Acquiring health care a dangerous struggle for American Indians

by JAMIE A. WELCH

American Indians are 249 percent more likely to die from diabetes compared to the general U.S. population. They are also 533 percent more likely to die from tuberculosis and 627 percent more likely to die from alcoholism. Without enough medical treatment and health care coverage, American Indians are subjected to a life expectancy of 71.1 years. This is four years less than that of the general U.S. population.

According to a report by the Utah Department of Health in 2001, 17.3 percent of American Indians and Alaska Natives have been unable to get the health care they need. This figure can only be fought by tackling some of the most difficult problems within the health care world as it pertains to American Indians.

A major factor is geography. Melissa Zito of the Utah Department of Health serves as the Indian health liaison/health policy consultant. She compared the state of American Indian health to a ripple effect in a pond. “The closer you are to the center, the higher quality you will receive,” she said. Many American Indians live far away from major cities and hospital clinics. The farther they are from a clinic, the lesser their chance of attaining quality health care.

One resource, the Indian Walk-In Center of Salt Lake City, assists registered American Indians with gaining access to medical resources such as immunizations, acute or chronic health care, eye care services, nutrition counseling, dental services, and primary health care. Often, however, the help the center offers is limited and can be difficult to attain.

To qualify for coverage at the Walk-In Center, Zito says individuals must be registered members of an American Indian tribe. The center’s Web site lists the steps individuals must take to register for health services. An individual must bring a photo ID, documentation of income, proof of residency, Social Security numbers for self and family members, documentation of Indian blood, and a basic knowledge of which type of health insurance is needed. Because nearly 50 percent of Utah’s American Indians live on reservations, it can be difficult to obtain such documentation without traveling to a larger city and filling out forms for each article, which can be a time-consuming task.

LeAnna VanKeuren, health program manager of the Indian Walk-In Center, recognizes the challenges facing American Indians. She said another major struggle the health care world encounters is the “lack of data to accurately describe the health status of American Indians who live on reservations.” In other words, without detailed information, it is difficult to estimate exactly what kind of help most American Indians need and how many need it.

So, if an American Indian needed emergency care and didn’t know the kind of coverage he or she had or the medical history of the patient, time could run out for the patient, assuming the distance traveled to get urgent treatment was not a factor involved.

Anthony Shirley, coordinator of recruitment and financial aid at the University of Utah College of Nursing, says health care access for American Indians is in a worse state than it was 10 years ago.

In an e-mail interview, Shirley said “most American Indians are not insured so they [are referred] out of the Indian Walk-In Center in Salt Lake City. These doctors and nurses and health professionals are unknowledgeable of our culture so we often do not get referrals within the Salt Lake Valley.” Also, many people are forced to return to the reservation to find an Indian health service clinic or hospital.

Another problem, Zito admitted, is that “it’s difficult to get folks enrolled in the health care they need so desperately.” Older generations of American Indians are not accustomed to receiving regular health check-ups and therefore see little reason to travel far away to get them. This is especially dangerous because American Indians are at a high risk for developing diabetes. Without habitual care, suffering can be prolonged.

“Diabetes is at all-time high for American Indians,” Shirley wrote in his e-mail. He said the problem “is a combination of education/awareness and demographics. Many American Indians are not educated on proper diet and with many American Indians living on the reservation, the only resources they have are cheap foods that contribute to diabetes.”

Zito recognizes this as well, saying, “Diabetes is a problem in the social, cultural and physiological parts of American Indian society.” It is a problem that is especially difficult to combat without modern treatment such as insulin and medications.

Currently, the Utah Department of Health uses the Utah Indian Health Advisory Board (UIHAB) to connect tribal, state and federal governments in an effort to better address American Indian health policies and concerns. UIHAB is also used to establish trust among governmental groups and American Indian organizations. And, according to Article III of the board’s bylaws: “UIHAB will advise and make recommendations for improved physical, mental, emotional, and spiritual health of American Indian people in Utah.”

Zito quoted a historic phrase used by Cherokee leaders to say, “as long as the grass grows and the rivers flow the government will provide for the Native people.”

TEA of Utah

by JENNIFER MORGAN

Teinamarie Nelson and Rebecca Wilder were having lunch one day and discussing an issue they heard about from the media regarding transgender people that they thought was unfair. The two women wanted to do something to help transgender people and those who interact with them so they didn’t make the news the same way. They decided to form a nonprofit organization but, it wasn’t until Christopher Scuderi came on board that things started moving.

