As members of the Choctaw Tribe of Mississippi, Fay Givens and Kay Givens McGowan can tell you all about the lost status of American Indians in their own homeland and the numerous problems Indians face in modern-day America.
In fact, they consider it their duty to do so.
It's a responsibility the 52-year-old identical twins believe they inherited at birth as members of their tribe's Turtle Clan.
“Each clan has different responsibilities, and the members of the Turtle Clan are responsible for the future of the tribe,” McGowan explains. “We're responsible for making decisions that are right for Indian people and for working together to see that those things happen.”
It's something their Choctaw grandmother taught them as little girls, and it's something they take very seriously. They've trained for it all of their lives.
The Healthcare Crisis
Though the sisters speak softly and laugh often in conversation, their voices betray a hint of sadness and frustration when they talk about the current state of American Indian life.
Two of the most devastating problems today, the black-haired sisters say, are the healthcare crisis and diabetes epidemic that are destroying the lives of so many Native Americans.
One of the main reasons for the problems, Givens asserts, is that “the United States government spends less per capita for the healthcare of American Indians than it does for the healthcare of federal prisoners.”
Although this statement might sound shocking, Givens isn't just voicing a baseless complaint. As a holder of a Master's Degree in Labor Relations and the director of American Indian Services, a local organization in Michigan that provides social services to American Indians, she has the experience, education, and knowledge to back it up.
In addition, she has a U.S. Commission on Civil Rights report on 2003 healthcare spending that supports her claim. Though the government spends about $3,803 per federal prisoner each year for healthcare, the report says, it only spends $1,914 per Indian each year for healthcare. Even more shocking, it spends about $5,065 per person for those in the general population – about 2.5 times more than it spends per Indian.
And this makes the two sisters angry.
What bothers them, Givens says, is the U.S. government's failure to fulfill its treaty obligation to pay for the healthcare of American Indians.
It bothers them so much that three years ago, they founded the National Urban Indian Coalition (NUIC), a coalition made up of Indian agencies from around the U.S. that represents the interests of Indians who live in cities. “
American Indians have the highest rate of diabetes and disability in America and the highest rate of alcoholism, suicide, homicide, infant mortality, high-school dropout and unemployment,” Given says. “We're at the bottom of every socioeconomic indicator in America today. We also have the highest rate of amputation, mostly as a result of diabetes.”
The statistics are indeed grim. Overall, American Indian diabetes rates are thought to be four times the national average, and for some tribes even more. In addition, the rate of lower-limb amputations for American Indians with diabetes is also approximately 3.5 times higher than that for non-Hispanic whites with the disease.
These problems, the twins contend, are largely caused by or worsened by poor healthcare. “And that all goes back to the government's failure to provide adequate funding,” Givens says.
The Fight Against Diabetes and Amputation
In addition to trying to increase funding for healthcare on a national level, the sisters and the NUIC are trying to prevent diabetes and its terrible consequences on a more personal level. “We're concerned about nutrition, about educating Indians on what they can and can't do, and about educating them about the risks of diabetes and amputation and the ways to prevent these problems,” says McGowan, an anthropologist and a professor of Native American Studies for 16 years.
She argues that the high diabetes rate among American Indians is directly related to their change of diet from the traditional native diet to a high-sugar, high-fat diet. “When Indians were put on reservations,” she explains, “the reservations tended to be the poorest, driest land in America, and there was not enough good land to grow enough food to feed Indian people. So the U.S. government started giving Indians foods that are high in sugar and foods like cheese and SPAM. And that type of food is directly responsible for the high rate of diabetes among Indians.” Then, once Indians get the disease, she continues, they become less physically active, which worsens their health even more. “It's a vicious cycle.”
Part of Their World
Today, as part of their work and part of their attempt to keep American Indian culture alive, Givens and McGowan attend many Native American events where they often see something that most Americans rarely see in one place – a high percentage of amputees.
Recently, for example, they attended a meeting of American Indians in Detroit, Michigan, not far from Givens' home in Downriver and McGowan's home in Grosse Ile. “Indians were coming in in wheelchairs, with artificial limbs, and with bandaged feet with their toes missing from diabetes,” McGowan says. “Whenever we come together for social events, you're going to see Indians who are sick with diabetes. It's just part of our world.”
