Mysterious Force Attacks Small Western Tribe's
Young in the Womb
Date: 03/27/2000
http://www.nytimes.com/library/national/science/health/032600hth-tribe-miscarriages.html
Mysterious Force Attacks Small Western Tribe's Young in the Womb
By SAM HOWE VERHOVEK
HOALWATER BAY INDIAN RESERVATION, Wash. -- The tiny tribe that lives here on a wind-battered, rain-swept spit of land hard by the Pacific Ocean knows something about fighting for survival.
Members of the Shoalwater tribe fight the heavy erosion that over the decades has eaten more than half of the one-square-mile reservation created in 1866 when President Andrew Johnson signed an executive order removing the tribe from nearby villages. And they fight for economic survival, their latest battle a feud with federal marshals over the number and type of slot machines they may keep at a casino that is their main source of income.
But the most difficult battle is for the women who live here, who are up against an unseen foe, a killer that seems to come and go over the years, though no one can even prove it exists. For some reason, it is frighteningly difficult to give birth to a living child here.
The worst year was 1998, when all but one of nine known pregnancies on the reservation ended in a miscarriage or stillbirth. Since then, eight pregnancies have lasted 12 weeks or longer, and half of them have ended in miscarriage.
"You look around the village and you start asking yourself, 'Where are the children?' " said Lisa Shipman, who had a stillborn son in 1990 and whose sister-in-law, Vernita Norman, has miscarried three times and recently left the reservation, in fear, when she became pregnant.
Mrs. Shipman and her husband, Michael, finally had happy news last April when a healthy daughter, Kaylee, was born. "This was everybody's pregnancy," she said. "She is the community baby. Everybody dotes on her. But you still wonder, where are all the others? Where is the next generation coming from?"
It is a question that neither tribal leaders nor federal investigators can answer for sure. The national Centers for Disease Control and Prevention, called in after the 1998 calamity to study the alarmingly high rate of fetal deaths, issued a report this year that confirmed the fears of the tribe, one of the smallest, with 204 members, and poorest in the West.
The agency's study pegged the miscarriage rate after an established pregnancy at 50 percent to 67 percent, roughly three to four times the expected rate. But while such a cluster of health afflictions is disturbing, the study cautioned that it was dealing with such a statistically small sample that a definitive problem could not be proved -- nor, as is the case with other federal studies here, did it find a cause.
The killer could be lurking in the environment. Pesticides are routinely sprayed on cranberry bogs north of the reservation, on forestland to the east, and even into Willapa Bay, to control parasites that attack the oysters that are a big industry.
It could be a genetic flaw, though marriage among tribal members is rare and several of the miscarriages have been experienced by nontribal women married to Shoalwater men. It could stem from poverty and poor diet.
Alcohol or drug abuse are often a factor in miscarriages, but the federal study found no evidence of either problem here.
And several women on the reservation talked of the meticulous care they took during their pregnancies, down to drinking bottled water and even avoiding any food grown here or plucked from the nearby sea.
Still, there were miscarriages.
And, of course, it could be just an awful run of chance, though no one seems to believe that is the case.
"It would almost be easier to take if it was just a random occurrence, just a stretch of terrible luck," said Gale Taylor, the tribal health director, a non-Indian who had a miscarriage.
"That would be nice because you think, well, it could stop. The fact of the matter is, though, every day I'm waiting for the other shoe to drop. One month here, we lost four pregnancies. It was like a war zone."
The tribal chairman, Herbert Madzu Whitish, who also owns a convenience store on the reservation, said he was frustrated by the lack of answers and worried about both "the generation that is missing here" and the women on the reservation who wanted to bear children.
"A lot of people are afraid of pregnancy," Mr. Whitish said. "Instead of it being the most joyous time of their lives, it's like they're on pins and needles, worrying that something is going to happen."
The tribe concluded there was a serious problem when its records showed that from 1988 to 1992, at least 10 of 19 pregnancies had ended in miscarriage or stillbirth.
The miscarriage mystery has only been compounded, Ms. Taylor said, by the fact that those babies who have been born are generally healty. A clinic was built, largely with federal dollars, to provide more immediate care and monitoring of pregnancies. State and federal environmental reports found high levels of three pesticides in the drainage areas of the cranberry bogs, but did not find the tribe's drinking water to be unsafe.
The problem slipped from public attention when the tribe had several healthy births from 1993 to 1996; by 1998, though, the level of miscarriage was at its highest in memory, and the fear returned.
"I did everything I thought I could possibly do to have a healthy baby," said Kim Zillyett, the business manager at the tribal clinic here, who has miscarried twice in the last two years and is expecting a baby in May -- an event she alternately views with joy and worry.
"It's not over till he's out," Ms. Zillyett said, referring to a boy whom she and her husband plan to name Teegan, an Irish name they found in a baby book.
"It's not over until he's here and he's healthy."
The tribe, which was created a century and a half ago when several bands of Lower Columbia Chinook Indians were put together after refusing to sign a treaty with the United States government and live on a reservation with the rival Chehalis Tribe, "is not going down without a fight," Mr. Whitish said.
It has applied for federal money for more extensive environmental testing of reservation land and greater monitoring of all pregnancies. It has an extensive grief-counseling program, including a series of art projects in the log-frame tribal center here that allows the Shoalwaters to express grief over the tribe's mysterious affliction.
"These people are survivors," said Dr. Kristen M. Swanson, a professor of family and child nursing at the University of Washington, an expert on dealing with miscarriage who has been invited by the tribal council to study the community's response to the miscarriages.
"They've had a lot that they've had to survive," Dr. Swanson added.
"And the chairman has been very clear whenever I've met with him that they will do all they can to get through this. In a lot of ways you have to stand in admiration as to how the tribe has not let this roll over them. They've gone to the Centers for Disease Control, they've gone to the universities, they've gone to the Indian Health Service, they're fighting for what they need."
And yet there remains enormous frustration that no one has a clear answer for why the problem has arisen. "When the recent report came out, I was glad that, yes, they recognized there were significant problems," Mr. Whitish said. "But they didn't offer much in the way of any kind of answers. I guess I got caught up in the TV version. I thought the investigators could ride in here and give us the answer."
Ms. Taylor, the tribal health director, is also dismayed that she cannot give certain answers when women ask how to improve their chances of a healthy pregnancy.
"When you have to tell people that maybe the water they drink is the cause, or just walking on the beach is a cause, or that maybe there's no cause at all, that's frightening," she said. "A lot of women feel, if you want to stay pregnant, get the hell out of the reservation. It's hard. We're losing our land on one side, and we're losing our babies on the other. It's not a great way to live."