— This is the second 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
Thirteen teenagers crowded a small, unadorned stage in the Wind River Hotel and Casino ballroom in early June. They wore bright white shirts, but the tees proved flimsy armor in the expectant gaze of 100 adult faces. Kids fidgeted, stared at the floor and cast about self-consciously for places to put their hands. When their adult collaborators finally assumed their positions and took up their scripts, the young people retreated to seats at the back of the platform and took shelter in their roles.
Lillian Zuniga read the part of a tribal health office client. Allison Sage sat across from her at a folding card table and played the caseworker. He asked about her Medicaid status. When Zuniga demurred about the difficulty of the enrollment form, one of the kids stood with a placard that read “Illiteracy,” and made a slow, somber loop of the performance area.
Asked why she missed their last appointment, the client mentioned car trouble and another teenager repeated the process with “Transportation.” Questions about her family’s diet brought the “Food Access” sign-holder to her feet. Comments on no-shows at the IHS clinic and Lander hospital earned tours for the “Child Care,” “Legal Trouble” and “Substance Abuse” placards. “Domestic Violence” rose from the back row when the caseworker finally asked about his client’s black eye.
The young adults from the Wind River Unity Council were trying to explain the tangle of barriers that stand between their community and optimal health.
Asked later that day to name the greatest challenge to Native health equity in Wyoming, Richard Brannan identified the common ancestor behind all those barriers. The busy murmur of side conversations and the clinking of dishes fell away as Brannan stood to deliver his answer into the handheld microphone.
Thirteen years with the Indian Health Service, most of them as CEO of the Wind River Service Unit, had, along with his history as chairman, vice-chairman and business council member of the Northern Arapaho tribe, earned Mr. Brannan a seat on the expert’s panel in a ballroom full of experts at the Native American Health Equity Conference in Riverton. At 60, he is practiced at speaking his mind. People who know him are accustomed to listening when he does.
“Poverty” Brannan said. “Just pure, pure, poverty. If you don’t have money, you don’t have health care.”
Poverty at Work
Jayisha isn’t interested in healthcare or economic status. All she wanted, one recent afternoon, was to find Nemo. Her orange plastic fish had rolled under a pickup. On her mission to retrieve it, the three-year-old displayed an ingenuity and resilience that would serve most CEOs well. She’ll need every ounce of those talents, and more, if she’s going to have a chance at the corner office though, because Jayisha’s family has been poor for generations.
Endemic poverty is a powerful health factor, and like historic trauma, it pervades every facet of health on the Wind River Indian Reservation, where unemployment hovers around 76 percent. Poverty correlates globally with adverse childhood experiences, inadequate housing, poor sanitation, insufficient nutrition, discrimination and substandard education. Poverty depresses political influence, magnifies stress, and inhibits access to health care. In fact few, if any, factors mirror health outcomes as closely as poverty, according to Ashley Busacker, Senior Epidemiological Advisor for Maternal and Child Health with the Wyoming Department of Health.
Jayisha has known only a few short months of stable, safe, secure home-life in her first three years. Her parents were unemployed and addicted to methamphetamine when she was born. Her network of family and friends has scarcely more resources. When her mother went to jail, Jayisha was sent to live with her biological father. Unable to provide for a young child, he left her with a cousin. That’s where Child Protective Services found her swollen and bruised from beatings.
Her mother, Tanisha Oldman, is 24. She also is the daughter of addicts. Growing up, she maintained a running inventory in her head of all the food in the house. It was usually a short list. She lived with her maternal grandmother, a drug-and-alcohol counselor of modest means, until graduating from high school in Montana. Graduation brought new responsibilities, but as best as Tanisha could tell, no new opportunities. An 8-gram package of methamphetamine could bring $1,000 profit, though, to someone who knew what to do with it. She was never so well fed, or comfortable, as when she was selling $25, $50 and $100 bags of meth.
