher cancer rates," said Alan Dellapenna, deputy director of the Indian Health Service Office of Environmental Health and Engineering in Rockville, Md. "That would mean young people were living long enough to develop those kinds of diseases."
Promise madeIn the early 1800s, the push for westward expansion resulted in war between the United States and many Native American tribes. Treaties, which stripped Native Americans of more than 400 million acres of ancestral lands, promised health care, as well as peace.
"When people say, 'You get free health care,' I say, 'Bear sweat,' " Maldonado said. "There's no 'Free.' Blood was spilled."
Today, the Indian Health Service, part of the U.S. Department of Health and Human Services, provides care for about 1.5 million Native Americans, living on or near reservations, some of the most remote and impoverished parts of the country.
But it has never been fully funded.
This year's budget is $3.2 billion. But according to a study conducted by a group of tribal and Indian health leaders, more than $7 billion annually would be needed to provide care similar to that other Americans receive. And $15 billion would be needed to add and improve facilities to make the system equal.
The Indian Health Service spends about $1,920 per person annually. That compares with more than $4,390 that private insurance budgets for most Americans' health plans, or the federal government's $3,859 for Medicaid, $5,600 for Medicare and more than $5,700 that veterans receive.
"Health care for Native people has never been a high priority nationally," said U.S. Sen. Ben Nighthorse Campbell, R-Colo., a Cheyenne chief and the only Native American in the Senate.
Campbell, a member of the Senate Committee on Indian Affairs, said most Americans feel a moral debt of gratitude to veterans, but do not understand the "unique legal, moral and historic relationship with Indian tribes."
Funding also has suffered because of the evolving misconception of the "rich Indian," the mistaken belief that Native Americans were raking in money first from land and oil, and now, from casinos, Campbell said.
"These headline-grabbing myths lead policymakers to conclude that most Native Americans do not need federal assistance for health care," Campbell said. "Of course, the opposite is true. The vast majority of Native Americans remain mired in poor economic conditions and continue to suffer from significant health problems."
Sen. Tom Daschle, D-S.D., whose state has some of the highest death rates for Native Americans, is so concerned that he plans to request an additional $4.4 billion for the Indian Health Service this year.
"While Congress debates how to allocate trillions of dollars, medical treatment for American Indians and Alaska Natives is being rationed," said Daschle, who called the situation inexcusable.
Dr. Craig Vanderwagen, chief medical officer for the health service, acknowledges that the system is seriously flawed.
"We don't feel good about the number of patients who need care who are rejected because their problem is not life-threatening," said Vanderwagen, based in Rockville, Md. "It's rationing. We hold them off until they're sick enough to meet our criteria. That's not a good way to practice medicine. It's not the way providers like to practice. And if I were an Indian tribal leader, I'd be frustrated."
But there is little or no support from others in Congress, said Dr. Stephen Kunitz, a professor of community and preventive medicine at the University of Rochester School of Medicine who worked for IHS and has studied it for many years.
"Virtually no one has an interest in funding it except the Indians themselves," Kunitz said.
The bulge was small at first. Just a bump, really. Sticking out near Felipe Robles' backbone. But it grew. It grew until it was the size of his fist. Until he had to struggle to get out of bed. Until he couldn't stand without his carved rattlesnake-head cane.
At first, doctors thought it was cancer. They were wrong.
The disease lodged in his spine, gnawing away at his vertebra, was something you expect to see in someone's lungs: tuberculosis.
The rate of TB in Native Americans is more than five times greater than for other Americans.
"I got it three years ago, when I was in jail," said Robles, 46, a Pima. "I was stuck in a cell for three days with a guy who was coughing a lot. I finally asked him what was wrong and he told me he had TB. I called the guards and they pulled me out of there, but I guess it was too late."
When the lump appeared, Robles went to a clinic in Guadalupe, but was turned away because he had no insurance. Eventually, he ended up at the Phoenix Indian Medical Center, where his name is on a growing list of patients who are closely monitored, watched each time they take their medication, for one year. Any less, and the TB might not die, might spread to someone else.
Robles can't work any more and may need surgery to stabilize his spine.
"I'm scared," Robles said. 'I'm afraid a slight move in the wrong direction and I'll be paralyzed from the waist down."
For now, he spends his days reading the Bible at the Phoenix halfway house where he lives.
"I'm not proud of my past," said Robles, who has been in prison for drug charges. "But I'm born-again now. I'm trying to do the right thing."
The first health care for Native Americans, provided by the U.S. Army, was designed to protect Whites from uncontrolled epidemics of smallpox, measles, diphtheria and malaria. The diseases, brought by Whites, devastated the Native populations, which never had been exposed, and threatened to boomerang into the ranks of the military and the settlers.
