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conditions and attendant problems, as well as diseases of the poor—including malnutrition, tuberculosis, and high maternal and infant death rates. Poverty and isolated living serve as further barriers that keep American Indians from using limited health care facilities even when they are available (National Con- gress for American Indians, 2010).
The traumas that the American Indians in the Plains states experienced over the past 175 years, such as the massacre at Wounded Knee, are part of the problem, as is the decimation of the land and culture.’