In the crevice of a pine-studded hill near her home, Luanne Belcourt pauses in the stiff spring wind to light a cigarette.
Instead of smoking, however, she takes a solitary puff and then places it upon the grave of her brother-in-law, Robert Geboe. To an outsider, this act might be viewed as a bizarre display of irony, as Robert died of lung cancer. But here on Rocky Boy’s Reservation, this cigarette is a sacred offering.
Across the road, several curves deep into Parker Canyon near Rocky Boy Agency, a dirt lane loops in front of a small blue house. The address is Elsie’s Circle, home to Robert’s widow, Elsie.
Inside the home, after navigating through a gaggle of rambunctious children, one finds Elsie in the kitchen. A small, compact woman, Elsie radiates the warm smiles and personality of a beloved grandmother, which she is 27 times over. She bakes, sews powwow costumes for her family and collects teapots. These vessels, of all shapes, sizes and colors, line one of the dining room walls. Elsie says she ought to dust her collection once a year, but at 70, she admits she isn’t as spry as she once was.
Most of the teapots are gifts from friends and relatives and all of them would tell unique stories if they could speak. Her nephew, Donnie Belcourt, brought one back with him when he competed in the 1992 Olympic track trials in Louisiana. A faded orange one belonged to her mother, Celia, a Cree-speaking master beader. The last time Elsie counted, she nearly had 200, despite the actions of her carpenter husband a number of years ago.
“My husband put new siding on the house,” Elsie says with a half smile as she sits at her kitchen table. “He was just pounding away and they were falling off the wall.
“I wasn’t here. I came home from work and asked, ‘What happened?’ I gathered all the pieces and tried to glue them back together. Some I couldn’t.”
In 2004, Elsie was once again picking up shattered pieces. A mere 23 days after being diagnosed with lung cancer, her husband of 46 years passed away.
“Twenty three days.” Elsie says the words slowly, as if they are still hard to believe. “We went to Great Falls and the doctor said, ‘It seems like you’re losing a lot of weight.’ So they did all these tests and they said, ‘You’d better stay, we’re going to do some more tests,’ and then they told him that he had cancer.”
Although the cancer had spread from his lungs to his other organs and brain, the diagnosis didn’t deter Robert, whom Elsie says often exhibited a stubborn streak, from lighting up his beloved unfiltered Pall Malls as soon as they started on the 100-mile-trip back home.
“When he got out of the hospital, he said, ‘Where are my cigarettes? Give me two,’” Elsie says, holding her hands at chin level. “And he said, ‘I’m going to put one in each hand.’”
Because Robert refused hospice care, Elsie quit her job at the tribal office to nurse him at home. Doctors gave him about six months to live. A man who had worn cowboy boots and Levi’s every day for years now napped on the living room couch wearing pajamas and tennis shoes.
“He just got weaker every day,” Elsie says of the man who once took morning jogs a mile around the circle. “Pretty soon he couldn’t drive. He was here up until the day he died.”
While the Lung Cancer Alliance rates lung cancer as the third-leading cause of death for American Indians, the statistics are even more dire for Montana’s Indians. Indian Health Service statistics reveal that the Billings-area IHS, which includes Montana’s seven reservations, has the highest lung cancer fatality rate of any IHS area in the nation.
Elsie, who also lost a daughter and a brother to cancer, was herself diagnosed with cervical cancer last year. After receiving treatment five hours away in Billings, she is cancer free, but her attitude is somber after witnessing her loved ones’ deaths.
“No one tells me anything, if I have a week, a month, or a year,” she says. “So I just wait and take each day at a time. Whatever will be, will be.”
Many on Rocky Boy’s share a similar attitude; that one’s fate is fixed and therefore, the present day ought to be enjoyed to its fullest, health consequences be damned. When taking the tribe’s turbulent history into context, this philosophy is more readily understood.
Rocky Boy’s is a reservation that almost wasn’t. In 1896, when the state’s other reservations had been long established, Congress appropriated $5,000 to deport the “Canadian Cree” back to their ancestral home in Canada. Although they were transported across the border in boxcars, the tribe returned to north-central Montana, the only home the current generations had known. Once known as “the only people in the United States without a country,” a 1916 congressional order finally gave the scattered and starving Chippewa Cree a sovereign home, a 55,000-acre reserve at the foot of the Bear Paw Mountains. Although the restoration of a homeland was complete, the tribe had learned not to take anything for granted.
Today, no true town exists on the reservation. As the smallest of Montana’s seven reservations, Rocky Boy’s would fit comfortably inside Flathead Lake. Small clumps of houses and administration buildings appear along a network of curving roads. Vast fields, contained by fences choked with plastic bags and tumbleweeds, separate individual neighborhoods.
