Rhoades, Kiowa, MD, is having an exciting,
service-filled life as physician, teacher, researcher,
scholar, author of a book and more than 100 scientific
articles, administrator, advocate for Indian health,
creator of several organizations, civic leader,
husband, father of 5 children, grandfather of 10 and
much more. Despite three retirement parties, he is
still going strong. Rhoades is best known nationally
and internationally as the first American Indian
Director of the Indian Health Service and
Rear Admiral and Assistant Surgeon General.
First American Indian Director of the
Directing the Indian Health Service
“I went to IHS in 1982 – a time of great transformation,” he recalls. In the previous four or five years, the organization had grown in size and complexity. It was more stratified, more corporate. As my predecessor, Emery Johnson, said, ‘IHS can no longer be run out of one’s hip pocket.’”
As Director of IHS, Rhoades was responsible for a national health care delivery program of preventive, curative, and community care for about 1.5 million American Indians and Alaska Natives. In time, the resources he had to oversee included 50 hospitals and several hundred clinics staffed by approximately 14,000 people.
During Rhoades’ 11 years as Director of IHS, the budget for the Indian Health Service’s budget grew from $617 million to $1.85 billion. Hospitals were built at Tahlequah, Oklahoma; Browning Montana: Kanakanak, Alaska; Crown Point, New Mexico; Chinle, Arizona; Rosebud, South Dakota; and Sacaton, Arizona. Three other hospitals were under development. Seven ambulatory centers were built and 5 were in progress. Ambulatory visits increased by 25 percent; dental services by 37 percent.
Rhoades worked hard to increase the involvement of Indian people in decision-making about their health care. “We established a much more formal process – and my successors have built on this – so Indian tribes across the country have a prominent and effective voice in shaping Indian health policy.”
Other accomplishments included upgrading research with an emphasis on local epidemiology, refining resource allocation and the rationing of care, and developing community programs that emphasized health promotion and disease prevention. In addition, Rhoades and his colleagues established a cancer detection and prevention program, a women’s program and a chronic diseases center.
During Rhoades’ tenure, IHS interrupted the largest outbreak of hepatitis B in North America, established a national adolescent alcohol and substance abuse prevention and treatment program, created the country’s leading fetal alcohol syndrome program, and mandated a smoke-free environment in all clinical and administrative areas.
Hopes for IHS
“We need some entity (and it might not be called the IHS) that has a central synthesis function,” says Rhoades. He explains that since 1990, there have been 3 different systems of Indian health services. First, there is a tribal system of care. Tribes who have contracts and compacts with the Federal Government, basically operate their own programs. Second, there are Indian populations that still receive services directly from the IHS. Third, nearly two-thirds of self-identified Indians are located in urban centers distant from IHS or tribal programs.
“Integrating and synthesizing in effect 3 different systems of care is a challenge that some agency (presumably the IHS for the next decade) must deal with on behalf of the Congress. Some of the tribes in this country don’t realize that every request for help that they make to the U.S. Congress gets referred to the IHS. The Congress can’t deal with 500 different entities coming to them with a variety of demands. Every year they turn these demands over to the IHS, asking IHS for feasibility opinions. Most people don’t realize what an extraordinary service the IHS provides to the Congress by doing this. That’s not to say whether what they’re doing is good, bad or indifferent. (I think it’s quite good). But that function is going to continue to be needed. And the country is going to have to deal more appropriately and effectively with those tribes that receive their services directly from the federal government. Soon the country is going to have to come to grips with the more rapidly increasing urban population.”
According to Rhoades, another challenge for the IHS and the whole country, even the world, is the rationing of health care. “There aren’t enough resources in any country of the world to provide all the health services that are needed, let alone demanded,” he asserts. Even though some people pretend it’s not the case, health care has always been rationed, and it will continue to be rationed. I think the IHS has tried to do this on a sensible basis. Some entity needs to do this task.
Another challenge that faces IHS and health care nationally and internationally is the fact that the doctor-patient relationship (the human side of medicine) is being negatively impacted by increasing regulations, paperwork that physicians have to complete, and pressure on physicians to see more patients. “There’s something magical about the physician-patient relationship,” says Rhoades. “I’ve felt this magic many times when I’ve sat up all night with a dying patient. We have to find ways to protect this relationship.”
Rhoades describes yet another challenge: “Far too many Indian people don’t have a satisfactory family situation. It breaks my heart to deal with children who have a home situation that would absolutely terrorize me if I were in their position. I don’t know how to make up for that. That will be a big challenge for several generations.”
Despite these challenges, Rhoades feels that in many ways the health of Indian people has been improving. “It’s not where we want it to be, but health and health services are getting better. A prominent epidemiologist once said to me, ‘Everett, if you have diabetes, you better hope that you’re Indian.’ In 2005 the services that are available to any Indian patient dealing with diabetes are much greater than the services that are available to the average non-Indian person who goes into the U.S. non-system of care.”
Rhoades feels confident that Indian people can turn the challenges they face into opportunities to continue to enhance Indian health.
