05/21/2010 05:12 am ET Updated May 25, 2011

Lack of Funds Cripples Indian Health Care

When determining the businesses that contribute to the economic well-being of a community, the financial contributions of Native American institutions and businesses are too often overlooked.

This oversight gives Indian institutions and businesses a serious disadvantage. As a result the local Chambers of Commerce, Visitors Bureaus, and business associations fail to recognize the sums of money Indian ventures contribute to the local economy.

There is an Indian Health Service Hospital in Rapid City. It started out in the early 1900s as an Indian boarding school, was converted to an Indian hospital for tuberculosis patients, and then became a full-fledged hospital for the large and growing Indian population that gravitated to Rapid City in search of better economic opportunities.

The hospital is known locally as the Sioux San, a shortened version of the Sioux Sanatorium. The Sioux San has an annual payroll of about $15 million dollars. It contracts medical services to the Rapid City Regional Hospital and other medical facilities to the tune of another $15 million dollars.

Not only that but the hospital purchases goods and services amounting to hundreds of thousands of dollars to locally owned business. They buy produce, milk, and other dairy products, fresh vegetables and dry goods for the hospital kitchen, and they contract for plumbing, electrical, and construction services from local businesses. That does not include the computer purchases and services that also go into the pockets of the local merchants. The electric and natural gas bills for the hospital runs into the thousands per months and the local Black Hills Power and Montana Dakota Utilities (gas) are the recipients.

Fred Koebrick, Cheyenne and Caddo, is the CEO of the Sioux San. He admits to his frustration in trying to get across to the local community, how important the Sioux San is to the local economy. He said the hospital received about $643,000 from the stimulus package for construction at the hospital and nearly all of it went into the hands of local businesses.

The Sioux San has a Wellness Center that draws more than 70 visits per day and is geared to address the serious illnesses caused by the epidemic of Type II diabetes so prevalent in Indian country. "We are only open during regular business hours for now, but even then I am surprised how many people take advantage of our facility," Koebrick said.

Rapid City has an Indian population that is hard to determine because it moves from the Indian reservations to the city and back to the reservation continuously. Some estimate the Indian population to be more than 15,000. This makes the Sioux San a very important hospital to that population. The San has a pharmacy that dispenses medication daily and a cafeteria that makes every effort to served healthy and nutritious food. Koebrick said the cafeteria is now open for those patients in the waiting rooms, but also for members of the Rapid City community. He said, "A good and healthy meal costs about $4.50 and we really encourage the Indian members of the community to come in and have a meal, especially those suffering from diabetes."

Koebrick recently turned over all of the mail, including the mailing of medications, to the Veterans Administration. He said, "They have a long history and the system in place for handling all of our mail needs and once again, it reduces our expenses."

And yet, of all of the medical facilities in the tri-state area of North and South Dakota and Nebraska, the Sioux San is at the bottom of the totem pole when it comes to the allocation of funds. "We have the smallest budget serving one of the largest Indian populations, but we're working hard to make every one of those dollars work for the people," Koebrick said.

Koebrick grew up in Indian country and has seen the good and the bad of Indian health care from both sides of the fence. He brings to the job this unique background of having learned his lessons not only in school, but on the mean streets of the Indian reservations.

He is often chaffed by the long arm of the bureaucracy, but he understands that the system can be challenged and for the good of the people, he has been willing to put his head on the block and is no stranger to getting his wrists slapped upon occasion.

It will take people like Koebrick to change a health system that has fallen short of its treaty obligations and he knows that he needs powerful allies to secure the money to make and to keep the Sioux San as one of the best Indian hospitals in America.

And in Indian country, the chief villain in poor Indian health care is the lack of funds.

By Tim Giago (Nanwica Kciji)
© 2010 Native Sun News

(Tim Giago, an Oglala Lakota, is the publisher of Native Sun News. He founded Indian Country Today weekly newspaper in South Dakota. His book Children Left Behind was awarded the Bronze Medal by Independent Book Publishers. Giago was inducted into the South Dakota Newspaper Hall of Fame in 2007. He can be reached at