Everett Rhoades
Everett
Rhoades, Kiowa, MD, is having an exciting,
service-filled life as physician, teacher, researcher,
scholar, author of more than 100 scientific articles
and a book, 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
IHS
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
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.”
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.
Medical
Education
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.
Air
Force
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 Serve. 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
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.”
Johns
Hopkins
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.
Retirement?
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.
I’m on the board of the Oklahoma City Indian Clinic, which
is a state-of-the -art, world-class clinic with fabulous
people.
“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.