George Blue Spruce Jr.
George
Blue Spruce Jr., DDS, MPH, an enrolled member of the Pueblo
Tribe (Laguna/Ohkay-Owingeh), DDS, MPH, is the first
recognized American Indian dentist. He was also the first
American Indian dentist to be given the title of Assistant
Surgeon General. Although he officially retired in 1986, he
has continued to work hard to enhance the health of
American Indian people and to encourage Indian people to
become dentists as well as leaders in the other health
professions. In 1990 he was instrumental in founding
the Society of American Indian
Dentists.
Today he is Assistant Dean for American Indian Affairs at
the Arizona School of Dentistry & Oral
Health.
The following interview was first published in 1999 but
updated by Dr. Blue Spruce in 2009.
First American Indian Dentist
What
are some of the things that you want American Indian young
people to be aware of when they are considering careers in
dentistry or the other health professions?
Young people considering these careers need to make a solid
commitment, because it will take 8 or 10 years before they
are ready to go out into a clinical practice of some sort.
There also needs to be commitment and support, particularly
in the early years, from the parents, the immediate family,
the extended family, the community, and role models.
Students need proper counseling so that they take the
correct courses and don’t need to play catch up when they
enter college. Sometimes Indian youngsters who don’t have
support get discouraged, and their self-esteem is damaged.
This can lead to early dropouts.
Why do you feel that American Indians should consider
careers in the health professions?
That’s very easy to answer. According to the last census,
there are approximately 4 million American Indians in the
U.S.. The Indian Health Service has been the federal agency
responsible for their needs, but in recent years under the
Self-Determination Act, Indian tribes have been taking over
a lot of their health care delivery systems. Unfortunately,
very few Indians are in the health care system at a
meaningful leadership level where they can be the ones that
assess their people’s health care needs, set up the
priorities, and manage and control the health care
programs. As a consequence, non-Indians still assume these
leadership roles for these programs. What is really
disappointing for me is that although it has been almost 55
years since the Indian Health Service took over health care
from the Bureau of Indian Affairs, the Director of Dental
programs is still a non-Indian.
For many years I worked to encourage Indian young people to
graduate from high school. I then encouraged them to go
into the various disciplines in the health care arena. In
recent years I’ve concentrated on increasing the numbers of
Indian people who are doctors. It’s at the doctorate level
that you have the golden key to open up doors. You can go
into the meeting rooms and be heard. You can be part of
decision making. In the United States it’s the medical
doctor or the doctor of dental surgery that has these
opportunities to be heard.
In 1990 I helped organize the Society of American Indian
Dentists. From that
time our society has been working on increasing the
number of Indian dentists. I think we’ve been
successful. For 19 years I was the only identified
Indian dentist. The second one graduated in 1975 with
others to follow. In the 1980s the numbers picked up
when federal programs were beginning to fund dental
schools to increase the numbers of Indian dentists and
minority dentists. In the 1990s we picked up our largest
numbers of American Indian dentists, and we've continued
to increase in numbers during the present decade, with
the accurate numbers still to be forthcoming.
We have strict criteria for who is identified as an
American Indian dentist. The Association of American Dental
Colleges says that over 450 American Indians dentists have
graduated from dental schools. This is a shock to me
because I know that a lot of students who identified
themselves as Indians did so without valid documentation
that they actually belonged to an American Indian tribe. In
order to become a member of the Society of American Indian
Dentists, you have to have documentation from your tribe
that you are an enrolled member. When we count the number
of dentists who are enrolled in a federally recognized
tribe, we find that there are about 120 American Indian
dentists.
It hurts someone like me to know that so many people went
through dental school claiming to be American Indians, and
now they are no where to be found. The schools got funded
because they counted these people as American Indian
dentists. Now you can’t find these people because they’ve
submerged into suburbia somewhere and are in private
practice. Our Society of American Indian Dentists is all
about trying to encourage our American Indian youngsters to
pursue careers in dentistry and come back and serve Indian
people.
