Healthcare in Montana:
Tribal efforts to heal the consequences of old wounds
FLATHEAD RESERVATION — The Flathead Indian Reservation is on the way to Glacier National Park, and its vistas of idyllic pastures, towering mountains and endless skies can be breathtaking on bright fall days. But when the weather turns and becomes overcast, it is apparent how bleak and brutal such a beautiful place can be.
“There are often times on Monday morning, what I do … is figure out who died over the weekend, what trauma has gone on, to decide what we are going to do over the next week,” said Anna Whiting Sorrell, the administrator of Tribal Health, the healthcare service of the Confederated Salish and Kootenai Tribes.
“As Indian people, taking care of our family and our communities are our number one priorities,” she said. “But people will be gone, and the work still has to go on.”
Young tribal members like Flower Gopher are training to join that work. Gopher was in the midst of preparing for midterms at Salish Kootenai College, the tribal college of the Flathead Reservation. But that didn’t stop her from participating in a training called Mending Broken Hearts. It helps tribal members facilitate conversations about personal trauma and unresolved grief.
“Knowing how bad some of our people … do struggle, with their own traumas or the traumas from generations before, I want to be that pillar to help them overcome those hurdles, because everybody deserves to have a good life, everybody deserves to be happy and healthy,” said Gopher, 33, who is an enrolled member of the Confederated Salish and Kootenai Tribes.
Gopher is about to graduate from a new two-year medical assistant program, her second attempt at getting her degree. The new program is one in a constellation of job training programs in the healthcare field that the tribes have started to provide, especially for tribal members who are unemployed or work in low-wage jobs.
Gopher sees being a medical assistant as a stepping stone — allowing her to work part time and pursue her education. An internship at the behavioral health department of Tribal Health had helped Gopher realize her purpose: to be a therapist.
A growing demand for healthcare jobs
Mental health and substance abuse disorders are pervasive issues on Native American reservations across the country. Meanwhile healthcare services — including those that can directly address mental health and drug use — represent one of the few growing industries in the state of Montana. The state’s Department of Labor and Industry predicts a 1.8 percent annual growth rate in healthcare jobs, with much of the growth concentrated in the Western part of the state, where the Flathead Reservation is located.
This is part of a national trend, with jobs in so-called “healthcare support occupations” expected to be among the fastest growing in the next decade. On the Flathead Reservation, the largest employers include the tribal government – which administers Tribal Health — and the private hospitals St. Luke Community Hospital and St. Joseph Hospital.
In 2014, the tribal Economic Development office commissioned a survey to learn about tribal members’ job interests and gaps in training opportunities, and how the government can implement programs to address them. Based on the survey results, the tribal government is working to provide training in the fields experiencing growth that unemployed workers have expressed an interest in. This includes focusing on healthcare careers.
Historical trauma and healthcare disparities
Native people face extreme health disparities in chronic diseases and mental health disorders. The role of historical trauma as a contributor to Native people’s health outcomes is well-documented. Historical trauma is a concept that was first used to describe the adverse psychological impacts experienced by the descendants of Holocaust survivors, but has since been expanded to include Native Americans and other groups that share a “collective trauma.”
The Flathead Indian Reservation was created by the Hellgate Treaty of 1855. The three tribes of the Salish, Kootenai and Pend d’Oreille lost much of their traditional homeland in the treaty, and individual tribal members were allotted parcels of land, an effort to assimilate Native people. Soon after, the United States government opened up the reservation to white homesteaders.
In addition to the forced removal from and loss of their ancestral land, another major historical trauma experienced by Native Americans was the loss of culture through the boarding school movement, where the federal government forcibly removed Native children from their family and tribes in order to assimilate them.
Today, the rate at which young Native people in Montana, those aged between 11 – 24, commit suicide is three times higher than the state as a whole, according to data from Montana’s Department of Health and Human Services.
Whiting Sorrell says that the toll of the suicides, on top of the daily responsibilities of administering the healthcare system — such as switching to a new electronic health record and rolling out a tribal health insurance program — can feel overwhelming.
“In the end, there’s just a lot of work and not a lot of us to do it,” she said.
Meeting the community’s needs
Salish Kootenai College (SKC) had already been running a nursing and dental assistant program. To help train more qualified medical professionals, the college created the Allied Health department which began operating in the fall of 2016. The department administers the two-year medical assistant program and offers workforce development courses in the healthcare field – allowing tribal members to take a single course to help them get their certification.
