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What do Native Americans want from a president?

Madonna Sitting Bear's sons, Keya Little Elk, 6, left, and Tokala Little Elk, 3, were born on the Rosebud Sioux reservation in South Dakota. Because the local hospital stopped delivering babies, Wase Little Elk, 10 months, was born off the reservation. Washington Post photo by Katherine Frey.1 / 3
A sign in He Dog, S.D., warns against using meth. Native Americans are more likely than Americans, as a whole, to die of drug overdoses, according to the Indian Health Service. Washington Post photo by Katherine Frey.2 / 3
Rodney Bordeaux, president of the Rosebud Sioux Tribe. Washington Post photo by Katherine Frey.3 / 3

Storms hit hard on the Rosebud Sioux reservation, but these reports sounded especially dire: A torrent of floodwater was cascading over the top of He Dog Dam; Cut Meat Creek was threatening the only road into a neighborhood. Across the homeland of the Rosebud Sioux Tribe in South Dakota, sensors on a half-dozen dams and creeks pinged red alerts of high water to the cellphones of tribal emergency responders. In his office, Rodney Bordeaux, president of the Rosebud Sioux - also known as the Sicangu Lakota - fielded reports from his safety-of-dams team while preparing to head out to see for himself. Meanwhile, any minute now on this March morning, the heavy downpour was forecast to switch to a two-day blizzard - a highly unsettling sequence of foul weather. "This is a freaky situation," he said. "Dams are flooding, and now everything is freezing."

Bordeaux, 67, was thinking far beyond the storm itself: As Rosebud's underfunded transportation department struggled to clear the roads, he knew stranded tribal members would run out of wood and propane to heat their homes. Dialysis patients would miss appointments. And, as if to drive home the disdain that the state and federal governments often show toward priorities that matter deeply to tribes, Republican Gov. Kristi Noem of South Dakota was poised to sign a bill related to the Keystone XL pipeline, which President Donald Trump has vowed to push through ancestral Lakota lands. The bill would increase penalties for protesting the project. "They throw this stuff at us, so what do they expect us to do?" Bordeaux said, waving his arm as if to conjure all the tribe's challenges, from the weather to the White House. "Lay down? We're Lakota - we don't do that."

Photos of President Barack Obama meeting Bordeaux and other tribal leaders were framed on a shelf behind his desk, a reminder that every four years the power dynamic briefly reverses. A gaggle of wannabe presidents crisscrosses the land, and some of them venture into Indian Country. For a little while, at least until the polls close, the future most-powerful-person-on-Earth may need Native Americans more than they need her or him.

During the 2008 campaign, Obama didn't make it to Rosebud, but in Sioux Falls, four hours away, he met with Lakota leaders. Later, Obama would hold annual meetings with tribal officials in the White House; at one of those meetings, Bordeaux personally asked him to reject the Keystone XL pipeline, which Obama eventually did. (Trump quickly revived the project, which is now tied up in court.) Yet as fondly remembered as Obama is by many Sioux, it was also during his administration that health care on the Rosebud reservation reached a low point, with the temporary closing of the Indian Health Service emergency room because of dangerously poor care.

Now the cycle is beginning again. As the field of presidential contenders seems to grow larger each week, Indian Country is wearily anticipating another round of genuflections to the "sovereignty of tribes" and the "special government-to-government relationship" between the United States and this land's First Nations. If campaign history is any guide, those lofty principles will trip off candidates' tongues. But how would candidates apply those ideals to make concrete improvements in people's lives? After hundreds of years of cruelty, indifference and insufficient good intentions, what is left for a candidate to say that could allow Native Americans to suspend their disbelief?

Before we ventured into the storm, I asked Bordeaux how he would make a visiting candidate understand life on Rosebud. "I would show him all over, show him the poorest communities, take him to the schools, take him to the IHS" hospital, he said. "Meet everyday people, and just show him the reservation, how beautiful it is, and some of the challenges that we have."

The challenges come in all varieties. We climbed into one of the tribe's small fleet of pickup trucks to check on the dams. We got only a few blocks before the truck broke down.

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The ways Native America penetrates non-Native America's consciousness these days can be exceedingly superficial. Frequently, it's through the cartoon refraction of Trump's tweets. In January, as Sen. Elizabeth Warren of Massachusetts was about to join the Democratic presidential race, Trump tweeted: "If Elizabeth Warren, often referred to by me as Pocahontas, did this commercial from Bighorn or Wounded Knee instead of her kitchen, with her husband dressed in full Indian garb, it would have been a smash!" The Battle of the Little Bighorn in 1876, of course, was when Lakota and Cheyenne warriors wiped out Lt. Col. George Armstrong Custer's cavalry; Wounded Knee was where, in 1890, U.S. troops massacred hundreds of Lakota men, women and children.

