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Indigenous health

by Lori A. Colomeda PhD (Salish Kootenai College, Pablo MT, USA)

Speech delivered in Brisbane, 9 September 1998

I begin by thanking the Creator for this beautiful day, for the land, and for the wisdom of the elders. And thank you too for paying so much money to hear me speak about the issues and solutions of American Native People.

It is an honor to be invited to speak with you this morning.

I hope to make you laugh, to give you food for thought and to tell you a bit about who I am and to whet your appetite about the health effects of economic development on Indigenous people in North America. I do not speak for any one tribe nor am I the official representative of any tribal government or any US government, but I do speak for Indigenous people who think as I think.

My tribe is not from the Plains area of the US. I am a descendent of French Canadians and Micmac Indian people from New Brunswick, and Quebec, Canada. Although I was born in the States, the ashes of my grandfathers and my grandmothers reside in the Maritime Provinces of Canada. Five hundred years ago, my tribe was impacted by whalers, fishermen, missionaries and other people from Europe. We learned their Christian religion, their whaling songs, jigs and reels, and their life ways. We were the People of the Dawn, the first tribe to live in two worlds.

I attended university in Boston and Philadelphia. I am a registered nurse with two master's degrees. One in Health and Therapeutic Recreation and one in Environmental Science. My Ph.D. is in Medical Ecology with a focus on Arctic Ecosystems. My research area is Arctic environments and their effects on human health.

Currently, I teach at a tribal college in Montana and my subject areas are Environmental Health, Tribal Health and Environmental Ethics; in addition, I am the curriculum specialist for the Distance Education Department.

I am drawn to the Arctic by a powerful force as intense as the migration instinct of the caribou or the tundra swans. I can't explain it. But the work that propels me there brings me closer to the women. The women are the strength of the Arctic. They survive in spite of the harshness of their lives in the boreal forest of tundra.

Although I was invited to speak with you this morning about economic development and effects of human health among Indigenous people of the Americas and solutions to these problems, I want to speak briefly about the Arctic ecosystem and the contamination that is occurring there and how it affects women's health.

Since the 1950s or just after World War II, 60,000 new synthetic chemicals have been introduced into the environment. Many of these chemicals use chlorine as a base. Organochlorine herbicides and pesticides for example. Another group of chemicals is the polychlorinated biphenyls or PCBs. These are used as lubricants, solvents and although they have not been manufactured in the States since the 1970s, these chemicals are persistent in our environment and affect human health.

The Arctic is a great heat sink into which these chemicals flow from the southern atmosphere. They are airborne and arrive on wind currents and are deposited on the land, snow and waters of arctic ecosystems. These chemicals have entered the food chain and reside in the fat tissues of mammals, insects, plants, fish, and birds.

Svalbard lies 1200 miles north of Oslo, Norway. Based on polar bear studies, researchers have found that this population of isolated polar bears is highly contaminated with chemicals including PCBs, DDT and other persistent organo chemicals. Some polar bears have a PCB level of 90ppm. The tolerable level or standards for foods fit for human consumption is 1ppm. In that same area harp seals are known to carry a PCB level of 70ppm.

On the Mohawk Indian Reserve bordering the St. Lawrence River, turtles examined by the tribe's environmental resource scientists have been found with a PCB level of 800ppm. Mohawk women have a high rate of breast cancer.

PCB contamination is also affecting the breast milk of Inuit women who have been tested at 14.7ppm. Babies in the Arctic Quebec have seven times more PCBs than children born in Canada.

Falk et. al in 1992 found that women with breast cancer have higher levels of organochlorines in their breast tissues and other fatty tissues than women without breast cancer. In Canada's St. Lawrence River, where PCBs have been dumped since the 1950s from GM and organochlorines are used in the paper bleaching process, the Beluga whale population has demonstrated an increase in mammary cancers. In fact, when these animals wash up on shore they are treated like toxic waste, so contaminated are their bodies.

Research from the World Health Organization demonstrates that industrialized countries have far more cancers those countries with little industry. WHO has concluded that 80% of cancers is attributable to environmental influence. (Steingraber, 1997, p.60).

