The vomit was yellow and foamy and it came up all the time. Arvilla Crasco had been sick before, but never like this.
She called them attacks. This one, at the bingo hall, didn’t come with the warning of nausea. One second she was filling in her card at the table, the next she felt it coming up. She took a short gasp and lunged for the nearest trash can. In front of her friends, people she knew, she gagged and heaved the bitter bile and foam. Foam. Because her stomach didn’t have anything left for her to expel.
It had to be H. pylori. Everyone on the Fort Belknap Indian Reservation in north central Montana knows someone who has it. Crasco does. Her niece has it, and a neighbor just on the other side of her house does too.
So does an estimated one-third of the U.S. population, but most who contract it will not have any symptoms. In any other place, a bacterium like H. pylori won’t likely be the topic of discussion at a local bingo hall. In any other place, at the mere mention of its name, people won’t be able to list the friends and family members they know who have gotten H. pylori.
Little data exists about H. pylori infection in the United States. Even less is known about infection on Fort Belknap, a 675,000-acre reservation located along Montana’s northern tier. So it’s hard to tell exactly whether H. pylori infection is higher on Fort Belknap than in other places in the state. It’s even harder to tell where it comes from.
For Arvilla Crasco, the answer is right outside her window. She can look out and see a water tank that towers over the one-story homes in her neighborhood. For her, she says it’s why she can’t eat red meat without retching it back up anymore. For her, the water is why she hasn’t felt like herself since 2003, when she was officially diagnosed with having H. pylori. For her, it’s the reason she can’t get out of bed some mornings, and missed so many days working for the tribal housing department, she says, that she eventually decided to quit. For her, it’s why she’ll still get the occasional attack after slipping a little and eating half of a burrito.
“I wouldn’t wish this on anybody,” she says. “You really get depressed. You get tired of feeling sick all the time.”
A lot of people on Fort Belknap are tired. They’re tired of water problems on the reservation and tired of the water woes inflicted on them. On the southern edge of the reservation, Swift Gulch runs red from pollution caused by the now bankrupt Zortman-Landusky gold mine in the Little Rocky Mountains. Up north, in the Agency, the murky water from the Milk River flowed for years into a dilapidated treatment plant that couldn’t keep up with the demands of a growing population or with the changing standards of the Environmental Protection Agency. For about five years, the EPA has maintained a regular boil order for Fort Belknap, a warning to boil the tap water before drinking or cooking with it because of an unsafe level of bacteria.
Meanwhile, people like Crasco get sick, and they deem it only fair to point their fingers at the water. People have gotten sick before, one water source has been polluted before, and the EPA has been telling people to stay away from the Agency’s tap water for about half a decade – those are the facts. Beyond that, the relationship between water and public health on this reservation exists solely in how people choose to perceive it. And that’s where the waters really get poisoned.
H. pylori is short for a bacteria called Helicobacter pylori. Infection can cause any number of stomach problems, ranging from dyspepsia, ulcers or, in rare cases, lead to stomach cancer. But in most cases, it doesn’t do much of anything. The only way to know whether someone has it is to test for it specifically. But since many people infected with it don’t show symptoms, it usually goes unnoticed.
Not in Fort Belknap, however.
Gregory Zaar, the chief medical officer for the Indian Health Service clinic at Fort Belknap Agency, says that although he sees only a few patients complaining of stomach problems, “the rumor mill is rampant.”
For Zaar, the reality exists in the data, and since it would take a significant number of stomach illness cases to attract the type of comprehensive study needed to examine H. pylori on the reservation, the only data he can rely on is in what he’s seen.
“I don’t think that there is a problem,” he says. But Zaar doesn’t discount the perception of one.
Don Thomas, a physician who works in the Eagle Child Health Center in Hays, a town on the southern end of the reservation, says perception can have a lot to do with even the number of documented H. Pylori cases on the reservation.
“It’s looked for very frequently, and so it’s found very frequently,” he says.
Thomas operates in Hays, where unlike in the Agency, efforts for an updated treatment plant are further on the horizon. For now, even though he has no reason to say that cases of H. pylori are higher on Fort Belknap than anywhere else, he won’t be drinking what comes from his tap anytime soon.
Whether H. pylori actually does come from the water is hard to pin down. The EPA lists 53 organic contaminants that it tests for in drinking water. The most usual culprit that the EPA finds after tests of the Agency’s water are bacteria usually found in fecal matter, which doesn’t rule out the possibility of H. pylori, but the EPA doesn’t test for the bacteria specifically.
Studies do list municipal water contamination as one of the sources of infection, because it’s most commonly passed from person to person, but a more likely cause relates to lower socioeconomic status and houses with many people living in close quarters. Both of those conditions exist on Fort Belknap, Thomas says. And after listing a host of other possibilities—food-borne infections, direct contact with fecal matter—Thomas eventually settles on the most common answer about this disease and its causes on Fort Belknap.
“We don’t know,” he says. “That’s the simple answer to that question.”
But not knowing is not an answer that satisfies many who live on this reservation. An Albertson’s grocery store in Harlem, just a few miles outside of the reservation borders and a five-minute drive from Fort Belknap Agency, has made a commodity out of people’s uncertainty.
