The primary commerce hub in Duck Valley houses a Gas and Go, Western Family grocery, local deli and ACE hardware store.
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Howard tells stories of a time when the Shoshone-Paiute could canvas the high desert and walk the banks of the Boise, Snake and Owyhee rivers and find everything they needed for subsistence and good health. Rituals spawned remedies in the Bruneau and Boise valleys of the past and medicine grew and bloomed in sync with the seasons. The Shoshone-Paiutes enjoyed good health through tradition, culture and the natural wealth that sprang from the land. But for some, those traditions faded, culture morphed and they became surrounded by a society that no longer measured wealth by what was left for those yet to be born. And their health began to change.
"This is certainly a special place to us because it's where our people have survived for centuries. Everything that we needed was here," Howard said.
"Traditional people are connected to their land, to their environment," he added. "When people are not connected to their environment, it's more about them. They don't really have a connection to anything. Mainstream society today is that way. It's about making a profit today, and it doesn't matter what you leave behind. We're always concerned about what we're leaving for the next generation. We don't own this land. We're borrowing it from our children. So we want to leave it better than we found it."
The glimmer of gold slammed against those traditional values when prospectors discovered their first nugget below the surface of the Boise Basin in 1862. Where Native Americans saw a loan, gold diggers saw a profit.
"They wanted the Indians out of the way. We were in their way. So we were forced out of there," Howard said.
The Shoshone-Paiute who once scattered across the high desert of Oregon, Idaho and Nevada and followed the salmon migration into the tributaries of the Snake River were squeezed beyond the far northeastern reaches of the Treasure Valley, along parts of the Boise River now submerged beneath the reservoir water of Arrowrock Dam. The lure of natural resources wrestled away that last hold, and in 1877, the U.S. government corralled the Shoshone-Paiute onto the barren borderland desert south of Bruneau. The tribes entered into two treaties with the U.S. government, but Congress never ratified them, leaving southern Idaho technically in the hands of the tribes.
"The Boise Valley and the Bruneau Valley were never given to the United States. There's no legal exchange of land title. We still hold title to those lands," Howard said.
Treaties and loose agreements brokered land deals and the beginning of an introduction of Western medicine to Native American life. The first full-time physician joined the Duck Valley reservation in 1882, and in 1897, the reservation erected a one-room infirmary that later gave way to a hospital, compete with 20 beds, a laboratory and X-ray facilities in 1937. That facility operated until 1976, when the reservation opened the Owyhee Community Health Facility, which still operates today under limited hours.
The unratified agreements between the Shoshone-Paiute make the tribe a self-governing entity, meaning it doesn't fall under jurisdictions serving treaty-bound sovereign nations, including Indian Health Services. The tribe lobbies directly to the government for health care funds, and how the tribe appropriates and manages those funds remains up to elected tribal leadership. While funding spurts spawned the growth of the first local hospital from a one-room infirmary during the first half of the 20th century, the Shoshone-Paiute watched those sources dwindle as the tribe moved into a new century.
"We are seeing more and more cuts," said tribal elder Ann Jimmy.
"We used to have a full hospital. And it was really nice because you could be at home. But slowly, by slowly, they started taking things away from us because they couldn't afford it. And now it's down to probably the bare minimum," she added. "What's sad about it is because they can't treat us, either because they don't have the doctors to treat us, or because they're no longer open 24 hours like they used to, if you have an accident on the weekends, you have to get an ambulance to drive you out or you have to call a Life Flight helicopter to come in. And that costs thousands of dollars."
Some residents visit the local clinic but find health care gaps between the local primary care and the specialized care found in cities across the desert. Marissa Dick's last trip to the clinic included a pregnancy test and tuberculosis screening. Dick, 20, found out she was expecting her first child, received instructions to come back at 12 weeks gestation and given a due date.
"I'm not sure that's even my due date," Dick said. "I just go to them and they don't tell me anything. I guess I'll just Google."
Boise Weekly asked if she planned to confirm the due date and receive prenatal care from an OB/GYN.
