LINCOLN, Neb. (AP) - Two years after Nebraska state regulators shuttered four beer stores for selling excessive amounts of alcohol near South Dakota’s Pine Ridge Indian Reservation, public health officials are still trying to clean up the damage left by decades of alcohol abuse among tribe members.

The stores in Whiteclay, Nebraska, faced intense criticism for selling millions of cans of beer annually, primarily to members of the Oglala Sioux Tribe. Native American activists and others who wanted the stores closed blamed them for widespread alcoholism and cases of fetal alcohol syndrome on the officially dry reservation.

The problem has drawn the attention of state lawmakers and officials with the University of Nebraska Medical Center, but both acknowledge there’s no easy fix. A delegation from the University of Nebraska Medical Center will travel this week to Gordon, the largest Nebraska town near Pine Ridge, and the reservation itself to teach local educators, health officials and social workers how to identify signs of alcohol-related disorders in children.

“My biggest concern is that when a kid goes undiagnosed and goes through school without appropriate support, they end up at a higher risk for alcohol consumption,” said Dr. Omar Rahman, a University of Nebraska Medical Center professor who treats children from the Whiteclay area remotely using telehealth video conferencing software. “They’re going to have more difficulty securing employment, socializing and making good decisions. My fear is it’s simply going to feed the same cycle.”

Cases of fetal alcohol syndrome and other alcohol-related disorders are well-documented on Pine Ridge and many of the border towns in Nebraska and South Dakota, although it’s unclear how many cases originated with purchases from Whiteclay beer stores.

Whiteclay, a village with a population of nine that touches the reservation’s southern border, sold the equivalent of about 3.5 million cans of beer annually before the stores lost their liquor licenses in 2017. The town’s streets are cleaner now, most panhandlers have left and new businesses have taken root, but longtime residents and activists say alcohol is still making its way onto the reservation. It’s not clear whether the amount has declined since the Whiteclay stores closed.

The alcohol problem is especially daunting in the region because it faces a severe shortage of specialists who treat alcohol-related disorders, said Dr. Catherine Jones-Hazledine, a clinical psychologist based in Rushville, Nebraska, who maintains eight clinics throughout western and north-central Nebraska.

Jones-Hazledine said symptoms of alcohol-related disorders are often confused with other conditions, such as attention deficit hyperactivity disorder, which makes it harder to treat kids who have developmental problems because of exposure to alcohol in utero. Both disorders make it harder for children to concentrate and leave them prone to compulsiveness, hyperactivity and poor decision-making.

“Schools bear the brunt of a lot of that,” Jones-Hazledine said. “When kids have needs that go unaddressed, it affects how well they can learn. That’s why it’s important for schools to partner with providers out here.”

State Sen. Tom Brewer, of Gordon, whose district includes Whiteclay, said he’s working with the University of Nebraska to try to bring more doctors, psychologists and counselors to the region to help those affected by alcoholism. He said the shortage is part of a larger problem around the reservation, where he grew up, and in rural western Nebraska.

“I think this could be a blessing in that area where it’s hard to get doctors,” said Brewer, a member of the Oglala Sioux Tribe.

Rahman, the director of genetic medicine at the university’s Munroe-Meyer Institute, said he hopes to expand the use of telehealth clinics in the region so more children can see doctors in Omaha without having to drive more than six hours one way. The university already has telehealth clinics in Gordon and Scottsbluff.

Rahman said the idea came from earlier listening sessions with teachers from northwest Nebraska and the reservation, many of whom said they didn’t know how to help children they suspected of having an alcohol-related disorder.

Some tribe members stressed the need for more alcohol and drug treatment facilities, but that isn’t a feasible option for the university right now, said Lisa Spellman, a University of Nebraska Medical Center spokeswoman and member of South Dakota’s Rosebud Sioux Tribe.

Spellman said the university was able to open a genetics clinic in Gordon to help diagnose children with alcohol-related disorders. She said a grant from the university’s College of Public Health helped pay for the educational sessions in Nebraska and South Dakota, and university officials hope to keep working with residents in the area.

Spellman said the university was helping South Dakota tribe members because its mission is to assist all people, including those who live outside of Nebraska. She pointed to the University of Nebraska Medical Center’s role in detecting and mitigating the effects of biological weapons and the creation of the National Ebola Training and Education Center, which has trained hundreds of military and health professionals.

“If our mission is to lead the world in transforming lives to create a healthy future for all individuals and communities, then that transcends borders beyond just the state of Nebraska,” she said.

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