Somewhere in the depths of the internet, a review page for the Rapid City Indian Health Service Hospital displays a stark 2.4-star rating on Google. The experiences detailed in the comments paint a grim picture.
“It’s very clear that the mental health department doesn’t give two craps about their patients,” writes Madeline Sneve. “I can never get directly to a person through the phone, only their answering service. It’s no wonder why there is a suicide epidemic among Natives—no one takes our mental health seriously. There hasn’t been an actual psychiatrist staffed in years. It’s clear that the people who work here only do so because they can’t get work elsewhere. It seems there are only four people who genuinely care who work there.”
For years, Rapid City IHS has been one of the worst clinics for Native Americans in the Great Plains area. In 2017, the Indian Health Service and Congress jointly shut down the building’s inpatient care and emergency room areas. In 2021, the Great Plains Tribal Chairman’s Health Board took control of the hospital’s operations. However, due to severe underfunding—a familiar story to Native Americans nationwide—the quality of care at Rapid City IHS has improved only marginally despite numerous efforts. The sad truth is simple: Rapid City IHS isn’t an anomaly but rather exemplifies a larger crisis gripping Indigenous communities: systematic governmental neglect.
This neglect, like the spurning of other marginalized groups such as Asian Americans, African Americans, and Latinos, has deep historical roots. When the United States government first established the Indian Health Service in 1955, it was already building upon a foundation of broken treaties and unfulfilled healthcare promises dating back to the 1800s. Many treaties explicitly guaranteed medical care in exchange for land cessions, yet these commitments were consistently underfunded or ignored entirely. The Snyder Act of 1921 first authorized Congress to appropriate funds for Indian healthcare, but the amounts were persistently inadequate. Even after the Indian Health Care Improvement Act of 1976 acknowledged the federal government’s responsibility to provide healthcare for Native Americans, funding remained chronically insufficient.
This historical pattern continues today. The IHS operates on a fixed budget that must cover all healthcare needs, unlike Medicare or Medicaid, which adjusts to meet patient needs. When funds run out—often by mid-year—many facilities must restrict services to life-threatening conditions only, leaving preventive care and chronic disease management severely lacking. The phrase “Don’t get sick after June” is the dark reality for many Native communities.
The life expectancy for Native Americans in South Dakota, where the Native population comprises 11% as of 2020, is 57 years—over two decades below the national average. Yet the federal government spends only a quarter per Native American of what it allocates for inmates in federal prisons. While incarcerated individuals deserve adequate healthcare regardless of their crimes, it’s unconscionable that the original inhabitants of this land receive such drastically reduced care.
Given the poor state of Native-centered hospitals nationwide, many ask, “Why go?” While other hospitals near reservations accept Native American patients, even the most prestigious facilities often provide subpar care to indigenous peoples due to various factors, most notably cultural insensitivity.
Many Natives, especially elders, hold worldviews that distinguish them from the general population, making their care a task requiring particular skill and understanding. Traditional Native American medicine often takes a holistic approach, viewing physical, mental, and spiritual health as interconnected. Many elders harbor deep-seated mistrust of Western medicine, born from generations of systemic oppression and medical exploitation.
Implementing culturally aware healthcare could transform this landscape. This approach would involve:
Healthcare providers should receive comprehensive training in Native American cultural practices, beliefs, and historical trauma. This education would include understanding traditional healing practices, respecting ceremonial medicines, and learning appropriate communication styles—such as avoiding direct eye contact with elders in some tribes and recognizing the importance of including family members in medical decisions.
Facilities could integrate traditional healing practices alongside Western medicine, creating a bridge between both worlds. This might include dedicated spaces for ceremonial practices, partnerships with tribal healers, and incorporating traditional medication when appropriate and desired by patients.
Language accessibility is crucial—providing interpreters not just for Native languages but also for cultural concepts that may not translate directly into Western medical terminology. Healthcare providers should learn to explain medical procedures and diagnoses in culturally relevant ways, using familiar metaphors and concepts from Native traditions.
Such changes could significantly improve health outcomes by building trust, ensuring better treatment adherence, and creating healthcare spaces where Native Americans feel truly understood and respected. However, without adequate funding to support these initiatives and basic healthcare needs, even the most culturally sensitive approaches will struggle to make a meaningful impact. The path forward requires both cultural awareness and a long-overdue commitment to proper funding—a debt owed not just from historical treaties, but from basic human dignity.
These doctors and other healthcare workers do not need to be Native American, but instead simply care about the communities who have been cast aside by the federal government for far too long. Something that seems to be too much to ask.
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