Case Studies for Discussion

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Mr. C is a 66 year old Oklahoma Indian who was orphaned at a young age and was raised in Indian boarding schools. His young adulthood was spent “riding the rails” and “hard drinking”. He was married twice and has no children. He has been a sober and productive member of a large urban Indian community for the last 20 years, and he presents with chronic uncontrolled diabetes.

Mrs. D was born and raised on a large southwestern reservation in New Mexico. Her mother was Indian and her father was White. Her husband moved the family to an urban area during the 1940’s, and he served 3 years in the military during W.W.II. Mrs. D. is now 76 years old, and spends time with each of her five children, two of whom live on the “home” reservation, and three live in different urban areas. Although Mrs. D is an enrolled member of her Tribe, she becomes ineligible for medical services if she is off-reservation for more than 180 days. Mrs. D. has arthritis, hypertension, and coronary artery disease. She has recently had a stroke, and now has a right sided hemiparesis.


Questions for Discussion

Questions for Discussion

1. How could you use the cohort analysis in these two cases?

2. What events may have influenced Mr. C ? How might they affect his health care?

3. What events may influence Mrs. D’s perception of health care? Her 50 year old children? Her 30 year old grandchildren?

4. What impact might Mrs. D’s migration between her children’s homes have on her ability to access health care?