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Carmelita
Skeeter addressing the crowd during a cedar ceremony blessing
April 15, 1998 at the groundbreaking of the IHCRC in Tulsa.
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For four decades, the Indian Health Care Resource Center of
Tulsa has provided quality, comprehensive health care to the city's
Native American people in a culturally sensitive manner. Born out
of a need to serve an urban Indian population underserved by the
city's existing healthcare facilities, the IHCRC has worked to eliminate
health disparities and strengthen the physical, mental, emotional
and spiritual wellness of those it serves. With the organization
since its inception has been Carmelita Wamego Skeeter, who currently
serves as chief executive officer and is a Citizen Potawatomi Nation
tribal member. Skeeter was recently honored by the IHCRC for her
four decades of service in building the organization into what is
today.
Born in Tulsa, Skeeter was a volunteer in her church's social
action group through a program called "Neighbor to Neighbor." Her
participation in the program, based in north Tulsa, helped residents
in need gain access to public assistance, housing and other social
welfare programs. This, combined with her active participation in
her two sons' school activities left little time for additional
work, but Skeeter made it work. She attributes her ability to multitask
to her role as the eldest of 13 siblings, a management background
unto itself.
"I'm high energy," Skeeter said with a laugh.
Some of those siblings were active with a program called Indian
Pupil Education, whose counselors knew of Skeeter's volunteering
and organizing with the Democratic Party. They approached her about
working for the Indian Health Care Resource Center to conduct a
needs assessment, which would be funded by the Indian Health Service.
Harking back to her role as eldest sibling, Skeeter said the
focus of healthcare issues was ingrained from a young age.
"When you're the oldest of 13 children, something's always going
on. They need healthcare," she explained. "And when you're working
with the poor, there's always the need for health, because if you're
not healthy you can't work, you can't be mobile, you can't do anything."
Healthcare services at tribal clinics, while often free to the
tribal citizen, are paid for out of allotted federal funds from
the Indian Health Service, third party billing from Medicare and
private insurance plans or even by revenues from the tribal nation
itself. Restrictions on funding from federal sources tied to jurisdictions
mean patients seeking treatment at a tribal clinic must get to the
clinic. Many of these facilities are in rural areas, far from major
metropolitan areas. Skeeter's 1976 needs assessment studied this
very issue. Along with her executive director at the time, Skeeter
investigated why Native Americans were not using existing healthcare
facilities in Tulsa, and why Native children were missing so many
days of school due to illness.
After personally visiting many of these facilities to understand
the reception given to Native Americans seeking care, Skeeter noticed
a startlingly trend. When checking in for service, she was questioned
about how the medical bills would be paid. Intake personnel would
ask a barrage of inquiries concerning her insurance status or whether
either the Indian Health Service or individual tribes would foot
the bill. When Skeeter responded that she would pay for the costs
of treatment, almost universally the response was for her to go
to the Claremore Indian Hospital, approximately 30 miles away.
"Indians in Tulsa were either going to Claremore or Tahlequah
or to Creek Nation facilities, meaning the mothers and fathers were
missing days of work and kids were missing days out of school. It
wasn't just a trip down there and right back. That's how we determined
that Tulsa needed a clinic for Indian people."
The IHCRC hired a grant writer to help find funding resources
while soliciting the federal government for money specifically for
Tulsa's Indian population. Eventually they secured the volunteer
services of a doctor in Tulsa and opened a small office for half
a day a week. The organization grew from there, with healthcare
equipment donated from military surpluses and World Medical Relief
and through contracts with the Women, Infant and Children Program
at Cherokee Nation. By 1978, after years of scraping together funding
and resources, the IHCRC hired a full time physician.
The organization is not funded by any one tribe, but is sustained
by its own fundraising and through monies from the Indian Health
Service. In 1976 the budget was $76,000, while in 2016 that figure
was approximately $20 million. From an initial count of four personnel,
today's roster of staff and health providers stands at 140.
Looking back at the challenges that the IHCRC encountered over
the years, the Reagan Administration's attempt to eliminate funding
for urban Indian populations stands out as a seminal moment for
Skeeter. As part of President Reagan's efforts at eliminating the
federal budget deficit, his administration cut funding for urban
Indians. Yet area directors of the Indian Health Service realized
the gap that the IHCRC and its Oklahoma City counterpart filled
in the state's healthcare system, and worked with Skeeter and fellow
officials there to compromise with Congress in order to save the
funding. The compromise, which began as an effort to stave off a
worst case scenario, developed into a significant victory for the
IHCRC.
"We would be part of Indian Health Service, a nonprofit and
still be able to seek private funding sources," she recalled. "This
was presented to Congress at the Indian Affairs Committee, they
passed it and in 1986 we became part of Indian Health Service. That
boosted our revenue tremendously."
The center began collecting Medicare and Medicaid at the same
rate as IHS, which it had not been able to do prior. Skeeter credited
that victory, and the center's continued success, on positive working
relationships with the state's Congressional delegation who has
advocated on the IHCRC's behalf through the decades. Like her counterparts
in the private sector might also explain, despite providing expanded
services to patients, the need never slows in terms of those utilizing
the center.
"I don't see that getting any easier," she admitted. "We continue
to have a major fundraiser once a year and continue to visit Washington
D.C. to explain how desperately Indian Health Service's budget is
needed, not just for our agency but for IHS nationwide. The challenges,
there's no end."
Despite having been at the IHCRC for more than four decades,
she said she looked ahead to tackle one continued impediment, a
lack of inpatient care services. Right now the clinic can only offer
outpatient services, and if specialty care is required, they can
only refer them to nearby tribal clinics.
"It's been a great ride," said Skeeter. "Our success is built
on collaboration, and if I feel good about anything it's that we
have been able to work in conjunction with the tribes, the federal
government, local government and agencies that meet needs that we
can't meet."
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