Health care has been a poplar topic in almost every community in America especially the Native American communities. The ideas or threats for new health care plans have flooded headlines in newspapers and have even become discussion topics for many programs and debates, but this isn’t something new in Indian Country.

While the general population tries to find a solution to many health care issue, Native Americans are also trying to to solve their own issues with health care in the United States.

One of those people is Margaret P. Moss, an associate professor at Yale University School of Nursing and is of the three affiliated tribes of North Dakota, who spoke about the barriers presented in health care during a presentation at the University of Montana in Missoula, Mont. on April 11. Moss is one of three guest speakers that are part of the Skaggs School of Pharmacy and the Native American Center of Excellence presentations entitled “The Native American and Minority Health an Cultural Competency Lecture Series”.

To a room full of about 30 people Moss spoke about the teachings of barriers in health programs and how it’s said that they are psychosocial, geography, language and culture barriers when really there are other barriers.

"The real barriers are beyond that,” Moss said. “Really [the] barriers are regulations, polices and laws that came before those other things.”

She said geography is only a barrier because it’s federal policies that keep reservations into place. While some call it a geography barrier it’s really just another policy.

Many Natives have to travel a great distance to receive any type of health care and it’s usually in the form of Indian Health Services.

According to the IHS website, IHS serves two million American and Alaska Natives and has 157 IHS facilities throughout reservations. Reservations can expand over thousands of miles causing a simple trip to the hospital to be over an hour in most areas. If there is an emergency then the distance can become costly.

Vernon Grant, a student in his second year in the doctorate program at the University of Montana and a Blackfeet Native, said he agreed with Moss on the struggles of health care or the lack there of.

"The content she talks about stirs up emotion," he said.

Grant had a grandfather who recently passed away from cancer and once while seeking treatment at the local IHS hospital he waited in the emergency room for three hours before being seen.

This is a horrible reality that will always stay with Grant, and he’s not alone.

After the hurtle of distance is jumped there can be issues of culture sensitivity or as Moss would say another policy. Many Native elders will turn down health care because they don't feel the trust is there and in most cases they aren't able to practice their traditions.

"They would thank you politely and go home. They would never ever do it," Moss said. "State law will prevent them from doing what they have to do.”

Even if surrounding areas with facilities are likely to be aware of the traditional practices of Natives, policy holds them back. They still aren't allowed to burn their cedar or go out in the early hours to pray because of policy regulations. And those patients who try to stay intact with their traditions can be seen as disobedient or unruly if they don't follow the established rules.

"Nothing, nothing about those two cultures (Native American and Federal Policies) go together," Moss said.

Which why many elders will refuse care and go home to where conditions may not be exceptional for their needs.

Another issues plaguing Native health care and health care everywhere is the lack of knowledge and ability to jump on diseases as they happen.

"The American Indians are the canaries in the mines for health,” Moss said. “Whatever is happening to American Indians is happening out in the dominate culture.”

However, when it’s happening to Natives nobody notices but when the dominate culture is affected then something gets done.

Moss said for example diabetes is a disease that has been infecting the Native people for years. However, up until recently diabetes wasn't a popular topic as it is now. There are now cookbooks for alternative foods and more programs out there to educate people about diabetes, as opposed to years before.

"Things are hitting the American Indians first and early and more severe,” Moss said. “While there is so much to be done...We just have to try to make these cultural things fit with state and federal laws."

Until then health care will continue to be the talk in newspaper headlines and communities in Indian Country and everywhere.

Stacy Thacker (Navajo) is from Navajo, N.M.