In 1964 two scientists with the National Cancer Institute (USA), stated "The unfolding cancer epidemic is fueled by increasing contamination of the human environment with chemical and physical carcinogens and with chemical that support the action of these chemicals. Their words fell on deaf ears (Steingraber, 1997).

Persistent organochlorines are currently under examination by researchers such as Theo Coburn for their endocrine disruption and estrogenic mimicry in the reproductive health of animals and humans.

If theories presume that breast cancers are caused by an increased exposure to estrogen through early menarche and late menopause as the data suggests, we are being flooded with estrogen in the form of these estrogen mimics and synthetic chemicals. For example, Dr Soto a well-known breast cancer researcher from Tufts University in Waltham was researching the effects of estrogen on breast cells. Her cells in the petri dishes grew without the addition of estrogen. Thinking that the sample was contaminated she made new samples and the same thing happened. Their lab traced the estrogen to the plastic petri dishes and the leaching out of nonly phenol into the samples. What does that say for the plastics in our lives? When Israel banned PCBs and organochlorines from their country, the breast cancer rate declined 30%.

In addition to the endocrine disrupting chemicals, nuclear fallout and waste from uranium mining affects the health of Indian people in a more insidious way. In Point Hope (Alaska), our wise federal government allowed contaminated soil from nuclear waste fallout in Nevada to be buried near an Inuit village. It went unmarked for 30 years. Hunters hunted near it and caribou migrated through it. The people wondered why they had such a high cancer incidence of 578 per 100,000.

Public Health studies related it to the incidence of smoking. Finally in 1997, Dr. Bowerman, Chief Medical Officer from the Borough of Barrow (Alaska) published his findings that this was indeed the result of the nuclear waste buried near the town.

Contamination by radioneuclides from nuclear fallout in above ground testing also affects the health of the Arctic people. Strontium 90 and Cesium are taken up by the tundra lichens. Through the lichen-caribou-human food chain, a direct correlation exists between the levels of strontium and cesium in caribou feeding on tundra lichens in the winter, and the levels of strontium and cesium in the bodies of Inuit people of the tundra.

In addition to the introduction of endocrine disrupters into the environment, mining, especially uranium mining and effects from nuclear fallout is taking a terrible toll on the lands and health of the world's Indigenous people. Uranium mining, has caused, and continues to cause, environmental, social and spiritual disruptions in the lives of our people.

The female breast is one of the organs most susceptible to radiation carcinogenesis. (According to the National Research Council, 1980). Direct absorption of radionucleides is the most intense process in which fallout occurs in arctic tundra ecosystems with lichens being particularly susceptible to contamination. Radioactive contamination in the Polar Regions comes from a number of sources one of which is nuclear fallout, the other is uranium mining. (Colomeda, 1996).

The Navajo mines closed in 1970. Thirty years after mining began, of the 150 Navajo men who worked in the mine, 133 died of radiation-induced lung cancer or had severe lung and respiratory disorders such as fibrosis. As their fathers continued to die of lung cancer, children played in the waters that flowed through abandon mines and tailings piles. The children developed burning skin sores (Grinde & Johanson, 1996).

Because of the radioactive contaminated waters, birth defects and Down's syndrome, previously unknown among the Navajo, soared (Weaver, 1996). Of all infant deaths in the Navajo IHS Service Unit for the years 1990-1992, 35.0% were caused by congenital anomalies (USDHHS, Indian Health Service, 1995, p. 40). Mortality attributed to malignant neoplasms age adjusted rate is 78.5% for the Navajo IHS Service Unit in the years of 1990-1992 (USDHSS, Indian Health Service, 1995, p. 65).

A 1976 Environmental Protection Agency report found radioactive contamination of drinking water on the Navajo Reservation in the Grants (New Mexico) area near a uranium mining and milling facility (Eichstaedt, 1994, p. 208).

The working conditions [in the mines] were terrible. Inspectors looked at the vents. When they weren't inspected, they were left alone. Sometimes the machines [for ventilation] didn't work. They told the miners to go in there and get the ore shortly after the explosions when the smoke was thick and the timbers were not in place. There was always the danger of the ceiling falling in on them (Eichstaedt, 1994. p. 173).