Jayisha, of course, has had no influence over her situation. The conditions of her life are completely beyond her control. Yet the experiences of her early childhood, established and determined by others who were dealt their own impoverished hands early on, are nonetheless forming the foundations of her life-long health.
Few officials cite poverty as a health problem as directly as Brannan. The topic flirts with too many firmly held views about personal responsibility, self-determination, and equality of opportunity for most medical professionals’ comfort. They’d rather leave the philosophical debates, and their accompanying distractions, to the politicians. But an examination of any given population-level health problem runs squarely into poverty at some point.
Economic insecurity fosters conditions in which health problems flourish. It simultaneously walls people off from the care they need to overcome those conditions. The resulting disease, disability and unfulfilled potential are expensive in terms of direct cost and lost opportunity, both for the individuals who experience them, and the community those individuals rely on. Those costs, in-turn, contribute to further economic insecurity. And so the cycle has continued, for generations for some families, feeding on its own negative inputs in a bottomless downward spiral.
Elk Sage, Director of Northern Arapaho Meth and Suicide Prevention Initiative, is familiar with the cycle. His imposing bulk and expansive tattoo collection belie an easygoing jocularity and deep-seated empathy for the suffering of others. He uses both qualities trying to explain the day-to-day mechanics of the process.
“Picture this,” he said. “You’ve got $5 in your pocket. You don’t know where the next five will come from, or when. You stay with four or five families piled into one beat-up, falling down little house, way out there far from nothing. There’s one car that may or may not run and probably doesn’t have gas in the tank anyway. If you’re not up when the car leaves, you’re stuck, not going anywhere. But whatever. What are you going to do with your $5? Buy some bologna and a loaf of bread for the kids? OK, they can eat today. That’s good. You still gotta get to the store first though. Or you could go to the IHS clinic and sit in the waiting room all day. Or you could come to my group therapy meeting, or a sweat. Or are you going to buy that bottle of vodka. I mean, everybody just wants to feel better right?”
A kid living in the scenario described by Sage probably doesn’t eat as well as his peers elsewhere. He gets less sleep and is exposed to more disease and dangerous situations. He lives in a perpetual state of stress, which taxes his mental and physically resources further still. He needs more professional healthcare services than other kids, but he receives less. Together, these factors inhibit his ability to thrive at school. In time, that educational underperformance narrows his employment prospects, and limits his ability to influence the world around him. Before long he’s got $5 in his pocket and a host of tough decisions to make.
Naomi Chavis also sees the challenge in her work as the Health Manager for Wind River Head Start. Two hundred infant to 5-year-olds count on her to mend their bumps and bruises. She makes sure they’ve had their requisite physicals, vaccinations and screenings, and she works with parents and providers to ensure they make it to their appointments and receive any necessary treatments. When cases are pressing, she leans on relationships and calls in the favors accrued over a quarter century in reservation health care to get kids the care they need. It isn’t easy.
“When your family doesn’t have anything — anything — and you never have, well you don’t expect to have anything,” she said. “Even health. You can’t build something from nothing.”
Breaking the Cycle
Chavis’s truism hit home for Tanisha Oldman in rehab. “I just realized what I was doing to myself and to my kids,” she said. “We weren’t going anywhere unless I did better.”
Today she’s clean, sober and determined to do better. Oldman now lives in a 200-square-foot studio apartment with Jayisha, newborn twins and her husband Tyle. The Riverton home – one of 16 units offered by the private non-profit Eagles Hope Transitions – is humble. But it’s safe, affordable, and drug-and-alcohol-free.
Tyle has steady work at a fast food restaurant. Jayisha is enrolled in Fremont County’s Child Development Services daycare program. The twins, and their mom, receive regular visits by Indian Health Service nurses.
Their safety net is desperately frayed, and the margin for error is thin. But at Eagles Hope they have a place where they can make a stand, break the cycle of poverty and poor health, and start to build a better life.
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: