Minneapolis – On a side street near the city, Mashkiki Wakigan Pharmacy offers its Native American clients the services of any general drug store – it provides complex medications and offers treatment advice.
There are, however, two main differences: each Mushki patient receives a free prescription – at no cost out of pocket – and access to care that is aware of the cultural heritage.
Operated by the Fund du Lac band on Lake Superior Chippewa, Mashkiki is a full-fledged tribal-funded pharmacy for members of the federally recognized tribes living in Henepin and Minnesota counties in Ramsay, regardless of their insurance status. It has about 10,000 registered patients and about 3,500 active patients and that number is increasing According to the 2020 census, Native Americans make up about 1% of the population in the two counties inhabited by Minneapolis and St. Paul.
When Mashkiki opened in 2007, pharmacist-in-charge Kelly Milich was filling out about seven prescriptions a day. Today, he and other pharmacists are distributing 300 to 400 prescriptions a day.
The pharmacy tells all its customers to try to get prescription insurance. If needed a staff member will help them apply for Medicaid. However, if customers cannot access insurance, the pharmacy provides them with services using tribal funds derived from initiatives such as gaming. Money never changes hands, and there is no cash on site.
“We try to bill the insurance to keep the program going, but if an insurance company does not cover a drug that a patient has to take, Fund du Lac decides that the patient’s health is more important than the payment,” Milich said. We spend on drugs. “
This model is not without challenges.
Pharmacies mostly carry medicines for chronic conditions, but due to financial constraints, pharmacies have a limited list of medicines. Milich says members of the 17-person staff reach out to suppliers to find alternatives to prescriptions they can’t meet, and Mashkiki is increasing the number of drugs it offers almost every month.
“It’s a fine balance, you know,” said Samuel Moose, director of the humanitarian department at the Fund du Lac band. “We have to try to keep the doors open and the lights on. But it’s something we’ve been very successful at. “
For more than 20 years, the Moss Fund has conducted tribal healthcare activities for Du Lac, which is part of the Chippewa tribe and has reservations about two hours north of Minneapolis near Duluth. Fond du Lac owns and operates two more pharmacies in other parts of the state. However, in contrast to Mashki, these two pharmacies use IHS funds directly.
The Indian Health Service – an agency within the US Department of Health and Human Services – is responsible for caring for Native Americans in more than 570 federally recognized tribes, but funding is limited, especially for those living away from conservation and in urban areas.
Most tribal members living in the Minneapolis area have difficulty securing prescription drugs through the IHS, as the nearest IHS facilities are hundreds of miles away from the city. However, urban natives living in Minneapolis may receive care from the Indian Health Board of Minneapolis, an urban Indian health center that offers both medical and dental services – but no pharmacy.
Dr. Sheila Thorstenson, a dentist at IHB, prescribes mesquite to patients in need of prescription medication. “We’ve actually added a lot of people who weren’t even aware that the existence of that pharmacy is now a pharmacy where they can go and get their medicine,” he said.
U.S. Sen. Tina Smith (D-Min), a member of the Senate Committee on Indian Affairs, noted that insufficient funding for health care for Native Americans is a long-standing problem. “If you adapt to inflation, the Indian healthcare budget has been flat since 1983, then it’s interesting to understand the scope of the problem,” Smith said. “So Indian healthcare costs less than $ 4,000 per user per year Any federal minimum [health] Activities. At first glance, you have Medicare, which costs $ 12,000 a year. “
Muse said the fund wanted to help eliminate that inequality by financing du lac pharmacy. “We’ve heard the story,” he said of people forced to make difficult choices to save money. “I’m trying to cut the pill in half and see how they’re going to cover the specific costs of their lives for their drug affordability.”
Milich has heard similar anecdotes from patients. “You hear every day about how much the drug costs,” Milich said. “For many of our patients, if we weren’t here, it would be a matter of, ‘Do you spend your money on your insulin? Or do you spend your money on food? ‘
Roger Dragon, a veteran of the Potavatomi tribe, said using the pharmacy has been a great benefit for tribal members, including diabetics. “I think if it weren’t for Mashkiki, I wouldn’t believe that many of our native seniors with diabetes would be able to carry their insulin,” he said.
Mashkiki provides culturally appropriate care. For example, Mashkiki offers a smoking cessation program that focuses on commercial tobacco and acknowledges that some people may want to use tobacco for sacred ceremonial use.
“We want to keep their culture as part of their care as possible,” Milich said.
Kathy Misho, an elder at Ojiboy’s White Earth band, said her husband received prescription care and regular follow-up services to quit smoking through Mashkiki. “They do it slowly, and they follow along, and she’s been smoking-free for almost two years now,” Misho said.
Also, Native Americans make up about half the staff, Milich says, who is not Native.
This is reassuring for Native Americans whose confidence in the national health care program has been eroded by historical injustice and violence, Moz said. He said his aunt was sterilized against her will under the supervision of a federal program. “It’s difficult to provide services to this population because there’s so much trauma,” Moose said.
Moose has grown under the influence of Native Health Care – cultural drum events and indigenous healing practices – and understands the need to integrate Western and Native medicine. “Our importance is ensuring that we spend time with our community, we spend time with adults, we spend time with people who have misinformation. [about health care]Moss said.
It’s especially important that Native Americans “probably lead to every healthcare inequality we track,” Moose said.
According to the IHS, Native Americans die of heart and kidney disease at a higher rate than the general population, and they die three times more from diabetes and five times more from liver disease.
“It’s really important for us to stay away from that inequality by focusing on the patient first and investing in native health across the board,” Moose said. “Unfortunately, we have a long way to go.”
Katherine Haggins and Julia Mueller are undergraduate students in the Middle School of Journalism program at Northwestern University in Washington, DC.
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