There are three places on Rocky Boy’s to purchase tobacco and all are within a five-minute-drive of each other. In 2005, the reservation entered into a tobacco tax revenue sharing agreement with the state of Montana. This means that all tobacco products, whether sold to Indians or non-Indians, are taxed at the state’s rate and the tribe receives an annual share of the profits, estimated to be around $500,000.
The cash influx is a welcome benefit to this isolated tribe. Without abundant tourism or natural resources, many on the reservation struggle to eek out a living. However, the health problems that arise from this tobacco income are crippling the older generation, who are often the primary caregivers for their grandchildren.
When visiting Rocky Boy’s, it’s impossible not to spot the men, women and teen smokers and chewers who are making the lung cancer statistic a reality. People congregate outside their places of work to take smoke breaks. Scattered cigarette butts are a common sight outside of building entryways.
Yet, when asked if they know of someone struggling with the disease, people wryly smile at their own cigarettes and shake their heads. The grim reality is that with its difficult, and often late diagnosis, few lung cancer patients survive to see their illness fade into remission. Their deaths help shadow the problem into oblivion.
Until Columbus stumbled upon the New World in the 15th century, tobacco was unknown to Western civilization. Originally grown in South and Central America, the tobacco plant migrated north through trade and agriculture. Ancestors of today’s Chippewa Cree traded fur pelts for it from southern tribes and the Hudson Bay Co.
To the Chippewa Cree, tobacco has a spiritual symbolism. The lighting of the ceremonial pipe is an act of a solemn ritual that is absent when taking a drag off a recreational cigarette. The tribe believes that pipe smoke carries their prayers to the Creator, and that for tribal members seeking knowledge, a gift of tobacco is always appropriate. Those who inhale concede that tobacco smoke might possibly cause cancer, but believe it is a part of the culture that cannot be ignored.
“Tobacco was a sacred plant given to us by the Creator,” says Lisa Whitford, a Rocky Boy’s native who once served as the reservation’s tobacco prevention coordinator. “The plant was taken when the white settlers came and added additives. We are hoping now to keep tobacco sacred, using it sparingly only in ceremony.”
Like many other facets of their life, the Chippewa Cree are stuck in a paradox when it comes to balancing their traditional uses of tobacco with the cancer sticks of the commercial age.
Rick Sunchild, who teaches Cree language at Rocky Boy High School, notes there exists a distinct difference between the two tobaccos, both in ideology and composition.
“The only time we used tobacco was during ceremonies, and we would smoke it using pipes,” he says. “It’s not really addictive.”
Sunchild says the Chippewa Cree traditionally combined their tobacco with other herbs and sweet grass. The resulting product, which they called kinnikinnick, meaning “that which is mixed,” often included only one-third tobacco. This tobacco was free of the additives found in its modern counterpart, including tar, arsenic and formaldehyde. When combined with 596 other additives, it’s enough to kill, as Helen Windy Boy discovered last summer.
Helen says she always wanted to go on a helicopter ride. On Aug. 17 of last year, she finally did. But instead of an excursion through the Grand Canyon as she had once planned, Helen was airlifted from the helipad at Rocky Boy’s to Benefis Hospital in Great Falls.
Earlier in the day, a recurring back pain had kept her from going in to work at the library at Stone Child College. Although Helen dreaded visits to the doctor, and hadn’t had a checkup since she’d suffered from pneumonia two years earlier, the pain was severe enough to persuade her to drive to the reservation’s health clinic.
“I remember having that backache for several months, maybe a year,” she says.
Doctors initially suspected a heart issue when she mentioned the shooting pain she was also experiencing in her left arm. Because that would demand more attention than the rural clinic could give, a helicopter was ordered.
For five days in Great Falls, Helen endured a gamut of blood tests, X-rays, MRIs, CAT scans and finally a PET scan before doctors broke the news: Helen had an advanced Pancoast tumor, one of the rarest forms of lung cancer. Unlike most lung cancer tumors that develop in the lower lungs, Pancoast tumors grow in the upper region and affect only 5 percent of all lung cancer patients.
“After they did that PET scan, (the oncologist) sat down with me and my family members,” Helen says. “He gave me the options and said you can think about it.”
Although she knew treatment would be costly and draining, both physically and emotionally to both her and her family, Helen chose to fight.
“I hate statistics,” she says, her articulate voice growing in strength. “I don’t like to think of myself, or anybody else, for that matter, as a number. I’m not a statistic, I’m a human being, so if the statistics say one thing I’m going to try to buck the system and be something else.”