Transgender Education Advocates, or TEA (pronounced “T”), was established in 2003 as a volunteer organization. It is an affiliate program of the Utah Pride Center and its mission is “to educate the public on transgender issues for better understanding and awareness of discrimination towards the transgender population.”

TEA offers a Gender 101 class, which aims to make people aware of individuals who don’t fit the binary gender system. Scuderi said 50 percent of the classes they teach are requested while the other half are through TEA’s outreach efforts. Because TEA doesn’t have an office of its own, classes are offered in the Utah Pride Center or at the organization receiving the training.

One group that received the Gender 101 training recently was the Public Safety Liaison Committee. PSLC is a group of individuals in service-related professions, including firefighters, police officers and EMTs that aim to educate those in their field about LGBT issues. Rachel Hanson of the Utah Pride Center and Scuderi conducted the training for PSLC, which lasted about an hour and half. Hanson felt it was a success because people openly talked a lot about biases and other subjects that came up during the presentation. Another good gauge for determining whether the training went well, is if participants feel free to ask questions. “I can often tell when people feel comfortable because they ask questions without worrying about sounding dumb,” she said. “A lot of people don’t understand transgender people.”

Gary Horenkamp, PSLC’s co-chair, said the training was “a well-organized, well-presented learning activity” with useful information that he hadn’t heard anywhere before. Horenkamp also is the project leader for OUTreach Ogden, which supports the “personal growth, acceptance and equality” of LGBTQ people and serves Box Elder, Morgan, Weber and Davis Counties. Gender 101 classes are available throughout the year, but TEA also hosts special events.

During November, TEA hosted a number of events in recognition of Transgender Awareness Month. For 2007 it brought in two speakers to provide workshops for medical and legal students and professionals. TEA also observes the Day of Remembrance annually on Nov. 20 with a candlelight vigil. The memorial commemorates transgender people who have lost their lives due to hate-crime violence.

Although it wasn’t a hate crime, Scuderi tells of an individual who was involved in a car accident that died because of a lack of understanding. When paramedics arrived they had to cut away clothing and when they discovered the genitalia of the victim didn’t match the rest of their appearance they were shocked. Apparently they laughed and poked fun but never helped, which resulted in the victim’s death. Some people have a hard time seeking medical help because they don’t know how they will be treated.

In the Salt Lake City medical community there are four family doctors who advertise that they treat transgender patients, but only one, Dr. Nicola Riley, is still accepting new patients. The others had to stop because their practices were too large. Riley received TEA’s 2006 award for Individual of the Year, while Equality Utah was given the Organization of the Year award for its work. Riley received this award partly because of her willingness to continue accepting transgender patients.

If a transgender person decides to have gender reassignment surgery, or GRS, they may have a difficult time finding a surgeon as well. Scuderi estimates there are a dozen throughout the United States, but none are in Utah. The closest surgeons are in Colorado, California or Arizona. Outside of the country, Thailand has the most GRS surgeons because of its progressive views regarding gender.

TEA’s 2007 keynote speaker, Dr. Marci Bowers, has a waiting list of 150 people. Her practice is located in Trinidad, Colo., which is the “transgender capital of the world” according to the city welcome sign. Born Mark Bowers, she transitioned later in life after marrying and having children although she had thoughts about becoming a woman by the age of 5. Bowers has helped more than 500 patients through this process and is considered a world-renowned surgeon. She has been a guest on “Oprah” and “Larry King Live.”

Locating a surgeon is just one challenge facing individuals. Securing funding also can be problematic. Many people can only afford changes from the waist up and can feel incomplete because of it. A few insurance companies cover GRS, but it has to be written into the plan. For male-to-female surgery, Scuderi estimates the cost ranges from $8,000 to $22,000. Female-to-male surgery costs considerably more: $30,000 to $150,000.

Because the costs are out of reach for many, TEA established the Cans For Change program. Aluminum cans are collected for recycling and the money goes toward a scholarship. The scholarship fund was developed to help with a portion of general reassignment surgery costs for an individual on a need basis. You can e-mail TEA to arrange a pick up of clean cans any time. While it has yet to raise enough to consider applicants, TEA hopes to have $1,000 soon for this purpose.

