The Choctaw: Taking Care of Their Own

Juantina Johnson was speeding southbound toward Meridian for her daughter’s dance performance when she noticed a mother and daughter retreating from a car stranded alongside the bustling highway.

“As a single parent I know how tough it is, so I pulled over,” Johnson said.
The family, members of the Mississippi Band of Choctaw Indians, were commuting more than 50 miles to Anderson Regional Medical Center when their car suddenly slowed, then came to a sickening stop. They had been making the hour-long trip for an appointment with a specialist the reservation’s outdated health center couldn’t offer.
Johnson lent a hand, a ride, and a can of gas to the family to help get them back on their way. She never made it to her daughter’s performance.
“I didn’t feel that bad about it because I helped a family that really needed it rather than my 4-year-old daughter who wouldn’t really remember me being there any way,” Johnson said.
Many other Choctaw families, on limited income and facing health issues, have had to make the agonizing decision of whether to spend money on gas to travel almost an hour away for an appointment or to skip it altogether.
“Truthfully, that is so many of their stories,” said Johnson, the Choctaw Health Center’s chief medical officer.
“Those are the kinds of stories that really broke my heart and showed the need to bring specialists to the Choctaw Health Center.”

Years later, a new, bigger, better-equipped Choctaw Health Center, which opened in March 2015, is doing just that. Mississippi’s Choctaw, almost wiped out by European diseases centuries ago, further thinned out by federal removal to Indian Country, then ravaged again by the worldwide flu pandemic in the early 1900s, now boast state-of-the-art medical technology, consistent staffing, and a slew of specialists.
Today the tribe can offer a badly needed, much larger dental clinic with an oral surgeon, a bigger diabetes unit to battle the tribe’s single most serious health concern, and an impressive array of other services — cardiologists, optometrists, mental health counselors, WIC, pediatric dental and primary care units, 20 inpatient rooms, a vast pharmacy, a women’s wellness center, an audiology unit, pain management clinic, pulmonology clinic and more.
“In the old facility we were busting out at the seams,” CHC Deputy Director Mary Harrison said. “Here we have room for the patients and their families to be comfortable.”
The old and cramped one-story facility with baby blue walls and orange carpets, built in 1976, was built to serve 4,000 patients, less than half today’s tribal population. Its waiting rooms were so packed that sometimes people had to stand shoulder to shoulder. Some offices were the size of broom closets.
Now patients flock to a modern, three-story building with sleek, timeless colors and wide-open areas that offer more and better care, a monument to just how effective Choctaw-run health care for the Choctaw can be.
The project, on an old stickball practice field, was a joint venture between the tribe, U.S. Department of Agriculture and the Indian Health Service (IHS). Chief Phylliss Anderson negotiated with IHS, which normally runs medical facilities on reservations, to agree to pay the tribe to operate the facility.
“The chief said we know best how to run it for our own people,” said tribal spokesperson Misty Brescia Dreifuss.
“We knew what it felt like to run out of room and so we planned this building so we would have room to grow,” Acting Health Director Tina Scott said.
Transitioning into the new center was like buying a new home. It doesn’t happen within a day, but after stepping over the threshold for the first time, it’s hard to think of anything other than the endless possibilities of what can happen within these walls.
Even the wallpaper speaks of Choctaw culture. Basket-weaving textures and diamond-shaped details frame large windows. Here, patients and staff alike have room. There are large lobbies on every floor and each patient has his or her own individual room— a bed, a couch where family members are encouraged to stay the night, and a bathroom large enough to do a cartwheel in.
“Patients have choices of where they want to go and we want to make it easy for them to choose here,” Johnson explained. “Now we are able to have patients see multiple specialists here rather than have to drive all the way to Meridian or Jackson.”
Once specialists see the facility, they’re much more eager to set up shop there.
“Build it,” Scott said. “And they will come.”
Physical expansion has also led to an expansion of opportunities. The health center is now able to control its own funding, create contracts with providers to bring in specialists, and “catch up with the norms.”
For example, “we’ve been able to have consistent staffing so they know the patients and their needs better,” Scott says.
One of those staff members is Gail Wilson, who works on the second floor in the dental unit.
Wilson, the dental assistant supervisor and long-time employee, is proud of her 16-chair clinic. She shows it off with a beaming smile.
“At the old hospital we had a four-chair clinic that could fit into our new lobby,” Wilson said.

