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“A child is not a pair of shoes.”

Those stark words put into perspective the scourge of alcoholism on the Pine Ridge Reservation and impact it has on the children born there. They came from Nora Boesem, president of Roots to Wings FASD and the parent to 12 children with fetal alcohol syndrome.

“Our FASD population has truly been a throw-away population,” she said Saturday at the Legislature’s Whiteclay Task Force Summit.

She learned the hard way. When she and her husband applied to be foster parents, they indicated that they would not take children with fetal alcohol syndrome. Their first three placements all had FASD. When she began seeking assistance for them, she was told they were lucky – they hadn’t adopted them yet and could send them back.

“I didn’t take that well,” she said. “We had to rebuild our lives.”

After changing their approach to everything, they decided they would only take in foster children with FASD.

“A lot of my children are products of Whiteclay, and their parents are products of Whiteclay.”

When her now 25-year-old son came home drunk at 17, she felt like a failure. But during conversations with him at the hospital, she realized her son didn’t realize that beer wasn’t the only thing he shouldn’t be drinking because of his disorder.

He was convinced he had a head injury and swore he hadn’t been drinking because he believed beer was the only thing he should avoid.

“They (FASD children) can’t think in abstracts,” Boesem said. “I can’t name every type of alcohol that is off limits.”

Instead, they now tell their children they can only drink milk or water.

There is no good data on the prevalence of fetal alcohol syndrome on the Pine Ridge Reservation or the towns surrounding it across the border in Nebraska. Diagnosis of the disorder can often run $2,600, and insurance doesn’t always cover it.

“That can be a yearly income for some of the families I work with on Pine Ridge,” said Boesem, who is also a clinical social worker. Thirty percent of children under 18 in Sheridan County also live in poverty, and a recent health needs survey by the Panhandle Public Health District highlights that cost of health care – whether it’s insurance or outright costs for medical care – is a barrier to access for much of the population.

Telehealth services through the University of Nebraska Medical Center, a collaboration that’s attempting to address a severe shortage of professionals in the Panhandle, may be a partial solution. The collaboration is already offering virtual drug and alcohol counseling at the Oglala Sioux Tribe Nursing Home south of Whiteclay for both scheduled and on-demand needs, said Dr. Fernando Wilson, who works with the UNMC Center for Health Policy.

The Medical Center also recently hired an expert in fetal alcohol syndrome, so the collaboration at least as the potential to expand.

Longterm, the Behavioral Health Education Center of Nebraska, also based at UNMC, has just started working with Chadron State College to determine if a master’s level curriculum for counseling services could be created at CSC. The idea is that individuals from the area who attend CSC will be more likely stay in the region and provide drug and alcohol counseling in the region.

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While closing the Whiteclay liquor stores in April doesn’t won’t solve the alcoholism and drug problems in their entirety, Boesem said it creates a sense of hope that more is possible.

Raised by his grandmother, Leo Yankton, suffered from alcoholism until 2009. She taught him the ways of the Lakota.

“It wasn’t enough for me (to beat his addiction) because I live in a society with two worlds. You have to be able to survive in both of them to flourish.”

During his time in a residential rehabilitation center, he learned financial skills that helped him build a life once he was released. Now, he owns two businesses and a home.

Those life skills are an important piece of recovery, said Selina Hayle, the national expansion director for the Association of Gospel Rescue Missions.

The Pine Ridge region needs a detoxification center, an expanded residential treatment facility – the current one on the reservation has a capacity of seven – and transitional facilities. If any of those steps in the recovery process are missing, individuals are more likely to fail, Hayle said.

Options for family treatment, where an addicted mother can be in a residential setting with her children while seeking treatment, is also ideal, said Marry Barry Magsamen, the chief officer of organizational growth at St. Monica’s in Omaha. Women will often choose to delay or deny treatment if it means leaving their children, or have domestic trauma that they are uncomfortable discussing in mixed gender groups.

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