It’s the middle of July, but the parking lot outside Browning High School is full.
Inside, a line of people snakes down the hallway and the muffled sounds of friendly chatter bounce off the brick walls. The basketball hoops of the cavernous school gym are raised to make room for rows of white tents. Red bleachers on either side of the court are filled with seniors, adults and children waiting for their number to be called. Meanwhile, a steady stream of people come and go, their shoes squeaking on the wooden court.
Browning High School has been transformed into a health clinic run by the U.S. Department of Defense to serve residents of the Blackfeet Indian Reservation and anyone from the surrounding areas. Over 200 service members hailing from all over the country traveled to Browning by plane and bus, accompanied by pallets of medical supplies carried via military transport. On the first day alone, the clinic served about 200 people.
Dubbed Operation Walking Shield, the clinic served 3,258 people between July 18 and July 27. A spokesperson for the program said the services provided in Browning represent $1.4 million worth of care in a typical medical setting.
“The sheer number of people we have been able to see is pretty incredible,” said Sgt. Trenton Hughes, who works as a nurse in Indiana and as a medic in the military.
Browning is the seat of the Blackfeet Indian Reservation, where rates of respiratory disease, obesity and diabetes far outpace those among the rest of Montana. The average life expectancy for American Indians on the Blackfeet Reservation is 15 years below white people statewide, according to public health data.
Despite these staggering health disparities, patients regularly wait months to get an appointment at the Blackfeet Community Hospital, run by Indian Health Service (IHS), the federal agency responsible for providing health care to tribal members. The IHS fails against its own recommendations of a maximum wait time of 28 days to secure a primary care appointment.
Long-standing systemic barriers such as underfunding of the IHS and a shortage of health care workers mean the system can’t serve the community’s needs. High rates of poverty worsened by historic marginalization mean care that catches disease early or prevents it altogether is critical, but those same conditions severely limit access.
Operation Walking Shield sought to alleviate some of those shortcomings over the course of the mission in Browning. Service members from the Air Force, Army National Guard and the Reserves from Army, Air and Navy provided health care services to a community that might otherwise not get them.
Durand Bear Medicine, clinical director of Blackfeet Tribal Behavioral Health, took advantage of the medical and dental services offered at the clinic.
“This is definitely needed for our community,” he said. “Accessibility is a major deal here.”
Bear Medicine said it’s not uncommon for community members to wake up early and drive to IHS hoping to be seen by a provider. If people don’t get in, he said they may wake up early the next day and try again. That’s assuming they have access to a vehicle and are able to take time away from work or caregiving. Eventually, Bear Medicine said people get discouraged and may stop going to IHS altogether.
“It’s sad our community members will sit back and wait until something major happens before they go to a doctor,” he said. “We have to settle for (low quality) care, which really sucks when we have a lot of health disparities here.”
Operation Walking Shield was part of the military’s Innovative Readiness Training (IRT), paid for by the Department of Defense so service members receive valuable training and under-resourced communities get access to essential care.
It’s a win-win, according to military personnel and people who visited the Browning clinic as patients. Garland Stiffarm, CEO of the Blackfeet Tribal Health Department, said he applied to participate in the IRT program in the fall of 2022. When he heard the application was accepted and learned that hundreds of military personnel would come to Browning, he thought, “OK, this is going to be really good.”
“This isn’t anything against IHS,” he explained. “They just lack resources. IHS has one optometrist, and these folks brought eight. I think we have maybe three dental officers in Browning. These guys brought 16.”
IHS, Stiffarm said, was a key partner in the initiative, providing some supplies and working with the clinic to arrange follow-up care.
“(IHS) gave us their waitlist and basically said, ‘Wipe it out,'” Stiffarm said. “They were happy these people on the list got taken care of.”
IRTs enable enlisted service members, many of whom work as medical professionals in their civilian lives, to receive hands-on training in environments that more closely resemble the kind they might encounter while deployed. It’s an exercise in creativity and resourcefulness.
In Browning, medical equipment was sterilized in a makeshift lab inside the school’s carpentry workshop. Pharmacists doled out medications rather than hot dogs from the concession stand outside the gym. They stored limited runs of antibiotics, pain medications and topical ointments on shelves buttressed against a 7-Up cooler. Service members on the mission slept on cots assembled side-by-side in classrooms.