Even an attempt by Trump to honor Native Americans went awry: In 2017, he assembled Navajo code talkers, who helped the United States win World War II, beneath a White House portrait of Andrew Jackson, who presided over the forced relocation of the Choctaw and other tribes, known as the Trail of Tears. Then Trump riffed to the code talkers about his nickname for Warren, which seemed to perplex the veterans.

On such occasions, many non-natives join natives in their umbrage. But for non-natives, the flaps create the illusion that they know what preoccupies Native America. (Same goes, arguably, for every twist in the saga of what to call Washington's football team.) Whenever these buzzy eruptions occur, the nation is momentarily fixated - and then, in short order, Native America disappears again. The relative invisibility of the nation's 6.8 million Native Americans (counting those who claim more than one race) persists, even though they outnumber, for example, the 3.5 million Muslims in the United States, who are never permitted to exit the political spotlight.

"There are dozens of issues that tribes are eager to insert into the national discourse," Mark Trahant, editor of Indian Country Today, wrote in February. Trahant's list includes fighting the scourge of missing and slain indigenous women, and defending an Indian child welfare law from a conservative legal attack. I heard similar concerns on visits to three reservations, in congressional hearings and at a recent pan-tribal council in Washington. What was remarkable was how many of the issues could be grouped under the umbrella of a single demand - that the spirit of the treaties signed long ago between tribes and the United States be respected. In his essay, Trahant summed up the prevailing attitude: "What is important? A candidate could promise to literally fulfill promises already made to tribal nations and citizens via the treaties."

Non-Native America doesn't talk about the treaties anymore, as if their purpose has already been served. Between 1778 and 1871, the United States signed about 370 treaties with Native Americans. Details vary, but generally in exchange for peace and land from the tribes, the federal government promised to set aside smaller parcels that would forever be tribal and offered other benefits such as schools, doctors, carpenters, blacksmiths, millers, hunting and fishing rights, access to sacred sites, farm supplies, clothing, small annual cash payments and federal agents who were supposed to look out for the tribes. Since then, the federal government, while breaking many treaties to grab more land, has also aspired to assume the responsibility - implicit in the treaties - to pursue modern means of promoting tribal welfare.

When I called Trahant, he reminded me that Article VI of the Constitution classifies treaties as "the supreme law of the land." "I'm just sometimes stunned by how folks will say over and over that they love the Constitution," he said. "Yet when it comes to something as fundamental as funding [Indian] health or salmon restoration, the money's not there." Within those old, beautifully lettered documents, the concept of perpetuity is rendered in poetic phrases such as "so long as the buffalo may range." (Several treaties are on display in the "Nation to Nation"exhibit at the Smithsonian's National Museum of the American Indian.) Yet more than antique curiosities of the frontier age, the treaties are what separate Native Americans from any other group. Native American demands for civil rights and access to quality housing, education and health care are founded not just in the moral duty to treat all people equally. The continent's first occupants prepaid for what they are owed by ceding millions of acres. If they collected a fair rent on that real estate today, they would be in rather strong financial shape.

The treaties are a ready-made issue for candidates who are serious about connecting with Native America. But when talk of respecting treaties gets thrown around, the 2020 candidates, and the rest of non-Native America, must decide whether they really mean it. The danger in a presidential campaign is that promises become another sheaf of treaties - this time rhetorical ones - that inevitably will be broken.

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After the truck carrying Bordeaux and me broke down in the storm, I caught a ride with Robert Oliver, emergency preparedness coordinator for Rosebud. We drove through snow drifts to He Dog Dam with Joe Espinosa from the Tribal Land Enterprise office. Floodwater was tumbling over the stone blocks of the dam, but the structure was holding. Down below, on Cut Meat Creek, we found the road that had been washed out, stranding some homes. A man appeared out of the whiteness of the blizzard and blurted, "My brother-in-law has one foot - we need help evacuating the house." Oliver called for another truck so he could continue to other dams.

People in fragile health are at greatest risk in emergencies everywhere, but the quality of health care in Indian Country is a particular concern. As we made the rounds, Oliver and Espinosa told me their own stories of Indian health care. When Oliver's then-wife was pregnant with their eldest son, now 11, the Indian Health Service hospital sent them 45 miles away to a clinic in Nebraska for an ultrasound exam. Back at the IHS, the doctor interpreting the results said it indicated that the fetus was abnormal and the couple should consider an abortion. "It p---ed me off and made her cry," Oliver said. "Regardless how my son came out, I would love him." The couple drove four hours to Sioux Falls to get another ultrasound. It showed the fetus was normal after all, and the baby was born healthy.