Due to confidentiality and stigma, few statistics are available on the transgender population. But Scuderi and Rachel Hanson believe the transgender youth population is growing. They think this is partly due to the media. Films such as “Boys Don’t Cry” and Barbara Walter’s segment on “20/20” bring exposure to the transgender community. Also, the Internet provides a forum for youth to discuss their lives and issues in a safe environment.

Hanson is the youth director at the Utah Pride Center and facilitates the transgender youth group that meets weekly. She said many transgender people are not receiving support from family or friends so they are at a higher risk for suicide and other self-destructive behavior than gay and lesbian youth.

Utah law doesn’t allow the promotion of homosexuality in schools. Hanson says that when they have approached schools to educate them they often shy away from the training because they’re afraid it’ll fall under the “promotion” of alternative lifestyles.

Scuderi says TEA has had conversations with two school boards. “We’ve contacted most of them, but they’ve either declined or haven’t returned emails or phone calls.”

On campus and elsewhere, the most obvious place transgender people encounter problems is the bathrooms. If a female has male genitalia and goes into the boy’s bathroom she’s more likely to have a problem than using a girl’s restroom.

Another place that is high risk for transgender people is correctional facilities. Currently when someone is picked up they are placed in holding cells based on their genitalia. Because their outward appearance is generally different than those their holed up with, they become easy targets for harassment or worse. Horenkamp said there was a senior officer from SLCPD at the Gender 101 training and he felt it was well received.

Hispanic health care difficult for patients, doctors

by JEFF DUNN

It’s a typical Monday afternoon at Dr. John H. Newton’s downtown orthodontist office. Patients are flipping through entertainment magazines, checking their voice mail or engaging in light conversation. In an adjoining room, Newton is tightening wires and applying fresh rubber bands. Of the nine people waiting in the cushioned chairs, four are Hispanic. And they all have different stories to tell.

Cassandra Avila, 16, attends night school at Horizonte High School to make room for her busy work schedule. The teenager works as a Subway sandwich artist five days a week. She’s required to work to help her single mother cover expenses, particularly health care. (Her parents are still married; however her father resides in Pachuca, Mexico, after giving his immigration papers to his brother 20 years ago.)

“I have a job so I’m helping,” she said, speaking of health care costs. “I hardly have time for myself. I have to make time to come to the dentist.”

Though she knew about the cost of orthodontia when she began the treatment program, Avila said she wanted braces to help correct her severely crooked teeth.

“My teeth were really messed up. I had a tooth up here,” she said, pointing to her upper gums near her left nostril.

Avila’s teeth are nearly straight now, and she happily reports her braces will be off in a few months. She should be happy. She’s worked harder than most 16-year-olds for her movie star smile.

Anna Cataxinos, 41, has also sacrificed for her health coverage. She actually worked for a time in medical records at a local hospital. While working there, the daughter of Chilean immigrants said she often got requests from different departments to translate for Spanish-speaking patients.

“A lot of people needed help understanding simple things like changing rooms,” she said. “Learning a new medical system is difficult and complicated for them.”

Despite being fluent in Spanish, Cataxinos said she struggled with different dialects and confusing medical terminology.

“It’s the terms that are hard,” she said. “It took me awhile. I didn’t trust myself to remember.”

Cataxinos said she knew the patients needed as much medical information as possible, so she made a list of all the terms she needed to know so she could make sure she got everything correct.

Avila agreed that translating complicated procedures for family members or friends can be extremely taxing. Her aunt, for example, doesn’t speak English and therefore doesn’t feel comfortable going to the doctor’s office alone.

“Every time she goes, she gets me or my cousin to go with her,” Avila said. “There are some big words they use, like doctor language that I don’t get. I speak both languages fluently, but it’s hard for me to understand.”

More importantly, it’s hard for her aunt to understand. Avila said it often requires repeated, simplified translations before her father’s sister-in-law can grasp what’s going on.

“I let her know until she gets it, and then she’ll go, ‘Oh, okay,'” Avila said.

Explaining the financial side of health care is even more challenging, according to Cataxinos. She said many Latin Americans she has worked with are used to different payment plans and protocols.

“The system is so different in South America,” she said. “Here things work so differently. They have to learn a whole new system.”

Dr. Newton, who has worked as an orthodontist for three decades, estimated he sees Spanish-speaking patients once or twice a month. He said many times the Hispanics people are required to have their children translate for them, which makes things difficult.

