did not reject the Indian Reorganization Act and thus are eligible for the purchase of land under this act. The Sacramento Area Office of the Bureau of Indian Affairs should determine that the land is merchantable and free of encumbrance. I am directing the Sacramento Area Office to assist in the preparation of a document containing a membership roll and governing papers which conform with the Indian Reorganization.

As the Commissioner of Indian Affairs, I therefore, hereby agree to accept by relinquishment of title or gift the following described parcel of land to be held in trust for the Ione Band of Minwok Indians:

Beginning at the point of intersection of the center line of the County Road to Jackson, with the Westerly line of the fifty-two acre tract of land owned by Anthony Meath, Armando Dellaringa, Rocco Dellaringa, and Albert Dellaringa, as recorded in Book 130 Official Records, Amador County, California page 98; thence following the center line of said County Road, North sixty-five degrees, fifty minutes West (N. 65° 50′W.) One thousand seven hundred twenty five (1725) feet to a point; thence at right angles, North twenty-four degrees, ten minutes East (N. 24° 10'E) One thousand seventy two (1072) feet to a point; thence at right angles, South sixty-five degrees, fifty minutes East (S. 65° 50′E) One thousand five hundred thirty one (1531) feet to the West boundary of the said property of Anthony Meath, Armando Dellaringa, Rocco Dellaringa and Albert Dellaringa; thence following said boundary line, South fourteen degrees, eight minutes West (S. 14° 08′W) One thousand eighty-seven (1087) feet to the point of beginning.

Sincerely,

LOUIS R. BRUCE,

Commissioner.

Senator ABOUREZK. I want to thank you all very much. It has been a good discussion and I appreciate your contributions. Keep up your good work, by the way.

The next panel of witnesses, the second to the last, is the California Rural Indian Health Board, led by Mr. Timm Williams and also by Jim Medina.

STATEMENT OF TIMM WILLIAMS, YUROK, CHAIRMAN; JIM MEDINA, CHEROKEE, EXECUTIVE DIRECTOR, REPRESENTING THE CALIFORNIA RURAL INDIAN HEALTH BOARD, BERKELEY, CALIF.

Mr. WILLIAMS. My name is Timm Williams. We decided in making our presentation. We have a written presentation. I know you have the copies there. It is a long presentation.

To start out just lightly on the subject, in a June 15, 1953, transmittal by Assembly Joint Resolution No. 38, the California legislators memorialized the Congress of the United States to take the necessary steps to terminate the authority of the Bureau of Indian Affairs in the State of California. The resolution further stated that the State was able to provide for the well-being of the Indian people.

As a direct result of the California Assembly Joint Resolution No. 38, action was taken by the House of Representatives in the form of House Concurrent Resolution 108, 83d Congress, 1st session, naming California as a State slated for termination of Federal services and control.

Utilizing the resolution as a guideline, the U.S. Public Health Service, Division of Indian Health, immediately took steps necessary to phase out health services to California Indians.

However, California legislators, recognizing the great injustice. and hardship imposed by House Concurrent Resolution 108 on the Indian people, took ac to rectify the mistake that they had made

during the previous session by passing Assembly Joint Resolution 4. Thus, by Senate Joint Resolution 4, April 1954, the U.S. Congress was memorialized to take necessary steps to continue Federal services and controls for California Indians. The resolution further stated that the State of California was not prepared to meet the needs of the Indian people within its boundaries. The U.S. Congress disregarded the California Senate Joint Resolution 4 and the U.S. Indian Health Service continued their termination policy in California. This chain of events gave rise to a great deal of uncertainty among both the Indian population and many State health personnel, regarding which agency had responsibility or jurisdiction for the provision of services to Indians. The inactivity which followed this period of indecision contributed to the deterioration of the Indian health in California.

"Through the efforts of Indian leaders in California, the Bureau of Maternal and Child Health of the California State Department of Public Health initiated a pilot demonstration project in nine rural Indian communities in the State. The Division of Indian Health provided the State department of public health with $152,000 in passthrough funds to be subcontracted to the Indian groups.

In January 1970, the Department of Health, Education, and Welfare established the eligibility of California Indians to participate in Federal Indian health programs.