Espinosa, for his part, recalled how, several years ago when he was in the IHS hospital with pneumonia, he rejected an offer to sign up for an insurance plan. It would have made it easier to get treatment outside the Indian Health Service, but "to me, it felt like a treaty violation," Espinosa said."Trying to get me to sign up for what should already be provided by the IHS."

As it happens, Rosebud - where about 30,000 tribal citizens live on rolling plains in an area larger than the state of Rhode Island - is the perfect place to learn how health care became a treaty obligation. One of the more significant treaties was negotiated in 1868between the Sioux and a federal delegation led by Lt. Gen. William T. Sherman at Fort Laramie, in what is now Wyoming. The treaty established the Great Sioux Reservation over much of the territory that would become South Dakota.

Within a few years, gold was discovered in the Black Hills, and the United States reneged. Eventually, different Sioux bands were settled onto separate, smaller reservations, with the Sicangu Lakota withdrawing to Rosebud. In 1980, based on the Treaty of Fort Laramie, the U.S. Supreme Court awarded the Sioux compensation for the taking of the Black Hills. With interest, the sum has grown to more than $1 billion - but the Sioux have refused to accept the money. They want their land.

Yet it is another clause of the treaty that has extra relevance during a presidential campaign in which health care is a top issue: "The United States hereby agrees to furnish annually to the Indians the physician ... and that such appropriations shall be made from time to time, on the estimate of the Secretary of the Interior, as will be sufficient to employ such persons."

Later, the general idea that the U.S. government should be responsible for Native American health care became a specific promise to all American Indians - enshrined in federal law - "to ensure the highest possible health status for Indians and urban Indians and to provide all resources necessary to effect that policy." Toward that end, the IHS was set up in 1955. Today it provides health care to 2.6 million Native Americans living on or near reservations.

But instead of enjoying the "highest possible health status," Native Americans have a life expectancy that is 5.5 years lower than average, according to the IHS. Life expectancy on a poorer reservation like Rosebud is about 10 years lower than the national average. Native Americans are more likely than Americans, as a whole, to die of heart disease, cancer, diabetes, liver disease, strokes, flu, pneumonia, drug overdoses, kidney disease and suicide, according to the IHS.

And instead of providing "all resources necessary" to achieve good health for Native Americans, the United States, through the IHS, spends on Native Americans just over one-third of the money that is spent per capita on health care nationwide, according to the agency. The IHS received $5.6 billion this year, plus $1.2 billion in reimbursements through Medicaid and other programs. To fully fund the agency - and approach that elusive "all resources necessary" - the National Congress of American Indians, a broad coalition of tribes, is calling for a sixfold increase to $36 billion, phased in over 12 years.

Failings at the IHS are a perennial source of bipartisan concern in Congress. At a hearing in 2016 titled "Reexamining the Substandard Quality of Indian Health Care in the Great Plains" - which includes the Rosebud reservation - Republican Sen. John Barrasso of Wyoming said, "What we've found is simply horrifying and unacceptable. In my view, the information provided to this committee ... can be summed up in one word: malpractice." This past March, Republican Sen. John Thune of South Dakota said at a budget hearing that the IHS "has just been a complete failure when it comes to taking care of the people that they're tasked with caring for in Indian Country."

Responding to criticisms at a separate Senate hearing in March, the IHS' principal deputy director, Rear Adm. Michael Weahkee, who is filling the role of acting director, described recent reform efforts such as establishing an Office of Quality in January. "IHS has realized significant progress in making improvements to quality care for American Indians and Alaska Natives," he said. "The IHS is taking its challenges seriously."

The 35-bed IHS hospital at Rosebud has been plagued with problems over the years. Federal inspectors uncovered deficiencies - including broken sterilization equipment, a baby born on a bathroom floor, and a heart-attack patient receiving delayed treatment - that led to the closing of the emergency room for seven months in 2015-16. During the closure, nine tribal members died and five babies were born in ambulances on the way to clinics 50 miles away, the tribe's health board chairman testified to Congress at the time.

In 2016, the shutdown of the emergency room prompted the tribe to file a lawsuit in federal court based in large part on the 1868 treaty. The suit seeks no money damages; it asks for a judicial declaration that the federal government is violating the treaty, and for an order that the IHS should raise the health of tribal members to the "highest possible" level. "With that kind of a ruling in hand, we hope that not only Native Americans, but the executive branch itself, could say to Congress, 'Look, we have a declaratory judgment from one branch of the government that we have failed as a government in our treaty and statutory obligations to Native Americans,' " says Bruce Finzen, a lawyer with the firm of Robins Kaplan, which is representing the tribe pro bono. "What is going on is absolutely shameful." The judge in the case cited the treaty in rejecting the government's motion to dismiss, and the case is ongoing.

