HELENA, Mont. — Karen Jester went to a local emergency room several years ago with complications from diabetes. When the doctor asked what the trouble was, she began by saying she had heard her late grandfather talking to her that day.
"They thought I was crazy, of course," recalled Jester, 46, an Assiniboine Indian. "They said: 'We think you're depressed. Here are some pills.' "
Jester recalled the incident as a cultural clash: To her, it was natural to invoke the spirit of an elder in describing her condition. It is just the sort of thing she feels comfortable expressing at the Leo Pocha Clinic, a federally financed Indian health clinic, where Jester comes regularly to manage her illness.
The clinic is one of five such facilities in Montana and 34 across the nation intended to serve about 70% of American Indians who live in urban areas, not on a tribal reservation.
But in a budget-cutting proposal that has set off protests and indignation among Indians from Los Angeles to New York and several smaller cities in between, the Bush administration has proposed eliminating funds for these clinics, which served about 106,000 Indians last year.
Under the plan, Native Americans in urban areas would use the already overburdened municipal clinics, hospitals and other health services that most Americans use -- and that many Indians say have no concept of their traditional forms of care and healing, which are often used in tandem with modern healthcare.
Alternatively, under the plan, urban Indians could go to federally funded clinics on the reservation of the tribe to which they are registered. For many Indians, some of whom left those reservations because of crushing poverty and a lack of jobs, the latter option smacks of insult.
"They're basically saying, 'Go back to the Rez,' " said Donald L. Clayborn, executive director of the Helena Indian Alliance, which runs the clinic here. "There is an absolute sense of frustration over that message. They are trying to balance the budget on the backs of some of the poorest people in the nation."
Federal budget officials deny that is the case, arguing that the $33-million subsidy for the inner-city clinics provides an unnecessary duplication of services.
"Unlike Indian people living in isolated rural areas," President Bush's budget proposal says, "urban Indians can receive healthcare through a wide variety of federal, state and local providers."
