to fit his culture as nearly as possible if maximum utilization of health services is to be achieved.

I would not call it superstition; I would call it more that he has a different sense of values, and he has a different mode of operating, if you want to call it that, than the non-Indian, which may interfere with the most effective use of the resources.

But we find him extremely cooperative and often accepting many things which are contrary to his culture if we take the time and put in the effort to sit down and explain to him what we are trying to achieve, and let him participate in the program rather than impose it upon him without any consultation.

To carry on the illustration of these facilities, we have here illustrated an old field health station which is, as you will recall, the station where medical services and preventive health services are provided on a scheduled basis rather than on a continuous basis. This is located at Gila, Ariz., and to compare it to a modern station, here is one at Pryor, Mont.

Thirty-two of these field health stations have been completed or are under construction or are being planned.

Now in the construction and use of Indian sanitation facilities there has been a tremendous and remarkable impact upon the Indian and his health status. The Indians have taken particular pride in their personal contribution to this program. More than one-third of the program effort since the enactment of Public Law 121 has been provided by the Indians themselves. And in many instances the tribe

has provided funds to match the funds that were appropriated by the Federal Government for this construction of water supply and sanitation facilities.

Some 72 projects have been completed; 80 are in progress and final agreements are being completed with the tribes on mutual participation in the remaining 16 projects authorized to be underway this year. In addition, under the public works acceleration program, $3 million has been allocated for 29 construction projects which are under

way.

When completed, these projects will provide a safe domestic water supply and sanitary waste disposal facilities for some 16,000 Indian and Alaskan native homes.

It is almost unbelievable that the vast majority of these people do not have any of the modern conveniences which we take just for granted. Many of the families have to get along on 1 to 3 gallons of water a day when the poorest non-Indian rural family has double and three times this amount of water and accepts it as a matter of course. This slide illustrates the participation of the Indian in removing rock from a trench for a water line. The participation of the Indian is achieved in every single project so that in the process of building it he is learning to understand what it is, how to maintain it, and how to use it for the advantage of his health.

The next slide illustrates a community water supply system providing piped water for the community of about 50 homes and it shows the water storage tank and the housing of the pump which provides the water to the system.

Now, in addition to the community water system, we must be able to provide individual water systems for the homes where the houses are markedly isolated and are not located in community groups. I would like to point out here not only a modern well with a gasoline or electrically-operated pump, but also the effect that this has had upon the house itself. In the next slide I will show you what the typical house is like on the Apache Reservation.

With the bringing in of a water supply and sanitation facilities, the Indian himself, using his own money, his own ingenuity and effort, has constructed, as partially illustrated here, a relatively modern house to go with the modern facilities, the water supply, the waste disposal, and so forth.

We think that this is a remarkable change.

In the next slide you see the typical wickiup of the Apaches which is a cone-shaped bunch of saplings, usually covered by brush, but here it is modernized somewhat by tin roofing.

In the next few moments, Mr. Chairman, with your permission I would like to concentrate upon what are the remaining program needs which we have not been able to achieve.

Despite the steady gains in the improvement of the health of these peoples and progress over the past 8 years, they still bear excessive burdens of disease, illness, accumulated disability, and premature

death.

MORTALITY

About one-sixth of deaths due to infectious diseases.

Average age of death: Indian, 42; Alaska native, 30; general population, 62. Infant mortality accounts for 21 percent of total deaths in a year.

Leading causes of infant deaths: Respiratory, diarrhea, and other infectious diseases.

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