The nine original rural Indian health project areas were geographically spread across the State from Humboldt County in the north to San Diego County in the south. The Federal funds contracted to the State were subcontracted to the nine project areas through their tribal councils or local Indian health boards. The Indians at the various locations set their priorities of programs and hired their own staff. Due to the limited funding of the program, local projects focused primarily on community organization, health education, transportation services, assistance in establishing eligibility for medical and other benefits. Although no funds were made available for direct medical services, project staffs were instrumental in saving several lives and in obtaining volunteer medical and dental assistance. Volunteer assistance was also made available to build dental and medical clinics on reservations.

Today the projects number 16 and services have been extended to serve 34 counties with an Indian population of approximately 40,000. The 16 projects form an all-Indian federation comprised of 2 delegates from each project. This board is formally called the California Rural Indian Health Board, Inc., CRIHB.

CRIHB is now funded directly by the U.S. Indian Health Services, and is recognized as the prime contractor for rural California Indian health. We are in the unprecedented position of being the only allIndian body administering a statewide health program in the Nation. This is truly a great challenge and important role.

In dealing with the growth of our organization, it is important to note that growth in any organization is never totally painless. New problems and challenges arise constantly, and are often compounded by the process of expansion.

For example, CRIHB's main thrust, that of utilizing Indian health aides in the best interests of consumer-oriented health delivery sup

port work has proved to be a viable system. The workload of the health aides, however, is becoming overwhelming. More and more Indian families and their health needs are being identified. Followup visitations are increasing. Each project could easily double its work force and still be behind in its caseloads.

Many of the projects with clinic facilities are using equipment that borders on obsolescence. Whereas it is desirable to replace this equipment, priorities have dictated that this undertaking be delayed, so as not to come at the expense of the implementation of initial clinic operations in new project areas.

Many projects must utilize the services of volunteer physicians and dentists. This is quite obviously not as desirable as full-time professional care, but, again, priorities have dictated this course of action be pursued.

The California Rural Indian Health Board is ready to accept whatever challenges arise within the realm of elevating the level of health of its target population. We are aware that in any civilization which has as its characteristics limitless needs and limited resources, difficulties in deciding who shall be worthy of resource support will be present. We are confident that CRIHB's past accomplishments will stand us in good stead, and our future needs will be met through proper expansion and new programing.

The accomplishments of CRIHB can be measured in many ways. Perhaps the most striking is the effectiveness with which Indians have managed and maintained their own health programs. The projects, overseen by democratically selected governing boards, have found that organization is an important achievement in itself. Having organized to do a job, the projects then began to cope with the problems of health program planning, fiscal and program management, hiring of staff, and securing the expertise of health professionals to help plan the short-range strategies and long-range goals. Simultaneously, the administrators of the local projects have been able to direct a viable health care program and gain valuable experience within the health field.

Further, the staff of the various projects are manned largely by members of the local Indian community, providing another twofold effect. Indian health aides, besides being motivated to reach a higher employment level within the health field, are able to impress upon their neighbors the importance of proper health care practices. We have reached a state in our society's development in which a contrasting stiuation exists. On one hand, technological advances have created both the potential for pressing health needs to be met, and the expectation that they will be met. Opposing this, however, is the generally acknowledged fact that adequate manpower, at all levels in the health care field, has not been developed. CRIHB lists among its accomplishments the training of personnel to implement its health care programs, and the fact that this pool of manpower is almost overwhelmingly Indian is especially gratifying to us.

Further accomplishments of our program have been motivating Indians to become involved in health care, increasing the knowledge of the members of the community with respect to health care practices, helping Indians become aware of already existing health care facilities, and overcoming restrictions on obtaining health care caused

by geographic isolation. These four achievements are listed together because they all are functions of the role of the community health aide. In order to examine these achievements it is necessary to understand the community health aide aspect of CRIHB's operation.

Rural Indian communities in California have become a part of a relatively new trend in health care procedures. Health aides, selected and supervised as employees of the community, are being used as liaison personnel between the Indian community and the outside world. Too often the term "aide" implies a person trained as a technician, working under the direction of a health professional. The community health aides working with the rural Indians of California are more than this. Besides being health workers trained in skills and practice, they are also the primary body involved in focusing upon health difficulties and priorities facing Indians. The community health aide has not only helped provide for the delivery of health care, he has also been the voice allowing the demand for increased health services to be made.

