Diabetes Forecast

Diabetes Programs Benefit Native Americans

ADA honors successful initiatives with Voices for Change awards

By Katie Bunker ,

The Grand Canyon skywalk operated by the Hualapai tribe in Arizona.

Kirby Suathojame always rushed headlong into the roughest rapids on the Colorado River. The daredevils in each tourist group rode with Suathojame, knowing he'd hit the whitewater full force to intensify the rafting experience. Later, he'd strum his guitar and tell stories of the history of the Hualapai Indians, his voice echoing inside the walls of the Grand Canyon. More than anything, he remembers the smell of the mud and the river, and the sight of desert bighorns coming to the water to drink.

Suathojame loved his experience guiding river tours several years ago, but his first season was also his last. By the time he turned 33, he was completely blind. Today, Suathojame, 37, a member of the Hualapai tribe, uses a white cane to navigate his surroundings on the reservation in Peach Springs, Ariz. If not for a wellness and prevention program called Hualapai Healthy Heart, Suathojame says he would most likely have lost more than his eyesight: He'd probably be on dialysis for kidney failure. The initiative, which received an American Diabetes Association John Pipe Voices for Change Award this year, helped Suathojame reduce his A1C of 11 percent to the 6-to-7 range. The program's education classes and one-on-one counseling helped him develop a positive attitude and commit to an intensive exercise routine, which includes stretching in the morning and weight lifting and cardio in the afternoon.

Three diabetes programs serving Native Americans were presented with John Pipe Voices for Change Awards (left) at the National Indian Health Board's 27th Annual Consumer Conference in Sioux Falls, S.D., in September. The awards recognize effective initiatives under the Special Diabetes Program for Indians (SDPI), which includes efforts managed on the local level and supported with federal funds administered by the Indian Health Service. The American Diabetes Association has urged Congress to renew SDPI, which otherwise will expire in September 2011, for five years and to increase its annual commitment of $150 million to $200 million. Diabetes affects Native Americans more than any other racial or ethnic group in the United States: Nearly 17 percent of all American Indians and Alaska Natives have the disease, compared with 8 percent of the total U.S. population.

The Hualapai effort, which began five years ago and is part of a network of Healthy Heart programs on 30 reservations, received the advocacy award for reaching out to get tribal leaders and elected officials involved in the fight to stop diabetes. Of the 1,600 tribal members living on the Hualapai reservation, 322 have been diagnosed with type 2 diabetes, says Nicolette Teufel-Shone, PhD, a project coordinator for Hualapai Healthy Heart and an associate professor of health promotion sciences at the University of Arizona. The program enrolls Native Americans who already have diabetes and aims to prevent complications like cardiovascular disease, she says. (The tribe has a separate Hualapai Diabetes Prevention Program, also supported with SDPI funds, for youth and others who are at risk for diabetes.)

Life on the reservation presents its own challenges. Because Peach Springs is so far from the closest city—it's 60 miles to Kingman, Ariz.—the clinic serving the Hualapai has trouble keeping a primary care doctor on staff, let alone attracting diabetes specialists. And healthy foods aren't readily available: For a substantial selection of fruit and vegetables, the Hualapai have to drive to Kingman, Teufel-Shone says. Nor is exercise as easy as it might seem. A number of factors "end up getting translated into: People don't walk," she adds. "You just have to see a pack of dogs or a snake, or fall down because of uneven footing, and you get discouraged."

In recent years, health services and tribal leaders have helped the Hualapai reduce these obstacles. Sandra Irwin, director of the Hualapai's health department, worked to put up street lamps and hire additional dog catchers to keep walkers safe. The tribe matched Indian Health Service funds with its own in order to come up with enough money to build a fitness center four years ago. "Hualapai is a really good example of a small, isolated tribal community that is doing something [to stop diabetes]," says Teufel-Shone.

To learn more about ADA's programs for Native Americans, go to diabetes.org/nativeamericans.

One member of the tribe who has taken the lessons he learned at Healthy Heart and applied them in the workplace is Rudy Clark, the Hualapai's director of human resources. He has rolled out a wellness program for tribe employees that includes free health screenings, nutrition education, and time off each day to exercise. Clark's friends call him the "poster boy" for good health, but that wasn't always the case. In 1977, his doctor told him he was on the verge of a type 2 diagnosis. A decade later, he started taking insulin. Over the next several years, he developed severe neuropathy. Yet none of these developments inspired Clark to really take control of his health. Then, five years ago, he needed surgery to save his feet, and his doctor told him that he would have to dramatically lower his blood glucose level and keep it low for three months before the operation. At the time, his A1C was a whopping 12.3 percent. Clark signed up with Healthy Heart and, in just a year, brought his A1C down to 7.4 and no longer had to take insulin. Today, he walks 3 miles a day and says he doesn't require any medication to control his diabetes.

Clark says that Hualapai values are at the core of the fight against diabetes. Central to the tribe's beliefs, he says, is the idea that the Creator calls on the Hualapai to help one another and to give freely of themselves. Good health is the gift Clark is working to share today. "When I went to the meetings with Healthy Heart, [the others] were talking to me, and they helped me heal," Clark says. "I look at . . . what I should do to maintain that healing."

Voices for Change

The American Diabetes Association's awards honoring diabetes programs for Native Americans were renamed this year in memory of John Pipe, an Assiniboine Sioux from Wolf Point, Mont., and a longtime ADA advocate, who died in January. John Pipe Voices for Change Awards are presented in the categories of advocacy, outcomes, and innovation. Besides the Hualapai Healthy Heart program, this year's winners include:

Outcomes Award:

The Bristol Bay Area Health Corp. in Dillingham, Alaska, which provides health services to 34 villages of Alaska Natives throughout the Bristol Bay region.

Innovation Award:

The Tuba City Regional Health Care Corp. in Tuba City, Ariz., which provides diabetes treatment and prevention services for the area's Navajo and Hopi Indians.
For more information, visit diabetes.org/2010voicesforchange.



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