Valerie Johnson runs Allied Health, which, in its first year of existence, offered an EMT course and a certified nursing assistant course in addition to the two-year medical assistant program.
In the EMT course last fall, Johnson, who is a trained nurse, said eight out of 12 students graduated. Six are still in the process of certification, and two are in the last step — waiting to get approval by the state in order to work as EMTs in Polson. In conjunction with the tribal Department of Human Resources Development, Johnson said the college offered a course to get their workforce certified as certified nursing assistants in over the summer.
We want the best program in the state…not only for our students, but as a reflection of the college and the tribal community.
Allied Health Department Head, Salish Kootenai College
But offering these courses consistently is still a work in progress. She is teaching a phlebotomy course in the spring, and will offer the EMT course again in the winter. When I visited Johnson in October, she wasn’t sure she’d be able to offer another certified nursing assistant course because she couldn’t find an instructor. But in a follow up conversation in December, she said she had managed to find two instructors to split the clinical and classroom teaching.
“Everything [under] Allied Health is brand new,” Johnson said. “Up until this fall, I was the department…so we are trying to meet the community’s needs in doing those things.”
However, Johnson is optimistic about the growth of the medical assistant program, which started in 2015 and had its first graduating class in the spring of 2017. The second graduating class of medical assistants has three students, and eleven students enrolled in the medical assistant program this fall. “We are getting more and more students as we are getting more and more established,” Johnson said. Her next step is to get the program accredited.
“We want the best program in the state…not only for our students but as a reflection of the college and the tribal community,” Johnson said. “[Getting] the program accredited, I think, is the first step in doing that. We want 100 percent placement when our students come out of here.”
The Confederated Salish and Kootenai tribes are unique among tribes because they provide their own health care to tribal members, instead of depending on the federal government to provide it through the Indian Health Service. Tribal Health provides comprehensive care — from primary care to dental and optometry — in clinics throughout the reservation.
“We had six tribal members that graduated — not necessarily from the Confederated Salish and Kootenai Tribes — but other places, and it was like, ‘Why aren’t you guys coming to work here?’” Whiting Sorrell, the Tribal Health administrator, said. “We need to recruit them better.”
Whiting Sorrell added that while the Tribal Health system doesn’t have many medical assistants now, the position should be integrated into the clinical staff.
(Johnson, the Allied Health administrator, says syncing up graduates with Tribal Health is a priority. “It is an avenue we want to pursue,” she said.)
Kelsie Jones was one of the first graduates of the medical assistant program this spring. She said it was easy to find a job as a medical assistant, and she works now for Polson Health a clinic run by Kalispell Regional Medical Center. She added that she did try to see if the Tribal Health clinic on SKC’s campus was hiring a medical assistant, but there was no job opening.
Like Gopher, Jones also went back to school after a first college attempt didn’t work out. She had her daughter in 2014, and she knew she couldn’t be a waitress for the rest of her life.
“I split up with [my daughter’s] dad, and he always made comments that I wasn’t going to do anything with my life, so it gave me more motivation to show that I could get a career,” said Jones, who is 26. “It’s part of the reason I walked into SKC.”
Jones, who is an enrolled member of the Tlingit tribe, says that she likes her work as a medical assistant so far, but she sees the need for more culturally-based substance abuse counseling. It is something she wants to pursue.
“It would be nice to have some sort of rehab across the [Flathead] lake at Big Sky, I’ve always thought of this,” Jones said. “That way [people with a substance abuse disorder] can get out of here, but not so far away that families can’t visit, and they can learn new activities, even bringing Native culture there. Showing them how to bead. Showing them how to cook jerky.”
Whiting Sorrell showed me the work that occurs at the main Tribal Health clinic in St. Ignatius. It’s a beautiful building — formerly a hospital — that incorporates tribal art in its decor. The entrance for patients is a grand sunlit gallery held up by stone pillars.
When I visited, it was Breast Cancer Awareness Month, and the corridors were decorated with bras. The main clinic has an audiology department, an optometry department, a pharmacy, a dental clinic, the medical clinic, a community health nurse who makes home visits, a behavioral health department (where Flower Gopher interned), a physical therapist, and a whole program dedicated to diabetes care, including nutrition and prevention.
Two nurses were preparing for a class on cooking for diabetics, and setting goals about calories, carb and fat intake.
The community endures and the work goes on.
This story was produced as part of the “Crossing the Divide” reporting project with support from the Solutions Journalism Network.
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