Veins of the River

Veins of the river

The Fort Belknap tribes’ water rights stagnate in the House

Story by Lucy McDonald-Garrity & Sav Chavez | Photos by Mark Elkins Davidson

It started with a silent heart attack. Tracy “Ching” King required surgery for the incident. The follow up treatment required the use of contrast dye injections, which made it easier for doctors to see the heart valves, coronary arteries and heart chambers in King’s heart.

However, the dye destroyed King’s kidneys, which now only function at 7% capacity.

Now, King must travel to Havre three times a week to receive the dialysis treatment he needs to survive.

A man sits at a table recording his blood sugar. — Tracy “Ching” King records his blood sugar at his home early in the morning. King records his vitals every day to keep track of trends in his health.

The drive is only about an hour away, but the process is arduous and takes about four hours, requiring the better part of each of those three days, weekly. Dialysis takes a toll on King’s 68-year-old body.

Getting up hours before the sun breaks over the horizon, King sits at his kitchen table to check his vitals to keep his doctor up to date on his health. By 4:30 a.m., a minivan’s headlights shine into his home, alerting him it is time to go. The van is driven by one of the three drivers working for a transportation program provided by the Indian Health Service, or IHS. After driving through the morning darkness for an hour, King arrives at Northern Montana Health Care in Havre. Here, a nurse hooks him up to dialysis.

A man in a cowboy hat stands in front of a horse paddock, looking off into the distance. — Tracy “Ching” King looks off into the horizon from his front yard. King lives just south of Fort Belknap Agency.

This is the morning routine King does when he goes to his dialysis treatment, partially made possible by the Indian Health Service.

The tribes have considered constructing a dialysis center on the Fort Belknap Indian Reservation, which would help more than a dozen patients in the area. However, a lack of funding and dilapidated infrastructure has put that dream out of reach for decades.

A man sits in a hospital chair, waiting for a nurse to prepare supplies. — Once at Northern Montana Health Care dialysis clinic in Havre, Tracy “Ching” King waits for Nurse Vikas Yesodharan Baby (left) to prepare equipment.

On Fort Belknap, clean and safe water is not guaranteed. Water infrastructure in the area is outdated and, with both limited manpower and lack of funds, the reservation cannot work to meet the water demand necessary to support everyone.

For the past three years, the tribes on Fort Belknap, the Nakoda and Aaniiih, have been working on a new water rights settlement that could help resolve the water issues, however the argument has been caught up in the House of Representatives. The Senate has passed the bill unanimously twice. The Fort Belknap Indian Community Water Rights Settlement Act would offer $1.3 billion to the tribes for water projects, $275 million specifically aimed to repair the Milk River system that provides drinking water for 18,000 people and water for 121,000 acres of irrigation, including the people and land on Fort Belknap.

A building with a copper roof stands in front of a bluebird sky. — The Northern Montana Health Care is a hospital in Havre housing the dialysis center closest to the Fort Belknap reservation.

A dialysis center on the reservation has been nothing more than a conversation for 20 years, and until recently, that conversation remained on the back burner. Now, members of the tribal council hope to have a building to host a center as early as next spring, but there is still the financial burden. And that’s just the beginning.

Reliable access to clean water is crucial to a functional dialysis center as large amounts of water are exposed directly to the person’s bloodstream during treatment. When the reservation went on a six-week boil water advisory, proper treatment was all but impossible.

In December, windstorms with gusts up to 90 mph damaged a water tower on the reservation. Hundreds of residents were left without clean water to drink and shower with. This makes the possibility of constructing a dialysis center close to home difficult to imagine.

A dialysis patient takes a nap in his chair during his treatment. — Tracy “Ching” King sits through his four hours of dialysis treatment, passing the time either watching TV or napping in Havre.

King has served on the tribal council and was aware of the issues keeping Fort Belknap from having its own dialysis center. The frequent water and sewer line breaks mean the water quality isn’t good enough for what’s needed for dialysis. The water systems are outdated, originally built in 1889, and made of brick and not built for the current capacity of the reservation today.

“You look at maybe two or three times a week there’s water breaks,” King said.

The last time the tribal council considered a reservation-based dialysis center was in 2011, but the water from the Milk River was considered unstable. Tribal Council President Randall Werk Sr. said the reservation’s water supply is tested once every two months and, on paper, is fit for human consumption. But residents complain about the taste.

