Jean Harris (right) and her son Orion. As a mother of four, Harris says she uses IHS on Wind River Indian Reservation for herself when necessary. But she takes pains to ensure her kids receive private pediatric care in Lander. (Matthew Copeland/WyoFile)

— This is the fourth in a series of stories examining childhood health on the Wind River Indian Reservation, as part of our reader-supported Generation of Hope project. See below the story for more details. — Ed

Horse wrecks are a fact of life in Wyoming. Most bring bruises, bloody scrapes and the wisdom of experience. But some are worse than others.

In September 2013 Franklin Lee Martel III was injured in an ugly one. It was bad, but in the range of human-livestock encounters gone wrong, not so out of the ordinary. What followed, however, was quite different from the experiences of most Wyomingites.

Martel, like many in his Native American community, avoided going to the hospital at all costs. He feared arrest if he left the reservation. He didn’t believe he would be helped. So, in what would prove a fateful decision, he stayed home, and hoped for the best.

No healthcare system exists in a vacuum. Regulatory, socioeconomic, environmental, geographic, and market forces all influence, for better or worse, the efficacy of the programs and institutions we rely on. In the case of health care for Native Americans on the Wind River Indian Reservation, the uneasy history between tribal people and the American institutions that serve them, along with a culture of low expectations, exacerbate an already long list of challenges.

Teens members of the Wind River Unity Council put on a skit in which a patient dies while waiting for paperwork to be completed — a perception of health services tied up in bureaucratic knots. (courtesy HHS Office of Minority Health)

In a skit at the Native American Health Equity Summit in June, teen actors from the Wind River Unity Council portrayed a young man complaining, suffering and ultimately dying in a clinic waiting room while clerks fussed over paperwork and asked inane questions.

Many of the professionals in attendance were visibly upset by the portrayal, and with good reason. It wasn’t a fair representation of the care they work hard to provide. The one-act play was, however, a genuine representation of the kids’ perceptions. That alone is enough to keep them from crossing the clinic’s threshold. And they’re not alone.

The population of the Wind River Indian Reservation is strikingly young — more than half the Native population here is under 18. Yet even with calls for the prioritization of childhood health by tribal leadership and the Indian Health Service, the IHS Wind River Service Unit treats fewer children than its counterparts elsewhere in the country. Clinic visits for kids age 1 to 4 and 10 to 20 are actually declining across the reservation.

Low expectations explain much of the lack of engagement.

Northern Arapaho tribal member Nicole Antelope, like many others on the Wind River Indian Reservation, avoids using the IHS clinic due to low expectations of services and a distrust of federal programs. (Matthew Copeland/WyoFile)

Asked if she used IHS for her young child’s health care, Riverton resident and enrolled Northern Arapaho tribal member Nicole Antelope said, “No. Not if I can help it.”

Jean Harris, a mother of four, uses IHS for herself when necessary, but takes pains to ensure her kids receive private pediatric care in Lander. Asked about the double standard, she expressed concerns about corner-cutting and bare-minimum, checklist-style care before falling back on universal maternal sentiment to explain her position; “Because they’re just children,” she said.

A perception of inadequacy, based on reputation as often as firsthand experience, was repeated by nearly everyone queried. Those with means to do so seek services elsewhere. Those who can’t afford a doctor in Lander or Riverton often choose to go without help.

Anticipated shortcomings are one obstacle. Remembered offenses are another.

In cultures that revere elders and emphasize oral history — like those of the Eastern Shoshone and Northern Arapaho — past wrongdoings cast resilient shadows. Stories of long-ago misconduct — dentists who refused to “waste” numbing medicine on “savages,” doctors who sterilized young mothers without their knowledge — have remained in circulation for generations, and they’ve lost little of their punch to time. The result is a persistent and pervasive skepticism of federal services — a distrust that divides people who need help from the professionals trying to provide it.

Health care, education, housing, natural resource development, wildlife management, law enforcement — the federal government continues to play a role in nearly every aspect of public life on the Wind River Indian Reservation. The fleet of vehicles and array of communications antennae at the Law Enforcement Services Center in Fort Washakie serve as a prominent and often uncomfortable reminder of the government’s role to anyone passing through town. (Matthew Copeland/WyoFile)

Faith in federal institutions has not, on balance, served Native Americans well. A litany of ill-fated endeavors — the disregarded peace treaties that forced Native people onto reservations; the allotment framework used to swindle tribes out of their best remaining assets; the forced boarding-school programs that shattered families and abused children; and nutrition programs that forbade breastfeeding and introduced unhealthy, highly processed foods — all arrived with a similar message; some iteration of “We’re from the government and here to help.” The same pitch also accompanied the first healthcare services provided to American Indians. Those services were delivered by the War Department.

Today, patients don’t die in IHS waiting rooms. Generations of mistrust and friction do have a meaningful negative impact on population-level health, though. Sometimes those impacts are acutely evident in a single, tragic case.

Martel suffered at home with internal injuries for days before finally seeking treatment, too late. Shortly after walking into the Lander Emergency room he was life-flighted to the Wyoming Medical Center in Casper. He died there on September 16, 2013 of wounds that, had Martel had faith in the system, could have been treated. He was 31 years old.

Franklin Martel III died at 31. Though tragically short, his life span isn’t unusual among the grave markers in the Friday Cemetery near Ethete. (Matthew Copeland/WyoFile)

Read the entire Generation of Hope series:
Generation of Hope: Future of Native health depends on kids, Oct. 20, 2015
Pure Poverty: ‘If you don’t have money, you don’t have health care,’ Oct. 27, 2015
Broken Promises: Despite treaty assurances, health care remains underfunded, Nov. 3, 2015
With low expectations, many Natives go without health care, Nov. 10, 2015
Leaders confident Native community can reorder status quo, Nov. 17, 2015

Generation of Hope is a special project of WyoFile, focusing on childhood health on the Wind River Indian Reservation. It is made possible by generous readers who donated to WyoFile’s crowdfunding effort in March, via the Beacon crowdfunding platform. Please share these stories with your friends, and tell us about your experiences regarding childhood health and well-being on the Wind River Indian Reservation. If you enjoyed this story, please consider making a tax-deductible donation to WyoFile. We could not have done this series without the support of our readers. — Ed.

WyoFile writer Matthew Copeland and WyoFile editor-in-chief Dustin Bleizeffer discussed the Generation of Hope series with Miranda Birdahl and Sean Ingledew, who produce Rally Casper‘s No Label Roundtable podcast. Take a listen:

Matthew Copeland

Matthew Copeland is the chief executive & editor of WyoFile. Contact him at matthew@wyofile.com or (307) 287-2839. Follow Matt on Twitter at @WyoCope

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