The Albuquerque Area Indian Health Board I work for the Albuquerque Area Indian Health Board, a non-profit corporation owned and operated by a consortium of Indian tribes that are spread out across 450 miles of New Mexico and Southwest Colorado. I am part of a team that includes four audiologists, two audiology technicians, and a program ... Features
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Features  |   May 01, 2005
The Albuquerque Area Indian Health Board
Author Notes
  • Leslie Hinshaw, is an audiologist with the Albuquerque Area Indian Health Board, Inc., in Albuquerque, NM. Contact him by e-mail at lhinshaw@aaihb.org.
    Leslie Hinshaw, is an audiologist with the Albuquerque Area Indian Health Board, Inc., in Albuquerque, NM. Contact him by e-mail at lhinshaw@aaihb.org.×
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Hearing & Speech Perception / Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / Cultural & Linguistic Diversity / School-Based Settings / Professional Issues & Training / Regulatory, Legislative & Advocacy / Features
Features   |   May 01, 2005
The Albuquerque Area Indian Health Board
The ASHA Leader, May 2005, Vol. 10, 11-13. doi:10.1044/leader.FTR3.10062005.11
The ASHA Leader, May 2005, Vol. 10, 11-13. doi:10.1044/leader.FTR3.10062005.11
I work for the Albuquerque Area Indian Health Board, a non-profit corporation owned and operated by a consortium of Indian tribes that are spread out across 450 miles of New Mexico and Southwest Colorado. I am part of a team that includes four audiologists, two audiology technicians, and a program manager. Together, we see to the hearing needs of some 60,000 Native Americans living in 25 mostly rural reservation communities, plus another 25,000 Native Americans in the Albuquerque urban area who are members of tribes from all across the United States.
We service about 400 regularly scheduled clinics each year. In 2004, we saw more than 3,000 patients and screened the hearing of about 5,250 school children. In addition to scheduled clinics, we go where and when the Indian communities call us to be whatever kind of audiologist is needed, whether diagnostic, rehabilitative, educational, or industrial.
Like most audiologists, I meet with patients, run tests, educate, counsel, fit hearing aids, consult with physicians, keep the paperwork straight, push hearing conservation, make presentations, and try to stay current. Each day I’m in a different place, most often doing something I didn’t do yesterday. Along with variety comes a lot of travel. I drive about 20,000 miles and spend 60 nights away from home each year.
A Typical Day
My most recent out-of-town trip was typical. After a morning of preparation in the office, I drive three-and-a half hours to one of the communities I serve and check into a motel. I arrive at the clinic the following morning, unload what I need, set up, check the equipment, and review the schedule.
The first appointment is an auditory processing evaluation requested by the school. I’m surprised; this wasn’t on the schedule I saw at the end of last week. I didn’t bring the equipment and materials I need. The child is rescheduled, so I do some paperwork and stop by the clinic director’s office to remind him how much the Health Board would like to buy the clinic a booth, if space could be dedicated to the purpose.
At 10 a.m., I have a double appointment with a husband and wife, elders I tested two weeks ago. Today, they are back for hearing aid consults and earmold impressions. A 3 year-old boy is in for follow-up on his middle ear status. I deliver a repaired aid to another elder, and see a woman for a hearing aid clean and check, who gives me lessons in her Native language and always makes me laugh. I stop by the pediatrician’s office to drop off a note about referring the 3-year-old to an ENT, and go to lunch at the casino.
The afternoon takes a diagnostic turn. I meet two patients for hearing evaluations, both normal, and hand out fistfuls of foam earplugs. A young man comes in who experienced sudden, unilateral hearing loss about a month ago. His appointment runs long. The next patient is a middle-aged woman who is dizzy. Two more patients and the schedule is completed.
I finish the patient charts, pack up, and talk with the head nurse and a physician about the sudden hearing loss case. After that, I drive two hours to another community and check into another motel. During the night, it snows three inches.
Next morning, I rescreen the hearing of nine children at the tribal Head Start and begin seeing clinic patients at 10:30 a.m. I’m home at 7:30 p.m. that evening.
Back at the office, in Albuquerque, I process paperwork from the trip, write reports, handle hearing aid orders and repairs, see urban patients, and work on the current special project.
I am responsible for the hearing health care of the Southern Ute Indian Tribe and the Ute Mountain Ute Tribe, both in Southwest Colorado, and the Jicarilla Apache Nation in Northern New Mexico. In addition, I team with my colleague, Christy Taylor, to take care of the Taos Pueblo community in Taos, New Mexico, and to provide services to those Albuquerque urban Natives who receive health care through the Albuquerque Indian Health Center. Christy also works with eight more Indian pueblos. Lori Workizer is responsible for nine pueblos, mostly through regional Indian Health Service (IHS) hospitals. Kathleen Coghlan serves four tribes in the southern and western parts of New Mexico. The audiology technicians, Margie Saunders and Donna Lasiloo, coordinate schedules and billing, work with school screenings, translate, and provide supervised clinical assistance as needed. Chris Atkinson, our manager, handles the flow of administrative paperwork, keeps up with the budget, and maintains our connection to the bigger picture.
