Primary Care of Native American Patients: Diagnosis, Therapy, and Epidemiology (review)

Primary Care of Native American Patients: Diagnosis, Therapy, and Epidemiology edited by James M. Galloway, M.D., Bruce W. Goldberg, M.D., and Joseph S. Alpert, M.D.. Butterworth-Heinemann, 1999

This is the book everyone with any connection to American Indian and Alaska Native health must have right there on their shelves, ready to pull down when the tough questions come in!

There is one caveat: this book is restricted to data derived from the population of enrolled people of federally recognized tribes who utilize services provided by the Indian Health Service (IHS). This book is written by IHS professionals from data derived from the IHS population, an estimated 1.2 million people in the United States. These numbers indicate the need for a second volume on the estimated 2 million other American Indians. The majority of this other population are urban Indians, with a profile probably different from the largely rural IHS population.

All the many authors make it plain that Indian health has improved since midcentury, with a shift from infectious diseases to chronic diseases. But the health status of Indians and Alaska Natives remains very different from other American populations.

Every page is well worth reading, and every reader who reads director of Indian Health Service Dr. Michael Trujillo's foreword will be stimulated to go on to read every page.

The first thing I did, as will probably be true of others, was to look for diseases of particular concern to me. First, I looked up Neisseria meningitidis, which I found in the bacterial meningitis category. I thought it deserved more space and information because of my experience with the 1990s occurrence of this disease in Washington and Idaho. Then I looked for Hantavirus, which is listed under "Hantavirus Pulmonary Syndrome." The section is well written with useful references. Then I checked type II diabetes, which is the only disease listed in the endocrine disorders category. The first line in the article indicates the importance of information about diabetes: "Diabetes is the most common reason for visits to a physician for adult patients in the Indian Health Service. . . . Type II diabetes is a chronic disease epidemic among the Native Americans." The intent of the chapter is to provide a practical approach to diabetes management. In my opinion that is exactly what the chapter does.

After reading and reacting to these topics of personal concern, I moved on. In the preface the three editors say that they hope the information will be useful to newly arrived health care providers in Native American health facilities. I do not think there is any doubt that the information will be useful. But I also think that some thought should be given to providing information for the already arrived providers. What is seen in the Southwest is not necessarily what is seen in other regions of the country and vice versa, for example.

Chapter 6 is in need of revision. Dr. Hollow writes about TIM, traditional Indian medicine, as if there is only one TIM. I accept that there is and has been a mix-and-match approach to TIM for some time now in both clinics and programs, usually urban. I also accept that many urban Indians value and are benefited by such treatment. But people who are participants in Indian cultures that include functioning practitioners of culturally based health and illness curing and prevention systems are not the same kind of people as the marginal participants who accept and need TIM. These systems are not always derived from anything traditional but may have been taken from other cultures. There is, for example, a diagnostic technique practiced by some individuals in the Northwest involving a bowl of water that may be derived from French-Canadian folk medicine. The technique seems to be region specific and idiosyncratic elsewhere. It is certainly important that...