When Barack Obama was running for president, he made it a point to visit Indian reservations. Among other promises, he said he was committed to "providing quality, affordable healthcare…on reservations all across America."
The result — Obama won strong support from Native Americans. But years of bare-bones funding for the Indian Health Service has already forced one Northwest tribe to go its own way.
This week, we're taking a closer look at tribal economies. In our third installment, Amanda Loder, of Spokane Public Radio, reports on how one reservation clinic has become a regional healthcare hub.
If you drive through Plummer, Idaho too fast, you can blink and miss it. The biggest thing here is the Benewah Medical Center. Executive Director Ginger Carpenter's office there is adorned with photos of the facility's humble beginnings.
Ginger Carpenter : "In 1987, the clinic was this building, it was a condemned building…and a doctor came once a week for an afternoon and saw patients, and a dentist came once a month."
Today, the Benewah Medical Center is a multi-building complex. Its staff includes eight doctors and three dentists. It also has a mental health program, diabetes unit and fitness center. It's the only medical service on the Coeur d'Alene Indian reservation, which has suffered from chronic poverty for generations.
Ernie Stensgar: "We got tired of not having quality healthcare."
Ernie Stensgar is Vice Chairman of the Coeur d'Alene Tribe. About 20 years ago, as Chairman, he headed-up the tribe's efforts to build its own clinic.
Ernie Stensgar: "As we thought through this and looked at money that was available, which was hardly any …we also discovered that people living with us, and amongst us, were suffering from the same inadequate healthcare that we were, long distances to travel, poor healthcare in general, and so we, why don't we collaborate?"
So the tribe signed an unusual agreement with the City of Plummer, opening this clinic to non-natives. Now, Benewah Medical Center patients are almost evenly divided between native and non-native. About half of the clinic's funding comes from the federal government-Indian Health Service, or IHS.
Non-natives bring in other revenue. And, money from the Coeur d'Alene casino allows the tribe to buy health insurance for all its members.
The clinic's Ginger Carpenter says the influx of private money has allowed Benewah to evolve into a regional medical facility.
Ginger Carpenter : "We have about ten-thousand active patients, even though we're a town of 800, people travel from all over to get services here."
That's not unusual in Indian Country. For many Native Americans, traveling to remote clinics-like Benewah-is the only option.
More than two-thirds of American Indians live urban areas. Yet, most Indian Health Service clinics operate on reservations. And, according to the U.S. Census Bureau, about one out of three Natives don't have health insurance. So they have to get help from the federal government.
Kim Cunningham-Hartwig: "Correction…This looks like a broken leg…bad, very, very bad…"
Dr. Kim Cunningham-Hartwig is a member of North Idaho's Nez Perce tribe. She's just 35-years old, and only two years out of residency. And, she's already the Medical Director at Benewah.
Kim Cunningham-Hartwig: "Because Native doctors are so hard to, I mean, because the numbers are so small…We come out of training knowing that administration is going to be part of our duties at some point."
And she was fortunate to get this position, given the troubles IHS clinics have across the country. Many Indian Health facilities are so chronically underfunded, they have trouble keeping doctors and providing quality care.
Robert Davis: "I was born and raised on the Nez Perce reservation, and have been involved in the Indian Health Service pretty much since I was born. And knew that Benewah Medical Center was kind of an exception in Indian Country."
Robert Davis, a newly graduated physician assistant, has the same view.
Robert Davis: "I've interviewed at other IHS sites before coming out here. So, I've seen the worst of the worst, and the best of the best, and this is the best."
In fact, the clinic's developing a national reputation. Coeur d'Alene Vice Chair Ernie Stensgar says the unusual tactic of opening the facility to non-Natives has inspired other tribes to trek to rural North Idaho, in hopes of mimicking the Benewah model.
Ernie Stensgar: "Almost every treaty and every executive order that the United States made with Native Americans, healthcare was in that treaty…That promise has never been fulfilled…But tribes throughout the years have learned to be innovative and do for themselves and get by. That's what the Coeur d'Alene's are doing. We figured no one was going to do it for us, so we're doing it ourselves."
It's been 136 years since the federal government established the Coeur d'Alene reservation. Since then, life here has been a constant struggle against poverty. But, after years of waiting for quality healthcare, today, the tribe is not only able to fend for itself, but also care for its neighbors.
Reporting on poverty is supported in part by a grant from the Northwest Area Foundation, helping communities to reduce poverty by identifying, sharing and advocating for strategies that really work. On the Web at www.nwaf.org .