In
the year 2015, several American Indian relief groups have zeroed in on my
mailing address and phone in hopes of my donating to their cause. An
especially insistent phone caller yesterday, trying to shame me into
feeding the starving children in South Dakota, prompted me to review
my own experience on a South Dakota reservation, which is recorded
below. It does not qualify me as an expert, but offers a different
perspective:
In 2001, when I worked as a locum
"rent-a-doc", a medical staffing agency assigned me to fill
in for a week as the night-shift emergency room doctor in Eagle Butte,
South Dakota. Although I have lived and worked in Asia among tribal
groups, this was my first time with a minority culture in my own
nation. My work schedule was fifteen hours on call each night, with
the day time for sleep and everything else. This would leave little
time for sightseeing, so I came a day early to look around.
A
town of about a thousand people at that time, Eagle Butte was the
center of the Cheyenne River Reservation, an area of some 4,000
square miles, comparable in size to the entire state of Connecticut.
Except for all the government offices, the town looked about like any
other high-plains community, amid
hay fields and cattle, with rolling prairie stretching out to a far
horizon in the July sunshine.
Next
to the motel was a building decorated in Native American motif,
labeled Cultural
Center.
A monument outside honors the "Sioux Chiefs who gave their lives
in World War I." But the word "Sioux" isn't heard
often; the people prefer the name "Lakota." Sioux comes
from the Chippewa language, meaning snake or enemy. I soon found that
using the word "Sioux" could shut down a conversation.
The
Center's door stood open. The lobby held a guest book and four glass
cases of artifacts. The high-domed hall beyond stood empty except for
pictures on some of the wall panels, and stacked chairs against one
wall. Aside from a small gift shop, that was it.
I
spent some time with the pictures, most of them tribal leaders of
by-gone times. One panel held a six-page account of the massacre at
Wounded Knee Creek, by a survivor who was an eleven-year-old girl at
the time. She told a vivid account of what she saw and heard, but it
was mostly the "what" with little of the "why".
Perhaps from her standpoint there was no why; the white soldiers
killed for no reason.
But
there is always a why. Someone digging superficially might give a
ready answer: for example, "greed―the white men wanted our
land." This is probably true, but I suspect that digging
more deeply might shed light on the interplay of fears and goals and
of character strengths and weaknesses on both sides. That, in turn,
might provide clues to some of today's issues, in particular the
division that even a new-comer can sense between the haves and the
have-nots within the tribe itself.
For
there is such a division. I include among the haves the apparently
prosperous Lakota farmers in the region, the competent and caring
Lakota nurses and medical technicians I worked with in the town's
hospital, and some of the young families who came as patients with
the usual night-time emergencies―earache, abdominal pain,
childbirth, etc.
The
have-nots included a nightly procession of very obese, diabetic,
hypertensive, and acutely alcoholic patients, and both victims and
abusers in domestic fights. They were cooperative within their
ability to function at the moment, had a passive acceptance of their
situation, and glib agreement: "Yes, Doc, I know I drink too
much; yes, I'll try to lose some weight," etc., but no expressed
intent to carry through. The Native American nurses and doctors were appalled at the
nightly number. People lined up in the waiting area each day from
five pm (when the day-clinic closed) until well past midnight. I have
worked in much bigger hospitals with half the number.
A
well-built youth in his early teens with a high blood alcohol had
been beaten unconscious by unknown assailants. Soon after the
ambulance came in, his mother arrived wearing a look of quiet
despair.
A
middle-aged man had a blood alcohol five times the legal limit, and
the ambulance crew found him lying in the street downtown. As we
waited for the X-rays, one of the Lakota staff remarked that the
man's abdominal scar was from the time he swallowed a sharp object to
qualify for permanent disability.
And
there was an elderly woman, beaten up by her drunken son, and so
obese that the x-ray tech was unable to show me her neck spine. I had
to send her 175 miles by ambulance to Rapid City where there is
better x-ray equipment. Her diabetes was was poorly controlled; her
son had been harassing her that day to the point where she had
neglected to take her insulin.
I
saw a poster on a hallway bulletin board showing an elderly farm
couple standing in their barn doorway: the message read "When
Jim hurt his back, his neighbors helped him get his hay crop in. They
helped him with his chores. They even helped him beat his wife to
within an inch of her life. Because they knew. And they did nothing
to HELP
HER.
Sometimes it's hard for a neighbor to know what to do. You can call
us, at . . ."
Up
until this trip, I had encountered the aggressive, politically active
side of the Lakota occasionally in the news media. But here "on
the Rez," in the emergency room, I saw the other side: quietly
non-confrontational, but quietly non-cooperative with the majority
white culture. A five-day visit does not give an outsider the
authority to analyze behavior, especially that which is not unique to
that group, but I can speculate. Alcoholism is often associated with
chronic depression and a perception of "no way out." There
is a tendency to look back at former days. Military victory against
the invader is no longer a viable option, but Wounded Knee is still
fresh in the collective memory, more than a century later.
Few
raise their voice or argue unless really stressed. Few in this
under-layer of Lakota society comply with suggested treatment. The
patient may take the pills, but advice on lifestyle change meets
passive resistance.
But
apparently the tribal leaders, social activists, or others are trying
to teach the younger people better self-help skills. I saw two such
groups in session in the motel conference room as I passed by. (The
local Super 8 Motel itself is a Lakota enterprise.) And there is a
satellite college campus on the far edge of town, though no one at
the hospital could tell me much about it. The future is not yet set
in stone. The Lakota may one day overcome the alcohol and metabolic
diseases that devastate their people, though maybe not in this
decade.
When
that day comes, it probably won't happen through the U.S. Indian
Health Service bureaucracy, nor the well-intentioned efforts of
outside organizations, but from the initiative of the Lakota
themselves. These people were, after all, the prime warriors of the
plains, who with their allied tribes beat the hell out of the United
States army at the battle of Little Big Horn. Back then, they coped
very well.
The
depression following their loss of land and way of life, and some of
the policies from Washington, have led many of them to focus on the
past. But when forward-looking tribal members increase in number,
this is going to change. The Cheyenne River Reservation potential is
good. The land is fertile and green even in July, unlike some other
Native American lands.
And
ironically, many tribes lately have discovered a way to "rob the
white race back," raising capital funds by operating gambling
casinos. Whatever it takes (within reason anyway), more power to
them!