Eventually, health care was taken over by the Bureau of Indian Affairs, then moved to the U.S. Department of Health, Education and Welfare, now Health and Human Services.
Model of efficiencyThe blueprint for the Indian Health Service is seen as a model of efficiency, studied by countries around the world. It offers cradle-to-grave care and one-stop shopping at its hospitals, where medical, dental, podiatry, psychiatry, optometry and even pharmacy services are available. And its public health arm builds water and sewer systems on far-flung reservations.
Through efforts to reduce infectious disease, increase immunizations and improve water system, the service greatly upgraded Native American health in the 1950s and '60s, significantly reducing infant mortality rates and deaths from gastrointestinal diseases.
The system has been less successful dealing with behavioral health problems like alcoholism, drug abuse and obesity.
Native Americans have the worst diabetes rates in the world, nearly four times greater than other Americans, and the worst alcoholism rates in the country, more than seven times greater.
"When you're dealing with these conditions - consuming food, alcohol, tobacco - you're dealing with people's beliefs, values and behaviors," said Kunitz,of the University of Rochester. "It's very hard for the health system to address these as effectively as they could address the contaminated water supply."
Some Native Americans say they must do more for themselves, eat right, exercise more, restore balance, all teachings of their elders.
"We have a moral imperative to take care of ourselves," said Maldonado, of ASU. "We can't point all the fingers at the Indian Health Service."
Inequalities exist in the system, sometimes for logical reasons, sometimes because of politics. For example, in Alaska, where it costs more to deliver care to remote Native villages accessible only by plane, IHS spends more than $6,080 per person annually for health care. But in the Kayenta area of the Navajo Nation, it spends only $766 per person.
The limited funding, isolated locations and lack of support staff all make it difficult to recruit and retain doctors, nurses, dentists, pharmacists and other health professionals.
Many in the system call the pay abysmal, offering examples like ophthalmologists, who make $100,000 at IHS, but can make twice that in private practice. And there are high vacancy rates - 17 percent for nurses at Phoenix Indian Medical Center.
"The people who are here are not here for the money," said Dr. Ken Steward, head of the Emergency Department at the Gallup Indian Medical Center. "They're hardworking, conscientious. Money is a secondary consideration."
The tight budget also forces the system to focus on primary care. Patients needing specialists, for things like heart operations, hand surgery and neurology, must be referred to doctors and hospitals in the private sector. The service has limited funds for this "contract" care, however, and the money runs out each year.
So the service often guarantees payment only for people who may die. Others must pay for the care themselves, or qualify for Medicare, Medicaid or other private insurance.
Lita Piffero quit worrying about her dignity long ago.
"I was down there at the clinic crying, literally begging for help," said Piffero, 48, who lives in Southern Bands, near Elko, Nev.
When Piffero's 14-year-old daughter hurt her foot in gym class in November, Piffero took her to the Indian Health Service clinic near Elko because there are no IHS hospitals in Nevada.
An X-ray revealed a deformity of the bone, Piffero said, and the doctor recommended magnetic resonance imaging, possibly surgery, services not available through the Indian Health Service. Piffero was told her daughter was being referred out, but that the service wouldn't pay for it. Piffero, who is unemployed, was told to apply for Medicaid.
"Medicaid took the full 45 days to decide," Piffero said. "We had to wait."
Her daughter limped through school on crutches.
When Piffero finally was approved for Medicaid, Piffero said the private doctor refused to do the MRI, saying he would lose money on a Medicaid patient. He referred them to Elko Hospital. Piffero said they still are waiting for an appointment. "I worry about what else they won't do because it's Medicaid," said Piffero, crying.
"She's only 14. She doesn't deserve to be treated any less than anyone else. This is her foot. I don't want her to be deformed.
"It just seems like unless you're on your deathbed, you can't go for services."
Her legs, which peek out from her traditional three-tiered calico skirt, are wrapped in cotton stockings, but they're still cold. She has high blood pressure and thyroid problems, but otherwise Nettie Yazzie, 92, who lives on the Navajo reservation, is remarkably healthy.
She gets B-12 shots from a public health nurse who visits her home, and occasionally sees a doctor for a check-up. But she attributes her longevity to eating lots of corn, the symbol of life for many Native Americans, and childhood visits to medicine men who taught her to make medicinal teas from herbs.
In fact, Native civilizations had extensive knowledge of diseases and medicines, knowledge that has contributed to Western medicine. And many still use a combination of Native and Western medicine.
As part of a move toward self-determination, many tribes are taking over their own health care, running their hospitals and clinics and deciding how to spend federal dollars.
More than 40 percent of the system now is run by tribes or the non-profit groups they have hired. In February, the Navajo Nation rejected a takeover of its $500 million system, but is considering running the programs in three small communities.
"IHS is going to continue to exist," the University of Rochester's Kunitz said. "What is unclear is whether it will increasingly be a pass-through program or continue to be a provider of services."
Either way, more money is needed.
Although the Native American population served by the Indian Health Service is growing by about 2 percent each year, and medical costs are rising at about 10 to 12 percent a year, the agency's budget has remained nearly flat, which means services fall farther and farther behind.
"If Congress in its wisdom, or malevolence, or thoughtlessness holds funding constant or at a 1 to 2 percent increase, things will get worse," Kunitz said.
Reach the reporter at mailto:judy.nichols@arizonarepublic.comor (602) 444-8577.
CheyFire
I wish to comment on the article presented here by adding what I personally believe and have been taught.
The article does teach many good and true aspects of Shamanism, however, following the ways of Shamanism and being a Shaman are not the same.
Shamans are spiritual beings in human form with the power to heal, work with Earth energies and 'see' visions, among many other things. One does not "up and decide" to become a Shaman by learning the ways of the earth energies, healing, herbology, taking vision quests, staying a "real" native sweat lodge, or any other aspect of the Native culture.

How Does The Shaman Heal?
By Susan Keiraleyn, Ph.D.
The spiritual healing methods of shamanism are now receiving increased and significant attention in our culture as a result of the widespread search by many for effective, efficient, and non-invasive assistance in healing and personal growth. Because shamanic healing affects the energy field of a person, it may be appropriate in a wide variety of circumstances and can be used for problems throughout the lifespan - even during and after death.
To better understand how the shaman heals it is important to understand some of the fundamental concepts of what shamanism is. Some people mistakenly believe that shamanism is a religion. In fact, however, it is not a religion but a specific set of methodologies for accessing the spirit or energy field of anything or anyone. The shaman heals by working in unseen/inner/spiritual reality to create changes there, which in turn create changes in seen/physical/ everyday reality.
The essential perspective of the practicing shaman is this:
1. Everything is alive. Everything has spirit and awareness.
2. Energy and matter are the same. Everything is vibration. Everything that exists is an energy system within a greater energy system.
3. Everything that exists is connected to everything else in a web of energy or life.
4. Unseen/inner/spiritual reality affects visible reality.
Working within this system of perceptions. the shaman strives to create balance or harmony or free flow of energy or spirit. This work typically focuses on the individual human, but traditionally also often was applied to social groups such as an entire tribe. The same kind of healing energy work can be applied to anything that exists - animals, plants, geographical locations - even to ideas.
What distinguishes a shaman from other types of healers are her/his methods. The central technique used by the shaman is what has been called "soul flight" or journeying." To journey, the shaman enters a particular kind of trance state sometimes called the "shamanic state of consciousness" or SSC. Entry into the SSC can be accomplished in a variety of ways; drumming is one very widely used induction method.
While in the SSC, the shaman sends out part of his/her consciousness/ spirit/energy to obtain information or do work in the realm of spirit or energy. The information obtained by the shaman's journeying consciousness may come from a variety of sources, including communication with nonhuman beings and the shaman's own visions or "second sight." This information is retrieved and used for insight and healing.
The work the shaman may do while in the SSC has to do with directly affecting the presence or flow of energy in one or more energy systems. For example, a shaman might help a person heal a broken bone by opening up increased energy flow to the affected area; a shaman might help a person heal from emotional depression by restoring emotional energy lost as a result of a traumatic event.
In summary, the practice of shamanism involves making conscious connection with that which is spirit or life - that which is sacred - in all things. Healing can be accomplished through this connection by working directly to create greater balance and harmony of energy or spirit, and by bringing back to the "ordinary" world transformative awareness from sacred space and time.
To do healing work of any kind, a shaman typically will first make a journey to learn (through "seeing" or through communicating with helping spirits) the spiritual cause of a given problem. A particular problem in everyday life (such as depression) might have very different spiritual causes in different people. In other words, illness that looks exactly the same symptomatically in two different people might be the manifestation of very different underlying situations. In one person, for example, depression and fatigue might be caused by spiritual injury to the heart; in another person, identical symptoms might be caused by habitual thought patterns of intense rumination and worry.
The shaman seeks to address the underlying spiritual cause that creates observable symptoms. Therefore, treatment of identical symptoms might be very different in two different people, depending on the spiritual cause. This concept is similar to ideas of traditional Chinese medicine, in which it is understood that "anything can come from anything."
Once the shaman gains an understanding of the spiritual cause of a given problem, she/he may use a variety of healing modalities to resolve it. Although there are a number of specific techniques employed, they generally fall into three broad categories:
1. Taking things out of the energy field that don't belong there.
2. Restoring lost energy or power to the field.
3. Altering the balance or flow of energy within the field.
In all of these methods, the shaman is a mediator between physical and non-physical reality, between the seen and the unseen.
