The hardships the main character are both by-products from birth, and from the situation he find himself in on the reservation.
He has cerebral spine fluid on his brain, which made his brain as though it was "clogged up with grease". This makes him susceptible to seizures and birth defects, such as extra teeth, extreme foot growth, being abnormally skinny, and having an extremely large head.
He also lives on the reservation, and finds himself a statistic of the poverty that affects his people. For instance, in the first part chapter of the book, his dog, Oscar, becomes sick, and his parents say they can't afford to have him go to the vet, and instead, his father ends up shooting Oscar. The main character remarks, "a bullet only costs two cents. Anybody can afford a bullet."
