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.)
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”.
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.