Page:LewisMeriam-TheProblemOfIndianAdministration.djvu/36

Absence of Well Considered, Broad Educational Program. The outstanding evidence of the lack of an adequate, well-trained personnel is the absence of any well considered, broad educational program for the Service as a whole. Here the word education is used in its widest sense and includes not only school training for children but also activities for the training of adults to aid them in adjusting themselves to the dominant social and economic life which confronts them. It embraces education in economic production and in living standards necessary for the maintenance of health and decency.

Work for the Promotion of Health. The inadequacy of appropriations has prevented the development of an adequate system of public health administration and medical relief work for the Indians. The number of doctors, nurses, and dentists is insufficient. Because of small appropriations the salaries for the personnel in health work are materially below those paid by the government in its other activities concerned with public health and medical relief, specifically the Public Health Service, the Army, the Navy, and the Veterans’ Bureau, as well as below those paid by private organizations for similar services. Since its salaries are sub-standard, the Indian Service has not been able to set reasonably high entrance qualifications and to adhere to them. In the case of doctors the standards set for entrance have been too low. In the case of public health nurses the standards have been reasonable, but it has not been possible to secure at the salary offered a sufficient number of applicants, so that many people have to be employed temporarily who do not possess the required qualifications. Often untrained, inexperienced field matrons are attempting to perform duties which would be fairly difficult for a well trained, experienced public health nurse. For general nursing positions it has often been necessary to substitute for properly trained nurses, practical nurses, some of whom possess few qualifications for the work.

The hospitals, sanatoria, and sanatorium schools maintained by the Service, despite a few exceptions, must be generally characterized as lacking in personnel, equipment, management, and design. The statement is sometimes made that, since the Indians live according to a low scale, it is not necessary for the government to furnish hospital facilities for them which are comparable with those supplied for poor white people in a progressive community. The survey