The Rosebud hospital fixed the problems, and the emergency room reopened in 2016. But this past summer federal inspectors found more shortcomings - including the case of an intoxicated 12-year-old girl who was left unattended for a period, during which she tried to strangle herself with a call-light cord. (The hospital addressed the new concerns raised by the inspectors by the end of last year.)

Because Rosebud is so remote, the hospital's biggest challenge is attracting and retaining staff, says Jon Schuchardt, a captain in the U.S. Public Health Service and the Rosebud hospital's acting CEO. (He was brought in last summer to improve procedures after the recent inspection report.) "It's a hundred miles from the nearest Walmart," he notes. The hospital has 43 vacancies, including for 12 doctors, 12 nurses, two dentists and two pharmacists, according to the IHS' Web page for job listings. Schuchardt says the hospital relies on contractors to fill most of those positions. Still, the hospital does not have specialists to perform surgeries, deliver babies or even set broken bones. Patients needing that care must be sent to hospitals up to four hours away.

Moreover, when patients are sent for care elsewhere, the IHS only has enough money to reimburse them for the most critical care, commonly referred to as matters of "life or limb." Anything less - broken bones, for example - must be paid by tribal members out of pocket unless they qualify for coverage through other programs such as Medicaid or Veterans Affairs. The cost of accompanying loved ones for treatment off the reservation is an added burden in a place where about half the people live in poverty.

Royal Yellow Hawk, who works for the tribe's Lakota Language Preservation Project, told me how several years ago his son Hoksila broke his arm at school. The IHS, he says, told him to take the boy to Rapid City, South Dakota, 170 miles away. But because of a paperwork mix-up, when he got to a hospital there, he was told that the case had not been referred. Yellow Hawk turned around and drove back to the IHS hospital, which sent him to Sioux Falls, 220 miles away. By now it was late at night. The doctors in Sioux Falls told him that because of the delay, the arm was too swollen for immediate treatment, according to Yellow Hawk. A week later, they set the bone. The boy's pain during the extended delay in treatment, and his parents' powerlessness to do anything to comfort him, were a harrowing event that changed the boy's personality, Yellow Hawk says: "He became more in the shadow. He wasn't outspoken anymore. He was more bottled up. ... He's still traumatized."

Another lingering repercussion is financial: The IHS would not pay to treat the arm, let alone the cost of trips out of town, including overnight stays. Yellow Hawk, who at the time was paid as a member of the Tribal Council, says he didn't qualify for Medicaid. He says he took out a loan to cover the travel, and he accepted a payment plan for the medical care of more than $100 a month, which he expects to continue paying for years to come. Such cases are a prime example of care the hospital doesn't provide and can't pay for, Schuchardt says: "Ortho[pedics] like the one you mentioned, with the broken arms, that's one that's frustrating. We see a lot of those that just aren't going to get funded."

I asked Schuchardt if he thinks the IHS is living up to the spirit of the treaty and providing the best possible care. "Given the resources we have," he said, "we are providing the best possible care. You know, I mean, a definition of 'best possible care'? I mean, are we ever going to be a tertiary Level I trauma center? That's probably unrealistic. But if that's the way you define that through the language in the treaty, then obviously that's not where we're at. ... But given the resources, we're doing well."

---

In the spring of 1968, as the Democratic presidential primary was heating up, Bobby Kennedy's campaign aides did not share his obsession with Indian Country. Ever since launching his bid in a speech where he denounced the plight of Native Americans, Kennedy insisted on including tribes in his campaign swings. When strategists suggested he shouldn't take precious time in obscure rural outposts that required an entire day to get in and out of, he wrote them a terse note: "Those of you who think you're running my campaign don't love Indians the way I do, you're a bunch of b--tards."

Ramon Bear Runner was 16 years old that April when Kennedy arrived at the Pine Ridge reservation in South Dakota, just to the west of Rosebud, home of the Oglala Lakota branch of Sioux. Everyone on the reservation was captivated by the unprecedented visit. Bear Runner and his teenage friends followed Kennedy's motorcade around the reservation, and Bear Runner got close enough to shake the candidate's hand. Kennedy met with tribal leaders and spent time with an orphan boy, whom Kennedy invited to stay with his family in Hyannis Port, Massachusetts, that summer. Before he left, he paid respects at the mass grave where the victims of the Wounded Knee massacre are buried. "Our people were really suffering," Bear Runner told me. "The way our people felt about him at the time was like he was sent from God. Our people felt he was going to be this president that was going to turn the tide."

