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Problem of Indian Administration

The low cost of maintenance in Indian Service sanatoria can be accounted for in the following manner:

  1. Salaries paid the superintendent and employees are lower than the average in other institutions. This is especially true in relation to other federal sanatoria.
  2. The staff is always less per unit of patient population. This makes it necessary to have much of the service done by patients. The lack of order and cleanliness in institutions is doubtless a reflection of this same situation.
  3. The lack of equipment to render reasonable service saves much money, but at the same time it results in inferior treatment. This fact, combined with that of limited personnel, is definitely reflected in the impermanence of results obtained with discharged patients. In the State of Washington, frequent comments were heard from tuberculosis workers not in the Indian Service, as well as from Indians, that the discharged patient from Indian Service sanatoria did not remain in an arrested condition of health as long as those from state and county institutions.
  4. A difficulty that has existed in the past, but is not so prevalent now, is the authority the agency superintendents have exercised over administrative policies of the institution. Not appreciating the needs and requirements, they have ignored the pleas of the physician for additional employees, and insisted that sick children able to be up and around should devote their activities to some occupation or service about the building.

In connection with these figures it should be said that the many elements of cost, such as food, technical service, heating, repairs, special activities, and depreciation, should be higher in Indian Service sanatoria because of their location than in institutions more favorably situated. These items caused a wide variation in cost in the institutions studied by Drolet. He found the highest maintenance cost in federal institutions.

The physicians in charge of the Phoenix, Fort Lapwai, Sac and Fox, and Talihina institutions have all had some special training in tuberculosis work. The superintendent at Chippewa is taking a special course in tuberculosis this summer at Colorado Springs. The other superintendents have had no special training. For the most part, all these employees have been fairly permanent. The marked exception is at Pyramid Lake, where in eleven months of

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