Another tragic piece of data is that there is only roughly
one American Indian dentist for every 32,000 America
Indians. In contrast, there is about one non-Indian dentist
for every 1,200 non-Indian people in the U.S.. This means
that to have parity (a dentist/patient ration that matches
the non-Indian U.S. population), we need approximately
3,000 American Indian dentists.
Indian Health Service scholarships have been ongoing since
the later 1970s. I wrote the first draft of Title 1 of the
Indian Health Care Improvement Act in 1974. Title 1
provides for scholarships for American Indian students. It
was written for the doctorate professions. Now it’s open to
over 20 different disciplines. The proviso in that
scholarship is that for every year that you get a
scholarship, you have to pay back services in an Indian
community. It’s a really good scholarship because it
provides not only your tuition, your books, instruments and
supplies but also a stipend. I’m happy to report that we
are beginning to get a cadre of Indian doctors out in the
community as a result of that scholarship.
Are there any particular kinds of dental health
services that are being neglected in the Indian population?
GBS: Yes. The budget is not increasing to keep up with the
demand and with the great unmet dental need in the Indian
population, so priorities have been set up regarding who
should be seen first and what types of disease patterns
should be addressed first. This means that you don’t have a
comprehensive dental health care delivery system occurring
in most communities. The care is based on how far our
finances will go. The priorities, understandably so, are
for the problems of children, adolescents and for
emergencies, such as tooth decay, bone and gum disease and
the consequent fabrication of dental prosthesis.
Some children who are less than 10 or 11-years old already
have massive decay. They carry this problem into their
adolescent years when they have part baby and part
permanent teeth. Some children have diseases that typically
don’t occur until the adult years. This is tragic but not
as bad as it used to be.
This massive turnover of dentists in the Indian community
is also a problem and results in many vacant dental
positions. There are non-Indians who are making a career of
serving Indian people, and credit needs to be given to
them. But a lot of non-Indian dentists on the reservations
are there for two years as part of paying back their
student loans. As soon as they finish their loan
forgiveness, they go into private practice. A lot of Indian
people refer to their dentist as “the two year doctor”.
Many Indian people, like other people, are apprehensive
about going to a dentist. When they find one that they are
finally comfortable with, it’s a sad day when that dentist
announces that he or she is leaving.
We don’t have the data yet on whether Indian dentists who
go to an Indian community stay longer than non-Indian
dentists do. But hopefully an Indian will stay longer and
provide the continuity that the people need.
Could you elaborate please on some of the challenges
facing Indian people who want to become dentists?
A lot of Indian students don’t have a grandparent or a
parent who was a dentist, so these students are the first
generation trying to pursue this career. Parents who have
not gone to college may encourage their children from their
heart and soul, but many of these parents won’t be able to
guide their children through the prerequisite courses and
other things that they’ll need. That youngster will have to
go some place else for that help.
Thank goodness, since the Indian Health Service was created
in 1955, there have been training programs for auxiliary
health care personnel. A lot of Indian people trained under
those programs and became dental assistants, licensed
practical nurses and so on. Some of them encourage their
children and other children in their extended family to
pursue a career a little higher than they attained.
There aren’t enough Indian role models. I can’t tell you
how many times Indian youngsters have told me that I’m the
first Indian doctor that they have ever seen. Some Indian
doctors who are graduating tell me that when they first saw
me years ago, they realized that there was a real live
Indian dentist and that if I could become a dentist, so
could they.
Counselors can be a problem, though they aren’t the problem
that they used to be. When I told my counselor that I
wanted to become a dentist. My counselor said, “Blue
Spruce, that sounds like an Indian name. Are you an
Indian?” I said, “Yes.” The counselor said, “What do your
mother and father do?” I said, “Well my father is a cabinet
maker and my mother is a cook at the Santa Fe Indian
School.” So my counselor said, “You’ll never make it
through to become a dentist. First of all, your folks
probably couldn’t afford it. Secondly, there are no Indians
who pursue doctorate health careers. Indian people are
dropping out of high school, and those very few who have
gone on to college are not making it either, so you should
probably consider another career.”
