Emily Haozous knows the struggle to provide quality health care for all Native Americans is probably going to outlast her.

"Like a lot of things in the grassroots, you want to establish a baseline [and] say, 'This is what people want,' and push from there,'" says Haozous, an associate professor at the University of New Mexico's College of Nursing. "We'll continue pushing as long as it takes, and that could take years or decades."

It's no secret that the United States government has mostly abrogated its historical mandate to provide care, despite being bound to do so by treaties spanning several centuries.

Across different health agencies, including Veterans Affairs, Medicaid and Medicare, federal dollars spent on Indian Health Service—the federal agency that oversees health facilities for Native Americans scattered across the country—are by far the lowest per patient, according to numbers from 2013 compiled by the National Congress of American Indians.

In order to understand the health needs of Native Americans in Santa Fe, Haozous, a member of the Oklahoma-based Fort Sill Apache Tribe, led a team of researchers two years ago in the creation of a groundbreaking health impact assessment supported by a number of local organizations, including the Santa Fe Indian Center, the Santa Fe Community Foundation and the New Mexico Health Equity Partnership.

The primary health issues respondents listed as priorities were relatively simple to treat, though seemingly impossible for the federal government to drum up the political will to fund. Many of the assessment's recommendations were pie-in-the-sky demands for major increases to the budget of IHS, which oversees the Santa Fe Indian Hospital at 1700 Cerrillos Road.

By analyzing the survey responses of 165 local Native Americans who frequent the hospital, Haozous' team found that diabetes, heart disease and obesity were respondents' top three concerns. Lack of exercise and alcohol and drug use ranked highly as well, and respondents also named depression and stress as leading personal concerns. Almost 30 percent said healthy food was unaffordable for them.

And more than half said they had neglected to seek out care within a month of answering the survey because their condition couldn't be treated at the Indian Hospital. The most common reason they couldn't afford treatment elsewhere was they needed specialty care that IHS referral services wouldn't cover.

Known as the Purchased/Referred Care program, if a Native American patient cannot get a procedure they need from an IHS hospital, the IHS hospital can refer them to an outside facility, such as a private clinic, and cover the cost of the procedure (if there's enough money left in the pot, and if the patient's own insurance can't cover it).

But an IHS hospital will only try to cover the procedure if the patient is a registered member of a tribe whose geographic location is located within the same federally-drawn boundaries of that particular IHS hospital.

So, for example, members of certain Pueblos who need same-day surgery—something that hasn't been offered at the Santa Fe Indian Hospital for years—could be referred by the hospital to Christus St. Vincent for the procedure, and then have IHS pick up the tab. But a Diné patient, whose IHS "service area" is located within the Navajo Nation, would be ineligible for purchased referred care unless they traveled back to their tribal lands. SFR explored this highly complicated structure in a cover story last summer.

Despite several centuries of neglect and underfunding, a few silver linings have emerged since the health impact assessment was published last year. One positive change is that the Trump administration's budget for fiscal year 2019 actually proposed a $413 million increase for IHS, bringing the total to $5.5 billion.

That's still far below the annual addition of $2 billion that the National Congress of American Indians says is needed over the next decade to fully fund IHS, but an improvement from the $300 million cut originally proposed by Trump last year.

Hospital staff have also been in talks with the Santa Fe Community Foundation's MoGro project, a nonprofit grocery delivery service that would deliver locally grown produce and staples like eggs and bread to the hospital once a week.

MoGro director Rebecca Baran says the project could begin making deliveries as early as mid-June. The idea stems directly from a recommendation in the health impact assessment that local groups expand nutrition services for the Santa Fe Indian Hospital community.

The hospital is also coordinating with the Santa Fe Indian Center to increase outreach to patients, according to Caren Gala, director of the center. Staff from the hospital and the center attended an open house at the Center for Progress and Justice on May 9.

Dr. Douglas Zang is a physician at the hospital.
Dr. Douglas Zang is a physician at the hospital.

Trays of fruit and cookies greeted attendees. Dr. Douglas Zang, a family physician at the Santa Fe Indian Hospital, opened the event with a discussion of changes to the way the facility serves patients, including the rollout of the Patient Centered Medical Home model that emphasizes people's relationships to their primary physician in the overall care they receive.

"It's always been something the [Santa Fe Indian Hospital] has implicitly done," Zang told the room. In the model, he says, patients will be cared for by a "whole team" who will "bring services all under one roof."

Gala says patients of the Indian Hospital should be on the lookout for future open house events. "At the end of this presentation, we did say this was a good start," she says, "and we should have more in the future."