× Expand Daderot Indian Country is being ravaged by the opioid crisis, and though this issue is also prevalent in the rest of the United States, for Indians, it’s part of a larger issue of trust in health care institutions.

During my mother’s generation American Indians were terrified of going to the hospital. This was especially true of native women who feared they would be sterilized without their consent. And those women included my mother.

Things have changed in Indian Country. Indians will go to the hospital. But still, it’s often too late. They end up in the emergency room for health problems that have reached a crisis because of a lack of preventive healthcare.

Convincing many Indians to take advantage of such things as free pre-diabetic screenings and other forms of advanced medical care remains a tough sell.

So why the reluctance to seek out early preventative care? Making major changes in lifestyle is a big part of it. When I was diagnosed with Type I Diabetes I had to make big changes in my lifestyle. It’s not easy and I would be the first person to tell you I have a long way to go. But there’s a deep fear of change among Indians.

We all know relatives and friends who have died from complications of diabetes, drugs, and alcoholism. I often think of the grandmothers I know caring for their grandchildren who have been removed from their homes because mom and dad were addicted to drugs. Without the grandparents these kids might be taken to a white foster home, potentially cutting them off from their culture for years.

My mother died at the age of forty-six due to complications with diabetes . . . Had she had community support, such as a trusted health worker, I believe she would have lived for many more years.

But the biggest challenge facing most of these tribal communities is the lack of real, widespread support that connects people to health care. There are care workers who check up on the elders from time to time, but mostly it is inadequate. And while strides have been made in culture-based treatment, such as using traditional medicines and talking circles for drugs and alcohol recovery patients, the lack of support remains real.

Given the number of our elderly who are homebound and live in isolated, rural places, meeting their needs—running errands, making sure appointments are kept and being aware of prescriptions to refill—is an obvious priority.

My mother died at the age of forty-six due to complications with diabetes. Yes, she was desperately afraid to go to the hospital. She was screaming in pain and still refused. My father had to force her. But my mother had no support, very few friends, and lived with an alcoholic husband. The struggle of raising kids and working hard in isolation all took its toll on her health. Had she had community support, such as a trusted health worker, I believe she would have lived for many more years.

Right now, the most pressing scourge in Indian Country is the opioid crisis. While it is rampant throughout the United States, for Indians the crisis seems more acute.

When I was working for my tribe, the Bad River Band of Ojibwe, I remember a young mother just released from jail for drug use. The tribe found her meaningful work, but it was temporary. On a Friday, the last day of her work with check in hand, she purchased some heroin. By Sunday morning she had overdosed and died, leaving behind two young boys.

Deb Tutor, director of the Bad River Health and Wellness Clinic, says too often drug users get out of jail and refuse to go into treatment. They feel empowered, believing they have kicked the habit because they have not been able to use for weeks while in jail. Despite the clinic’s new in-house alcohol treatment culture-based program, few people attend.

This story reveals one of the biggest challenges in Indian Country. At Bad River, attempts to hire our own have been hit and miss. Indians will clean themselves up, work at the casino for a month, and then go back to drinking and drug use. Many end up living in the woods.

We all know that one of the main reasons people drink and take drugs is to escape. For Indians it is escape from poverty, despair, and having to deal with rising numbers of suicides, especially among youth.

There are no easy answers, but finding strength in community and culture is a start. Tribes continue to create culture-based health programs, and teach the young their tribal languages. Pow wows, ceremonies, and feasts also help foster a sense of community.

It will likely be many years before tribes can get on top of challenges like better care for elders and successfully reaching out to desperate addicts. And the problem with “many years” is how many will end up dying. But there is no “magic bullet” that can replace the need to build community connections and trust in health care.