Nov. 1, 2018 -- Joseph Whiting strokes the coarse hairs of a gray beard and waves his hand over an imaginary map. It’s a tour of the Pine Ridge Indian Reservation -- from his home in Kyle, SD, to the rock outcroppings at the border of the Badlands, past sun-drenched sunflower fields and golden mullein stalks to the 1890 site of the Wounded Knee Massacre.

He’s 74, a wooden cane propped at his side -- a crutch for the swollen knee that bears the scars of knee replacement surgery.

For all the pride he has in his homeland, there is an equal amount of pain. Pain that people die young. Pain that he is among thousands of Lakota diagnosed with diabetes. Pain that he can tell you exactly where to get crystal meth.

“I could tell you 10 places within a mile of here,” he says.

It’s just one piece of a complex puzzle that has marked Oglala Lakota County with the lowest life expectancy rate in the country. There is a way to change that, says. Donald Warne, MD, but it will take years and a seismic shift in the social and political climate of those on and off the reservation.

“It’s heartbreaking and enraging,” says Warne, associate dean for diversity, equity, and inclusion in the School of Medicine and Health Sciences at the University of North Dakota. “It doesn’t have to be this way.”