Yvette Roubideaux recognized the problems with Native health care and they sent her on a path to make things right.
As a child growing up in Rapid City, S.D., Dr. Yvette Roubideaux hated waiting in the cramped lobby at the local Indian Health Service Clinic.
So she would bring a backpack full of books to keep her preoccupied during the often four-hour-long waits to see one of 10 staff physicians.
Year after year, the clinic was chronically underfunded and overstressed.
As she got older, she heard her relatives complain about the long waits and how they never saw the same doctor. Eventually, those complaints helped motivate the 46-year-old Rosebud Sioux to become a physician.
“I heard a great metaphor for IHS: It’s a really good car. It just needs more gas,” said Dr. Roubideaux, who, in 2009, became the first female Native American director of the Indian Health Service. “The system is so stretched. I was visiting an area office, and everybody who introduced themselves had three or four jobs that normally you’d expect one person to do.”
The circumstances hadn’t changed much once she began working at a rural Arizona IHS clinic after graduating with a master’s degree in public health in 1997 from Harvard Medical School. She always had ideas about things she could change about health care, about the system, but there wasn’t much she could do as a physician.
Now, she’s calling the plays.
It wasn’t long before she realized she had inherited an agency that chronically underfunded, yet is responsible for a population that suffers far higher rates of diabetes, alcoholism, tuberculosis and suicide than the general population. Natives born today have a life expectancy that is 4.6 years less than the general U.S. population, according to IHS (72.3 years to 76.9 years, respectively).
It’s even shorter for those living on rural reservations. There, residents can expect to live only 66 years because care often is delivered by overtaxed medical staff working with outdated equipment in aging buildings.
But Roubideaux isn’t hitting the panic button yet.
The budget is the biggest obstacle, according to IHS officials. They say the current $3.6 billion is a little more than half of what they need to fully fund the agency’s mission – which is to provide comprehensive health care to 1.9 million American Indians and Alaska Natives.
It’s common knowledge around the rez to “don’t get sick after June,” when federal money often runs out until the new fiscal year begins on Oct. 1.
But Roubideaux, the eternal optimist, is taking pride in the improvements to health care thus far – like the fact that life expectancy for Natives has increased nine years since 1973.
She said more change is needed and she has met with tribes and asked them to recommend those changes.
“Instead of coming in and saying we’re doing X-Y-Z, I’m asking the tribes, ‘If we’re going to improve the Indian Health Service, where should we start? What are your priorities?’” she said.
Gerald Hill, president of the Association of American Indian Physicians, commended Roubideaux during her confirmation hearing as someone who “not only understands Western medicine but how to apply this knowledge in Native communities.”
“We have all the elements in place to really address these health disparities,” Roubideaux said. “It’s just that we need two things: If we can begin to address the problem of resources, we can do a lot. But the second area is how we’re providing that care and making sure we’re doing it in the best way possible.”