A local health center for Native Americans isn't receiving its federal funding during the shutdown.
The San Diego American Indian Health Center (SDAIHC) is using its reserve cash funds, even as it expands its services.
For the last 40 years, SDAIHC in Bankers Hill has been helping American Indians and Alaskan Natives. Health care workers focus on managing chronic illnesses such as diabetes, high blood pressure and respiratory disease.
"We do know there are higher burdens of chronic mental illness in native communities for a number of reasons. Also higher suicide rates," said Melissa Deer, M.D., chief medical officer at SDAIHC.
Providers treat patients with the understanding that health disparities among American Indians have existed for hundreds of years.
"We're basically talking about a group of people who have experienced historical trauma and who are largely impoverished," explained Deer. "Particularly in some of our more rural areas that tend to be geographically isolated. Access to care, access to jobs, access to good education might be more challenging. When people don't have access to treatment, sometimes, they'll self-medicate."
"We really have a focus on building cultural identity," added Deer. "We know that resiliency is a protective factor that mitigates chronic illnesses, chronic mental health conditions."
The emphasis on respecting culture is one of the reasons David Joseph Castleberry, with the Mesa Grande Reservation, has been coming to the center for the last few years for help with substance abuse.
"It's not as big as other medical facilities," said Castleberry. "It's more of a community, more of a togetherness to where you know people on a first name basis."
Castleberry, who said he is three years clean and sober, also said he feels as if he's part of the clinic's family.
"There's no judgment bestowed upon you," added Castleberry. "There's no 'you should of, you could of, you would of.' It's 'where can we go from here, what's the next step,' and they'll walk along with you, instead of just directing you."
While SDAIHC is the only urban American Indian health center in San Diego, its services are open to the entire community.
Paula Brim, SDAIHC board chair, said a few years ago, the center reached capacity at the space it had been leasing on 1st Avenue. After looking at other potential locations, in November 2017, the center purchased the three buildings where it had been leasing space, for $6.2 million.
While the clinic receives 60 percent of its funding from the federal government, and 40 percent through earned income, Brim said none of the money used to buy the property came from federal funds.
"We've managed to accumulate a pretty good cash reserve and we used part of that to make a down payment," said Brim.
Most of the previous tenants have left, and the center is currently remodeling two of the buildings.
The third building is being leased out to a private firm until the health clinic decides how to best utilize it.
"Unfortunately we're probably not going to be able to do the kind of expansion that we really want to do," said Brim. "Sometime in the future we may look at opening up another site."
The health center also wants to add a community room, where elders can meet.
"American Indians find it important to have a central place where we can gather and see each other and have our culture reinforced," said Deer.