“There’s a lot lost in translation,” he said. “[The kids] frequently don’t understand the financial aspects, and 12-year-olds have a hard time explaining.”

Though working with child translators is strenuous and time consuming, he said he’s happy to do it. However, he said he knows several orthodontists who aren’t as willing.

“There’s that attitude that, ‘Hey, this is America. You have to learn English, because we’re not going to learn Spanish,'” he said.

Erik Storheim, 35, can relate. Storheim is a local dentist fluent in Spanish, thanks to a two-year mission to Santiago, Chile, for The Church of Jesus Christ of Latter-day Saints. He said explaining dental terminology in a foreign language is a constant struggle.

“Even though I speak Spanish, there’s definitely a communication barrier,” he said. “It’s hard to go in-depth and explain procedures. I didn’t learn dental terms on my mission.”

Storheim used periodontal disease prevention as an example of a difficult concept to describe to his Latino patients.

“It’s hard enough to explain to someone who is a native English speaker,” he said. “When I try to explain it with my limited Spanish ability, it’s even harder to convey the importance.”

But the complications don’t stop at the dentist chair. Because no one else on Storheim’s staff speaks Spanish, he is required to handle all the scheduling and financial arrangments for his Hispanic patients. Managing the receptionist’s duties often causes delayed appointments for other patients, he said.

Still, Storheim said it’s not the delays and complications that bother him the most, it’s the lack of care created by the language barrier.

“I get frustrated communicating sometimes,” he said. “I feel like I can’t communicate adequately and educate my patients like I want to. I feel like they don’t get the care they need sometimes.”

Storheim said he genuinely cares about his patients’ well-being and didn’t go through the rigors of dental school just to punch a time card.

“I’m not a dentist just to fill cavities and pull teeth,” he said. “I want my patients to come away more educated about their dental health. I don’t feel that I can provide that service all the time.”

Newton said he has been working with Hispanic clients since he attended orthodontist school at the University of Illinois in the early 1970s. During his last two years, Newton accepted a summer job in Alamosa, Colo., helping undocumented Hispanic workers get adequate health care.

“A lot of people think Colorado’s main source of income is skiing, tourism and John Denver,” he said. “I learned that that’s not true. The main source of revenue for Colorado is agriculture. And of course, they need field hands to work the crop and prepare the fields.”

Newton was one of around 20 upper-class medical students who worked to provide medical attention to needy migrant workers. He described his experience as eye-opening and disheartening.

“It was very hard,” he said. “Many were seriously ill, but they didn’t have any money or medical insurance.”

He also added the experience gave him a better understanding of some workers’ conception of health care.

“It was fascinating to see their folk remedies that didn’t exactly [jibe] with western, traditional medicine,” he said.

Although the team of students and doctors did all they could to help the workers, Newton said they simply didn’t have the resources to take care of everyone.

“It was like trying to hold back the ocean with a broom sometimes,” he said.

The orthodontist said he doesn’t think the situation has improved in the last 30 years.

“They’re outside the system,” he said. “No one’s interested in helping them, because there are no political benefits.”

No one except for dentists like Erik Storheim. Though he has his own financial issues stemming from buying his own practice in January, he said he still tries to help out when he can.

“Sometimes I give people a good deal,” he said. “I’ll say, ‘Listen, this is just for you.’ I don’t want word to get out that I do free dentistry.”

Storheim said assisting others is his way of showing gratitude for all he’s been blessed with.

“Everyone deserves a break once in a while,” he said. “You can always give back.”

An hour has passed, and the waiting room crowd is starting to thin out. The magazines are read, the voice mail checked and the light conversation complete. Dr. Newton appears, motioning in another patient. His tired eyes require no translation.

Neither do theirs.

U of U weighs in on campus climate scale for first year

by STEPHANIE FERRER-CARTER

When interns and the advisor from the LGBT Resource Center at the University of Utah go recruiting at local high schools in an effort to turn graduating students into the school’s next batch of freshmen, they’ll have the U’s honor roll standing to aid them.

In today’s competitive campus atmosphere, students are not the only ones being evaluated on whether they meet the qualifications of a school. Students seeking a school that caters to their individual needs and desires in areas outside the curriculum also are scrutinizing universities nationwide.

