As Chuck said I'm part of the Fond du Lac reservation as he is in Fond du Lac reservation Human Service division, which locally is part of the IHS service system and and being part of that system. We also are charged with the responsibility of carrying out the mission of IHS, which is to ensure Equity availability and accessibility of comprehensive high-quality Healthcare to Indian people living in this area and for us that means we basically provide services to any identified Indian person living in Carlton or South st. Louis and the continuous counties around here.And a key component of our health service is very obviously involving the local tribal government of Fond du Lac reservation, which is played a key rule the key role in determining what the health care needs of the local Indian. People are what the priorities are and how they and communication with us. And with the Indian Health Service have determined to develop a health care delivery system to address them. Back in 1979 when the health care providers and the health care programs were being at developed at Fond du Lac the tribal government was talking with the local Indian people and some key questions were asked such questions as what kind of existing healthcare services are there in the area. What kind of existing sources are our people accessing and if they're not accessing which one should we be about developing so as not to duplicate services and yet assure that Indian people will be able to get the health care needs that they have met and so what was done some comprehensive needs assessments were done with the Fond du Lac reservation staff in combination with the University of Minnesota and some determinations were made and basically that there were hospitals in the clock a and Duluth area that Indian people could use and we're using but something that came up Bill nakedly was that although there were clinics and Physicians and other healthcare providers in the area. For some reason Indian people were choosing not to access them. It was determined that our resources that we were getting it came out back about that time that there was some Equity money and some of the smaller reservations of which Fond du Lac was one of them was given some new monies that hadn't been there before and so the reservation determined that real clearly that we need to look at and that there wasn't going to be a lot of money determining how we could best meet those needs. And so we stopped and thought looking at what the needs assessments had shown us that what we would choose to do would be to develop a large field staff. They could go out into the Indian Community and talk with the Indian Community and find out a little bit more about where they were at and looking at their health care needs. It was also determined that in developing a new healthcare delivery system that we wanted to develop a system that was unique and the unique part about it was that we were going out into the field and that we did have a staff that was largely made up of Indian people over 85 percent of our staff was Indian. And in fact even today now 8 to 10 years past that time they're still over 75% of our staff is made up of Indian people. The other thing that was unique about our system was at the key role of the system was to educate Indian people about wellness and how to be consumers of healthcare. For many years Indian people felt that there had been various put up that inhibited them from accessing health care and a few times when they built up courage and were able to initiate an interaction. They perceive themselves as being treated with inappropriate Healthcare and Healthcare. That was sometimes less desirable. No, I hope you clearly heard the two words that I use felt and perceived. This is what Indian people felt and thought it may not necessarily have been true. But nevertheless it was a way that Indian people in this area felt. It also needs to be stated that many Indian people have different perceptions about wellness and yet and you'll notice that a lot of the non-indian people to General Notions that illness and disease is caused by a foreign substance that's introduced into their body that is sent by someone or by spiritual powers. Or that it's a product of bad luck or bad medicine that's sent to them by someone else. Or that it's simply a hardship which a person has to go through to learn a lesson. These again are perceptions are Notions that are still held by a lot of Indian people today. What I'm referring to here is called the locus of control that many Indian people have been conditioned to believe. We have a whole community of people who have been raised to feel powerless and unable to do things. To not take choices to not feel any power in making choices that will affect the outcomes and therefore a lot of Indian people have difficulty taking responsibility over their Wellness. Since behaviors are based on perceptions and outcomes are predestined and inevitable. Why would any person why would any Indian person spend time or energy working on their Wellness? This understanding has been kept in mind as a Fond du Lac Human Services delivery system was established. As I said before we began with a large field staff. And in actuality. We still have more Public Health nurses than any other reservation in the Bemidji area here and the reason why we had and the reason why we still have so many nurses is so that we're out there were visible. We're accessible to Indian people so that they feel that their needs are being looked at. Another key thing and being out in talking with Indian people is that anytime any of our providers from The Fond du Lac Human Service division establish interaction with clients from the very beginning. We try to empower them to understand that they have the control that they are the ones that are making decisions that are going to be affecting their health care. And initially when we went out into the field and started interacting with Indian people, they were real weary of us as health providers because Health Providers don't go to you and they don't ask you what you can do for them. People at First Sight our field staff for County people who are going to go out and Snoop and find out what was going on. But when they saw and heard that we were an Indian agency and that of a lot of us were Indian people they let us in and educational process began men between Indian people and providers that still very much is ongoing today and has a big impact on the level and the quality of Health Care that were able to provide to the Indian people in our area. Over the past nine to ten years many Indian people have become good consumers of health care not only of the Care through Indian Health Service, but of that care that are given at local Hospitals and Clinics and from other medical providers, they expect and they demand high quality Health Care Services. They willingly demonstrate that they do have the ability and the understanding to make choices for them step for themselves. They also clearly