Take a Stand & Propose a Solution on Hepatitis C
Historically, the Indian tribes of northeastern Montana were first ravaged by outbreaks of smallpox, and then by both malnutrition and starvation as the great buffalo herds dwindled to nothing. More recently, the Native population from that part of the state, which now lives on the Fort Peck Indian Reservation, has suffered from the effects of diabetes, alcoholism, and drug addiction to the point that people on the reservation live shorter lives than anywhere else in Montana. Now, another killer has made its presence known—Hepatitis C.
Although Billings and Yellowstone counties have the most cases of Hepatitis C in the state, Roosevelt County, where the Fort Peck reservation is located, has more documented cases of Hepatitis C per capita than anywhere else in Montana. Out of approximately 11,000 people residing in the county, there have been nearly 500 cases reported in the last seven years—an astonishing rate of one case for every 22 residents (State of Montana, 2012-2013). Patty Presser, a resident nurse on the Fort Peck reservation, calls the rates “staggering.” From a mere 22 cases reported in Roosevelt County in 2007, Hepatitis C affected 115 new victims in the county in 2013 and nearly 200 people in the last two years. This is rapid growth for a disease unknown in the United States until 1989 (Presser, 2014).
Presser blames the sharing of needles, used in both drug use and tattooing, as being the main culprit in the outbreak of Hepatitis C on the reservation. Presser sees the number of cases continuing to rise, as the poor quality of life, unhealthy lifestyle choices, and hopelessness brought on by the social and economic factors contribute negatively to the current crisis. Still, Hepatitis C is not just an “Indian problem.” As Presser cautions, “Although most cases of Hepatitis C are reported among Native Americans, some of that is because the Indian Health Service does more testing for that disease than do clinics and hospitals found in non-tribal areas” (Presser, 2014).
Presser believes the number of cases of Hepatitis C on the reservation will decline if we can decrease drug use and bring stability to families. Presser sees a change in the economics and policies of the reservation as being the key to accomplishing these goals (Presser, 2014).
Kris Four Star, Fort Peck Tribes Health Department communicable disease officer, sees a more practical solution. He believes since injection drug use is the main cause of Hepatitis C in Indian Country, and since the Fort Peck tribes are sovereign and have their own health code, tribes could reinstate a now defunct program that would provide sterile needles and clean supplies to addicted drug users (Scott, 2009). Studies have indeed shown such a program to be an effective tool in reducing Hepatitis C rates (Scott, 2009). Right now, health departments often refuse treatment to a Hepatitis C patient if the affected person is currently using drugs. A drug user often refuses to reach out for help anyway. So by at least providing sterile needles, the community is providing a measure of help to a population that right now is receiving too little aid because of a lack of money, manpower, or understanding.
Hepatitis C puts a real strain on local community resources. “The average cost of treating one Hepatitis C patient is $20,000,” says Presser. On top of that cost, liver failure is a very expensive condition to treat. There are lengthy and repeated stays in the hospital, life-flights, and costly liver transplants—if a patient can even get a donated liver (Presser, 2014). Presser says that Project ECHO (Extension for Community Healthcare Outcomes) is one treatment option on the reservation that has offered huge benefits to local health departments. Although this treatment is available to Native Americans, there are no county or state resources available to Hepatitis C patients at this time.
Presser would like to see the county, state, and tribal departments work as a team to educate the public about Hepatitis C. Asked about the education programs currently in place, she replied, “There are really none at this time.” Healthcare workers would like to come into the junior high and high schools on the reservation and educate the students. The sooner children are warned about the causes and effects of Hepatitis C, the more likely they will be to abstain from drug use involving syringes and needles. Education about the disease could be provided through the Drug Abuse Resistance Education program (D.A.R.E.) in order to reach children between the ages of 10 through 13. At the junior high and high school level, health classes will need to put just as much emphasis on Hepatitis C as they do on HIV/AIDS” (Presser, 2014).
It should be mentioned that not all people with Hepatitis C are drug users or unsavory characters. Many victims of the disease contracted it through normal blood transfusions before safer methods were instituted in 1992. Because of stereotypes, many of these innocent victims fear being ridiculed by people in their own community and may be afraid to speak out about the disease or to even seek help.
Overall, the medical field has made substantial progress in diagnosing and treating Hepatitis C and in discovering new medications to help patients recover from the effects of Hepatitis C. It seems that it will be only a matter of time before a vaccine will be developed that will fully eliminate the virus and save hundreds of thousands or even millions of lives. Still, much more funding and health care resources will be needed nationally before this goal is realized. Not having those funds or resources locally, education about drug abuse and its effects is our best bet to decrease the rate of Hepatitis C on the Fort Peck reservation while we wait for medical science to come up with a miracle drug to treat it.
Adam Denny resides in Wolf Point, Montana, on the Fort Peck Indian Reservation. He attends Fort Peck Community College, is a member of the Phi Theta Kappa Honor Society, and hopes to work for the Montana Highway Patrol upon graduation.
Presser, P. Communicable Disease Nurse at Roosevelt County Health Department (Interview). 20 Nov. 2014.
Scott, T. (2009, October 11). AIDS, Hepatitis C Cases Increasing in Montana. Missoulian, p. 1. Retrieved at: <http://missoulian.com/news/local/aids-hepatitis-c-cases-increasing-in-montana/article_52e17ec6-b622-11de-be68-001cc4c002e0.html
State of Montana, Department of Health and Human Services. (2012-2013). Montana Infectious Disease Information/Reporting System: Case counts of viral hepatitis by jurisdiction of residence.