Half the population over 40 on Pine Ridge has diabetes, and tuberculosis runs at eight times the national rate. As many as two-thirds of adults may be alcoholics, one-quarter of children are born with fetal alcohol spectrum disorders, and the life expectancy is somewhere around the high 40s — shorter than the average for sub-Saharan Africa. Less than 10 percent of children graduate from high school.

One reason businesses don’t invest in reservations is that even though unemployment is so high, companies find it difficult to recruit dependable workers, according to Robert Brave Heart, who runs the Red Cloud Indian School.

“People here still have to develop good work habits, even getting to work on time,” Brave Heart said. “And people here have constant family crises that cause them to miss work.”

Brave Heart, the son of a medicine man, is a success story and is turning out more of them at his school. These young people are going off to college to acquire skills that may help them turn the reservation around in the future.