While the U is looking at applicants’ grade point averages, some students will be looking at the school’s gay point average. The University of Utah is one of two Utah colleges and universities ranked on The Campus Climate Scale. The scale is designed to measure and rate how LGBTQ-friendly a certain campus is and ranks colleges and universities nationwide, giving future students access to the school’s ratings and the ability to search different schools online.

Daniel Hill, 18, is the youth program coordinator for Tolerant, Intelligent Network of Teens(TINT), a chapter of the Utah Pride Center, which serves teens, between 14 and 20 years of age. Hill, who is gay, graduated from East High School in Salt Lake City in 2005.

Hill said an LGBTQ-friendly campus is more important than incoming students may realize. “At the time when I was trying to figure out what colleges I was going to go to, or whether I was going to head straight out to a university, it wasn’t a big deal,” he said. “But then when I got into the scene and I got my job here, I heard stories saying how it can be just as bad than, if not worse, depending on what college and what state you’re in. So I would totally think that [the U’s ranking on the Campus Climate Scale] would be a beneficial thing for anyone.”

The U has an overall ranking of 4.5 out of five stars, placing it in the top 30 LGBTQ-friendly campuses on the list nationally, and in the top 10 in the Western region of the schools featured.

“This is more based on the certain policies we have at the University of Utah,” said Cathy Martinez, director of the U’s Lesbian Gay Bisexual Transgender Resource Center. “This isn’t based on a survey of students.”

Martinez said researchers who created the Web site contacted her and sent her a survey, which she completed by calling various departments at the U. She spoke with people within the departments who were best qualified to answer the specific questions of the survey.

“I didn’t answer it based on what I thought was true,” Martinez said. “I answered it based on talking to somebody in housing and residential life, or campus safety and what their answers were.”

Martinez then returned the survey to the Campus Climate Scale, which calculated the U’s overall score according to the site’s assessment standards.

According to the site, the national average is a three-star rating. Utah’s only other ranked campus, Utah State University, has a two-star rating.

But what looks like a below-average score may not necessarily mean USU isn’t making the grade.

Martinez says the LGBT Resource Center at USU is new this year. A search of the school’s Web site did not yield any specific web pages or contact information for the center.

“The fact that they have a resource center is a positive thing,” she said. “It’s taken us since 2002 [the year the U’s LGBT Resource Center opened] to get to this point.”

Martinez says she believes USU is taking steps to become more LGBT-friendly, and that the low ranking does not mean it is not a good school.

The U scored a full five stars in areas like Academic Life, Student Life, Counseling and Health and Recruitment and Retention Efforts due to efforts to improve the services offered by the LGBT Resource Center and annual student recruitment.

The U’s lowest rankings were three out of five stars in LGBT Policy Inclusion and Housing and Residence Life.

However, Martinez cautioned that these rankings could be misleading.

Some of the U’s missed points came from policies concerning employees, not students, such as cheaper health care for married employees or the ability to buy life insurance for oneself, but not one’s partner.

Martinez also said that not every answer to every question was clear-cut. The U does prohibit discrimination based on sexual orientation, but she says the policy could be made stronger by also including gender expression and gender identity in it.

The U’s low score in LGBT Housing and Residence Life may be due to the fact that the school does not provide themed housing for LGBTQ students. Martinez said the school does have a diversity-themed house, which may not be specific to the students, but certainly includes them.

Overall, Martinez said she feels the U’s score is an accurate reflection of the campus’ climate.

“It says a lot to LGBT students. It says the university is actively making changes, acknowledging the fact that these services for LGBT students, faculty and staff are important,” she said.

But the fact that the survey isn’t student-based could bring the U’s high score into question. Martinez said there are surveys conducted by students that have listed the U as the least LGBTQ friendly.

“So depending on who you’re asking the questions of, you’re going to get different answers,” she said.

David Daniels, 21, a volunteer at the U’s LGBT Resource Center, thinks the poor student evaluations could be due to students not finding the resources that the university does have to offer.

“I know students who are on this campus and don’t feel like it’s very LGBT friendly,” Daniels said. “I think the university does a lot of things to just be aware of the diversity population that we have here on campus. And I think there are a lot of outlets. However, I don’t know if we do enough here to make those outlets available and known to people.”

It has yet to be seen whether the U’s honor-roll ranking on the scale will influence incoming freshman.

“I think certainly, to a degree, when you have information like that, it can have an impact,” Daniels said. “What’s more important is finding out for yourself; going to a campus, doing a tour and actually asking people who are there.”