We will consider each of these categories in greater detail in Part 2 of this article.Susan Keiraleyn, Ph.D., is a counselor and shamanic healer in private practice in Portland. She is a former research faculty member at Oregon Health Sciences University, and has taught, guided and done clinical research on shamanic journeying techniques and related processes since 1978.
CheyFire
Power Animals
The concept of a Power Animal is universal to all cultures. Tribal cultures will recognize a Totem for the tribe, one for the clan one belongs to, and one for the family that one is born into. In the United States, and in other countries, the Tribal and Clan Totem still exists, although it is thought of in a slightly different manner.
There are also totems for our adopted cultures, such as clubs or societies which we may belong to, such as the Benevolent and Protective Order of Elks, the Loyal Order of Moose, and the Lions Club.
Even Christianity, the prevalent religion of this country, has maintained two Totem animals, these being the Fish and the Lamb. Specialized Totems are also seen in organized sports, their names being reflected in the team names. Example: Chicago Bulls, Atlanta Falcons
The next type of Power Animal or Totem is that which is personal for the individual. These Totems are protective spirits which help us in our everyday life. Everyone has such a Totem. Even today most parents give a special protective Power Animal to their children and tell the child that it will be protected over night by that Power Animal.
We often unconsciously recognize the Power Animal affecting someone, and use terms which give away our unconscious recognition.
The first item of business is to learn your power animal. It may entail learning deep inner relaxation so your spirit self can speak to you, and then while in that peace-filled state you can discover your Power Animal. That knowledge is necessary in order to start the long process of learning.
Power Animals are usually a reflection of your deepest self and also represent qualities which you need in this world, but which are often hidden or obscured. A mistake that people often make is to be dissatisfied when they find that their Power Animal is some non-ferocious animal like a mouse.
We tend to think that a mouse is not very powerful - that it is meek and afraid. What they forget is that spirits are not limited to physical reality and that size is irrelevant. Your Power Animal may be a tiny mouse, but in times of need this mouse can and will change its size and deportment to that which is appropriate to the occasion.
There is nothing weak of meek about a 500-foot tall mouse! Your personal Power Animal (as opposed to your family, clan, or tribal spirit) may change several times in your lifetime, depending upon your specific needs. If you are dispirited, your animal is far away from you and needs to be brought back, or a replacement found.
When you make your first exploratory journey you are likely to encounter spirits which may represent themselves as being your Totem or Power Animal. If you are already aware of your spirit that spirit may greet you and give you additional power.
All of creation has positive and negative energy. It is the individual who chooses to use that energy wisely or selfishly. Any animal spirit may be your Power Animal. Your Power Animal may also be a considered by some to be a mythical animal, such as a unicorn or Pheonix.
Meeting Your Power Animal
We all have power animals - spirit animals - that are connected to us as protectors.
Many power animals are our spirit guardians that exist in other realms.
Some animals were with us from past lives but may have been another physical form. Example: We might have had a wolf or other wild animal as a friend or protector. In this timeline the animal incarnates as a dog.
Time to find your power animal.
Find or quiet place or just relax at your computer. . .
Relax your mind . . .
Feel the muscles in your body relaxing . . . your head . . . your shoulders . . . your neck . . . your jaw . . . the torso of your body . . . your arms . . .
Close your eyes . . .
Take 2 long slow deep breaths . . . breathing in through your nose . . . holding the breath as is comfortable for you . . . exhaling slowly through your mouth . .
Still your thoughts.
You are going to watch the screen just behind your eyes . . .
You may see a pretty color . . . or shape . . . coming into view . . .
Telepathically ask your power animal to show itself to you on the screen in your mind.
Be patient! Your third eye (pineal gland) must open before you can see images.
Soon the image of an animal will appear.
It may - or may not - be the animal you are expecting - so have no expectations.
The image may come all at once or appear to move towards you.
You may see the front view of the animal or see it at another angle.
The animal may not be your favorite animal!
Just allow the image to manifest before you!
Once you see the animal - watch it carefully to see what it does.
Listen with your thoughts to get a telepathic message from the animal.
It may seem funny to get a message in a human language - from an animal - but it can happen.
Your animal may appear in a scene that is significant for you.
Focus as best you can . . .
Note the colors around the animal - colors have significance.
When the image fades . . . slowly open your eyes and write - or draw what you have seen.
You may see more than one animal.
You may see an animal that seems mythological vs. animals in our reality.
You may find that another day brings a different animal with a different message.
The material above was taken fromthe site CrystalLinks and may be read in it's entirety there.I have individualized many aspects to apply for Native belief system as I have been taught and not for other faiths or beliefs that may also use relaxation techniques and mental imagery.
CheyFire