The place is busy, busy, busy. Most chairs are full and dentists scurry from patient to patient. People pour in for routine exams and cleanings, an oral surgeon visits every week, seeing about eight to 10 patients each time, and stickball mouth guards are molded in large quantities.
In the old laboratory, employees were crammed in like sardines, always bumping into each other. Now, the lab is four or five times larger and tasks are cranked out with ease, like making 75 mouth guards in a single morning.
The clinic is manned by 23 staff members, including five dentists and 14 dental assistants.
Wilson said if the center could secure more dentists, they’d be ready to expand immediately.
The tribe’s population is about 10,800. But as an IHS facility, the health center also serves those who are members of federally recognized tribes and their dependents.
The center also offers a spacious diabetes clinic, where the staff finds itself on the front lines of a long-term war against an epidemic that has plagued tribes across the United States. Diabetes has become such a problem that President Barack Obama extended a special diabetes program offered under the Indian Health Care Improvement Act. It provides $150 million a year for support programs.
Darlene Willis and Dr. Chandrashekhar Joshi are two of many workers striving to help the Choctaw battle the reservation’s leading health concern.
About 1,900 Choctaw have been diagnosed with the disease, especially type 2 diabetes primarily caused by lifestyle habits—poor diet and lack of exercise. About 1,600 of those are classified as active, meaning they receive services at the center at least once a year.
U.S. health care officials report a 16.1 percent diabetes prevalence rate among Native Americans, as opposed to a 12 percent Mississippi rate and 9 percent national rate. The statistics don’t adequately describe the human carnage – amputations, kidney failure, blindness, heart disease, death.
For a long time, diabetes statistics among the Choctaws were murky, but the extent of the disease has become more obvious because on the reservation the tribe is like a captive audience, making screening highly effective. At least the tribe knows what it faces.
Willis, who has been the diabetes prevention coordinator for 18 years, said when she started, only about 55 people on the reservation had been diagnosed. With more efficient screening, more people are being diagnosed and advised on ways to better their health.
The number of diabetics has remained high for decades. Things have improved in recent years but it’s a slow, long-term siege.
“Change is going to be hard. Change is hard for these people,” Willis admitted. “They’re going to do what they do. They’re going to eat what they eat.”
Traditional Choctaw foods such as fry bread and fried chicken are major perpetrators in the poor diets that trigger the disease. The diabetes unit works to teach patients the benefits of a healthier low-fat diet, nutrition, exercise, and complete lifestyle change. But Joshi says all the preaching and cajoling in the world can’t solve the problem unless patients decide to change their ways. The toughest part of his job, he says, is fixing general attitudes toward diabetes.
“People do not change because somebody tells them to change,” Joshi said. “The only solution that is left is you have to make them want to do it. Change is going to happen very slowly.”
Joshi, who has been practicing medicine for 41 years with almost 30 dedicated to the reservation, has been lovingly dubbed an “honorary Choctaw” by the staff and has big dreams for the tribe and its future.
With a growing grin, Joshi admits his dreams are not practical but he still dreams them. He describes an ideal reservation that is virtually car-free to promote walking and exercise, healthy foods on sale at the grocery store, junk food sold at inflated prices, and more.
He has genuine hope for what is to come.
“I have never really had negative thoughts in the respect that nothing will change, that things would remain the same,” Joshi said. “Sooner or later. It will take time. It will happen.”

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By Lana Ferguson. Photos by Chi Kalu. 

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The Meek School faculty and students published “Unconquered and Unconquerable” online on August 19, 2016, to tell stories of the people and culture of the Chickasaw and Choctaw. The publication is the result of Bill Rose’s depth reporting class taught in the spring. Emily Bowen-Moore, Instructor of Media Design, designed the magazine.
“The reason we did this was because we discovered that many of them had no clue about the rich Indian history of Mississippi,” said Rose. “It was an eye-opening experience for the students. They found out a lot of stuff that Mississippians will be surprised about.”
Print copies are available October 2016.

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