Since she moved to Salt Lake City from the Navajo Indian Reservation, Priscilla Harvey has relied on the Indian Walk-in Center for health care and occasional food assistance.
But for Harvey, 37, the center is more than a clinic. It also provides a social network, helping her stay connected to her culture through activities such as powwows. That's critical for Harvey, who lived her entire life in the Four Corners area until she moved here about a year ago.
"We're out in the middle of the white man's world," Harvey said. "It's nice to keep tradition."
But now, Utah's only urban Indian health clinic is threatened by President Bush's 2007 budget proposal to erase the $33 million federal allocation for urban Indian health clinics. At least 17 of the 34 clinics across the country, including Salt Lake's, may have to close their doors, while the rest would be forced to cut services.
If the center were closed, Harvey said she doesn't know where she'd go for the same services.
"I'd probably move back" to the reservation, she said.
Dena Ned, executive director of the Indian Walk-in Center, 120 W. 1300 South, said the center serves an estimated 4,000 urban Indians each year, most of whom are uninsured and at or below the poverty level.
"If we were closed, I don't know where they'd go," Ned said. "The only viable solution to this is that the dollars are fully restored."
In Bush's 2007 budget proposal, it is suggested that urban Indians can go to community health centers instead, since those centers are slated to receive a $181 million increase that would build or expand 300 sites.
Alex Conant, spokesman for the White House Office of Management and Budget, noted the increase and said: "Urban Indians, like all Americans, continue to benefit from the president's initiatives to make health care more affordable and available."
But clinic directors and urban Indians say increasing community health center funding doesn't solve the problem.
"Many tribes are viewing this as an assault on trust responsibility," said Geoffrey Roth, executive director of the National Council of Urban Indian Health.
Community health centers are already "stretched to the limit," said Amy Simmons, spokeswoman for the National Association for Community Health Centers. The proposed program expansion isn't designed to meet the needs of urban Indians, said Daniel Hawkins, the association's vice president for federal, state and public affairs, in a recent letter to Bush.
In Utah, Dexter Pearce, deputy director of Community Health Centers Inc., said he wasn't sure about the current proposal, but a federal funding increase of $1 million over the past five years all went to rural areas.
Community Health Centers has a $200,000 contract to provide primary care for the Indian Walk-in Center.
"If there's not a dollar-for-dollar exchange, we would have to make that up somehow," he said. "Someone would go without services."
Ned said she's optimistic that Congress won't let the budget cut stand. However, if the center were to lose its $1.1 million in federal contracts, it would also lose grant funding, effectively cutting 90 percent of the center's $1.5 million budget, she said.
The Indian Walk-in Center's free health and behavioral health services include diabetes education, immunizations, substance abuse treatment, mental health counseling, holistic care, HIV testing and counseling, and youth programs. It also operates a United Way-funded food pantry, which handed out some 5,200 boxes of food to both Indians and non-Indians last year.
Ned questioned whether many of the area's American Indians would use other community health facilities, since they tend to seek health care only when they are in crisis. They then contribute to crowded emergency rooms. As American Indians, they would still qualify for care at tribal health facilities on reservations, but for most who live in the cities, such a lengthy trip might not be realistic, she said.
Nationally, some 60 percent of American Indians and Alaska natives live in urban areas, according to the Census Bureau. And for years decades in some cities they have been receiving health care at clinics in or near the cities where they live. Providing health care to all Indians is part of the government's trust responsibility.
Sen. John McCain, R-Ariz., noted during a Senate Indian Affairs Committee hearing last month that even though the proposed cuts could be restored, "I think some of these cuts . . . clearly send out the wrong signal to Indian Country as to what our belief and our fulfillment of our obligation to Native Americans is all about."
Sen. Bob Bennett, R-Utah, who sits on the Senate Appropriations Committee, did not respond to interview requests.
Forrest Cuch, director of the Utah Division of Indian Affairs, said eliminating the urban health clinics would violate treaty agreements.
"We can't even provide adequate health care to our elderly . . . , much less to the indigenous people who originated here," Cuch said. "Our government has reduced them to their present status, which is very deplorable health conditions. If they're not going to honor the treaty, they should give the land back to the Indians."
Compared to the U.S. population as a whole, urban Indians have a 178 percent higher death rate from alcohol abuse and a 54 percent higher death rate from diabetes, according to a 2004 study by the Seattle Indian Health Board's Urban Indian Health Institute.
Utah's Indian Walk-in Center's influence reaches beyond those living along the Wasatch Front.
Felecita FoolBear of Fort Duchesne traveled to Salt Lake for a two-day tobacco cessation training that she said isn't available on the reservation. The training will help her explain to youth on the reservation the "big picture" of the impact of tobacco.
"It's really mind boggling, all the chemicals," she said. "It's not enough to tell young people it's bad for you, but they need to know what's in it."
FoolBear said the training will also help her explain the difference between traditional ceremonial use of tobacco, and smoking cigarettes on a regular basis."Every tribe varies on how they use it," she said. "For Utes, it is for ceremonial purposes. It's not to be abused."
Contributing: Associated Press E-mail: firstname.lastname@example.org