If I didn’t have folks that were so encouraging, I probably
would have believed the advice of my counselor and not
pursued a career in dentistry. That was 60 years ago, but
Indian students are still telling me that counselors are
not giving them the support, advice and knowledge that they
need. And students tell me that it’s challenging to deal by
themselves with a very difficult curriculum, when their
roommates and others are college-prepared and come from a
family of doctors.
Also, some Indian students are used to a different life
style. When I went off to school, I left my family for the
first time, and I went to a big city for the first time.
When everybody went home for vacation, I was left as the
lone student in the dormitory. In my day you couldn’t
telephone home. If you were lonesome, you just had to bear
it.
Another problem is that the minute your peers find out that
you’re an American Indian, you become different. I was
asked every question in the book about American Indians,
and here I was trying to be like everyone else. When I went
home, I went to the museums and learned all about Indians.
Now we are setting up programs in the schools so Indian
students can have support systems. That’s helped a great
deal. Students don’t have to feel so alone any more.
Eventually Indians students reach what I called my “comfort
zone”. When I went into my clinical years, it was like I
was home free. I was able to interact one-on-one with
patients. I had the skills. Then my esteem just blossomed
because I felt that I was doing just as well as anybody
else. And I felt very, very proud when I graduated. And I
did well.
What
a wonderful story.
My story can be duplicated today. Today students relate to
what I tell them were my problems, my obstacles. I tell
them what I had to do to overcome. It’s not easy. It takes
an extraordinary person to do it, but if you have the
support system, you can.
Can
you back up a little in your own story and talk about what
led you to be interested in becoming a dentist.
My mother and father were very, very strong supporters of
my brother and sister and I getting a college education
because they didn’t have that opportunity. They were
frustrated because they were bright, intelligent people.
They worked at the Santa Fe Indian School for 27 years.
They reached a level where they couldn’t go any higher, so
their pay and benefits remained the same. But they saw
non-Indian people, coming out of college, coming to the
Santa Fe Indian School, taking over the leadership roles as
teachers or administrators. Immediately these people got
more pay and benefits then my parents had, so my parents
swore that their kids were going to get a college diploma.
My dad in his endeavor to make sure that we were going to
be prepared for college put my brother and I in the all
boys Christian Brothers School in Santa Fe because he heard
that they were strict disciplinarians who prepared students
to go to college. I graduated as valedictorian from that
high school.
While we were youngsters, my father wanted us also to pick
up skills and be in contact with influential role models.
As a result, my brother and I were probably the only two
Indians who participated in teen-age events that were
sponsored by various organizations in Santa Fe. I was
reticent because I was a fat little kid and very, very shy.
One day before a bicycle derby, Dr. Renfro, the man who was
always in charge of all of these events, took the time to
put his arm around my shoulder and wish me luck. He
comforted me in my nervousness and gave me words of
encouragement.
I admired Dr. Renfro. He was a leader in the community. It
just so happened that Dr. Renfro was a dentist. I decided I
wanted to become a dentist, not because I knew what the
profession was all about, but because Dr. Renfro was a
dentist, a leader, and a kind man.
Then I began to take interest in what dentists did. As a
youngster I once had a rather negative experience as a
dental patient. I hoped that I would become a better
dentist than the one who made me feel so uncomfortable.
Several months ago I had the honor of giving an address at
my alma mater, Creighton University in Omaha, Nebraska.
Some of my former classmates who heard the lecture told me
that when I was a freshman, I was already telling people
that when I graduated from dental school, I was going to
return home and work among my people. Later when I attended
my high school reunion, my high school classmates told me
that even as a high school student I said that I was going
to work as a dentist among my people.
When I went to the forty-second reunion of my dental class,
my classmates were part serious, but in a kidding way they
said I was such a good dental student that it was a shame
that I didn’t go out into private practice and be a
successful private practitioner. I knew what they meant was
that like a lot of them I would have made a good income and
provided very well for my family. Yet after all these
years, I’m the only one who never went into private
practice because I spent all my years working with Indian
people.