Path into Medicine
Rhoades isn’t certain what drew him into medicine, but he suspects that he was influenced by the fact that his maternal grandfather was a physician and that there were a number of traditional healers on his grandmother’s side of the family. He also enjoyed science. As he reflects on his career, he says, “I think I was fated to become a physician.”
About 1895 Rhoades’ non-Indian grandfather, who came from a prominent family in Stamford, Connecticut, traveled to the Kiowa, Comanche and Apache reservation in what was to become rural SW Oklahoma. (This was before Oklahoma statehood in 1907.) While caring for patients in Connecticut, he had developed tuberculosis and wasn’t expected to live. However, while residing in the Mt. Scott area of the reservation, he made a somewhat miraculous recovery and married Rhoades’ Kiowa grandmother.
“After my grandmother died, we lived with him. Although he didn’t have an active practice at that time, people still came to his house to seek him out because they were suffering. I was struck by the kind of a calling that he had.”
Rhoades was also acutely aware of the prominence of his American Indian forebears as healing people. His continued respect for traditional healers is evident in his becoming a hereditary keeper of Kiowa Buffalo Medicine, a responsibility that he believes is too important and too sacred to discuss casually or publicly, a belief that he feels extends to what he calls “true Indian medicine.”
Dr. Rhoades in Kiowa gourd clan regalia
In Rhoades’ article in the Summer 1996 issue of Winds of Change entitled “Two Paths to Healing,” he wrote that during his tenure as Director of the IHS, he didn’t establish a corps of traditional Indian consultants. “I belong to the group that feels strongly about the sanctity of Indian medicine and believe it would necessarily become trivialized if it were to become part of the ‘bureaucracy.”
During the Great Depression, Rhoades attended a one-room country school. Only 36 students were in his high school graduating class. The sciences, such as chemistry, were taught every other year.
Rhoades attended Lafayette College in Easton, Pennsylvania on a scholarship. For financial reasons, after three years of college, he applied to, and was admitted to medical school. He considered attending the MCP Hahnemann School of Medicine from which his grandfather graduated in 1895. He decided instead to return to Oklahoma and study medicine at the University of Oklahoma.
Rhoades was the first member of his tribe to receive a doctoral degree. After receiving his MD, Rhoades spent a year at Gorgas Hospital in the Canal Zone doing a rotating internship, in which he spent time in all of the major specialties. The residency slots in internal medicine at Gorgas were closed when Rhoades belatedly decided he wanted to be an internist. Fortunately, he was able to complete his internal medicine residency with a sub-specialty in the relatively new field of infectious disease at the University of Oklahoma Medical Center.
In 1957 when Rhoades began his residency training, he entered active duty in the U.S. Air Force. He was paid at a lieutenant’s salary. Following his residency, Rhoades did his payback for 5 years (1961-1966) at 800-bed Wilford Hall Hospital at Lackland Air Force Base in San Antonio, Texas. Rhoades established and become chief of a new infectious diseases section, which over time included 80 inpatient beds, a large outpatient service, and an active clinical research program. Rhoades directed patient care and teaching, guiding the work of 5 full-time physicians, 4 residents, interns, and fellows. He remembers it as a “fabulous” experience.
Working with His and Other Tribes
Rhoades returned to Oklahoma from the Air Force in the late summer of 1966. “This coincided with the appointment of Robert Bennett, Oneida, as the Commissioner of Indian Affairs. Bennett made a tour through the U.S. getting acquainted. He came to Oklahoma City to meet with all of the tribes. I was interested in doing something with my own tribe, so I went to the meeting.
Rhoades’ tribe put him right to work, helping them organize themselves. In 1961 the Comanches had withdrawn from the former Kiowa, Apache and Comanche business committee and established their own governance and constitution. The Kiowas were left with the Bureau of Indian Affairs running all of their business. “We had no organization of any kind. More programs were becoming available through the old Office of Economic Opportunity. So I became very heavily immersed in Kiowa activities. I was elected to serve on an Interim Committee to get the constitution and other programs underway.
“This period also coincided with a greater interest in seeking advances in health. In 1954 the responsibility for Indian health care had been transferred to the Public Health Service. This led to the creation of the Indian Health Service in 1955 when I was in my senior year in medical school. So I became more and more involved in local, regional and national matters related to Indian health.” (For example, Rhoades was a founding member of the Oklahoma Area Health Advisory Board and the Committee for Long Range Planning of the IHS. He sat on the health committees both for the National Congress of American Indians and the Association on American Indian Affairs. In 1976 he was active in securing the passage of the Indian Health Care Improvement Act.)
University of Oklahoma (1966-1982)
Rhoades returned to his alma mater, OU, to establish an infectious diseases section and direct patient care, research, and teaching. During this period the infectious diseases section became nationally recognized for its teaching and research in the fields of nosocomial infections (infections originating in the hospital); tuberculosis; and fungal diseases. Again Rhoades guided full-time physicians, residents, interns, and fellows.