The Health Board provides a helpful and effective clerical and administrative staff to support all the Board’s programs, which presently include audiology, HIV/AIDS education, tribal capacity building assistance (focused primarily on women’s health), and research programs. I have the use of excellent equipment, funding for the continuing education of my choice, licenses and professional memberships, and a car. The organization will also be covering the cost of AuD programs, which my colleagues and I plan to begin later this year.
Although the Health Board is independent of the IHS, we work closely with IHS personnel and generally see our patients in IHS facilities, where we have staff privileges. Some of the clinics have testing booths and state-of-the-art diagnostic equipment in dedicated space. For example, the new Jicarilla Health Center in Dulce, New Mexico has a five-room audiology suite with booth, fitting room, and balance center. Other clinics may have nothing at all. To these, we bring portable equipment and set up in the optometry room, a mental health office, or wherever quiet space can be found. We also work with the tribal early childhood programs and school systems to provide hearing screening and early identification and management of children with hearing loss.
Since the tribes allocate funding for our professional, clinical, travel, and administrative costs, this allows us to pass on to the patient our exact invoice cost of hearing aids, assistive devices, or other equipment. Our relationship with the IHS gives access to special pricing from those manufacturers on government contract, and other manufacturers have been willing to negotiate remarkable discounts for us as well. On average, we provide a wide range of digital hearing aids at 15% of the going retail price, or less. Some tribes pay part or all of the cost for their members, others do not. Funding may come from Medicaid, Vocational Rehabilitation, a school, or the patient may pay. When no money is available from any source, the Health Board absorbs the cost for qualified patients. Custom hearing protectors are provided free.
The Health Board contracts directly with the leaders of individual tribes under the provisions of P.L. 93-638. This legislation defined the process by which tribes can take the lead in prioritizing and delivering health care and other services to their members. In this context, my work is twofold. On the one hand, I see patients; I provide and coordinate care. On the other hand, and every bit as important, my work supports the rights of Indian tribes to self-determination and sovereignty in their health care choices. It seeks to uphold and respect the spiritual and cultural values of the people and communities I serve.
Each of the 25 tribes we work with has ancient and unique stories about how the first people emerged from the earth and migrated in search of a place that spoke to them, a place that was home. These rich and complex stories have at their core a reverence for the earth and for all life. They inform many aspects of each tribe’s tradition and culture, including health beliefs.
A distinction is drawn between natural aging and disease processes, and diseases which arise from abuse of the body, which occurs from failure to follow traditional teachings. The tribes have also adapted to modern ways, including contemporary health practices and technology.
My role is to offer the best of modern hearing health care and technology, while opening myself to the history, perceptions, and beliefs of my patients, and being willing to learn from them how best to integrate the benefits of technology into ancient ways of perceiving, valuing, and behaving. It is within this framework that I counsel a lifelong hunter about hearing protection, or approach fitting hearing aids on a person who suspects he acquired a hearing loss by listening to things he shouldn’t have.
Funding and Health Coverage
Funding for the IHS, a part of the U.S. Public Health Service, has been trimmed significantly in recent years. Congressional efforts to reauthorize the Indian Health Care Improvement Act die annually, as they have done for five-plus years. As a result, impediments to health care delivery have been growing in Indian Country, and are starting to bear fruit. Here in New Mexico, we are seeing a significant curtailment of access to basic medical services, particularly for those urban Natives who live away from reservation resources and may be poor and uninsured.
Since we are a private contractor, funding for audiology services has been little affected so far. A more immediate dilemma is that no ENTs work for the IHS in our geographic area. All ENT referrals must go outside the system and IHS pays the cost. Balancing over- and under-referral is not easy in a time of dwindling resources. IHS physicians make specialty referrals prudently, so a collaborative relationship is necessary for limiting expenses while meeting patient needs. My challenge is to know enough and communicate clearly enough to be of genuine use to patients and physicians alike.
I am practicing the sort of audiology I envisioned in graduate school. It was different when I worked in a dispensing office. If test results suggested something amiss, I referred. My job was to sell hearing aids, not to probe diagnostic subtleties. I never became comfortable with that segment of retail audiology in which patients are called “opportunities,” or with having my value assessed mostly on my closing rate, my return rate, and my monthly gross. In the ENT offices, I felt I was primarily a technician. Now, I enjoy true autonomy and significant responsibility. I see something new almost every day. I serve a population that is underserved. I work with bright, dedicated people and collaborative peers. I have the financial resources, equipment, and access to the continuing education that I need. The rest is up to me.
For More Information

There is great need in Indian Country for health care providers of American Indian or Alaskan Native descent. The Indian Health Service offers a variety of programs to enable and support the training of Natives interested in Indian health careers, as well as a program for non-Natives who want to work with the Indian Health Service, tribal health programs, or urban Native programs. For more information about career opportunities, visit the Indian Health Service Web site or come to New Mexico for a personal tour.

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May 2005
Volume 10, Issue 6