A Week on an Indian reservation

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!