There is a lot of nonsense being written by all sorts about the late Senator Teddy Kennedy, but as a Senator, he was a hard worker for his constituents.

Yes, I know. Kennedy didn’t do such things personally, but he had a large and energetic staff to help him, and half the “trick” of being in politics is to find good people to work for you.

So my only experience with Senator Kennedy was a good one: He actually tried to help me keep my job working in an isolated, rural hospital where physicians were desperately needed, but where the federal bureaucrats were more interested in getting rid of a whistle-blower and keeping within the budget than with providing quality medical care to the Native Americans in that area.

Let me start at the beginning.

Thirty years ago, after leaving an African country in a hurry, I arrived back at the US without a job.

So I signed up to work with the Indian Health Service, in a physician poor area. Since the draft has just been eliminated, they no longer could order physicians to work at their facilities, so were desperate for help.

So, I ended up in a small 20 bed hospital in the US mid west.

The facility was basic, but the really hard part was the lack of diagnostic equipment. For example, Our lab was limited, so a lot of lab was sent out and took two weeks to get the results. But the worst problem was our X rays. We could take X Rays, we had to read them ourselves, with the “official” reading coming in two weeks later.

When I arrived to work at the hospital, the tribe itself was in the midst of a major rebellion against the IHS about this problem.

It seems that a middle aged man was diagnosed with simple “pneumonia”, but he actually had active tuberculosis, which was missed (something that is easy for non experienced physicians to do). And six weeks later, when he came back to the hospital, he was again treated with simple antibiotics, and not transferred until he started spitting up massive amounts of blood from his tuberculosis (hemoptysis) . As a result, this man, with an easily treatable disease, ended up dying during the long transfer to our specialty hospital.

So when I arrived, there were write ups in the press, and a lot of patient hostility against anyone who worked there. I not only was assaulted, but my window was shot out at one point (my joke is that I’ve lived through two wars in Africa, but the only place I was ever shot at was in the US).

Because of the complaints, we started transferring seriously ill patients much more aggressively, and messed up our budget.

But the “budgetary restraints” affected us in other ways.

One time, during a stint of cold Dakota weather, we lost our heating system. The nearest IHS hospital was 100 miles away, and full. The nearest civilian hospital was 40 miles away, and the “budget” couldn’t afford transfer for our inpatients to go to that civilian hospital.

So instead of closing the hospital for a week until it was fixed, we brought in electric space heaters.

There I was, delivering a baby with an electrical space heater, with the room temperature about 60 degrees.

No, no problem here, thank you.

But at least, that lady was delivered by one of us who knew how to do obstetrics. Some of our temporary physicians lacked this skill, and there was many a time that the nurses called me in to help with some problem (for which I was admonished that “he has a medical license, so you are not supposed to do this extra work”).

But the real reason I got into trouble was that I transferred too many folks. Those who I was worried I couldn’t diagnose with our limited laboratory and X rays got sent out. I was wrecking the budget, and telling official “visitors” that the place needed an upgrade “stat” or more people would die.

Not the way to make friends and influence people.

Well, anyway, when the administration thought it was easier to transfer me instead of fighting for improvements, I put in an official grievance against the administration, complete with chart numbers of patients harmed by our low budget.

Since I had worked in Massachusetts and kept that state as my official address, my Senator was Teddy Kennedy. So I wrote him a letter asking him to insure that the grievances be investigated.

Did the letter help? Yes and no.

The “grievance” was (illegally) lost by the local office, but a phone call from the Senator’s office to the Washington office resulted in them quickly finding the documents and sending them on for review, as mandated by law.

So what happened?

The dirty little secret is that whistle blowers are toast in the government.

So I was advised (off record) by my government advisor that my career would be miserable until they managed to get me fired for some minor reason.

So I went into private practice (in a physician poor rural town), and the hospital?

Well, eventually they fixed the problems–thirty plus years have  passed, after all– but there still are a lot of problems in that area, and few IHS docs like to work there because of it’s reputation.

You know, a lot of Senators don’t care about the problems of minorities unless they can get a lot of publicity.

But Senator Kennedy, coming from a state where Native Americans are not a major voting block, nevertheless was active in promoting their welfare.

(Nick) Rahall (D WV) called Kennedy “a tireless and long-time advocate for improving health care in this country and extending educational opportunities to Indian,” and stressed that “Senator Kennedy’s legacy will continue to live on in the hearts of all Americans.”

The subcommittee report …. cited the government’s failure to “understand the human needs and aspirations of the American Indian” as justification for the formation of a committee that would eventually become the Senate Committee on Indian Affairs.

Kennedy will also be remembered for his tough stance against IHS [Indian Health Service] budget cuts, as well as for his support for the Indian Health Care Improvement Act and Tribal Self-Governance.

So I will say a prayer for the late Senator, because despite all of his faults, he did get things done that helped a lot of folks, even though his work rarely got publicity.


Nancy Reyes is a retired physician living in the rural Philippines. She blogs at Finest Kind Clinic and Fishmarket, and writes essays at HeyDoc Xanga blog.

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