"American Indian Health and Family Services helps the 57,000 Native Americans living in the greater Detroit area. Services are delivered at an old church and rectory donated by the Detroit Archdiocese in 1993. Jerilyn Church is the executive director of AIHFS. She’s Minnecoujou Lakota, born and raised on the Cheyenne River Sioux reservation in South Dakota. When she moved to Detroit she says she “wasn’t prepared” for the same type of unemployment as back home on the reservation.

“Yet despite our surroundings, we get a lot done with little resources,” Church says. “We could write a book about it.”

That book would detail the logistics of serving people who are mostly uninsured – and too often ineligible for safety net programs like Medicaid. Among the AIHFS clients only about a third have full-time employment. So when a patient requires health services beyond the basics of the clinic, the health provider – a doctor or a practical nurse – spends hours on the phone looking for a doctor or hospital that will provide “uncompensated care.” So instead of treating people, these health professionals must act as brokers, looking for someone, anyone, in the health care system to help.

The paradox that is urban Indian health is that more than two-thirds of American Indians and Alaska Natives live in cities and yet receive only about one percent of the Indian Health Service budget. There is hope, however, because of health reform and the Indian Health Care Improvement Act. The new law, Church says, should make it possible to hire at least one more health professional for the clinic. Another possibility down the road is to qualify American Indian Health and Family Services as a “Federally Qualified Health Center.” This is a designation that opens up the potential for additional federal funds, as well as better malpractice protections."

Get the Story:
Detroit’s geography of despair include many seeds of hope (Mark Trahant 4/19)

Related Stories:
Mark Trahant: Health reform debate to continue for years (4/12)
Mark Trahant: Should Native Americans buy own insurance (4/5)
Mark Trahant: Obama's exciting pick for Medicaid agency (3/30)
Mark Trahant: Delivering promises for Indian health care (3/22)
Mark Trahant: Health care reform vote as a litmus test (3/15)
Mark Trahant: Facebook group gathers IHS war stories (3/8)
Mark Trahant: IHS not mentioned at Blair House summit (3/1)
Mark Trahant: Reaching consensus on Indian health (2/22)
Mark Trahant: Alaska Natives create a model system (2/15)
Mark Trahant: Growing the IHS budget in tough times (2/8)
Mark Trahant: Transparency and Indian Health Service (2/1)
Mark Trahant: Transparency in health care reform bill (1/25)
Mark Trahant: Starting over on Indian health reform bill (1/20)
Mark Trahant: IHS Director Roubideaux on passing IHCIA (1/18)
Mark Trahant: Business model for Indian Health Service (1/12)
Mark Trahant: Some resoluting on Indian tobacco use (1/6)
Mark Trahant: IHCIA now a part of Senate health bill (12/21)
Mark Trahant: Projects improve Indian health care (12/14)
Mark Trahant: Work together for health care reform (12/8)
Mark Trahant: Health care system tied to economy (12/7)
Mark Trahant: Health reform bill tests democracy (11/30)
Mark Trahant: Health reform boosts Indian Country (11/23)
Mark Trahant: Health care reform dead in Senate (11/17)
Mark Trahant: New Republican 'interest' in IHCIA (11/2)
Rep.Hastings objects to IHCIA in health reform bill (10/30)
Mark Trahant: Send Medicaid funds right to IHS (10/29)
Mark Trahant: Health care debate drags on and... (10/26)
Mark Trahant: Guaranteed rights to health care (10/19)
Mark Trahant: Health care debate not over (10/12)
Mark Trahant: Effortless Indian Country care (10/5)
Mark Trahant: Tribal provisions in health reform (9/28)
Mark Trahant: Taxation of tribal health benefits (9/21)
Mark Trahant: Indian Health Service paradox (9/17)
Mark Trahant: Indian exemption and insurance (9/16)
Mark Trahant: Revive the public health hospital (9/14)
Mark Trahant: Grandma and health care reform (9/9)
Mark Trahant: Ted Kennedy steps aside for health (8/31)
Mark Trahant: Tribes, IHS and health coverage (8/25)
Mark Trahant: Ideas for health care reform (8/17)
Mark Trahant: Duality in Indian health care (8/10)
Mark Trahant: Health care from a different view (8/4)
Mark Trahant: Indian businesses and health care (7/28)
Mark Trahant: First Americans are last in health (7/21)
Mark Trahant: Getting into Indian health reform (7/14)
Mark Trahant: Lessons from Indian Country health (7/10)
Mark Trahant: IHS isn't broken, just underfunded (7/9)
Mark Trahant: Indian health care at the local level (7/8)