Vol. 15, No. 3, Spring 2002

Sonoma County's Healthy Traditions Diabetes Program

Ruth Dubin

Steeped in Native tradition and on the cutting edge of diabetes care, the Healthy Traditions Diabetes Program at Sonoma County’s Indian Health Project in Fulton is an innovative clinic devoted to diabetes.

Helen Maldonado (Kashaya Pomo), a certified physician’s assistant, is a staff member at the clinic. She says that diabetes care is different from what it used to be. Gone are the days of getting a card from the doctor saying how many calories you can eat for your weight and which foods you are allowed. Modern guidelines promote self-advocacy. New patients, after being diagnosed, often have grim images in their minds. "Well, my mom had diabetes; or my grandmother or grandfather had their feet cut off, they were on dialysis for years, then they died. The same will happen to me, so what’s the use?" Fear and a sense of powerlessness take over, and patients do not come in for medical help that might prolong their lives. To help prevent this, members of the clinic strive to educate and empower patients. They have trained four community action leaders, all of whom are diabetic, to help diabetics take care of themselves at home. Said Maldonado, "I think if we start giving people the power to take care of themselves, and the education, it’s going to go a long way. We’re going to turn ourselves around as a Native community, and we’re going to be healthy; we’re not going to submit to diabetes any longer."

Modern diabetes care places a large emphasis on prevention; let’s put a stop to limb amputation and kidney failure. Exercise and eating right are the best ways to prevent these avoidable outcomes and, in the long term, are more effective than medication. Furthermore, they are measures for which the patient can take responsibility.

In an effort to encourage people to exercise, the Healthy Traditions Diabetes Program began the Hundred Mile Club. Started by Cathi Sassin, certified diabetes educator and registered dietician, and modeled after a similar program on the Zuni Reservation, the club encourages patients to set exercise goals every five months. According to Cathi, most people walk for exercise, but someone confined by an injury or rheumatoid arthritis can join the club by doing armchair exercises. The point is to do aerobic or muscle building exercise every day. Diana McGill (Wappo/Coast Miwok) is a Community Health Educator. In addition to visiting diabetics in their homes to make sure they are taking care of themselves, she believes in being a role model for other diabetics. She has fought high blood pressure and lost weight through walking, and adds that walking is also a good stress reliever. She and Lucy McKay are the only members of the elite Thousand Mile Club.

As for motivating people to eat right, Susan Lafleur, registered nurse, asks her patients about what they are currently eating, what they are willing to try, and recommends gentle changes. If people have to eat out because they are on the road a lot, she recommends healthier choices at restaurants. "If someone is only eating one big meal a day at a restaurant, try packing a lunch also. Our bodies work best if they eat healthy food every four to five hours. This helps keep blood sugar more balanced. If you eat oatmeal once a week, try twice a week."

The staff is especially interested in encouraging traditional foods. They held their first Traditional Food Fair in December 2001. Future plans include an organic garden and cooking classes to teach people how to prepare fresh vegetables. More than anything, the staff at the clinic want to avoid the isolation and shock that often come with being diagnosed diabetic.

Emotional support and encouragement take many forms. Josephine McKay, Lucy’s daughter, has a bachelor’s degree in psychology. She notes that physicians, nurses, and community educators will sit down with new patients and console them. Helen Maldonado explains that each new patient visits several departments, including education, nutrition, and behavioral health. This way, the person gets to know several people who are sources of information and who can help the individual deal with the often devastating feelings that accompany being diagnosed.

Lucy McKay has led a talking circle as part of the program’s diabetes class for the past three years. She herself had gestational diabetes (a type that occurs during pregnancy and then goes away) and has since been diagnosed with another type. Lucy tells people that Pomo Indians had a custom similar to talking circles: they would communicate while grinding acorns or doing other activities together. In traditional talking circles, a feather is passed around, and the person holding the feather speaks uninterruptedly as long as he or she wishes. In Lucy’s culture, women do not touch feathers. So she came up with something different: a little bear, which is symbolic of California, as well as being a prominent character in stories told by Pomo Indians. The group meets once a month and has grown from five to more than fifteen people. Anyone may come, and members are invited to talk about their health and learn from others (but due to time limitations, individuals speak for minutes, not hours). Afterwards, there is a potluck where recipes are shared. "It’s like a family," Lucy said.

The people at the Sonoma County Indian Health Project believe they can stop the epidemic of diabetes in their community. With this kind of determination and creativity, they will do it.

Ruth Dubin, News intern, is currently taking time off after her third year of medical school. She hopes to become a pediatrician.