2019 Annual Report (5)

MGH Rural Health Leadership Fellowship Program | Rosebud Indian Reservation
Hosted by Program Director Dr. Matthew Tobey, M.D. , M.P.H & Nicole Collins, M.P.H
June 24th - 26th, 2019
On June 24 - 26, I conducted a site visit to the MGH Rural Health Fellowship Program on the Rosebud Reservation to
observe local conditions at the program, consult with various stakeholders, evaluate our grant, and make
recommendations for future funding. The MGH initiative in Rosebud is critical, impressive and humbling given the extreme
poverty and health challenges on the reservation.
I had the opportunity to do a tour of the reservation with Damon Leader Charge, visit the hospital with Dr. Tobey, meet the
leadership, participate in a teaching session at the Tribal Jail and attend a meeting at the Substance Abuse Rehabilitation
Center. I stayed with the team at the doctors?housing overnight and learned a great deal about the challenges, progress
and opportunities. Thank you for this extraordinary opportunity - the site visit allowed me to better understand the context,
community, landscape, history, wildlife and how SF can continue to be most effective.
Site Visit Activities:
1. Tour of the Rosebud Indian Reservation led by Damon Leader Charge
2. Health Programs Appreciation Lunch with Rosebud Health Administration
3. Meeting with Wizipan Little Elk at Rosebud Economic Development Corporation (REDCO)
4. Visit to Rosebud Sioux Tribe Adult Correctional Facility during student outreach session followed by Dinner with
MGH team, students and Janet Routzen, J.D.
5. Meetings and tour of the Indian Health Service - The Hospital
6. Visit to the Rosebud Sioux Tribe Drug and Alcohol Treatment Program
7. Visit, Tour and Overnight at the Conata Ranch
8. Pine Ridge Relief Meeting- Ernest Pourier, Peri, Ernest, Pine Ridge Reservation
Context
A perfect storm of state and federal policy failures, underfunding, geographic remoteness and extreme poverty on the
Rosebud and Pine Ridge Indian Reservations create unique health care challenges the Indian Health Services has tried in
vain to overcome. The population lacks consistent preventative care, live in areas considered food deserts and experience
diabetes at the highest rates in the state. Median life expectancy among Native American people in South Dakota is
devastatingly low, the second lowest in the Western Hemisphere (second only to Haiti).
Housing on the reservations is limited. Safety is a concern, and schools there are some of the worst-performing in South
Dakota. Obesity and alcohol and drug addiction rates are high. Many of the leading causes of death are fueled by alcohol
use and many of the leading cancers are related to alcohol use (pancreatic, stomach, and liver).
These health problems are exacerbated by the geographic isolation of the hospital. The facilities are in extremely remote,
impoverished areas, making it difficult for the agency to recruit doctors to send there. For example, the nearest Walmart is
130 miles away. And while doctors may be interested in IHS jobs, their families aren't. Doctor turnover is high, which
makes it hard for patients to see the same doctors consistently. There is one primary care provider for every 9,960 people
in Todd County, a county on the Rosebud Indian Reservation with a total population of just over 10,000. That?s a
doctor-patient ratio eight times that of the state average in what is one of the poorest counties in the nation. Dozens of
patients have died needlessly due to errors made in IHS hospitals in South Dakota alone. Thousands more in the state?s
rural Indian reservations face limited access to primary care providers, long wait times for basic medical treatments and
outstanding medical debt for necessary care sought outside the federally-funded facilities.
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