    The water [from the drilling hose] was leaking from the drilling into a pop can wedged under the water hose. [The leaking hoses provided a source of drinking water) I drank that a lot of times. It was fresh and cold (Eichstaedt, 1994, p 189).

    At Moonlight Mine they used to work with their bare hands and shoveled the uranium into a bucket and hauled it showers. They worked you like a slave. They wanted the miners to work twenty to twenty four hours a day (Eichstaedt, 1994. p. 188).

Not only did exposure to uranium cause health problems in the miners themselves, uranium continues to create health hazards for Navajo families. There are twenty-two homes in the Red Valley area and several dozen more across the reservation constructed from mine tailings or radioactive rocks. Because uranium bearing sandstone fractures easily into squares and provides a readily available source of construction materials. With the help of federal assistance, the tribe has replaced seventeen of the homes in Red Valley.

When the mines finally closed, millions of tons of tailings were abandon by processing companies and have been blowing in the wind since the 1960s. The tailings contain thorium-230 and radium-226 which are doomed to leach into the ground water for over 1,000 years (Eichstaedt, 1994.)

In a situation that occurred in 1979, 94 million gallons of water contaminated with uranium mining waste broke through a United Nuclear Corporation storage dam. The water poured into the Puerco River in New Mexico, the main water supply for the Navajo Indians that live along the river, and a tributary of the major source of water for Los Angeles. Navajo ranchers, their children, and farm animals waded through the river unaware of the radioactive danger. This tragedy continues to take toll on the health of Navajo people, who lost the use of their water. To the Navajo, this event is also a prophetic warning for all humanity (Keane, 1997).

In New Mexico, roads to the Laguna Pueblo were resurfaced with low-grade uranium ore. Similar material was used to construct the tribal buildings and housing. Birth defects soared as they did in the case of the Navajo. In 1995 the Indian Health Service unit serving Indian people in the Phoenix area listed 27.9% of infant deaths were caused by congenital anomalies (Indian Health Service, 1995, p. 41.). The age adjusted mortality rate for malignant neoplasms in the IHS service unit in Phoenix was 76.9% (Indian Health Service, 1995, p. 65.).

In the State of Washington near tribal lands, the Hanford Nuclear Plant released more than 440 billion gallons of irradiated water thirty miles upstream from the Yakima Reservation between 1945 and 1989 ... oysters caught at the mouth of the Columbia River were so toxic that when one Hanford employee ate them and returned to work the following day, he set off the plant's radiation alarm (Weaver, 1996, pg. 49).

In Tennessee, the Nashville IHS Service Unit serves Indian people from Oklahoma, home of General Atomic's Sequoyah Fuels uranium processing facility which was closed in 1992. In its 21 years, it was cited for more than 15,000 violations of federal and state laws. Native Americans for a Clean Environment (NACE) was instrumental in its closing ( In the Nashville IHS Service area, 32.3% of all infant deaths were due to congenital anomalies in 1991-1992.

It is highly likely that the congenital anomalies problems that we experience in these three IHS service units are from genetic mutations from radioactivity from closed uranium mines.

As Indian people we continue to experience many health problems as a result of the collisions of our culture with the dominant culture.

In the United States there are 1.6 million Indian people. 50% of them live in urban areas and 33% live on reservations. The rest live in rural areas adjacent to reservations. Indian people are educated in the culture of the Europeans. In addition we retain our own identity ... even though many of us retain our Indian names like Running Crane, Big Crane, Heavy Runner, we also have English names as well and we live in modern houses, not tipis; but sometimes we use tipis in the summer when we camp at our celebrations called Pow Wows. Many Indian People use microwave ovens, telephones, computers, and WE know how to program our VCRs. On the other hand, many Indian people in North America live in abject poverty, sub-standard housing, and have no access to running water, electricity, or flush toilets. Indian people on some reservations are the inhabitants of the 4th World and are largely ignored and undocumented in publications from the World Health Organization.

Although our Indigenous cultures vary from continent to continent, the concept of Earth as Mother or land as the ashes of our ancestors unites Indigenous peoples around the globe.