indicate that sometimes they are going to make choices that we as health providers may not necessarily agree with but they realize now that that is their right to choose their level of Health that they want to attain and maintain Another thing that we've discovered with some of the health statistics that Chuck related to is that there is a difference between the statistics that are coming in for Indian people living on a reservation and those are living in urban areas and it has something to do perhaps with that the services that are given out at Manoa you and Clooney are really built and extended to Indian people in their environment and that the clinic is their Clinic. It may also have something to do with a nurturing environment on the reservation. And again, it may also have something to do that. There are lots of urban Indian people living in areas like Duluth that are still having a real difficult time accessing Health Care Facilities. In general IHS facilities are more prevention orientated and aggressive in the follow-up of illnesses than our private counterparts. Our staff concentrates on providing health education health promotion and disease prevention services and we neck work very closely with all the other resources in the area to argument the services and our health care delivery system tremendous improvements have been made and raising the overall health health status of Indian people to the purity of the general population and yet much Still Remains to be done. Almost a third of Indians living on reservations live on or near the poverty level. The medium income of urban Indians is also substantially lower than dominant culture people. Percent distributions by age show that the Indian population of Minnesota is significantly younger than all Races distribution with 50% of the Indian population being under the age of 19 as compared with the general population where it's age 29. The Indian population is it is increasing at much faster rate than the general population Indian births were six times Indian desk while that in the normal population in the general population was a ratio of two births for every death. Nationally Indians have a life expectancy less than the general population. So that only five percent of our population is aged 65 and over. Proper diet is a problem for many Indians because of low income and lack of understanding of nutritional needs the food commodity program that has been present on reservations is a program that lots of Indian people choose to use and yet it in itself presents lots of problems in that the food that is available through the commodity program is either canned or non-perishable which means that there are lots of calories lots of starch lots of cholesterol. And if you look at those problems that are high within the Indian population of diabetes and hypertension and obesity. It doesn't do too much to really help us along. Indian people die from alcoholism at more than four times the general population rate and the average years of potential life lost through alcohol abuse is nearly five times the u.s. Rate. In addition alcoholism effects or has affected just about every one of our families it intensifies the other chronic diseases and other mental health conditions. So in light of all this what does it mean to be an Indian person that also participates actively in being an Indian health care provider? I guess sometimes for me. I feel really overwhelmed with the pride that I feel and being part of the Indian Healthcare System. At times I think I feel really frustrated because I'll be calling another agency and making a contact and it's always interesting. There's this pause and I wonder if the pause is one of two things one a lot of the local agencies have heard about the caliber Fond du Lac and it's you know, I want to think that that's what it is that they say. Oh that's Fond du Lac and yet I know that on some of the other ends that's not it it's frustration because they don't know about Fond du Lac so that immediate perception comes in. Oh, it's another one of those Indian agencies and you know how they are. They never follow through or it's a lesser quality care that's being provided that's still there and that's part of it. but most of all I do feel the pride and I think it's really neat to be part of an Indian organization that is taking control and taking power over determining what our destiny as Indian people is today and what is going to be in the future. Non-indian people have attempted for a good many years to turn Indian people into good little brown Americans and 2D Indian eyes us. Indian people and feeling rage and anger at this victimization have a lot of times fought one another and I've been trying to victimize one another when they are feeling powerless about themselves. It's really easy to turn on another Indian person and put Power put a Power Trip on them. But the tide is turning. An Indian people, I think in this area with the leadership that we have at Fond du Lac reservation of local Indian Community and also from our Bemidji area Indian Health Service are realizing and really asserting that there are choices to be made and that we can choose to make an impact on our communities health status. and I think probably most importantly we're learning as a people that there is a recovery process and that putting our energy into helping other Indian people is probably about the most satisfaction satisfying feeling that we can have and I think it's only probably second best to win in the process of your everyday work and when you're working seem to get in the Whirlwind that it does for all of us, you also realize that there's somebody else in your agency who's willing to take time to help you in that process to even though you've put your foot in your mouth and the process they're still willing to be there and that's the type of thing that we see at our agency at Fond du Lac reservation Human Service division where there are a lot of Indian people working towards the betterment of Health for other Indian people and I think I'm most no, that's because I also am one of those Indian Who's kind of stumbled along the way and sometimes just gone on my way and thought well the the heck with you know, this, you know, it's no point in going any further. The government is always putting down rags and always trying to put down other things to control it and just the heck was that I want to get out of it and then I stop and really think that now is the time when we as Healthcare Providers and we as health professionals are trying to talk and work with lots of our people and saying, you know, you know, why are you just going on that way the way that you have been you have choices to make you don't have to be that way you can choose to have something else. And so I think that's that's really right there where it's at for me. That's why I choose to be part of the Indian Healthcare System and part of the Fond du Lac reservation, which is providing Health to our local people here and thanks very much.