January 17, 2017

Reservation's Healthy Start program at risk, endangered by lack of money, office space


Despite the search for office space, reservation babies keep arriving. They are born into families with high alcoholism rates, teen pregnancy and stratospheric unemployment. 

PINE RIDGE RESERVATION, S.D. – Small, delicate and vulnerable, babies born on the Pine Ridge Reservation can expect a life that will be inexhaustibly bleak. Their little lives will meld into wildly disproportionate social statistics on the Oglala Sioux reservation where the average median income hovers around $3,000 a year.

The hard scrabble region is a perfect match for Healthy Start, a pre-natal federal program that promotes family improvement through case management, site visits and classes. But finding safe office space on the reservation has hobbled the program meant to improve young lives. Northern Plains Healthy Start receives $1.2 million a year on a four-year federal grant.

Healthy Start boasts 105 programs in high risk areas including 39 states. The initiative, through the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), reduces risk factors that lead to high infant mortality rates tied to racial disparities. Those factors include poor nutrition, substance abuse, diabetes, alcoholism, poverty, domestic violence and others.

Most of the health disparities hold sway on Pine Ridge.  With infant mortality on the reservation seven times the national average, December was a particularly hard month when two infants died. Those two babies were not enrolled in Healthy Start, officials said.

Two case managers work a 270-plus active client list in a makeshift office for pre-natal patients, post partum mothers and newborn infants.  “There’s a lot of people we’re not able to reach because our reservation is huge, over one million acres,” said case manager, Roberta Ecoffey.

Healthy Start on Pine Ridge first lost its offices when asbestos overrun was discovered in the old Indian hospital. A back up plan to move into an old bingo hall backfired after mold was discovered on the site. Healthy Start then moved to a storage room in a local video store. That site was declared unfit by a health engineer after massive amounts of rat and mice droppings were discovered. Rodent waste raises the risk of contracting a Hantavirus especially when the heating is used. Clean up has been partial.

Despite the search for office space, reservation babies keep arriving. They are born into families with high alcoholism rates, teen pregnancy and stratospheric unemployment.  On Pine Ridge, men usually live until the age of 48 and women who reach 53 have already defied the odds. More than half the babies will likely be raised by grandparents at some point in their lives, statistics show.

Trouble shooting becomes a way of life on the reservation, Ecoffey said. A successful weekend is gauged by keeping warm and having enough to eat. Money the case workers earn can often go to meet out-of-pocket expenses not covered by grant monies. Gas is a big expense item.

“Sometimes a client will call and say they are walking,” she said. “And we’ll get into the car and go look for them.”

Case workers go and look for them because depression is a stronghold of young mothers on the reservation. Ecoffey said nearly every client reviewed for intake “rates off the charts,” in meeting depression criteria.

Meanwhile, their search for workable office space continues. Hopes are pinned on a campaign to build new offices if donors or grants are secured. But that is years away, advocates said. At present, Ecoffey said their end of Healthy Start receives about $200 to operate on per month. After salaries and expenses to eleven sites across a four-state (Iowa, Nebraska, North and South Dakota) area, HRSA funds don’t go far. Building a new facility with current grant funds is not doable, officials said.

“We kind of go into survival mode,” Ecoffey said. “We do what we can with what we have.”

Lack of office space for Healthy Start is further complicated by its sponsor agency, the Great Plains Tribal Chairman Health Board (GPTCHB), a nonprofit, in nearby Rapid City, SD which is already beset by a $1 million debt and a recent restructuring that reduced its employee base in late 2012.

Dr. Don Warne, an Oglala physician who also hails from the reservation, said that the GPTCHB administers various grants meant to help 18 tribes. Funds get spread pretty thinly, he said. The agency tried at one time to give the grant funds directly to the tribes but monies not being drawn down drew the ire of funding sources. Warne was a longtime senior policy advisor for GPTCHB.

“It’s a decent amount of money but then you’re talking about 18 tribes…” he said. “But then it’s terribly underfunded for the amount of work that needs to be done for the high risk population. We’re talking about one of the poorest tribes in the nation.”

Deanne Fitzmaurice  | COURTESY PHOTO

Healthy Start client, Miranda Day Boy, on the Pine Ridge Reservation in S.D. with her son Jasper. The case management program to reduce infant mortality on the reservation cannot find safe and adequate office space with more than 270 clients on their rolls.