"What's that?" she asked.
Boise Weekly told Dick about the funding cuts that left the reservation without the weekly visits from Brininger.
"That's crazy," she said. "Those are the people you need to keep hired. Being pregnant and having a baby for the first time, you want to know everything."
Duck Valley residents know that doctors come and go. They praise the skills of some of their favorite physicians. Some doctors appear fresh from residency. Some are recent immigrants who serve after just securing their medical licensure. And some land in Duck Valley for a moment before moving to a higher level in their medical career.
As a self-governing tribe with a medical system operated by tribal leaders, rather than IHS, the management and ultimately hiring of staff remain in the hands of the elected leadership. Community members say this doesn't give would-be docs a lot of job security on the reservation. A change in leadership could mean a change in doctors.
"It's hard to keep physicians around," Howard said. "For a lot of people, it's the remoteness that gets to them. Or sometimes a doctor will come for a while but their family doesn't want to come with them or there's no place for them. There's a variety of things that make it difficult here."
So they all seem to come and then go, Jimmy said.
"It makes it real hard to get a doctor-patient relationship going. You just a get a doctor who knows your history, that knows you, and then they go on. And then you get a new doctor in and they want to change everything. They want to change your medicines, everything. It's a merry-go-round," she said.
Native Americans are the only people born with the right to health care in this country. But their mortality and morbidity rates more closely parallel those of people born in Third World nations. The average American can expect to live to 78.2 years of age. A Native American's life expectancy varies greatly, with some tribes' average life span barely reaching 55 years old. People in Ghana and Bangladesh enjoy longer lives.
"When I was a child, someone dying from cancer was virtually unheard of. That was something that was not here. Our people mostly died of old age. But now we have even young people who are dying from cancer. Is there something in the environment? Is there something in the water? I don't know," Howard said.
Diabetes also draws concern on the reservation, he said.
"I think a lot of that is the result of the loss of traditional foods or the lack of using traditional foods. And a lot of it has to do with modern technology," Howard said. "Back in the olden days, people had to work for what they needed. Technology takes away the physical aspect of doing things. And also our kids are not getting out and being active. They're sitting at home, playing video games."
Howard, 65, grew up on a ranch, raising cattle across the expanse of the Owyhee desert. Chores and plenty of physical labor came with a lifestyle that faded out as fewer ranchers began running larger herds.
"And back then, we didn't even have inside plumbing. We had to cut wood and milk cows. Being the eldest, I was always out there working with my dad. And by the time the school bus came around, I had already put in a couple of hours of work. You go to school and come back and do your chores before it gets too dark. We did that every day. Now, looking back, I'm so grateful for that," he said.
"One day I said to my wife, 'Look at that ice out there. As kids, we used to ice skate a lot. You don't see anyone out there anymore," he added. "And when it was snowing, we'd be out sledding. You see a few kids out there sledding every once in awhile. But you don't see kids out doing physical things any more. I think a lot of that is leading to obesity and diabetes."
The impact of media is also changing the way of life on the reservation--particularly for the young.
"Those are the things our community is dealing with now," Howard said. "And of course, drugs. We don't have a lot of it, but we have some. A lot of these kids start looking at movies and such and start dressing like gangs and taking on that lifestyle. But we tell them, you don't have to be someone else. You have a lot to be proud of being yourself.
"We try to teach them that life is a gift. It is a gift from the Creator--you only have one body and you need to take care of yourself and not to consume things that aren't good for you. We always tell them that everything ends and begins with you."
Somewhere between the medicine man, whose traditions and knowledge of the Owyhee's plants and roots remedied the ills of Howard's ancestors, and the anticipated arrival of a health care system to cure the modern-day ailments of a people distanced from tradition, stands Mark Sope beside the ambulance, waiting for the next call.
"I know when I'm waiting for a helicopter, it can feel like forever, especially if it's critical," he said. "You make a connection with them. You feel for them. You may help someone you know. Or your family member. It's hard. But if you don't do it, no one else will."