The South Dakota primary was on the same day as California's. In the last hours of his life, before he was assassinated at the Ambassador Hotel in Los Angeles, Kennedy learned that he had carried both states.

Kennedy's short 1968 run set a standard for engagement with Native America by a presidential campaign. In the years since, candidates have tried to match the authenticity of his outreach to tribes with varying success. It's not enough to tuck tribal concerns into a speech or simply visit a reservation. "They have to understand what treaties are and how they play into that history," Bo Bearshield, a tribal prosecutor at Rosebud, told me. In campaign speeches to Native Americans, "before they go into health care, poverty, suicide rates, education, I would advise them to really start and hit it with some history and some heart, just to build that trust right off the bat."

Jesse Jackson showed how to break through during his 1984 primary run. He addressed the Tribal Council of the Navajo Nation in Window Rock, Arizona, and before long, according to Mark Trahant, who was present as an editor for the Navajo Times, Jackson had council members on their feet, chanting his signature rally cry: "I am somebody! I am somebody!"

In 2008, Obama campaigned in the Crow Nation in Montana and was adopted into the tribe with the name One Who Helps People Throughout the Land, while Hillary Clinton met voters in Pine Ridge. In 2016, Bernie Sanders mounted an almost Kennedyesque campaign through Indian Country, featuring regular outreach to tribes. Trump sent surrogates to campaign in Indian Country, and a week before Election Day announced a Native American Coalition of supporters chaired by Markwayne Mullin, a Cherokee Republican member of Congress from Oklahoma.

It's early yet in the 2020 campaign, but some candidates are nodding toward native issues. When the subject of reparations for African Americans hit the news, for instance, Elizabeth Warren said that reparations for Native Americans ought to be part of the conversation.

I contacted the campaigns of the seven Democratic candidates with the highest poll numbers as of late April, and two agreed to interviews. (Joe Biden announced his candidacy after this story was in production.) "The plight of Native Americans is not well known in this country, but you have a people who are suffering," Sanders told me. "People who in many cases are seeing life expectancy the equivalent of a Third World developing country, a people where health care is extremely inadequate, educational opportunities are limited. ... We will respect their sovereignty and will respect the treaties that have been signed with them. We will treat them as full partners rather than as subordinates. They need to have a say in the future of their communities in a way that they don't have right now. Their health-care system right now is totally inadequate, not well funded, not well staffed, and that has got to change. So there's some very concrete things that a president who wants to work with the Native American people can accomplish."

Mayor Pete Buttigieg told me he worked with a tribe on a casino project in his city of South Bend, Indiana. "Philosophically," he said, "the important thing is that you need a White House that interacts with cities, that interacts with states and that interacts with tribes, and views that as an important part of our intergovernmental relations."

What's new this year are better-organized efforts to force native issues into the campaign spotlight. A Native American advocacy group called Four Directions is inviting the candidates to a forum in Sioux City, Iowa, in August. "It's to call on the candidates not just to present their policy statement but to engage in a town hall centered around Indian Country issues, where they can't just say, 'Hey, we're for the Native Americans. Trust us,' " says Bret Healy, a consultant with Four Directions. The organization also is pursuing grass-roots efforts to get out the vote in seven swing states where there are enough native voters to decide a close election: Nevada, Arizona, Colorado, Minnesota, Wisconsin, Michigan and North Carolina. "You're seeing an awakening," says Tom Rodgers, a political strategist and member of the Blackfeet Tribe of Montana. "You're seeing a new generation of tribal leaders. They're much more aggressive ... less patient. They don't believe in the promises as much anymore."

One of those young leaders is Julian Bear Runner, 33, the newly elected president of the Oglala Lakota at Pine Ridge. (Ramon Bear Runner is his great-uncle.) The day I visited, Julian Bear Runner's office was fragrant with burning sage, traditional medicine meant to enhance energetic clarity. On the wall was a portrait of Sioux veterans of the Battle of the Little Bighorn and a photo of protesters whom Bear Runner had joined to oppose the Dakota Access pipeline. A copy of the Treaty of Fort Laramie was posted nearby.

Born nearly two decades after Bobby Kennedy's visit, Julian Bear Runner has fewer illusions about candidates than the Lakota perhaps harbored on that occasion in 1968. "I'm hoping that I can relate to one of these new candidates so that I can, I guess, endorse them as the Oglala Sioux Tribe," he said. But, he added: "Look at how many times we have gone to Washington. It's always the same song and dance. Our needs aren't really met. ... There's no really great improvement here in Indian Country."