We have an ancient and deep respect for the environment, embodied in the spiritual concept of Earth as Sacred Mother. We believe that She gives us everything we need to live: healing plants, animals, berries for food, clean water, clean air. Our art, our cultural ceremonies and our life ways all reflect this. For American Indians, we believe that the grasses are our mother's hair. When we burn our sweet grass in ceremonies the smoke carries our prayers to the Creator, much like the candles and the incense in other religious ceremonies.

So Mother Earth takes care of us, gives us everything that is good. To survive, we take care of her. We all need care. It is what cements our relationships with one another. We need to care for the earth, for our people, our students, and we need the earth to care for us.

In the past, Indigenous peoples did not experience the modern problems currently developing in our environment. We never took more than we needed, and always gave back to Mother when we took from her. A massive paradigm shift, from the Indigenous concept of land caring in which we learned to work with the nature in a positive way to the concept in vogue today of the European idea of "sustainable development". For Indigenous Peoples, this is a conflict in cultural values, or a collision of cultures.

Collisions of cultures are affecting all Indigenous cultures from those who do not respect the earth. Cultures are under siege from conflicts over treaty rights, water rights, and extraction resources, such as gold and uranium mining, and even tribal sovereignty. These collisions of cultures have been the root of physical and mental health problems in our youth; problems which are exhibited in poor self esteem, drug abuse, incarceration, and even suicides; among our women, the PCBs from industrial waste create toxic waste dumps of our breasts; we experience lung cancer, and our children are born with congenital anomalies from the effects of uranium mining.

After having free reign to hunt and travel where they liked, our ancestors in North America signed the Treaties of 1850's. Through these treaties the federal government let us retain some of our lands if we relinquished the rest for white settlement. The lands we retained are known as reservations. Reservation life was very difficult for our ancestors. Not only were they unable to roam at will, their whole life ways now depended on handouts from the federal government who wanted Indian people to be farmers on lands that would not support farming. We became nations of dependents.

We have always used tobacco in our ceremonies. Indian people taught Europeans to smoke our tobacco. We continue to use tobacco in our ceremonies and in our prayers ... even today ... but today commercial tobacco is not like the old tobacco. We are able to purchase commercial tobacco with the increasing amounts of nicotine, formaldehyde and 4000 other chemicals; we began to see an increase in lung cancers, emphysema, and a host of other lung ailments among our men and women.

To solve the problems of Indian poor health, the federal government developed the Indian Health Service. IHS was a department of the US government set up under the War Department in the 1950s to provide Indian people with health access, to treat the disease that initially resulted from European contact ... changes in diets and dependence on store bought foods resulted in an increase in sugars and carbohydrates in our diets leading to obesity and diabetes; we suffered from small pox, influenza, malnutrition. Indian Health Service in those early days was staffed by indifferent and often prejudiced non-Indians and wasn't very successful in providing health care for Indian people.

Today Indian Health Service is placed under the US Department of Health and Human Services, Department of Public Health which has the responsibility for providing health care for all Indian people. Today many of the staff includes native physicians, social workers, and nurses. Indian Health Services provides scholarships and training for Indian people who want to enter health care professions. How did we get to that point? From an infant mortality of 22 per 1000 births to what it is today?

In 1975 The Indian Self Determination Act was passed by the US Congress to give Indian people freedom of religion, freedom to manage our own education, our own tribal governments, our own tribal health departments, if we so choose. It was during these times in the late 1970s that the American Indian Movement was founded and Indian activists initiated takeovers of Alcatraz Island and of Wounded Knee. It was out of the Indian Self-Determination Act that Tribal Colleges and Tribal Health Departments were born.

The government responded to the Indian Self-Determination Act by allowing tribes the opportunity to administer programs that were run by the Bureau of Indian Affairs and the Indian Health Service. This law provided a wonderful opportunity for Indians to manage their own affairs. But the problem tribes faced was the lack of educated Indian people to carry out the managerial work of these programs. The elected tribal councils lacked education and experience, as did the people they hired (McDonald, 1998).

