The men in the middle: a dilemma of minority health workers

The perception of Indian health care needs are shown to be related to particular positions within the Public Health Service (PHS) structure. This study is based on interview data gathered from three groups: Navajo consumers (N = 271), Navajo PHS personnel (N = 80), and PHS non-Navajo professional staff (N = 31). The identification of health needs by the Navajo consumer is oriented toward unsolved problems in the immediate social and physical environment. Ninety-five per cent of the problems identified by the consumer centered around disease states, alcoholism, environmental problems, and transportation. Only 28 per cent of the Navajo personnel responses fell within these categories. The responses of the professional staff were systematically distributed among 14 identified health needs. Of major concern is the marginal position held by the Navajo PHS employee who seems to identify health problems which are similar to neither the Navajo consumer nor the PHS professional. While they are still tied to the Navajo culture per se, the Navajo personnel are economically dependent upon the PHS for a livelihood. This "man in the middle" position may require divided loyalties-to their community and to their employer. Such a schism can have serious consequences in their ability to function effectively as health workers.