Rhoades loved teaching. “Of all the things that I ever did in my career, I believe that was the most unadulterated joyful activity. I particularly loved the bedside teaching of medical residents where we’d work through a complicated case together. The application of the exploding fields of physiology, and biochemistry to a living human being was the highest form of enjoyment for me in medicine.”
Association of American Indian Physicians
Margaret Knight, Executive Director of AAIP and Dr. Everett Rhoades
In May 1971, Rhoades identify 14 Indian physicians and brought them together to organize the Association of American Indian Physicians (AAIP). “I learned a lot from that experience,” Rhoades remembers. ”I was anxious to get some bylaws passed. I was eager to form an organization and have us agree on what it would look like. But we couldn’t do any business until every individual told his or her personal story.
“Almost without exception, each individual, in order to go to medical school, had to make a severance of some kind with his or her reservation or local community. When they returned to their home community, they weren’t automatically accepted. They had to re-earn entrance back into their community. I can imagine that some were regarded as changed, no longer quite Indian.
"Our mission was three-fold," recalls Rhoades. "First, we wanted to increase the numbers of Indian students entering a health field – not just medicine. Second, we wanted to provide mutual support to each other. Third, we wanted to pool our resources – primarily our intellectually and professional resources – to share our collective wisdom to the betterment of Indian people through health. Our dominant activity, of which I’m most proud, has been getting Indian students interested in careers in science and the healing arts and then assisting them in getting into and through medical school by mentoring and other activities.
Rhoades became the first president of AAIP. In 2004-2005, he again served as president. In his Presidential address, as he reflected on the intervening years, he said, “Despite the advances that have been made on all fronts of Indian health in these 30 years, the health needs of Indian communities remain acute. Particularly needed are implementations of prevention and treatment programs that will relieve the burden of illness that rests upon Indian communities. At the heart of our survival as Native peoples is the restoration of a harmonious relationship of each individual with all of nature. The challenge is even greater, depending as it more and more does upon change in individual behavior in order to achieve this goal. In this regard, I urge the Association to recognize that healing begins within each one of us, and that our contributions in the field of health are enhanced to the degree that each of us finds this harmony within ourselves.”
In 1993, just before Rhoades left IHS, Dr. Mathuram Santosham who had recently founded the Johns Hopkins Center for American Indian Health asked Rhoades to develop an education program for the Center. “I couldn’t say, ‘No,’” says Rhoades. Rhoades consulted with the Hopkins Center for 7 years. Besides developing curricula and teaching, Rhoades established the first Internet course on Indian health. He also edited a well-regarded book entitled American Indian Health-Innovations in Health Care, Promotion and Policy. (Johns Hopkins University Press, 2000).
University of Oklahoma Again
When Rhoades left the IHS, Dr. Douglas Voth, an old infectious disease colleague who was then the Executive Dean of the University of Oklahoma School of Medicine, asked him to return to the university as Associate Dean of Community Affairs. Rhoades task would be to broaden rural health care for the university. “I told him that I was retired but would do it on a part-time basis,” Rhoades recalls. One of the accomplishments of which Rhoades is most proud was the establishment of a family medicine residency program in SW Oklahoma (Lawton) where he was raised.
As Rhoades was trying to wind down his work in the OU School of Medicine, the Dean of the College of Public Health at OU asked Rhoades for his help in renewing the Centers for Disease Control’s support for the Native American Prevention Research Center. Again, Rhoades couldn’t say no, so he became Associate Dean for Community Affairs for the College of Public Health and Director of the Native American Prevention Research Center. Wearing his Community Affairs hat, Rhoades established closer working relationships with Oklahoma communities, local and national tribes, the IHS, the Bureau of Indian Affairs, and other entities. Wearing his research center hat, he helped secure the renewal for the center and he oversaw investigations on such topics as the prevalence of asthma among American Indian school and the effects of mild walking exercise.
Rhoades has had 3 retirement parties, but none of them took. With his energy, optimism, and deep sense of service, he remains involved in Indian health and other work. “My major activities at the present time are serving as a voluntary, lay assistant to the Indian Health Board of the 7 tribes of SW Oklahoma that are involved in the Lawton Service Unit.
Capacity building with Lawton Service Unit of IHS
I’m on the board of the Oklahoma City Indian Clinic, which is a state-of-the -art, world-class clinic with fabulous people. [See the profile of Robyn Sunday-Allen, CEO of the clinic.]
“I consult with the Strong Heart Study, which I believe remains one of the largest prospective, most comprehensive, multi-center studies in Indian health that has ever been devised. I work with fabulous scientists.
“I’m a little busier than I had wanted to be. I guess I’m not really retired,” he admits with a smile.
This article was originally published in the Winter 2006 issue of Winds of Change. (The cover artist, Roxanne Chinook, is a tribal member of the Confederated Tribes of the Warm Springs Indian Reservation in Oregon. "My art emulates a personal and cultural experience, from the spirit of the trickster to healing from the traumas of my past." For more conformation, contact American Indian Art from the Pacific Northwest.