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Jonathan Nez, president of the Navajo Nation, welcomed me to "our nation's capital" - by which he meant Window Rock, Arizona - and took me out to marvel at the Navajo capital's eponymous feature, a monumental sandstone doughnut formation that frames the sky. The forces of nature shaped and scoured the 200-foot cliff over millennia. Nez, who was a delegate for Hillary Clinton at the Democratic National Convention in 2016, urged her advisers to have her hold a big rally in front of the celebrated geological feature. She never did. Clinton ended up losing Arizona to Trump by 91,000 votes - probably more than the Navajo alone could have made up. Still, some analysts have said that Clinton took Democratic-leaning native voters too much for granted.

Nez, 43, another of Native America's new young leaders, hopes the latest set of candidates will accept his invitation. "We'd put a big platform there and do a rally right underneath that hole in the rock. ... Whoever candidate can come out here and do something like that, I bet you they'd get the support of not just the Navajo Nation but all of the tribes."

So far only the Warren campaign has formally reached out to the Navajo Nation, though she has not committed to a rally at the window rock, according to Nez. As the largest reservation measured by land (27,000 square miles, bigger than West Virginia) and one of the largest tribes by population (more than 300,000 enrolled citizens), the Navajo hold some sway in Native America, and candidates usually do get in touch.

Nez wrestles with the necessity of constantly having to remind candidates and elected officials of the federal responsibility inherent in the treaties. It puts proud people in the position of always having to ask, plead, cajole. Even "beg," he said. So Nez has developed a new way to talk about treaties and a new pitch to make to candidates, which goes like this: Treaties never were conceived of as charity but as a trade - land for aid and legal rights, peace for peace. Even more, treaties were supposed to be mechanisms for tribes to transition to a new kind of self-sufficiency, since they were giving up many of their previous resources. Finally, Nez argues, the federal government living up to treaties would give tribes the wherewithal to stop asking.

"Tribal governments have been dependent on so much of these 'freebies,' if you want to call it that," Nez had said when I first met him in March in Washington - as he prepared to remind yet another House subcommittee of treaty obligations. "But we just need things to help us help ourselves. You know, that's the lingo of the Republican Party - self-sufficiency, self-reliance. And I agree."

I asked Nez for an example of a treaty obligation that presidential candidates could commit to that would, in his phrase, offer "a hand up rather than a handout." The one at the top of his list sounds boring, but it is vital, because it underlies so much else: infrastructure, especially roads. Lousy roads undermine economic development, education, health care and public safety.

While the words "roads" and "infrastructure" don't appear in the Navajo treaty, those obligations have been extrapolated in federal law as part of the duty the United States took on in its relationship with tribes. Shoddy infrastructure is a treaty breakdown across Indian Country, where some areas still lack running water and electricity, let alone broadband. The problem is especially acute in the Navajo Nation, given its size. It has 10,700 miles of roads - and 9,000 of those miles are dirt roads.

A look at the numbers suggests the United States is no more serious about fixing the roads and other infrastructure in Native America than it is about funding health care. The federal Bureau of Indian Affairs budget for road maintenance on all reservations is $36 million this year, compared with a maintenance backlog of $300 million to $400 million, according to the bureau. As for new highway construction, the Navajo Nation recently took over that responsibility from the federal government in a bid for self-sufficiency. The nation still receives about $55 million a year in federal highway funds to do the work. Since it costs about $3 million per mile to pave a dirt road, the nation can pave about 18 miles a year. Yet 450 dirt miles are so highly traveled as to require paving immediately. At current funding levels, it will take 25 years to pave just those most important routes - and five centuries to pave the rest.

Nez and I set out to experience the roads, passing vast plains covered in scrub brush and juniper trees, interrupted by dramatically rising mesas and spectacularly plunging canyons. Nobody wants to pave over this paradise, of course, but Nez says the well-being and self-sufficiency of scattered communities depends on better transportation. And it's not just about funding. He argues that paternalistic federal regulations undermine the tribe's sovereignty and hinder progress. For example, it has taken three years and counting to get permission to open a gravel pit so the tribe can efficiently cover dirt roads with gravel, as an interim measure before paving, he says. And fixing roads requires another set of sluggish permissions from Washington.

"The frustrating part about it is, sometimes we can't do what we want to do even on our own sovereign nation," Nez said. "It doesn't have to be in the form of dollars. Just change some of those laws so that we can streamline the process and get better quality of services for our people. We have our land - let us utilize it the way we know how."

