This Land - A Rising but Doubted Dream on a Reservation

By DAN BARRY
Published: July 12, 2009
EAGLE BUTTE, S.D.

John Hunt, a tribal member, works for the contractor developing the site of the health center, which will be three times as large as the one it will replace, left.
At the edge of the remote prairie town called Eagle Butte, just past a fireworks stand, there is construction. Where winter wheat once grew, workers in hard hats now pour the foundations that will cement buildings to dusty earth.

Perhaps somewhere else this might be just another construction site. But here on the Cheyenne River Sioux Indian Reservation, in what may be the poorest county in the country, people sometimes stand at the edge and watch, as if to convince themselves of at least this promise being kept.

They come to witness the rising of a health center triple the size of the one it will replace: a tired building whose very bricks, mortared in place long ago by the Army Corps of Engineers, recall displacement and loss. The site will also include dozens of houses to accommodate all the nurses and doctors the reservation expects — or hopes — will come.

“This right here is your entryway,” a tribal member named John Hunt says with pride, pointing to some churned-up soil. And here, the expanded dental clinic. And here, the traditional healing room, where those mourning a death will be able to burn sage in a ritual of assisting passage to the next life.

Mr. Hunt’s thick body is built to take a fall; he spent years as a rodeo cowboy, saddling broncos, before giving it up to work first for the tribal government and then for the contractor developing the site. He understands what this construction represents:

Better health care. More jobs. The culmination of years of determined advocacy by tribal leaders. And the concrete manifestation of that abstract concept known as federal stimulus money, coming from the even more abstract American Recovery and Reinvestment Act.

Even now, with the water tower built and the basement dug, some people here are so accustomed to disappointment that they don’t have much trust in the project. “A lot of disbelief,” says Mr. Hunt, 37. “A lot of — ‘I’ll believe it when I see it.’ ”

If a place can be reduced to topographical and statistical details, then this is the Cheyenne River Reservation: a 2.9-million-acre swath of plains and prairie, nearly treeless and beautiful in its starkness; home to about 15,000 people, most of them tribal members, and most of them poor.

The tribe has endured many indignities over the centuries, including one still fresh in the collective memory. In the 1940s and 1950s, the federal government built the Oahe Dam as one way to harness the powerful Missouri River. In doing so, it inundated more than 100,000 acres of fertile tribal land, washing out a way of life and forcing many families to be moved 60 miles west, to here: an arid railroad outpost soon to lose its railroad.

The Corps of Engineers built a health center to serve this grassy sprawl of distant towns and often-rutted roads, but as the only one of any size on the reservation, the center could not keep up with the growing population. The tribe began working on a plan for a better, larger operation that would also make it eligible for more money to improve services.

It clearly had the need, with higher rates of births and deaths, including infant deaths, than the region’s non-Indian population. The birthing unit had been closed because of quality-of-care concerns, the bathrooms could not accommodate wheelchairs, and recruiting efforts often died as soon as, say, a nurse from out of town saw the drab efficiency apartments set aside for the staff.

And there was the familiar matter of location, location. When tribal members require anything more than modest medical attention, they must be taken by ambulance or plane to hospitals far from the reservation — in Rapid City, S.D., or maybe Bismarck, N.D., both about 180 miles away.

A few years ago, Mr. Hunt fell off a ladder while holding a nail gun and accidentally shot a nail into his knee. His injury earned him a three-hour ambulance ride to a Rapid City hospital.

Some people gradually developed a distrust of the health center, and not only because its brick facade recalled the time of forced relocation. It was understaffed, it had become a patchwork of renovations and additions, and there was nothing native about the place beyond the staff. “It has no flow,” Mr. Hunt said.

Finally, in 2002, the Indian Health Service, the federal agency responsible for providing health care to American Indians and Alaska Natives, approved the proposal for an “alternative rural hospital,” with more attractive housing. Architects were soon traveling around the reservation to hear what people wanted, meeting in the bingo halls and community rooms of remote places like Bear Creek and White Horse and Thunder Butte. They especially listened to the elders.

“This was not going to be just a brick building,” Mr. Hunt said.

Now there was just the small matter of finding the money to pay for it all. So tribal leaders hit the road. For years.

They divided themselves into teams and took turns visiting the Indian Health Service’s headquarters in Rockville, Md., and paying calls to members of Congress in Washington, where they were helped by their senators, Tim Johnson and John Thune. They testified at any hearing anywhere that concerned the health care of Native Americans.

Along the way, they met tribal leaders from other reservations who were seeking the same financing for the same problem: the woeful inadequacy of the health care promised to American Indians long ago. “We all have the same disparities,” said Sharon Lee, the tribal vice chairwoman.

The tribal leaders made their case effectively, but in Indian Country, progress comes in phases, when money is available. The Indian Health Service works with 562 federally recognized tribes, a great many of them in need, so the project on that old wheat field in Eagle Butte took shape in fits and starts.

Then, two months ago, there came one of those news releases that seem to belch out incessantly from Washington, often incremental, often self-congratulatory. But this one said the Indian Health Service had allocated $500 million in stimulus funds for Indian health care, including $227 million for two “shovel ready” projects: a hospital in Nome, Alaska, and a health center in a place called Eagle Butte, S.D.

This $111 million health center will have an American Indian feel; it will be theirs, and not someone else’s. It will have a larger emergency room, two beds set aside for births, new medical equipment, and such basic, almost-forgotten amenities as a staff break room. It will also have that healing room, specially ventilated; no longer will mourners have to clog the bottoms of doors with towels when they burn sage.

But again, this is Indian Country. There are some basic health services the center will not provide; a CT scanner, for example.

Thomas Sweeney, an Indian Health Service spokesman, said the decision not to include this equipment was based on a formula that takes into account several factors: staffing, workload and population size. The agency receives slightly more than half the financing it needs, he said, which means “there’s always tough decisions.”

One step at a time, said Mr. Hunt: the building first, and then more visits to Washington to fight for more improvements — a CT scanner among them.

Until then, it remains a three-hour ambulance ride to Rapid City.