I first started at the Bemidji (Minn.) Pioneer as an intern in the summer of 1996. That would begin six years as a news reporter, sports reporter and copy editor for a small, six-day-per-week daily newspaper in northern Minnesota. I wrote a large range of stories from multiple beats, to features to sports, my favorite being the coverage of the Red Lake Reservation High School basketball team named the Warriors. Here is a collection of my stories from my time at the Pioneer.
May 11, 1997
By Devlyn Brooks
Staff Writer
Little more than two years ago, Dr. Kathleen Annette supervised 108 full-time employees who cared for the health of 70,000 American Indians throughout Minnesota, Wisconsin and Michigan. Today, she supervises 42 employees who still have the same responsibility of caring for the same responsibility of caring for those 70,000 Indians, but with less money, less help and fewer resources.
Such is the existence of the U.S. Indian Health Service, according to Annette, who took over as the three-state area director for IHS in 1990.
There are 12 IHS service areas nationwide, with the Minnesota, Wisconsin and Michigan office headquartered at Bemidji in the Federal Building, located on the corner of Minnesota Avenue and Sixth Street.
According to Annette, the IHS is at a crossroads in its existence, and the Bemidji office, which goes virtually unrecognized outside the local Indian community, has become a product of that change.
Even two years ago, Annette had a staff more than double of what remains in the IHS offices housed on the Federal Building's first and third floors. Pressures are encroaching on the office from all sides, she says, and if asked, she couldn't predict how many services here area will provide or how many people she will oversee two years from now.
The Indian Health Service, created in 1955, has a storied history, beginning in the late 19th century when the U.S. government authorized military forts to care for Indians in their vicinities. Known early as only the Bureau of Indian Affairs, the Indian Health Service was split from the BIA and found itself being dumped into many different governmental jurisdictions -- its most recent home being the Department of Health and Human Services in 1955.
The Bemidji area headquarters, established in 1985, was originally a field office serving the Aberdeen, S.D., area headquarters. However, according to Annette, powerful local tribal leaders such as Roger Jourdain of Red Lake were instrumental in the decision to establish an area office here. After all, she added, Red Lake, Leech Lake and White Earth Indian reservations are three of the largest reservations the Bemidji office serves.
Under its jurisdiction, the Bemidji area headquarters provides administrative, data analysis, environmental health and clinical health services, among others, to 33 reservations in the three states. A vast reduction of services from what was formerly offered, Annette said.
One cornerstone in the history of the Indian Health Service was passage of the Indian Self-Determination Act of 1975 -- a law that forever changed the focus of IHS.
Prior to "The Act," as Annette refers to it, the IHS would establish clinics and hospitals on reservations nationwide. It would then staff the medical facilities and pay for the services. However, under the act reservations were allowed to contract for their own local medical facilities and services receiving federal funding to do so -- meaning the role of the IHS was not only diminished, but its funds were as well.
"The Act was a big thing because it gives (Indians) much more governance over their health care," she said. "Instead of primary care, the IHS is in a partnership with the reservations, and is playing a supportive role."
Another issue IHS is facing is health care reform, according to Annette. For instance, health maintenance organizations which emphasize managed care are a relatively recent phenomena in the private health care industry, but the philosophy is nothing new for IHS.
"Managed care is not new to us. We've been prioritizing what (medical services) are most important to us since the beginning," she said. "For instance, we don't do any surgery. If somebody needs a surgery, they can't come to our hospitals."
And if bureaucratic pressures were not enough, there are continually new health threats IHS is battling. Cardiovascular disease and diabetes are still leading killers among Indians, and cancers and substance abuse are also major problems.
But for all of the losses Annette regrets, there is the positive fact that IHS is an efficient as it ever has been. IN fact, she said almost 80 percent of Indian health care needs nationwide are being provided -- incredibly high compared to earlier years.
"We are at an all-time high of getting our needs met, but I don't want to give the feeling we've done all we can as a government either. Because of medical inflation, our buying power is decreasing as our population increases," she said.
"There's a general perception by people that there is a full pot of money to pay for Indian services. This is not true. But we will take care of the Indian people. ... We must. No other agency is responsible for the health of Indian people."
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