At least, that's the way it seems to Theodore Lindamood, a Cherokee living in Somerset County, which the descendents of half a dozen tribes still call home. He sees no signs of the prosperous American Indian communities that once dotted Maryland's rural landscape.

Instead, he sees people who are too poor, sick or uninformed to find the health care they need.

"If you're native, doctors don't know you exist," said Lindamood, 49. "When you go to a clinic, it's like they don't even see you. You're invisible."

He's never been to a dentist, and until this year he thought a complete physical meant taking his temperature and blood pressure. His injured back sends painful spasms down his legs, dizzy spells knock him off his feet, and he sometimes can't remember what happened only days ago.

Recently he discovered a lump in his testicle that he's afraid might be an early sign of cancer.

State officials and community health experts agree that many of the 40,000 American Indians in Maryland have a hard time finding adequate health care. There's not enough data about Indian health issues or funds to address them. Many American Indians are intimidated by the paperwork required to get help, and those who do seek health attention often feel unwelcome in doctor's offices.

"Because they are such a small group, Indians are often overlooked when it comes to addressing minority health issues," said Carlessia Hussein, who directs the Office of Minority Health and Health Disparities, which the General Assembly established last year. "This population has never had an audience."

Their numbers may be small, making up only 0.7 percent of Maryland's population in 2003, according to the U.S. Census, but studies show that American Indians have more health problems than many other minority groups.

According to the Centers for Disease Control and Prevention, American Indian adults are more likely than their white and black counterparts to be overweight, diabetic, smokers and moderate to heavy drinkers. They are also more likely to experience dental problems, heart disease and hearing loss.

Their mortality rates from tuberculosis, chronic liver disease and suicide are higher than those of other minority groups.

The lack of preventive care available in Maryland's Indian communities is perhaps the largest problem, said Claudia R. Baquet, director of the Center for Health Disparities at the University of Maryland School of Medicine. For the past seven years, she's been working with state tribal leaders to find out more about American Indian health issues and why they are so rarely addressed.

Because there is such little data about American Indians in Maryland, she's found that many local health care professionals don't know what to look for when treating them. That makes many patients feel misunderstood by providers, she said.

"That becomes a barrier for health care if people don't feel like they'll get a welcoming reception when they go to a provider," Baquet said. "So most people just don't bother."

David Wolfe, a program manager and the American Indian liaison for the minority health office, said he doesn't think the projects have effectively addressed the issues American Indians face.

"Frankly, I don't believe the disparities program will help Native Americans at all in its present form," he said. "There's a lot of mistrust by the Native American community of any state agency, and I see no proactive efforts to build that trust."

Since Maryland does not officially recognize any of the state's tribes, they are not eligible for direct federal funding. In 2002, the state first recognized American Indians as a separate minority group when the General Assembly established the Minority Outreach and Technical Assistance Program, part of the state's Cigarette Restitution Fund.

Under the program, organizations that provide outreach services to minorities apply each year for about $700,000 worth of grants. American Indian organizations often don't have enough experience writing grant applications to win any of the money, said Hussein, who is part Apache.

Native Americans with Maryland roots, like the Susquehannock, Cherokee and Piscataway-Conoy, have settled in pockets on the Eastern Shore, but more than half of the state's Indian population lives near Baltimore and Washington, D.C. Many of them have moved from other states and belong to tribes that already receive federal funding, such as the Sioux and Creek tribes.

But Indian Health Services, the federal agency charged with providing health care to recognized tribes, only operates clinics near reservations that are hundreds of miles west of Maryland.

"About 90 percent of the people who come here have never even seen a reservation," said Crystal Godwin, a case worker at Lifelines Foundation, a not-for-profit clinic that provides referral services to American Indians. This year, the clinic received a $150,000 grant from the federal agency to help refer patients to appropriate treatment centers, but it isn't enough to meet the growing demand.

She's trying to find private funds to hire a public health nurse and to start a dental clinic and an exercise class. The center also receives about $8,000 from the state's minority outreach program.

"A lot of our patients haven't seen a doctor in at least 10 years," said Godwin, a 25-year-old Cherokee. "It's a cultural thing. . . . They don't like to ask for outside help."

Many are also intimidated by the paperwork to apply for Medicaid and disability insurance, she said, which deters many from taking advantage of public programs.

"They get used to the pain," she said, adding that many of the center's 300 clients come in to get help deciphering the social services forms. "It has to be really bad for one of our patients to go to the doctor. We have to drag them."

Roger Locklear, a counselor at the clinic, said a dental treatment is one of the biggest needs for his patients, some of whom need full sets of dentures by the time they're 35 years old.

"It's just tears down their self-esteem," said Locklear, a Lumbee Indian living in Baltimore. After dental attention, "they're more confident, they can go out and get jobs and they feel more like equals."

About a third of the 17,000 Native Americans living in the Baltimore area are Lumbees, who migrated from North Carolina several decades ago. Helen Heckwolf is one of them, and she's trying to reinvigorate the Baltimore American Indian Center.

She remembers when it was a thriving organization that provided support to Baltimore's Indian population, but the center has lost funds in recent years. Working as a volunteer, she's trying to start a smoking cessation program and a women's support group in an effort to create an anchor for the American Indian community.

"We are just barely keeping the lights on," she said. "My dream is to have a center here to make sure that when people come to our doors they feel comfortable instead of powerless."

Hussein said her staff is compiling more data about the health care needs of American Indians to help lessen the disparities between them and other groups. Using part of a $785,000 federal grant, the office is also trying to recruit more minorities, including American Indians, into health professions so that patients feel more comfortable seeking treatment.

On the Eastern Shore, Lindamood is saying goodbye to his 72-year-old mother Mary Langston, who has been in and out of five hospitals during the past year due to complications with diabetes, heart disease and malnutrition. Now she's in intensive care in a Salisbury nursing home.

Doctors have told Lindamood there's nothing they can do.

"Maybe if she had gotten the proper treatment from the beginning - if the doctors had known what to look for - maybe I wouldn't have to lose my mother," he said. "But if I can plant the seeds so other natives don't have to endure this, then I've accomplished something."

Copyright © 2005 University of Maryland Philip Merrill College of Journalism