Health and the Urban Indian: An Interview with Ralph Forquera

TC:  The idea of health in Native populations encompasses a broad spectrum of issues, is that correct?

RF:  Yeah. You know, the idea of homelessness and the idea of low-income housing and the needs of our elder population as they are starting to get older and their need for home healthcare and other kinds of things and supporting families who take care of their elders in their homes. Those are extensions of the definition of health that you wouldn't normally get from a community health center or certainly from the mainstream healthcare system. And yet I think that that's one of the responsibilities that we have as a Indian organization is to make sure that those things are at least being addressed in some capacity. And if they're not solving those problems then we need to figure out how we can go about solving those problems in the future somehow.

TC:  When you say dropout, you don't necessarily mean high school dropout?

RF:  No. Actually what we're finding is most Indian kids drop out in about the sixth or seventh grade. So they're not even part of the statistic. And we're finding some really disturbing things about Indian families and the number of Indian youth that are in foster care, for example. The number of Indian kids that are growing up in single-parent households where the parent is drug or alcohol affected and the child is doing the best they can, or where they're serially homeless. You know, they live for a while in one place and they get some level of comfort and then all of a sudden they've moved on to someplace else. And the effect that that has on a person in terms of their own development is enormous. And those are the kinds of things that big programs can't solve. Those are little-program activities. You know, and they're very specific to cultural identity. And they're very specific to institutions and individuals that people can relate to. And, you know, so frequently our public officials think, well, we'll just develop this homeless program and we'll have it encompass everybody because we have a big tent. You know, we all know about the big tent idea, but most of time the big tent really doesn't include us, or we get pushed out because the bigger groups within the tent push us out.

TC:  Do you do any work around health education or health resources and information? Does that fit into your mission?

RF:  Well, I think it has a fit. And there are people in the organization that have, in fact, looked at a variety of different models for trying to do that kind of work. And we've done some of it. I think that there are some things that we've incorporated into the work that we do that have been enormously beneficial. I mean, our diabetes program, for example, I think is state-of-the-art. I mean, I think we're doing as good in terms of our ability to not only find, diagnose, and care for our diabetic population as anybody, you know, including a fairly substantial educational program associated with that both on a prevention side, as well as on intervention/treatment side. And now we're starting to branch out a little bit and looking at those kinds of issues in a broader sense, and starting to look at cardiovascular disorders and obesity and some of those kinds of precipitating problems for diabetes and for heart disease and those kinds of things.

TC:  Treatment programs?

RF:  Yes. Yes. What we haven't really done, though, I don't think done well, or been able to sustain over a long period of time is a true prevention program, something that would really address strategies for people to improve and maintain their health over a long period of time. That's something that people don't pay for. You know, they'll pay for a pilot project and then it goes away. And those are also programs that are very hard to incorporate into a clinical model organization because they are more outreach, they are more community-based, they're more kind of loose-knit, they're more association with a population of people that are not as easy to categorize or not as easy to classify as you tend to need to do in order to be able to capture clinical service data, and so it's a much greater challenge to both find those kinds of resources, and then especially to sustain those kinds of programs over an extended period of time, because, again, they come and go very quickly.