Those uneasy about what’s in their tap water will come here and load down their carts with five-gallon water jugs of store-bought water.
A filling station for water jugs sits at the front of the store, often causing congestion between the people filling up and the people checking out. A section of shelves in one aisle is devoted to different brands of bottled water, and any other space the store has left is usually devoted to cases of 20-ounce bottles.
When Tracy King was growing up, the only running water he knew was the creek. King is the president of the Fort Belknap Indian Community Council, the governing body of the reservation that represents the two tribes enrolled in Fort Belknap, the Assiniboine and the Gros Ventre. King grew up here, and remembers a childhood in the 1950s and ’60s in which the only bathrooms he used were outhouses. By the 1970s, running water was a fairly new concept on Fort Belknap, and at about the same time, the Bureau of Indian Affairs decided to cede control of the water system to the tribal members. Fort Belknap’s original water treatment plant was built shortly after that. According to King, the reservation’s modern troubles with water began there.
“How do you make a decision when you don’t even know what toilet paper is?” King asks.
The original treatment plant soon became too old to keep up with the demands of the EPA, and too small to keep up with the demands of the reservation’s growing population. One of the main functions of the treatment plant is to measure the water’s turbidity, which is a measure of how clear the water is.
Murky water in itself doesn’t necessarily mean it’s unsafe to drink, but it can be an indication of bacterial contamination. The EPA has set turbidity standards for drinking water to prevent that. If the plant measures anything higher than those standards, operators must send a sample to a lab in Lewistown, where it will be tested for harmful bacteria to determine if a boil order should be issued. According to EPA standards, no more than 30 hours can pass between the lab request and the water analysis.
Under stricter EPA guidelines than in the past, more people to serve, and a fairly turbid water source to begin with, the plant has had no choice but to issue boil orders almost constantly since 2005.
That appears about to change. In late March, after almost a decade of trying to secure funding through government grants and loans, a brand new treatment plant opened up. It’s bigger, uses better technology and depends more on automation. But after almost five years of constant EPA violations, regulators with the federal agency won’t lift the current boil order until they see three straight months of operation without any violations. A rough road lies ahead in getting a mistrustful population on board with its new, and hopefully improved, tap water.
“I don’t drink any water unless I know that it comes from a bottle,” says Rowena Gone, who says she raised her children to never drink from the tap. Even though Gone has heard of the new plant and the possibility of clean water from the tap, she says she’ll still avoid it. Three of her adult children have gotten sick in recent years, she says, and the only reason she knows is because they drank from the tap.
Gone buys water when she’s pressed for time. Usually, like many others, she makes the 20-minute drive from the Agency to Snake Butte, where people can get free, clear water from a natural spring. For many, it’s the best option. But even Snake Butte is plagued by its own list of unknowns. Gone, even though she continues to drink it, has heard rumors about nitrate in the water. Others talk about the possibility of arsenic. Some who have gotten a case of H. pylori say that it wasn’t from the tap, but from Snake Butte.
Those rumors aren’t stopping the succession of people who come, minutes apart, with five-gallon jugs in the backs of their vehicles, to fill up their water and take it home with them. It’s natural, they say. It’s ours. And that’s enough for them.
At Snake Butte, the natural spring flows out through a long pipe that juts out of the stony flat-topped hill that overlooks the Agency. Clear, cold water streams from the pipe constantly, which is supported by two stone pillars that look almost like ancient altars —built to support a natural life source. Under the constant whisper of the water leaving the pipe and flowing into a tiny stream, there is a certain sacredness to what goes on here, here where the water flows clear. Not red. Not turbid. On the last stone pillar, five unlit cigarettes have been wedged on both sides where the pipe is secured to stone. A few quarters have been placed on whatever flat surfaces the pillar has. These are offerings, exchanges for the water that the people take to their homes.
But not all is sacred here. On the side of a flat rock, someone spray-painted the words, “No Dumping.” And around the water, McDonald’s wrappers, empty Bud Light tall boys and used plastic containers of hand sanitizer flout the message’s intent. There is no pattern or deliberate placing of these artifacts.
For Fort Belknap, water is something to both cherish and deride. It’s something that people will simultaneously revere as the source of life yet rue as something that diminishes it. A disease may not be epidemic, but confusion is.
Snake Butte’s whisper is gradually drowned out by Kanye West’s “Heartless” brimming out of the rolled up windows of a green midsize car.
George Tellstoomanystories and his buddy pull up to the spring and fetch a few five-gallon jugs out of the trunk. They’re talking about water. How it’s no good except for here at the spring and how his baby boy got sick from the tap water not too long ago. As he fills one of his jugs, it begins to leak. He curses and tosses the defective vessel on the ground where the water slowly leaks back into the spring. After filling up two good jugs, he has a smoke. Before he leaves, though, he breaks another cigarette in half and places it on the stone pillar.
Tellstoomanystories gets back in his car, and drives off with 10 more gallons of water that he’ll be able to bring home. Kanye fades and the perpetual whisper of Snake Butte’s natural spring can be heard again. On the ground, the leaky jug remains.