Wednesday Oct 1, 2008
Struggling to help women on reservations
By LJ Anderson
Bernadine Healy, MD, former director of the National Institutes of Health, described the Indian Health Service (IHS) in 2004 as "everyone's worst nightmare of what government healthcare would look like. The system is riddled with crumbling facilities, mindless regulations, ancient equipment, and far too few nurses, doctors, pharmacists, and dentists." When it comes to the care of Indian women who have suffered sexual assault, the current IHS is all that and more.
One in three American Indian women (34.1 percent) experience rape in their lifetimes as compared with 18 percent of white women and 19 percent of African American women, according to a Department of Justice study. Despite this high rate, there are few nurses trained within the IHS as sexual assault nurse examiners (SANEs), training which includes use of a police rape kit to gather forensic evidence and instruction on how to care for a rape victim in a respectful and medically appropriate manner. One report found that 44 percent of IHS facilities had no SANE-trained staff available. Other necessary care such as STD screening is also not being done.
Charon Asetoyer is executive director and founder of the Native American Women's Health Education Resource Center (www.nativeshop.org) on the Yankton Nakota Indian Reservation in South Dakota.
Q: What challenges face reservation-based Indian women who seek post-rape care?
A: At the local level, there are no standardized sexual assault policies and protocols within Indian Health Service emergency rooms. In some service units, there are protocols and procedures, but this is a federal agency that needs to be standardized - especially for Native American and Alaska Native women.
We also have a situation in which 44 percent do not even have [forensically] trained staff. If you don't have a rape kit done on a woman who has been raped, you don't have any forensic evidence. There needs to be trained SANE nurses able to do rape kits in every single reservation and Alaskan native village. You've got villages in Alaska where the plane only comes in on Wednesday. If you were raped on Thursday, Friday or Saturday, you have to wait that long - and they expect you not to bathe and wash away the evidence. That is totally unrealistic.
[Jurisdiction-wise] the Oliphant case was a blow to Indian country in that it took away our right to have law enforcement jurisdiction over non-tribal members. If a non-Indian comes onto Indian land and commits a rape or any other crime, the tribal law enforcement or the Bureau of Indian Affairs does not have the jurisdiction to arrest that person. It is left to the discretion of the FBI as to whether they want to pursue an investigation or bring that case into federal court.
Q: Why do American Indian women receive less comparable care than women outside of the reservation?
A: Tribal leadership has their plate full just trying to keep our IHS facilities open - even though the incidence of sexual assault and rape is so high within the Indian community. But it is a top priority for victims and women. Even though health care is a right guaranteed to us through treaty, the IHS still has to work on financial authorization from Congress. We receive less than half of what every other American is afforded for health care, and this has allowed the IHS to deteriorate to the level that it is now. The doctors do an incredible job with the resources that they have, but they don't have resources necessary to improve the health status for us.
Also, if you are a rapist and know that you can go into an area with impunity and not be held accountable, you are going to commit that crime as often as you can get away with it. They know, "They can't arrest me. I'm not Indian." And if you don't have a team to do a rape kit, collect the forensic evidence and get it into the lab, it will be pretty hard for the FBI to come down and do an investigation - let alone, get that into court.
Q: How does your agency help with this situation?
A: We run a shelter for victims of domestic violence and sexual assault, and we recently purchased transitional housing for women not wanting to return to the environment that they came out of. We do policy work, run a men's re-education group, and provide a number of services for victims of sexual assault.
(The recovery from rape) is a lifelong healing process, and reservations all over the country are starting up shelters and groups to address the historic trauma that women carry around with them once they have been sexually assaulted. Since the IHS does not provide resources, it's up to community based organizations to fill those gaps. There are few mental health services on reservations to address the caseload that exists, so there are people in trauma who are not getting services - and that sets a person up for self-anesthetizing and alcoholism. If you were to interview the majority of young women who drink on any one reservation, you are going to find that they have been sexual assaulted at some point in their lives. It's a way of numbing yourself from that reality. I think when women in other communities become aware of this, they're outraged. When people become aware, they want to know how they can help.
LJ Anderson writes on health every Wednesday. She can be reached at email@example.com or www.ljanderson.com.
This E-mail was posted by: Larry Kibby - firstname.lastname@example.org
Elko Indian Colony, Nevada