I imagine that you’ve given to your family in wonderful
ways.
They’re very
proud, and I’m very glad to have this caring family that
appreciates me.
Do
you have children?
Between the wife and I—this is a second marriage—she has 3
and I have 3. Between the 2 of us we have 10 grandchildren.
How wonderful! You went to Creighton University. Where
did you go to dental school?
I also did that at Creighton. When I was graduating from
Creighton and taking my state board exams and my national
board exams, my classmates and I swore that as long as we
lived we would never take another exam or write another
paper. But 10 years later, in 1966, I enrolled at the
University of California in Berkeley and went back to
school for the master’s in public health.
Why
did you choose to do that?
In 1963 I was
on a panel at the annual convention of the American Dental
Association. I talked about being the only Indian dentist
working on a reservation in a big health care system for
Indian people. I said that the health care policies being
developed for Indian people in many instances did not fit
because they were designed for the non-Indian population.
When seeing Indian patients for the first time, you don’t
just say, “Hello. I’m your dentist. Let’s get started.” In
many cases this was the first time that Indian people were
receiving dental treatment of any sort, so there had to be
a lot of TLC and patient education associated with it.
This caught the attention of people at higher levels. I was
told, “You could do more for your American Indian people as
an administrator than working one patient at a time. If you
got the credentials, you could probably be in a position to
set policy and priorities."
Unfortunately, I had many obstacles along the way and was
very discouraged. There were problems that didn’t allow me
to do the things that I would have liked to have done. The
federal government policy and the way they do things tends
to tie your hands to a large extent.
I had a varied career that took me half way around the
world doing other things than dentistry. When I finished my
career it was in Phoenix as Director of Health Care
Delivery Systems for all Indian people in the states of
Arizona, Utah, and Nevada. That job was very rewarding. I
retired in 1986.
Right now I’m all about trying to produce more American
Indian doctors, physicians and dentists primarily, so I
work very closely with the Association of American Indian
Physicians. In the 1970s when you talked about doctorate
level professions, you could hear your echo. Now the Indian
youngsters talk not only about being doctors but what
specialty they want to be in.
Is
there any other advice you’d like to give to readers who
want to go into the health professions?
Yes, my advice would be: If you like helping people in a
most profound way, then there can be no greater
satisfaction than the rewards one receives by being a part
of a profession that is all about relieving suffering and
pain. You are in that unique position to give comfort to
those afflicted with disease and have come to you for help.
You are a member of a proud group of dedicated individuals
that have been educated in the best institutions in the
world. If you are an Indian health professional, the need
for your services are abundant and the challenges are
immense but probably more fulfilling because you know you
are helping someone truly in need. And often times you may
be the first and only Indian health professional the people
you are serving have ever seen.
This
article was originally published in the Autumn 1999 issue
of
Winds of Change. (The cover
artist, Sam English, is a descendent of both the
Turtle Mountain Band and the Redlake Band of Ojibwe
Indians. He lives in Albuquerque, New Mexico. For more
information call (505) 275-0696.)
Update
2010
Dr. Blue Spruce’s book, Searching for My Destiny, is being
very well received. He has already done 4 book signings and
has 4 more signs scheduled for the next few months. He
appeared on NPR’s “Native America Calling”.
Update
2009
At the end of
2009 the University of Nebraska released
Searching for My Destiny, a book about
Dr. Blue Spruce's exciting, highly-contributory life. The
book is authored by George Blue Spruce Jr as told to Deanne
Durrett.
In an article entitled "Tribal members recruited into medical
fields," in the
April 27, 2009 issue of The Arizona
Republic, William
Hermann pays tribute to Dr. Blue Spruce's work in
recruiting American Indian people into the health
professions.
The second photo of Dr. Blue Spruce is by Cheryl Evans of
the Arizona
Republic.