While there are patients on Fort Belknap who must travel the 47 miles to Havre or the 170 miles to Great Falls to receive dialysis, some patients have managed to treat themselves at home.

Edward “Buster” Moore has been on peritoneal dialysis, home dialysis, for more than two years and prefers it to hemodialysis, which would require him to travel to a clinic.

“I’m still doing what I love and that’s why I like peritoneal,” he said. “I’m tired all the time, but I don’t want to be more tired. I like having my freedom.”

Moore started his dialysis treatment when his kidney function dropped to 12%. Though this function is still low, he is proud of how he’s maintained this. While home dialysis is the preferred method for Moore, he and his wife can no longer travel because his machine is not easy to transport.

A man sits on his bed next to a small machine on his bedstand. His wife watches him from the corner of the room. — Edward “Buster” Moore (right) sits on his bed next to his peritoneal dialysis machine and his wife, Dawn Bishop-Moore (left) in their home in Hays, Mont. The machine is strategically placed by his bedside and near the bathroom so he can get up in the night without unhooking from the machine.

“Unless I get a kidney transplant, I’m never going to get off of dialysis,” Moore said.

Buster Moore’s wife, Dawn Bishop-Moore, said Moore went on dialysis at a stressful time. Around the time he started treatment, the couple’s daughter passed and their granddaughter, who requires high support needs, was put in their care. Bishop-Moore was concerned about the home treatment, but now agrees it was the right choice.

“I do what I got to do to keep going.”

“I’ve had people I know very close to me that have gone on hemodialysis and they’re sickly,” she said.

Man prepares supplies in a small classroom. — Edward “Buster” Moore (left) prepares supplies for the art and crafts class he teaches in Fort Belknap Agency. Moore says that choosing the at-home peritoneal dialysis over out-patient hemodialysis grants him more freedom to do what he wants with his days.

Though Moore is unable to travel, he remains active in his community by teaching crafts, running an alcoholics anonymous group and helping with a narcotics anonymous group and grief support group.

Moore required three surgeries to insert a catheter into his abdomen. The home treatment allows him to hook up to his machine every night and do his 10-and-a-half hour dialysis cycle in his bed, running three gallons of fluid through his body.

This option is only possible for Moore because he has access to a private well. A sanitation department comes every two months to test the water quality to ensure its safe for consumption.

A man leans over a pile of cardboard boxes in his home. — Edward “Buster” Moore looks at his dialysis supplies in his home in Hays. Moore uses an entire box of fluids every night with his peritoneal dialysis machine.

The lack of a dialysis center also affects patients who require other lifesaving services like chemotherapy. Tescha Hawley is executive director of Day Eagle Hope Project, a cancer support organization in Fort Belknap. She said there have been times when cancer patients had to miss their chemotherapy appointments because there weren’t enough drivers and the dialysis patients took priority.

“So, he missed his appointment, and I went into IHS and I’m like ‘Where is everybody and what happened?’ And they told me they have a shortage of drivers and that dialysis people are a priority,” Hawley said. “How do you decide which disease is a priority over another disease?”

When a patient misses a dialysis treatment, they risk overloading their bodies with fluid and toxins, which could begin to flood their lungs or cause potassium to build up which can ultimately lead to a heart attack.

“When someone misses their treatment, that means they are missing a day of getting toxins removed,” said Abby Nicholas, director of dialysis at Northern Montana Health Care.

A man stands in his living room with his arm around his wife. — Edward “Buster” Moore and his wife, Dawn Bishop-Moore, stand in their home in Hays.

In the past when King has missed a treatment, he said he was instructed to limit his fluid intake to 32 ounces, significantly lower than the recommended water intake for an adult. According to the Mayo Clinic, an adult should drink about 115 ounces, or 3.7 liters, of water a day.

“There are some guys that miss three or four treatments. I feel bad just missing one,” King said.

King said he has grown to look forward to his dialysis days, mostly because he tends to be surrounded by positivity.

“You have drivers from [the Indian Health Service] that take us,” King said. “There’s probably four of us that go, and what I see is the drivers are good and the nurses that hook you up to the dialysis, they have good vibes, good energy and the director does so that really helps.”

“Unless I get a kidney transplant, I’m never going to get off dialysis”

A SPECIAL PROJECT BY THE UNIVERSITY OF MONTANA SCHOOL OF JOURNALISM

ADDITIONAL FUNDING SUPPORT FROM THE GREATER MONTANA FOUNDATION

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