For more than a century, American Indians have been significantly more vulnerable to illness and disease than other Americans. A dearth of nurses and doctors on or near far-flung, sparsely populated reservations makes it difficult for American Indians to take care of their most basic health needs. And the caregivers they do find may lack understanding of tribal cultures and traditional healing methods.

The government is seeking to address these problems, particularly in California and throughout the West. The result is increasing job opportunities for American Indians with the right skills.

"The Native American professional caregiver is in high demand," says Marilyn Pollard, director of the administrative services department of the California Rural Indian Health Board (CRIHB). "That population still has the worst health statistics in the nation, and many live on reservations in remote parts of California that are not attractive to people who do not have ties to Indian communities." Many elders, she adds, prefer receiving medical treatment from someone they know or whom they feel understands their health needs.

Founded in 1969 to address American Indian health issues in California, CRIHB has provided resources to help 33 tribes support 11 programs in 21 counties. CRIHB provides advocacy, funding, training, technical assistance, coordination, fund-raising and education, all focused on American Indian health issues. In addition to improving medical care, CRIHB offers important job opportunities to the same people it helps. Preference in hiring is given to qualified American Indians based on certified documentation of heritage.

Administrative and direct healthcare provider jobs are available at the central office in Sacramento and 28 rural health clinic sites. Healthcare jobs are available in dentistry, pharmacology, mental health, medical transcription, nursing, health education, laboratory and pathology services, radiology and imagery, social services, and therapy and rehabilitation. Administrative positions are in accounting, human resources, information technology and marketing.

However, Pollard warns, California Tribal Health Programs are federally funded at only 60 percent of need, resulting in below-market salaries. Recruitment and retention have proven difficult.

Opportunities Throughout the West

Other American Indian health boards provide similar functions outside California:

• The Alaska Native Health Board (ANHB) is the statewide voice on Alaska Native health issues. The ANHB considers "the spiritual, physical, mental, social, and cultural well-being and pride" of Alaska Native people to be important parts of its health mission. With a geographic area ranging from the Aleutian Islands and Arctic Slope down to Prince Rupert Sound, and with programs covering child abuse, epidemiology, HIV/AIDS, solid waste management and tobacco, employment opportunities are broad.
• The Seattle Indian Health Board (SIHB) is a nonprofit, multiservice community health center chartered in 1970 to serve the needs of American Indians and Alaska Natives living in the greater Seattle/King County region of western Washington state. The SIHB offers medical, dental, laboratory, pharmacy, mental health, nutrition, chemical dependency and youth outreach programs, as well as drug and alcohol abuse prevention. Administrative, clinical and medical positions are available.
• Further south, the Northwest Portland Area Indian Health Board (NPAIHB) was formed in 1972 to represent 43 Washington, Oregon and Idaho tribes on health-related matters. The NPAIHB hires physicians, registered nurses, nurse practitioners, pharmacists, nutritionists, medical technologists, health educators, dentists, dental hygienists and counselors.
• The National Indian Health Board (NIHB) oversees all of these organizations. The nonprofit organization represents tribal governments operating their own healthcare delivery systems as well as those receiving healthcare directly from the Indian Health Service (IHS). The NIHB conducts research, policy analysis, program assessment and development, national and regional planning, training and technical assistance programs and project management. NIHB jobs are administrative.

National Opportunities Available Through the Indian Health Service

The IHS is an agency within the Department of Health and Human Services. The IHS is directly responsible for providing federal health services to 1.5 million American Indians and Alaska Natives, belonging to 557 federally recognized tribes in 35 states. Jobs for medical and public policy professionals and others are available at IHS headquarters in Rockville, Maryland, and regional facilities.