Tech. Sgt. Steven Alvarez, an eye tech, said the equipment he uses in an optometrist’s office might cost tens of thousands of dollars. But in the field, that kind of supportive technology won’t be available. This kind of training forces him to become more adept at identifying the intricacies of eye conditions and what the subtle clues tell him about the disease process without those aids.
Practitioners evaluated 1,529 people using paper eye charts with big letters taped to a row of retractable risers. With support from volunteer group Remote Area Medical, they distributed 1,430 pairs of glasses, fashioned in a matter of minutes from the inside of a generator-run trailer parked out back.
Patients received screenings for the pressure behind their eyes, caused by fluid buildup. High pressure can be a sign of glaucoma. Left untreated, glaucoma can reduce vision or even cause blindness. It’s often co-occurring with other conditions that are more prevalent among Native Americans, such as diabetes or high blood pressure. Although providers at the clinic couldn’t treat possible glaucoma, they referred patients for expedited access to IHS and armed them with information about their own health.
“It’s a little disheartening, to be honest,” Alvarez said. “There’s a lot of need out there.”
For some military members, Browning was their first IRT mission. Others had been on a few. It was the third for Tech. Sgt. Kristen Fay with the Air National Guard who works as a dental technician back home and during IRT. She called the experiences “unmatchable,” which is why she keeps coming back.
Stephanie Vielle came to the clinic to get her teeth examined.
“Everyone told me it’s really easy and they do a good job, so I thought I would check it out,” she said, waiting for her appointment. “It’s better than IHS — you don’t even have to call and make an appointment.”
The Blackfeet Indian Reservation spans 1.5 million acres. Across its roughly 3,000 square miles, many residents live in remote areas cut off from health services by treacherous mountain roads and waterways.
Thanks to the help of key partners such as Blackfeet Tribal Health and Browning Public Schools, transportation was provided for people living outside Browning in neighboring towns such as Heart Butte, Babb, Seville and East Glacier. Elders were prioritized on the first day of the clinic with transport provided, and there was a whole day for students needing physicals ahead of the coming academic year.
Wanda Reevis brought her three grade school-aged grandchildren to the clinic last week. She said her whole family appreciated the care provided.
“It’s fast,” she said, sitting next to the children in the gym bleachers. “At IHS, it was a six-month wait to get my eyes checked.”
Vision and dental care were some of the most sought-after services.
Over 800 people saw a dental professional with appointments focused on immediate needs like tooth extractions or other conditions that might cause pain. When time allowed, teeth cleaning was provided.
A steady hum signaling constant but never chaotic activity buzzed through the gym from 8:30 a.m. when the clinic opened to 5 p.m. when its doors closed. Decked out in full fatigues, service members systematically moved through the streams of patients eager to be seen for any number of ailments, known and unknown.
Everyone who passed through the doors of Browning Public High School started with triage. Primary care providers addressed acute conditions like lacerations or lesions. They could also screen for chronic conditions that could signal underlying disease such as high blood pressure and send them home with the appropriate medication or information to take the next steps.
They could seek out specialized care or get face time with specialists.
As people waited, a presentation featuring public health information looped on a giant projector in the gym. They could also speak with a nutritional counselor while their kids passed the time with puzzles or coloring books in the informal play area.
Mental illness and substance abuse are commonplace on the Blackfeet Reservation, another casualty of generations of historical trauma compounded by poverty. More than half of respondents to one survey said their anxiety is so bad that it is “extremely difficult” to make it through daily life. In another, 42% of high schoolers said they had a family member struggling with substance abuse disorder.
Yet IHS staffs only five psychologists and two social workers for a reservation community of 9,500 people, according to its website. The waitlist to see a therapist through Blackfeet Tribal Behavioral Health is so long that some people give up, according to Heidi Bird, who works for the program. She said finding mental health providers to work on the reservation is the biggest barrier to growing capacity.
At the clinic, individuals could opt into a behavioral health screening. A questionnaire about substance use, feelings that could indicate anxiety or depression and support systems was given to patients. If their answers suggested they might be at risk of poor behavioral health, they could meet with a mental health provider from the military and a representative from Tribal Health’s staff to speak about services they might be able to access.
Bear Medicine said at IHS, it could take someone anywhere from three weeks to three years to access behavioral health services.
“It’s great for our community to get the help they need,” said Bear Medicine. “Even if it’s just for a week.”
___
(c) 2024 the Billings Gazette
Distributed by Tribune Content Agency, LLC.