Having realized that it would be totally unrealistic to expect the health aide to be able to function effectively without providing him with the necessary tools to carry out his function, CRIHB has implemented a community health training program. Training protocol has been structured in four basic study areas. As outlined by Dr. R. B. Uhrich, of the U.S. Public Health Service, these areas may be stated broadly as: (a) sociocultural, (b) communication skills, (c) concepts of health and disease, and (d) technical skills.

Sociocultural training is designed to give insight enabling the aide to constructively examine and review both Indian and non-Indian value systems with respect to health. It has become apparent that an understanding of both systems is crucial to the development of procedures for dealing with health problems of rural Indians.

The communication aspect of training is designed to make the health aide a two-way communicator between his community and the outside world.

Concepts in health and disease is an integral part of training, in that it provides the aide with an understanding of causal relationships, including the roles that social, cultural, economic, and environmental conditions play in the prevention and control of disease.

Finally, training in technical skills designed to stimulate confidence and proficiency is the training area which enables the aide to become a health worker. Specialized training, to deal with problems indigenous to the community, is provided upon request.

During the past year 53 CKIHB health aides conducted rigorous health education and preventive services relating to the major health areas. In the more than 29,000 patient contacts made by these aides, community members were both motivated and educated with respect to health care practices. Rural Indians in California were made aware of existing health facilities whenever possible, and over 10 percent of the health aides' patient contacts were referred to appropriate agencies of health care.

Indians in California are often restricted when attempting to obtain health care services, due to geographic isolation and lack of transportation. In an attempt to alleviate this problem, health aides were prepared to transport any person who could not be served in the home,

and could not get to a health service facility. To this end CRIHB health aides did in fact become involved in the transportation of over 35 percent of the more than 29,000 patient contacts made.

Another accomplishment to which CRIHB proudly points is the establishment of a system of communication between Indian communities throughout the State. The quarterly board meetings provide an opportunity for representatives of all 16 project areas to interact, and the central staff also expedites communications between projects. Discovering solutions to problems in one project area can often be facilitated by exploring the experiences of another project which has encountered similar difficulties.

Another major accomplishment has been the creation of all-Indian health clinics in the project areas with the input from many different community sources.

The first dental clinics were established with little financial backing. In those early days, CRIHB learned to manage with volunteer help of all kinds. More recently, most of our projects have developed their dental facilities to the extent that they now provide the complete spectrum of dental services. CRIHB's program is currently experiencing approximately 2,000 dental visits per month. Average cost per patient visit is $13.76. This cost is borne by CRIHB, and is not incurred by the patient. To provide the same range of services through private practice in California would have required $54 per patient visit, an approximate 4-to-1 cost-benefit return. Because of the economic status of the Indian people served few, if any, of these patients would have received dental services through private resources. The medical clinics which have been developed although not yet having achieved the success of our dental program, are nevertheless beginning to administer to the needs of a population group heretofore neglected by modern medicine. Well-baby clinics, immunization programs, eye clinics, are examples of services brought to California rural Indians by medical clinics in our project areas. We are convinced our medical clinics are well on their way to achieving the same lofty successes as have our dental programs.

Perhaps the most definitive study of the health needs of California Indians was the 1966 progress report of the State Advisory Commission on Indian Affairs to the Governor and Legislature of California. The report described the conditions under which rural Indians live in California as follows:

The health problems of California Indians are a result of a history of inadequate medical services and aggravation by conditions of poor housing and sanitation, lack of employment, poor nutrition, and the apathy which accompanies these social conditions. Leading causes of death among Indians are tuberculosis, accidents, cirrhosis of the liver, influenza and pneumonia, and congenital malformation. The death rates from these causes are many times higher for Indian men than for Indian women. Tuberculosis accounts for six times as many deaths among Indian men than among other Californians. Deaths from accidents and cirrhosis of the liver account for four times the number of deaths among Indian men as among all other races. The death rate for influenza and pneumonia is 2.2 times, and from congenital malformations 1.7 times the rate of death from similar causes among the population as a whole. Other problems mentioned include the inaccessibility of medical facilities, lack of transportation and lack of information on health and hygiene.

The report goes on to document that:

Conditions under which Indians live in California are the lowest of any minority group. Housing is grossly inadequate; living quarters are small, crowded and poorly furnished; existing houses are structurally unsound; foun