Health and the Urban Indian: An Interview with Ralph Forquera

TC:  And was it legislation out of the Nixon Administration?

RF:  It came out of the Nixon Administration, although the bill was actually signed by Gerald Ford, because it was passed in 1976. Everybody always thinks that Nixon was the guy that came up with this Indian self-governance idea. It was actually Lyndon Johnson. There was a speech that he made right near the end of his career, his term as president in 1968 when he made the statement that Indians really should be self-determined in how they run their own business and we shouldn't be terminating them just because they become self-determined. And that turned into the Nixon discussion and the policy that he published in July of 1970 that basically talked about the idea of self-determination without termination as being the policy of the land. And that's really led to the creation of the Indian Self-Determination Act which drives a lot of the Indian policy right now and turns over a lot of the managements and authorities to individual tribes to self-govern and self-manage.

In terms of our relationship, it's theoretically one of a contractor. There is a lot of confusion though, because we represent such a small element of the Indian Health Program that there are very few people within the Indian health system that really have much experience in working that way. Most of the Indian Health Service runs kind of like the Veterans Administration, so it's kind of a government-operation institution. And so we've had a number of difficult times working with the Indian Health Service because they've tried to apply similar standards to us that they applied to other tribal communities and other groups. And we don't have the same kinds of protections that they do. For example, Indians on reservations can discriminate in terms of who they see. You know, they can serve just Indian people on a reservation. Well, here we don't have those kinds of protections. And in fact, we serve anybody that walks in the door.

Sometimes a condition of some of the funding that we get is that we do serve anyone that walks in the door. And I actually think it's better, because most Indian people don't live in isolation in the city. They live in communities where there are people of mixed races living together and working together and doing all those kinds of things. And so, the ability to be able to serve more than just Indian people allows us to then serve family members of Indian people or relatives or acquaintances or whatever it happens to be, which can be very important pieces of that whole healing process. You know, this idea of fitting in and this idea of belonging somewhere, I think is probably the most crucial part of the work that we do. And establishing ways of trying to make people feel comfortable and make people feel that they belong is one of the most difficult and challenging elements of the work that we do. And we try to do that through the services. But we also try to do it through community events and through participation in a variety of other kinds of activities that wouldn't be necessarily labeled specifically health.