I would like to have you think of them as a Welfare Problem. The appropriations to do this work are limited, although they have been put up considerably in the past five years. It is our policy, in turning Indians over the community services, to try to impress them with the value of the quality of medical care. We want them to know what good care is and have them ask for good care. For instance, we are trying to promote Blue Cross and Blue Shield medical service programs in Utah, where we may end up with the entire tribe, an they will have free choice of physicians the same as anyone else.
In this part of the country we have San Xavier Hospital, which is no where near capacity for the group it is intended to serve. We are responsible for 7,000 Papagoes; have 3 doctors on the job. San Xavier Hospital is set up for a 7 patient load and is operating about 30 patients. One problem is that most of the Indians are so distant out on the reservation that many of them get sick and never see a doctor. Then, some Indians will come in and get the service as given service. In the last year we have had opportunities to pass out a health education through field nurses, making the Indians want service, which has resulted in about 50% increase in service. If the Papago Indians actually were to get service, in proportion to white people, you can see the amount of service which would be required for 7,000 people.
Most of you are familiar with the fact that Sells Hospital burned down. San Xavier Hospital was then converted to a general hospital, but with no surgery. Our surgery comes to Pima County Hospital, with a few cases transported to Phoenix.
Some of our major medical problems [ underlined ]--Tuberculosis is 10 times as great as in white people. We estimate that in the state of Arizona we fill about 400 or 500 beds with Indians who have tuberculosis. The Apaches have 100 cases of tuberculosis in hospitals. At the present time we have available through our office just 100 tuberculosis beds for the entire area, covering a population of 36,000 Indians! Quite frequently there a number of tuberculosis meningitis and joint and bone problems.
Among the Indians the regular communicable diseases are at just about the level at which the United States was 50 years ago.
Policy. In our overall policy we are trying to keep from going further into business on our own. Present policy is not to build any more, but to try to spread services for the Indians into local communities. Our plan here, if we actually get them to come in for medical services, is to try to contract service in this community. Along that line, in trying to find tuberculosis beds available, one of the committals we got was from Barfield's Sanatorium. We may end up with a contract which will hospitalize fifty Indians in that institution.
In doing contract work we get into a variety of situations. From our standpoint, it is better to contract for a complete service, and we have been talking with the owners of Barfield's on the basis of an overall contract. When we enter into such a contract it would be for the full maintenance of a patient for a full day in the hospital. That would mean that we would pay in honor of the institution for everything that goes to that patient in that day. To us, from a business standpoint, that is the most desirable handling. Another approach is to contract for hospital beds and then negotiate with the physicians for their service, and we are dealing with one person. My usual approach in dealing with such a community is through the Medical Society. There would be the matter of dealing with individual doctor on what his price is for his services. All of that, for us, is much easier handled through a Medical Society. We have done it on a deal very much like Blue Shield operates, in that we have been able to contract with the Society, paying the Society so much a month for the Society, the individual patients choosing their doctors, who turn in their bills with charges each month to the Society.
We have to appreciate the fact that we are limited by budgets, and have to plan expenditures on an annual basis. In other words, we cannot say, 'Go on and do the work and then we will pay you'. We have to stay within a specific amount of money on an annual basis. This year's appropriation is about a 30% increase for the Health Program for the Indian Service, but was specifically earmarked
