TOKELAND, WASH. -- The baby boy's parents want another name for him, a name in a language most of his people have forgotten, an Indian name.
His mother had nine miscarriages before he was born. So his father is looking for a word from the old language that means "something I've been waiting for a long time, a special gift."
Cash Christopher Rosander is one small reason for rejoicing in the Shoalwater Bay tribe of American Indians.
But his arrival is shadowed by a threat to the tribe's future: a mysterious inability to reproduce. Of the tribe's 27 confirmed pregnancies from 1987 to 1992, only 10 children have survived. Many young couples have given up trying to start families.
When Cash was born, the tribe celebrated, tentatively. "There was a baby blessing to introduce the baby and to say thank you to the Great Spirit for giving us a child," said his father, John.
In the sweat lodge ceremony -- in which steam is used to purify the body -- the hungry baby "screamed and screamed and screamed," his mother, Annie, said while affectionately blowing against the baby's cheek, making bubbling noises.
"He was letting the Spirit know he was there, too."
But tribal Chairman Herbert "Ike" Whitish can't stop thinking of the infants that didn't make it as far as Cash has. He calls the group's troubles -- with stillbirths, miscarriages and infant mortality -- "bureaucratic genocide."
Births rare, life span short
There are 150 Shoalwaters remaining. Their average life expectancy is just 42, said Mr. Whitish, who figures he's got four years left. Something is the matter.
"Why is that? Why didn't the Indian Health Service ever stop to ask that?" he said.
The Indian Health Service (IHS), responsible for the tribe's health care, took two years to begin a study of the tribe's reproductive problems, he said. Then, tribe members felt the service's preliminary report blamed their health habits and ignored possible environmental causes, such as a dump a mile from the reservation and chemicals used on nearby forests, oyster beds and cranberry bogs. Six years since the tribe first wrote to the IHS about its need for prenatal care and more than 18 months since the tribe declared a health emergency, the Indian Health Service is still studying the problem.
"They didn't try to get questions asked. We wanted them to look at environmental issues and the IHS' lack of health care down in this area. There are no neonatal programs that most other tribes have access to," Mr. Whitish said. "We're on the brink of extinction."
The Shoalwater Bay Reservation in Tokeland, Wash., is a three-hour drive from Seattle, out on the damp Pacific Coast where the trees are covered with lichen, giving the land the eerie gloss of a sunny day when the leaves are first coming out. Logging trucks and elk-crossing warnings are often the only signs of civilization between towns. It's a long way from sophisticated medical care.
The tribe is the poorest in the state -- 90 percent of its members live below the poverty line. Its mile-square reservation is a collection of fireworks stands, cigarette stores and cul-de-sacs with small homes. Yards have a variety of junked cars scattered around, some propped up on cinder blocks. It is all that remains of the "Land of the Fish Head Eaters." Denny Baker, who at 56 is the reservation's oldest American Indian man, said "I grew up with my grandparents, and they ate fish heads. I can't do it."
For those who can afford cars, the nearest IHS clinic is 82 miles away on the reservation of the Quinaults, traditional enemies of the Shoalwaters. The Shoalwaters say the Quinaults refused them care and discouraged them from visiting the clinic. Last April, the tribe decided to break with the Quinaults and manage its own health care, funded by IHS, through local doctors and hospitals. But both are notoriously overloaded.
With the help of funding from the tribe, and sometimes without pay, Dr. Mary Hodgson Rose of Seattle has run 11 clinics on the reservation. During those visits she discovered health problems that had been ignored for so long they became chronic.
Diabetic conditions rampant
Dr. Rose found 63 percent of the 75 people she tested were either diabetic or pre-diabetic. "Of course, diabetes causes a high rate of stillbirth, miscarriage and big babies that are very fragile and remain fragile," she said. "And people die young from it."
She estimated that the tribe's reproductive failure rate was 50 percent over three years -- half of all pregnant women either lost their babies before birth or did not see them reach their first birthday.
Dr. Rose said there was no indication that drug or alcohol use was a problem among the tribe's pregnant women. One tribal elder estimates that in the past five years, through a concerted sobriety effort, the tribe has gone from 99 percent drinkers to 85 percent nondrinkers.
Dr. Rose believes the tribe would have received better care without any IHS help.
"There's no question the service's resources have been distributed neither fairly nor on the basis of need," she said. "The Shoalwaters, as a small, isolated tribe, have been grossly under-served."
To help solve their health problems, the tribe decided to build its own clinic. It has received $550,000 in federal funding and needs several hundred thousand dollars more.
The tribe is not happy with IHS' efforts to help the clinic, especially with the congressional testimony of the service's acting director, Michael Lincoln, about the Shoalwaters' request for funding. "Mr. Lincoln said no less than 21 lies," Mr. Whitish said. "He said he made a mistake, but I know of no one except the Bureau of Indian Affairs that can make 21 mistakes at one time."
The alleged lies in Mr. Lincoln's testimony reportedly included his assertion that the tribe was only 30 miles from the nearest IHS clinic, and that the IHS immediately began a study of the problem, when according to the tribe it took two years. Before the study was even finished, he said it had ruled out pollution as a cause of the tribe's problems. IHS officials now say the study was never designed to look at environmental problems.
Though Mr. Lincoln declined to be interviewed, the service later admitted through the U.S. Department of Health and Human Services making "unintentional misstatements that may have contributed to misunderstandings between the IHS and the tribe." The service pledged to work with the Shoalwaters to improve their care.
James Floyd, director of the Portland, Ore., IHS office, said his office met with the tribe within two weeks after the Shoalwaters declared a health emergency in 1992, and that some of IHS' delays could be attributed to the way the Shoalwaters receive their care.
"Some of the information is just not brought to our attention," he said. "Most pregnancy cases are paid out of Medicaid, by the state, not the IHS. We're not managing those cases, so we're not aware of what's going on there. I think the tribe faults us for that."
A large pile of dirt in front of the Tribal Center is the closest thing to a sign of hope to be seen on the reservation. Beneath is the septic system for the clinic.
Mr. Whitish called it a leap of faith for the tribe to try to build a clinic. Some had wanted to do it cheaply, with trailers. "Anything we do has to be permanent," he said. "We've had things taken away in the past."