The nearly 20-year-old Lambert Tribal Health Center in St. Ignace, which serves area Sault Ste. Marie Tribe of Chippewa Indians members, will move its health services to its Tribal Health Center in the new Mackinac Straits Hospital when the facility opens its doors in the spring of 2010.

Lambert Health Center opened in 1990 as a one-room clinic on St. Ignace tribal lands. It has been expanded since then to accommodate growing needs of the tribal population.

The current tribal health center in St. Ignace serves about 8,500 people, providing about 16,500 patient care services and 33,000 prescriptions last year alone.

Patient services have expanded beyond the capacity of the existing facility, and tribal health officials said the new center is crucial to accommodate the existing services and leave room for expansion.

"The new facility is going to match the quality of care we are already providing to tribal members," said Bonnie Culfa, the health division director for the tribe.

Tribal day care, Head Start, and some other services at the Lambert Center will remain there, although medical, traditional medicine, dental, pharmacy, optical, nutrition, mental health, counseling, and health education services will all be moved to the new hospital on North State Street near the county airport.

The tribe has not yet decided how the rest of the space being vacated will be used, although the tribe plans to make use of that space in some way.

The health center provides its services without charge to tribal members and to any member of a federally recognized tribe who provides proof of enrollment.

Tribal employees and non-native spouses of tribal members can also receive treatment at both the current and new facilities, although they are billed, either directly or through an insurance provider.

Spouses of tribal members received free health care through the tribal health care budget until about two years ago, when the tribe restructured, put cost-containment measures in place, and opted to discontinue those spousal benefits.

"Financially, some of those things are not what we are here to do," Ms. Culfa said. "The mission is to serve Native Americans."

Since only about 40% of the tribal health care need is funded by the federal government, tribal leaders had to make decisions about funding that ended the free ride for tribal members' spouses.

"The federal government is not funding us to the level of need that we need as a tribe," Ms. Culfa said. "There is a problem with providing services to non-tribal members when it's difficult to even do it for tribal members."

The Tribal Health Center section of the new hospital will be leased from Mackinac Straits Hospital by the tribe. The money will come out of its health services budget and requires approval by the tribal board.

Several elements of the health center in St. Ignace will be expanded along with the move to the new hospital, or shortly thereafter.

"There is a definite need for expansion of dental services," said Marlene Glaesman, rural health director for the tribe.

In response to this need, her office is planning to add one dentist and two support staff positions to the dental program, which currently has one dentist and four support staff workers.

In the medical center, the tribe hopes to add an additional medical provider, more nursing staff, and possibly a third pharmacist.

The expansion means more space for tribal health services. The tribal health center will be moving from an 8,600-square-foot facility at the Lambert Health Center on Wa Seh Drive to a 15,000-square-foot facility on the north end of the hospital's second floor.

Expansion of space for all of the units in the new tribal health center will result in more examination and treatment rooms, more clinical area, and space that is more appropriate for its purpose, according to Ms. Culfa.

Serious planning went into designing the new facility, she said, and ease of use and natural flow were big considerations.

"They are going to have a nicer space to enjoy while they are being seen," Ms. Culfa said of patients. "We will continue to give the warmth and closeness we provide at all of our sites."

The Sault Ste. Marie Tribe of Chippewa Indians is the largest tribe in Michigan, with an enrollment of 32,000, 15,000 of whom live in the Eastern Upper Peninsula.

To serve this community in the EUP, as well as visiting tribal members from elsewhere in Michigan and out of state, the tribal health department staffs four large ambulatory centers, one in Sault Ste. Marie, one in St. Ignace, one in Manistique, and one in Munising.

There are also two satellite, community nursing clinics in Hessel and Newberry. The department also has partnerships with War Memorial Hospital in Sault Ste. Marie for a community clinic and a partnership with Mackinac Straits Hospital in St. Ignace for the Moses Dialysis Unit.

This partnership to provide dialysis to tribal and non-tribal residents alike was the beginning of a relationship with Mackinac Straits Hospital that would result in the donation of land for the new hospital on North State Street in St. Ignace and the establishment of the new Tribal Health Center and Mackinac Straits Hospital under the same roof at this new facility.

Ms. Culfa said the tribe's expansive resources over the years have allowed it to be instrumental in making improvements to communities that surround tribal members, and the donation of the land is part of this trend.

"The tribe has always been looking for ways to improve the health care of the communities tribal members are in," she said.

The tribe has come a long way in the past 20 years, when the tribe had only one ambulatory care center in Kincheloe, Ms. Glaesman said. There is now a strategic health plan in place for the next 20 years, targeting five key problem areas the tribe wants to solve.

"The tribe is very committed to health care services for its tribal members," Ms. Glaesman said. "We've been very lucky to have a tribal board with such support for the health care division."