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As the name implies, the reservation straddles the two states. Greiner sits in the back of a white van as it follows the Missouri River to White Cloud, which is 90 miles north of Kansas City, Kansas.
Last year, the National Institutes of Health awarded KU Med a $7.5 million grant to expand its work addressing the health disparities in American Indian communities. American Indians are more likely to die from tuberculosis, chronic liver disease, diabetes and pneumonia than members of other ethnic groups. Greiner and Christine Daley, an assistant professor of preventive medicine and public health, are the project's principal investigators.
In White Cloud, the van passes a small casino before reaching the tribe's community center. Greiner and his team spread their blood-pressure monitors and other devices on folding tables. The cholesterol testing station requires a team member who is willing to perform a moderately invasive procedure. "Are you comfortable doing finger sticks, or would you rather not?" Angel Cully, a community outreach coordinator in the newly created Center for American Indian Community Health at KU Med, asks another member of the team.
At 3 p.m., Greiner takes a look around the room. "All right," he says, "we just need people."
The 40 tribe members who show up for the health fair receive "passports" when they register. If they fill their passports with a stamp from each station, they are eligible for a raffle to win a Foreman grill and other prizes. The idea is to create an incentive for visiting all the stations. Greiner does not want the cigarette smokers to skip the lung test. "It works," he says of the ploy. "It really works."
A woman with long brown hair reaches the station that tells fairgoers their body mass index. She seems apprehensive about putting her feet on the scale. "I probably already know what that test is going to tell me," she says.
Greiner spends most of the afternoon at a table with an "ask the doc" sign taped to the edge. It's his custom at health fairs. Earlier this year, he manned an "ask the doc" table in the basement of a church in Garden City, Kansas, which has a large Hispanic population. Greiner is the principal investigator on another National Institutes of Health-funded project, one designed to improve cancer survival rates for American Indians and rural Latinos.
Greiner says he learned a lot in the church basement about the Latinos who live in western Kansas. "It was just great being able to sit there and talk to people all day long about the different doctors they'd been to, or the fact they couldn't get to any doctor at all, or the fact they were going back to Mexico next month, and they'd totally run out of their medicine and didn't know what to do," he says.
Greiner hopes to improve the level of communication with the Latinos he meets in the course of his work. When he's in his car, he listens to CDs that teach Spanish.
In White Cloud, Greiner's "ask a doc" station is located near a table that offers colorectal-cancer screening kits.
American Indians do not, in fact, report higher rates of colorectal cancer. This is partly because they're less likely to be screened for the disease.