To make matters worse, she says, rehabilitative and prosthetic care for American Indian amputees is virtually nonexistent. “Some Indians never have a prosthesis, and most only use a crutch or a wheelchair.”
This problem is especially close to their hearts because it has touched them personally. Both their father and grandfather were amputees as a result of workplace accidents, and they've witnessed the many problems that amputees live with on a daily basis. Especially when they have little or no prosthetic care.
Moving Toward Solutions
Unfortunately, because American Indians are only 1 percent of the population now and have the highest infant mortality and the lowest life expectancy in the country, Givens says, “we have no voice in our own land.”
Though she believes that part of the solution is for American Indians to have more children, she insists there's more. The key is having more children and getting them educated, she says. “Education is the ticket out of poverty. Without it, our people will remain at the bottom.”
The value of education is something else the twins learned from their Choctaw grandmother when they themselves were just little girls. “Our grandmother was one of the first Indian women in America to go to college,” McGowan explains. “She graduated in 1896 with 32 white men. She said if we got ‘the white man's knowledge' and our people's knowledge, we would be something. And she was right.”
Though the attainment of higher education is by no means the norm for American Indians, they both followed their grandmother's advice and somehow managed to succeed despite the odds against them. So how did they make it?
“It was sheer determination,” McGowan says. “I remember telling the head of the anthropology department that the only way they would get rid of me was to run over me with a truck. I told him I was going to be an educated Indian.”
The Importance of Diabetes Education
Education about diabetes and its consequences is also essential, the sisters say. “The better educated you are, the more you realize the effect that diet has on diseases, especially diabetes,” Givens says. “The hardest thing is getting people to understand the correlation between diet, exercise and diabetes.”
Much of this type of education is done at Indian centers and at the Indian Health Service. “At our Indian health center here in Detroit, we have nutrition classes, and we're teaching native women how to again prepare the healthy native foods that Indians ate before the coming of the Europeans,” McGowan says. “Unfortunately, because of poverty, most Indians still depend on government-provided commodity food at certain times of the month, which is not healthy food.”
As bad as the diabetes epidemic among Indians already is, it's getting worse, they say. Today, approximately 40 percent of American Indian children are overweight, and they are getting Type 2 diabetes faster than any other group.
To try to solve these problems, some tribes have been using incentive programs to encourage Indian youths to participate in diabetes awareness programs, to be tested for diabetes, or to participate in physical activity. For doing so, Indian youths might receive such incentives as a bicycle, tennis shoes, or clothing.
American Indians are also helping to develop diabetes education campaigns that are targeted to their own people. In its We Have the Power to Prevent Diabetes campaign, for example, the National Diabetes Education Program used testimonials from American Indians who have made lifestyle changes to encourage other Indians to do the same (www.ndep.nih.gov/diabetes/pubs/Power_tips.pdf).
“We want to give people the knowledge to prevent this disease,” McGowan says, “and we want to provide good healthcare so that when people become borderline diabetic, they can be alerted and warned that they're ‘playing with fire' and that they need to eat better and get more exercise.” Moreover, once they have diabetes, they need the treatment that will help them prevent the additional problems it can lead to, such as heart disease, stroke, dysvascular disease, eye and kidney problems, lower-limb amputations, and even death.
The Lesson of the Turtle
In the end, Givens says, additional funding for healthcare will be essential to bring Indian health up to where it should be. “Unfortunately,” she points out, “most elected officials don't know anything about Indian people or the issues that affect us.”
Though Givens and McGowan both know that getting additional funding and defeating all of the problems that American Indians face is an uphill battle, like Aesop's fabled turtle racing against the hare, they believe that persistence will ultimately pay off.
“We feel that by forming this advocacy organization and by coming back at them – by being there every time they open the door – eventually maybe someone will do something,” Givens says.
“That's right,” McGowan agrees. “We haven't gone down without a fight yet, and we're not going to.”
For more information about the National Urban Indian Coalition, please contact Givens or McGowan at 1110 Southfield Road, Lincoln Park, Michigan 48146.
