Health problems of American Indians will be targeted by new Hopkins center


He waved a black-and-white feather in all directions and, in a soothing and measured voice, asked his creator to bless a collaboration that may seem as unlikely as they come.

Ronnie Lupe, chairman of the White Mountain Apache Tribe in Arizona, set a spiritual tone yesterday for the opening of the Center for American Indian and Alaskan Native Health at the Johns Hopkins School of Hygiene and Public Health that will put the school's professors and students to work trying to solve the health problems that afflict Indians throughout North America.

It's a big job. American Indians are four times as likely to die of tuberculosis and twice as likely to die of diabetes as the general population. Only 60 percent of pregnant Indian women get prenatal care, and infant mortality is 50 percent higher than it is nationally, according to figures compiled by the public health school.

And among American Indians and Native Alaskans, motor vehicle accidents are the leading cause of death, outranking all other injuries and diseases. Many of the accidents result from alcoholism -- a problem that disproportionately afflicts Indians from Arizona to Alaska.

"Lighten their burden," Mr. Lupe said of the scientists who packed an auditorium, "so that achievement is around the corner like the sunrise."

The relationship began 20 years ago, when two professors traveled to the Apache reservation in Arizona to investigate the disturbingly high rates of diarrhea that were striking and -- in many cases -- killing infants there. They combined forces with the federal Indian Health Service to reduce that rate -- in large part, by introducing the use of oral rehydration therapy, a solution of water, glucose and essential minerals. Improved sanitation and personal hygiene also helped to reduce deaths from diarrhea, which had approached that of Third World nations. But much work remained: "While working on the diarrhea, we also realized that the population had a very high rate of meningitis, 20 to 50 times higher than the general population," said Dr. Mathuram Santosham, the center's director, who lived on the Apache reservation for six years beginning in 1981.

Meningitis, an inflammation of the brain and spinal cord, resulted from infections of the HIB bacterium.

While there were no licensed vaccines against HIB, Dr. Santosham and colleagues brought the infection rate down with a preparation made of the antibodies that adults produce in response to the organism.

"They worked extremely well, but they are very expensive and you had to give repeated injections" to give the babies continuous protection.

Commerical vaccines later went into use across the country but failed to protect many of the Indian children, whose immune systems simply didn't respond to the vaccines. The answer proved to be a more robust vaccine developed by the Merck

Sharp & Dohme pharmaceutical company and tested on Navajo children by Dr. Santosham and colleagues. "This one produces a good immune response at 2 months of age after a single dose," Dr. Santosham said of the vaccine, which was licensed last December.

The Hopkins presence on the Indian reservations grew to the point where the university now has 70 employees there, most of them Indians working as nurses, doctors and medical assistants.

They are spread out across the White Mountain Apache Indian Reservation and Gila River Indian Reservation, both in Arizona, and the Navajo Indian Reservation, a sprawling territory that occupies parts of Arizona, New Mexico and Utah.

The mission, which will now expand to other reservations, is to find solutions to the health problems afflicting American Indian cultures. The center will coordinate the various projects that are undertaken with diverse sources of funding, including federal, corporate and private grants, and the tribes that are being helped.

But hands-on health care is part of it, too. Dr. Raymond Reid, a Navajo physician trained and employed by Hopkins, works out of a clinic on the Apache reservation where he treats everything from childhood ear infections to respiratory infections and the myriad problems caused by alcoholism. He sees his role as that of a teacher, too. Parents, for instance, have learned from him how to recognize the dry lips, wrinkly skin and tearless crying that are hallmarks of severe dehydration -- and how to control the problem with oral rehydration therapy.

As the center expands its focus, he said, a key to success will be understanding the differences between tribes that mainstream America tends to lump together as one.

"I use this analogy," Dr. Reid said. We consider each of the nations in Europe to be different.

"It's the same way with the Indians. They have their own cultures, language, religions and ceremonies. A lot of people tend to lump all Indians together."

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