So to become educated, Indian people began enrolling in colleges and universities and by 1976 the number of American Indians in colleges had risen to 76,000 but the completion rate was very poor. The Congressional General Accounting Office audited ten colleges and universities trying to find out why Indian students were doing so poorly (Eschwage, 1977). They found that over one half of the first year students never completed their education.

It was out of this predicament that tribal colleges were born. A tribal college is a college declared by its tribe, governed by a tribally appointed board, and serves Indian students. Tribal colleges are the most successful access for reaching college aged people on the reservation since pre-contact with Europeans today. In the USA there are 29 tribal colleges.

Prior to the establishment of Salish Kootenai College, the drop-out rate for members of the Salish and Kootenai tribal members in post-secondary education was well over fifty percent (Eschwage, 1977). There are several theories why the drop-out rate was so high. One popular theory is that Indians are lazy and cannot get out of bed to go to school. Another theory is that Indians see no value in completing school and that there is little hope for them to have any kind of a quality life. Another theory focuses on positive role models for children who they follow, the lifestyles of the adults around them, adults who may be unemployed, chronic welfare recipients, alcoholics, and unskilled. There is a theory that the cycle of poverty, welfare, and despair is hard to break (McDonald, 1998).

Our college President theorizes that Indians drop out of school because they were not encouraged to stay in school, encouraged by friendly teachers and classmates, encouraged by a vibrant and exciting educational program, encouraged by feeling successful, encouraged by having parents and the Indian community be proud of the school they are attending, and most importantly, encouraged by being recognized as an Indian person, a group of people that are an important and positive part of American history and American culture.

Burke's (1996) research found the main reason Indian students dropped out of mainstream college was because in order to succeed, they had to give up thinking of themselves as Indian.

So often schools in America treat Indians as if they only live in the past. In current events Indians do not exist. National polls relate that this percent of Whites voted for President Clinton as did so many Blacks, so many Hispanics, so many Asians and so many others. The Indigenous people of the United States, the people that have always been the United States, the "First Americans" are referred to in polls as a part of "other".

Did you know that American Indians only became US citizens in 1929? Our grandfathers were warriors in World War One without even being citizens.

Indian people in America and Indigenous people throughout the world need more than just "mainstream" survival skills if we are going to function successfully in our respective societies. We need more than just survival skills if we are going see improved health. Our Indigenous people need to have their skills and ambitions realized, and they need to move on to be full participants in our high-tech work force, and in our professional fields such as medicine, research, law and engineering (McDonald, 1998).

Each course of study at Salish Kootenai College is enriched with teaching and activities that enhance the students' Indian identity. We want them to be proud of their Indian heritage and know why they should be proud. We also want each degree program to provide quality education, and for each graduate to be very competent in applying their education to their job and their everyday life.

There are no entrance exam requirements at our college. A student can receive financial aid assistance from the tribe or the federal government if he or she is eighteen years of age and has graduated from high school, or has obtained a secondary school general equivalency diploma.

On admission, the student is given a placement test, which determines where they should start in reading, in English composition, and in mathematics. A student may need to start in developmental courses with plans to take the General Equivalency Diploma examination. But there are still college courses that students can take successfully, for example, Indian culture classes, Building Self Esteem, College Survival and Study Skills. The students see themselves as a College Student even at this level. The student is eligible to receive financial aid. There is an increase in self-esteem and students learn about their culture as well as developing basic math and reading skills.

Remember in the beginning I said we all need care. Our students are treated with respect and with care; they are nurtured. Our faculty and staff have a personal interest in each student's welfare. The students respond positively to this environment. They are no longer failures. They are successful in their college careers.

Completion of a college certificate or degree certifies the student for entry into a particular job or qualifies the student to take a licensing examination such as a nurse, a dental assistant, or a medical record technician.

When parents become successful in college, the entire family demonstrates more interest in formal schooling. Their life styles become healthier. There is less alcohol and drug abuse. The children have healthy role models and are more interested in their own school. They complete a secondary school program and enter SKC as freshmen.

