Monday, June 2, 2008

Clinic called vital for 'urban Indians'

Clinic called vital for 'urban Indians'

Director has fought to keep federal funding
By Dana Wilkie

June 1, 2008

SAN DIEGO – For American Indians living in the city of San Diego, there are probably precious few doctors who will allow traditional healers to work alongside them, administering herbs and chanting prayers.

The San Diego American Indian Health Center, six blocks west of Balboa Park, is one such place, and it is director Joe Bulfer's belief that if his clinic were not there, many of the city's Indians would avoid doctors' offices altogether.

Bulfer has an adversary in the Bush administration, which believes federal money now going to clinics such as his is better spent on Indians who live in rural areas or on reservations.

“Our community clinic services are culturally sensitive,” said Bulfer, whose employees visit powwows to let Indians know that the center offers everything from children's immunizations to drug counseling. “No other system of health care offers this level of service to Native Americans.”

For the past two budget cycles, President Bush has suggested that Congress eliminate all federal support for the Urban Indian Health Program. The program funds Bulfer's clinic and eight others in California, which also treat non-Indians. In the case of the downtown center, at First and Laurel streets, that would mean near-certain demise, as 42 percent of the center's budget relies on this federal money.

The San Diego region has about 30,000 American Indians considered “urban” because they do not live in outlying rural settings or on reservations.

The White House Office of Management and Budget says that in fiscal 2007, about 42 percent of the San Diego clinic's operating budget came from the Urban Indian Health Program, while 58 percent came from other public and private sources. The office notes that in fiscal 2006, more than half of those served at San Diego's clinic – 54 percent – were Indians.

“Unlike many American Indians and Alaska Natives who live in rural areas and on reservations, urban Indians have access to publicly and privately financed health care services like other Americans,” said Corinne Hirsch, a spokeswoman for the Office of Management and Budget. She added that recent reviews found flaws in the program, such as few independent evaluations of services and how effective they are.

While Bulfer agrees that Indians living in or near cities are close to traditional hospitals and doctors' offices, he also knows that not all of them are comfortable in such places.

Western medicine is still viewed askance in some American Indian households, where close extended families and deep respect for elders mean that even youths are taught about tribal remedies that have been passed along for generations.

Bulfer's clinic has traditional healers available who will, at a patient's request, work alongside doctors with herbal remedies, songs and ceremonies. His staff of 28, most of them American Indians, is well aware that its patients are 3½ times more likely than non-Indians to have diabetes, and that decades on reservations have made them prone to obesity, alcoholism, chemical dependence and domestic violence.

Consequently, Bulfer's clinic does not treat only physical maladies. It also has behavioral health specialists, mental health experts and dentists. At the ready are the phone numbers and addresses for places that can help with jobs and housing. A youth group meets at the center twice a month to learn about disease prevention and nutrition. The center also holds classes on Indian culture.

“Traditionally, most native people view health as a balance between the mental, spiritual, emotional and physical states,” said Bulfer, whose center has a $2 million budget and sees perhaps 250 patients each week. “It's about taking care of the entire person. That's not necessarily true in Western medicine.”

The Urban Indian Health Program has a friend in Sen. Dianne Feinstein, the California Democrat who is chairwoman of the Senate Appropriations subcommittee responsible for the program's budget. This fiscal year, she was instrumental in giving the program $34.5 million after Bush proposed eliminating the budget. In fiscal 2007, the program got $33.9 million.

The center's budget is fed by insurance reimbursements, federal and state grants and donations. In recent years, funding has decreased by about 3 percent a year, and the center has started losing money. Bulfer has started asking for more donations, which he said “haven't been significant.”

“I think the federal government, when it goes through its budget process, thinks there's no need for an urban Indian health care setting, but there is,” Bulfer said. “Without (the centers), some Indian people would go without services. You'd have more illnesses, and you'd have a tremendous increase in unmet needs for Indian people.”

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