After driving about 75 miles on mostly paved roads, we reached the Tselani/Cottonwood Chapter, one of 110 communities with local elected officials. A public meeting was taking place in the chapter hall. Switching between Navajo and English, Nez addressed the couple dozen residents sitting on folding chairs. "What we want to do is tell those guys, the ones that are running for office, to come here and visit Navajo, come to our chapter meetings and sit here and listen to the real problems that are here within our communities," he said. "I'm not saying we want sympathy. No, we don't want sympathy. We just want to be able to improve our own Navajo Nation land. That means better roads, better infrastructure."

When Nez finished, residents and local officials proceeded to unload on him about the poor quality of roads, especially a 15-mile dirt loop where several hundred people live. One of the most passionate speakers was Linda Curley, a public health nurse whose job involves bringing medication to patients' homes.

I made an appointment to meet Curley later in the week, when Nez was bound for Washington, yet again, to fight for funding. Curley and I traveled along the 15-mile dirt loop; it passes beneath a cliff with a tall stone spire called Fish Point, which is slowly weathering away like the nub of a pencil. Curley said that, according to stories told by elders, when the point completely disappears, the world will end.

Along the way, we stopped at homes where neighbors told me how, when it rains or snows, the roads turn to mud and become impassable, trapping people. They told me about being unable to go to the store or to medical appointments. They described having to ferry injured or sick people in trucks to ambulances that couldn't reach homes. "This is, like, the lifeline through here, getting in and out," said Donovan Chee, a railroad maintenance worker who told me that he sometimes tries to smooth the road by dragging a railroad tie from the back of his truck. His family depends on its livestock for food, so it was a serious matter a couple of months ago when the road became impassable - that time because of snow - and Chee couldn't get out to the paved highway to haul feed for the flock; two sheep died as a result.

At the end of another dirt road sits Black Mesa Community School, where principal Marie Rose does her best to deliver an education to the 63 students despite the vagaries of the roads. While occasional snow days are familiar anywhere, the challenge for Black Mesa comes when melting snow turns dirt roads to mud. On a good day the school bus ride is two hours each way for some children. One family lives 80 miles away, but the route becomes 140 miles when a wash floods a road a few times a year. Students can end up missing two weeks of school over January and February because of the roads, leaving only March uninterrupted to prepare for the standardized tests of April. To pass the time on a bus marooned in the mud, the children will watch movies on the bus driver's phone or sing a traditional Navajo peyote song. "A human rights abuse is what it is," Rose told me. "The kids have a right to an education, but we don't give them 100 percent because of the road conditions that they live on."

"I like to mud-ball," Anita Yazzie, one of the bus drivers, said with a grin. "I'm the reverse," said Ralph Henry, another driver. "I don't like mud, but I like snow and ice." He drives about 175 miles a day, all but 30 miles on dirt. "If it's muddy, you're lucky to drop off the kids on the first try," he explained. "A lot of times we have to come back out to get somebody to help us go in there again."

Candidates have ventured to Black Mesa before, though never a presidential candidate, Henry said. "They ask a lot of stuff, like what you're doing right now, and the only problem is, we don't get no help from anybody after that," he said. When I asked Henry if he ever brought up the treaty with those visitors, he scoffed. "People really don't seem to know or really care about that anymore," he said. "We may say, 'You know, it's your obligation because we have the treaty signed with you guys.' ... The first thing they're going to say is, 'I don't know what you're talking about.' If you ask them a question again about it, they'll look at you as if you're from another world."

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When Trump issued his mocking tweet imagining Elizabeth Warren and her husband "in full Indian garb" at Wounded Knee, he was poking an unhealed sore. Today, the resonant ground of Wounded Knee is disguised as a poorly marked roadside pull-off on the Pine Ridge reservation. If you know enough to cross the road and climb a gentle hill, you'll find the simple stone monument where Bobby Kennedy stopped during the 1968 campaign. It marks the grave where 146 Lakota are buried - 82 men and 64 women and children - after being killed by U.S. troops on Dec. 29, 1890. Estimates of the death toll run to more than 250, with more bodies buried elsewhere.

The incident began with a large group of Miniconjou Lakota led by Spotted Elk (also known as Big Foot) journeying to Pine Ridge to seek the protection of the Oglala chief Red Cloud. White settlers and soldiers were on edge at the time because they interpreted a spreading form of Sioux spirituality known as the Ghost Dance as a resistance movement. Spotted Elk's group peacefully allowed soldiers to escort them to a place to camp by Wounded Knee Creek. The next day the troops were collecting the Lakotas' guns when a shot rang out, apparently by mistake. The soldiers opened fire from all sides. The Indians tried to flee up a ravine, but the soldiers hunted them down. A few of the Lakota men under attack managed to grab guns and shoot back.

