It’s been called the best-kept secret in health care. For over 200 years, the U.S. government has successfully provided free health care to American Indians and Alaska Natives (AI/AN)—first, as part of the War Department and later as part of the Bureau of Indian Affairs. Since the 1950s, the U.S. Public Health Service has overseen the Indian Health Service (IHS).

Dr. George Brenneman visits with one of his young patients. (Photo courtesy of Dr. George Brenneman)

Today, the IHS is a network of more than 600 medical facilities operating in 35 states and serving almost two million people. While the IHS is not without its critics, the agency has managed to deliver care to a population at risk for numerous health issues, and lessons learned there could serve as a model for the nation as we seek to reform the overall health care system.

For over 40 years, pediatrician Dr. George Brenneman has dedicated his career to serving native peoples. Besides his long association with the IHS, he also served as an associate director at the Center for American Indian and Alaskan Native Health at the Johns Hopkins Bloomberg School of Hygiene and Public Health and on many special committees and taskforces.

A man who clearly has a calling to serve and make a difference, Brenneman says his work has always been guided by principles. “But the American Indian understanding of life, living, and being has given substance to these principles,” he says.

The adventure begins

After graduating from the University of Virginia Medical School in the early 1960s, Brenneman faced the possibility of being drafted and sent to Vietnam. Instead, he chose to enter the U.S. Public Heath Service as a commissioned officer and was assigned to a tuberculosis hospital in Albuquerque, N. Mex., for two years.

He enjoyed the work so much that he continued on with the IHS, moving his family around the American West. Brenneman says, “We had an opportunity to be out in the bush for nine years in a place called Bethel, Alaska, which is about 450 miles west of Anchorage and maybe 50–60 miles from the Bering Sea Coast. It’s in an area where there were lots of Eskimo villages and a hospital that served the community.”

Brenneman says the experience was similar to the setting of the hit TV show Northern Exposure. “Bethel is out in the tundra where there are no trees and permafrost,” he says. “At the time, communication that we had with villages was primarily through short wave radio. There was one TV station that broadcast only part time.”

Groceries were shipped via barge from Seattle once a year. “It was a major change,” he says. “But adjusting to the cultural and geographic changes—we saw it as part of the fun!”

Challenges

Working with this population is not without its challenges. The overall health of AI/AN lags behind that of the general population. According to the latest U.S. Census figures, AI/AN have larger families, less health insurance, and a poverty level nearly twice that of the rest of the population. The nationwide epidemics of obesity and type 2 diabetes have hit this population especially hard, and alcoholism continues to plague them in disproportionate numbers.

Brenneman says the Indian population is “working very aggressively and creatively to control this.” He is also encouraged by the successes he has witnessed. Tuberculosis and other infectious diseases, which plagued the Native American population when Brenneman was starting out, have been greatly reduced or eradicated thanks to effective vaccination and public information campaigns.

Brenneman now spends about 20 weeks a year at the Crow Creek Sioux Reservation in S. Dak., located in one of the most impoverished counties in the nation. He emphasizes that despite their tough circumstances, his patients possess a marked resilience and that they are not a depressed people. Brenneman believes their strong sense of community and character will allow Native Americans to overcome hardship and, ultimately, to thrive.

At home

When he’s not on the road caring for his patients, Brenneman is at home at Charlestown, an Erickson-developed community in Catonsville, Md., where he’s lived with his wife, Jewell, an artist, since 2008. The couple explored at least five other communities before choosing the large-scale retirement community outside of Baltimore. “It’s good to be at Charlestown,” he says.

Though hardly the most glamorous or lucrative posts in medicine, Brenneman says the personal reward of working in the clinic with people and families makes his life’s work satisfying. “I take a philosophy of downward mobility,” he says. “I think that people who have been around for a while could make a bigger difference by going back to where they came from. So for myself as a pediatrician, I’m working in the clinic with patients and their families.”

For more information about Dr. George Brenneman, visit http://mysite.verizon.net/gbrenneman/.

michele.harris@erickson.com