While she decided to entrust her body to modern medicine, Helen chose to put her faith in the traditional spiritual ways of her people. A Cree medicine man from Canada came to Rocky Boy’s to perform a healing ceremony for her the weekend before she began treatment.
She took a leave of absence from her job to endure six weeks of chemo and radiation before undergoing surgery to remove the tumor. The surgery lasted eight hours, six hours longer than expected, and involved the removal of two upper ribs, one third of Helen’s left lung and a nerve cluster, which was the source of her back pain.
While Helen had experienced minimal discomfort from her chemo and radiation, the surgery pushed her body to its limits. As a result of nerve damage from the operation, Helen finds herself in daily pain, a pain that she says is on par with what she experienced when she first went to the clinic in August. A daily dose of morphine and Vicodin does little to ease her discomfort.
“I deal with it every minute, but you know what? I’m alive,” she says, tapping her fingers on a blue mug of coffee. “Without the treatment I went through, I might not be.”
Helen is not naïve about what landed her on the surgery table last November. The denial she once had about her former tobacco habit has been replaced with a strong conviction.
“I smoked off and on for 40 years,” she says. “If there was anything I’d do different it would be not to smoke, because I’m pretty convinced that that’s what caused lung cancer.”
Although she didn’t realize it at the time, Helen smoked her last cigarette on the day of her helicopter ride. Nicotine patches, which helped her fight subsequent cravings, were paid for out-of-pocket. Meanwhile, Helen, who doesn’t have health insurance, doesn’t know how much her hospital bills total. Envelopes arrive in the mail, but most remain sealed, helping to distill the dread of knowing the full amount.
“I opened one of them one day and it was $67,000,” she says. “Ever since then, I haven’t opened them.”
These envelopes can be found throughout the house she rents from her nephew, mixed in with Wall Street Journals, and piled on a desk. Helen picks one up and notes that it bears a muddy stamp from the shoe of one of the three grandchildren who live with her. Trying to stay positive, she ignores the bills, but collection notices have started arriving, adding to her cancer’s paper trail.
“They’re not getting paid,” Helen says, “but I know eventually they will. From my experiences in the past with contract health, is that it takes them time.”
Her husband, Andrew, drops off the bills at the health clinic on Rocky Boy’s when he goes to work. The envelopes end up in the hands of Carole Henderson, who manages the tribe’s contract health services.
Henderson is one of many access points to a bureaucratic chain that stems from a promise the U.S. government made to provide health care to Native Americans in exchange for their lands. Henderson works in a basement office at the health clinic, accessed through a maze of beige-painted hallways. It is up to her and another woman to sort through the medical contract bills and see that they get paid.
“There’s never enough money,” Henderson says, sighing as she leans back in her desk chair. Multicolored sticky notes adorn a bulletin board at her side, signaling the paperwork and deadlines she faces.
Because modern cancer treatment is nonexistent on the reservation, patients suffering from lung cancer must travel to Great Falls for their surgery, radiation and chemo. This journey adds hotel, gas and meal tabs to the total bill, some of which is picked up by a tribal transportation office.
Rocky Boy’s is one of Montana’s reservations that operates its own health care system. Although the tribe receives IHS funding, it controls and operates tribal health services without IHS’s daily oversight. While tribal leaders prefer this system to being run by IHS, the tribe faces difficulties in finding enough funding to ensure proper medical care for all tribal members. In 2006, the tribe borrowed $2.8 million from the Denver-based Native American Bank to cover a shortfall in contract health care. They pledged future earnings from their tobacco tax revenue to secure the loan.
It is another moment rich in irony. Essentially the tribe is taking care of its sick from money it makes off a product that makes its people sick.
Although health care on Rocky Boy’s has come a long way since the Depression—when a Havre doctor would drive 25 miles to visit the reservation once a month—to boasting a $13 million clinic, it remains an imperfect system. Wide holes exist in the cancer screening process, and many people slip through.
Three years ago, the reservation’s clinic was given a machine that uses computer technology to help radiologists detect lung cancer. But this addresses solely the symptoms of the problem and not the cause.
Only a systematic change will be enough to reverse the statistics; statistics, as noted by Helen Windy Boy, that stand for real human beings, and not meaningless numbers. These statistics represent the lives and deaths of Robert Geboe and countless others who gambled and lost on tobacco roulette.
Judi Houle is one tribal member who smokes, but doesn’t let it worry her.
“I’m healthy,” maintains Houle, who works at the Rocky Boy’s Senior Citizen Center, a lofty building that smells of cake and cigarettes. Houle, both a grandmother and a long-time smoker, believes that genetics play a part in determining who will get sick from cancer.
Although Houle appears to be a healthy woman of middle age, a sharp cough interrupts her train of thought and rattles her dangling feather earrings.