Maj. Gen. Nelson A. Miles - the overall commander, though he was not on the scene that day - was blunt about what happened in a letter the following year, as quoted in the magazine Nebraska History: "I have never heard of a more brutal, cold-blooded massacre than that at Wounded Knee. About two hundred women and children were killed and wounded; women with little children on their backs, and small children powder-burned by the men who killed them being so near as to burn the flesh and clothing with the powder of their guns, and nursing babes with five bullet holes through them." And yet, 20 of the soldiers were awarded the Medal of Honor, this country's highest badge of military distinction.

Wounded Knee was the last major clash between Native America and the new masters of the land. It coincided with the closing of the frontier; for a long time, in non-Native America at least, it was seen as the end of a way of life and the demise of Native Americans as an independent force.

Now, Wounded Knee is a place where the past pushes into the present and stakes a claim on the future. At the site of the massacre, I met descendants of survivors: Phyllis Hollow Horn, her sister Linda Hollow Horn, Phyllis' daughter Loreal Black Shawl, and Loreal's husband, Wendell William Yellow Bull. The Hollow Horns' great-grandfather Solomon Enemy Afraid of Him was shot several times; his wife, Hazel Eyes, was pregnant with Phyllis's and Linda's grandfather. "The soldiers tried to murder us," Enemy Afraid of Him said later in an oral history.

Yellow Bull's great-grandfather Joseph Horn Cloud was about 17 when the soldiers opened fire on him and his family. He helped rescue bleeding survivors, but his parents and two of his brothers were killed. He led the effort to erect the monument in 1903.

Ever since the bodies were laid to rest, survivors and their descendants have struggled to get the nation to acknowledge what happened. Rescinding the Medals of Honor would be a significant gesture in that direction, they say. And because of the symbolic place of Wounded Knee in the saga of relations between the United States and Native Americans, it would say something larger about non-Native America's evolving attitude toward the First Peoples. "If they rescind these medals, that's the beginning of healing," Phyllis Hollow Horn said.

Trump's tweet has fueled the effort. OJ Semans, the co-executive director of Four Directions - which is organizing the Indian Country town hall - was spurred to include the medals on the agenda that the presidential candidates should address. When I asked Bernie Sanders if he'd consider rescinding the medals, he said, "I would give that argument a great deal of sympathy." Pete Buttigieg said he wants to learn more about the Wounded Knee medals but spoke of "intergenerational justice": "Sometimes things like memory and history and monuments and honors are a really important part of that because the way that we reckon with that past can have real-world impacts in the future. So I don't know that I'm prepared to weigh in on that particular question, but it's certainly part of a bigger kind of moral puzzle that I think, you know, America is still working its way through."

To Semans, the medals of Wounded Knee help explain the ongoing neglect of the treaties. "The attitude set in 1890, when those medals were awarded for killing women and children, carries on to this day," he told me. "What are the attacks on tribal sovereignty, the attacks on [Indian child welfare], the attacks on our sacred sites? It comes down to 1890. ... Roads are a treaty obligation, health care is a treaty obligation. And what happened in 1890 basically allowed them to continue to chip away at every promise that they have made to Native American Indians."

Walking the ground with descendants of the survivors and standing before the mass grave, I wondered if it was really possible for any president to give Native America what it needs and deserves. What Native Americans are asking for, after all, is not just money - although covering many of Indian Country's funding requests would be a mere rounding error in the national budget - but a profound attitudinal shift; they want a federal government that fulfills the original treaties' promise of both mutual sacrifice and mutual respect.

On my visits to reservations, in addition to stories of shabby health care and miserable roads, I encountered stories of veterans. If a presidential candidate mounts a stage before the window rock in Arizona, he or she will look down and see a statue in honor of the Navajo code talkers. Despite everything, Native Americans continue to enlist at among the highest rates of any ethnicity. Those who have worn the uniform include descendants of Wounded Knee survivors such as Loreal Black Shawl, who was in the Army, and Wendell Yellow Bull, who was in the Marines. They serve their country, even as they expect more of it.

"I think as a native people, it's not that we surrendered or we were beaten down because of the Wounded Knee massacre," Black Shawl said. "It's more or less we finally reached the conclusion that it's never going to stop. The way the government treats us and continues to treat Native American nations is going to continue. ... We believed these white men would honor their words, but they have not. And they continue to show that they will not. So it's just like, where do we go from here?"

This article was written by David Montgomery, a reporter for The Washington Post.