As a result of the tribal college education, the tribe I work for, the Confederated Salish and Kootenai Tribe of the Flathead Indian Reservation, is more competent in every facet as a tribe. It is stronger in cultural participation. There are more young people pursuing cultural activities such as drumming and singing, Indian dance, crafting traditional dancing outfits. There are more ceremonial leaders, and prayer leaders. The educational and skill level of the tribal work force has improved tremendously. We now have Indian health professionals, nurses, human service professionals, lawyers, physicians and Indian technicians in almost every part of our tribal operation.

From my standpoint and from the standpoint of all of us who work at the College, we feel rewarded tremendously when we see previously oppressed Indian people in a seemingly hopeless struggle for survival, have an internal awakening, and realize they can learn and improve their lives. Life is not hopeless for them. We have many success stories of Indian people discovering their human potential, of setting and attaining goals, and improving their own health and the health of their family.

The United States of America has gained a great deal by the creation of tribal colleges throughout Indian country. A formerly dependent group of people is now becoming independent and capable of taking care of themselves. All governments should do this for their Indigenous peoples.

Tribal members are also more concerned about their personal health. There are more people striving for healthy lifestyles. We have fitness centers throughout the reservation. We have fewer tribal members abusing alcohol and drugs.

I truly believe the tribal college model can work with any Indigenous people. There is a college in northern Norway for the Sami (Keskitalo and Mohatt, 1994), and the Maoris in New Zealand are beginning to develop their own college system. A college in Barrow (Alaska) is being established for the Inupiat people (Ilisagvik). Several countries have colleges for their Indigenous people, but the people who are served do not have control of the curriculum or of the administration. In order to be truly successful the people being served must have control through the effort and support of the government.

Last June, Salish Kootenai College graduated 187 students with degrees in nursing, human services, environmental science, and dental assisting, medical records as well as degrees in office education, and vocational skills. The success tribal colleges have at graduating health care professionals and the increased level of education for Indian men and women have all contributed to improved health care for American Indian people.

Where once infant mortality was 22 percent in the 1970s, today it is 8.2 percent. Where once the life expectancy was 45 years old, in most cases it is 75 years for women, i.e. on a level with non-Indian people.

Although the cancer incidence for American Indians is lower than for non-Indians, the death rate is higher because we seek treatment later in the course of the disease. Women especially are afraid to seek help, to have white physicians see their bodies ...

Our Indian health care professionals are teaching our women with newly developed culturally appropriate videos and pamphlets about cancer, smoking, pregnancy problems, and baby bottle tooth decay. Many of the teaching materials are in the language of the people.

Collin Airhihenbuwa, Department of Biobehavioral Health at Pennsylvania State University once said (1998). "To invoke the centrality of culture in public health and health promotion is to challenge health promotion and disease prevention approaches that downplay or overlook the importance of history, politics, and education in shaping the landscape of cultural production ... The accomplishments of these tasks requires the deconstruction of existing systems of dominant values in a manner that challenges the very foundation of the social and cultural order. Such a challenge is not merely to destroy a few prejudices; rather, it is to see through the revolving door of all rationalizations by meeting head-on the truth of the struggle between fiction and reality." Tribal colleges contribute to that effort every year.

My friend and elder Ron Therriault, whose family also comes from eastern Canada, in Acadia, near my own family's roots, has told me, "We cannot be responsible for the actions of our ancestors. We can only be responsible for our own actions."

It isn't about what my grandfather did to your grandfather or if my grandmother did something to your grandmother. It isn't about Indigenous people as niggers, beasts, or pagan savages or the dominance of European white men. It is about what we can do together today as human beings living on the planet. It is about honoring Indigenous knowledge. It is about how we live our lives in harmony with the Mother we call Earth. It is about education and respect, not money or economic development.

    Our Indian heroes teach us the ways of courage. They look straight into the eyes of what others fear, and speak out with their best voice. They listen intently to those whose voice is sometimes unsure. Our greatest heroes, with fearless eyes and caring heart show us that there is power within us all (Dana Tiger / Creek).

It is time our wisdom and culture are respected. It is time to work collaboratively on issues affecting education of Indigenous peoples, the health of the planet and the health of all people. It is high time to mend the fences that divide us. We must walk the talk. And we must walk that talk together!

It is time for heroes!


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