Complete Transcript: Michael Watkins

Michael Watkins – Grand Ronde

00:00  My name is Michael Watkins and I am the health director for he Confederated Tribes of Grand Ronde, her at Grand Ronde, Oregon, and we operate a Tribal Health Clinic here at Grand Ronde that services the tribal population, and natives that live in the community, and non natives that live in the community area of Grand Ronde, Willamina and Sheridan.

We also, part of our component, in the health center is our diabetes program which we operate through our tribal wellness program and we currently employ a health nurse that co-manages our program with the clinical director of our medical clinic.

00:55  We also employ two health promotion specialists and two youth prevention education specialists through the diabetes program and through our wellness program that work hand in hand with our medical providers. Part of the program is prevention and we really made a shift in the last couple of years to a prevention model, really targeting our youth.

01:25  We currently have about 10 percent of our tribal population which is diabetic which is a little bit lower than some of the Southwest areas. I think that number is lower for a couple of reasons and one of them is just that the reporting mechanism. I would greatly say our diabetes rate is higher than 10% but we are currently looking at how we actually are collecting and reporting that data. So I don’t want to necessarily think the rate is a lot lower than typically what is seen in native communities. We would actually like the numbers to fet lower and that is part of our focus on prevention and working with our youth.

02:19  About two years ago , I was able to attend a tribal head start graduation where a nephew of mine was graduating and one thing that really stuck out to me as a tribal health director was how many children in our head start program were obese and were on the road already to developing diabetes and other health chronic conditions in their life. And at that point, I really took a look at what we were doing to work with our health care setting other than their normal checkups with their primary care doctors here. So we really empowered our diabetes program and our wellness program to really take a look at our youth and to start working among the education department here at the tribe actually in the classrooms doing a lot of prevention and health education work.

03:28  Currently we have where our Health Promotion Specialists actually goes into the headstart program and does exercise classes in their classroom setting and they get very familiar and they look forward to the health care worker actually coming over and actually leading the exercises classes and actually doing it along with them, and it has been a very good success with us.

04:00 We also do a lot of education work with our head start and we teach them the right food to eat and the wrong foods to eat and really getting them to be aware of nutrition and aware of things in their house that they should be eating that are good and to watch out what they and really getting them to look at moving and exercising and doing it in a fun way so it is not something that they have to do but something that they look forward to doing. And that has been a big success.

04:45  We had as an example one of the children in our head start class we see here in the clinic. Our clinical director sees that young man, and at the age of six years old, he had weighed 160 pounds and he was severely obese and was on his way to developing diabetes in the next year or two. And we started looking at how we could work with the Educational Department and the school district and others to really help that young man to overcome that and lead a much healthier life style down the road.

05:33  And we were able to bring several departments together and the school district into developing a plan for the young man, which included some regular exercise both outside of the school setting but we were actually able to work with the school district into developing a IUP for the young man which included some fitness things throughout the day of his school day where one of the school district staff actually took him out of class and did some fitness things through the day.

06:10  And then the School nutrition program was able to develop a special lunch for him that was more nutritious than the regular lunches that they serve on a regular daily basis. Our education which the young man graduated from Head Start program and moved into the after care program also was willing to work with us and develop fitness activities for him to do that was presented to him in a fun way of getting him to move.

06:53  We were able to purchase the young man a tricycle that he was able to do on his own time at home along with his parents, and incorporate the parents into the whole master plan. Through the aquatics program at Dallas, Oregon, which is about a half hour away from the tribe here, and we were able to enroll the child into swimming classes along with the mother, and try and incorporate the mother into transitioning the role of fitness over to the family. And the young child took off, as most kids do, were a fish out of the water and just loved the water and was able to use that again as a way of exercise and fitness in a fun and positive way for him.

07:48  Often the tribe does what is called Family Night out, fitness activities, and several have been family swim nights at the local aquatics center where we have anywhere from 150 to 200 tribal members who go down for a night of activities at the swimming pool. And this young child, prior to his swimming classes, had never participated in those. Once we enrolled him the swimming classes and the next family night swim that we had, the actual child and his mother were down there participating. And now he views swimming as a very fun activity that will also help him achieve some of his goals. So that was kind of the different ways that we looked at really incorporating the prevention model into our young children at tribe and health center and trying to integrate these services through those departments.

08:54  As a prevention model for older adults, we just recently just completed a Healthy Lifestyles Balance program which was a program that  lasted 16 weeks and really targeted our diabetes population and the employees of the tribe and patients of the health center and basically this program was a program that met weekly every Monday during the lunch hour and we served a nutritional lunch to all of our participants and we did health education or fitness activities during that hour also.

09:33 We started the program with about 70 participants the first couple of weeks and we ended up the program with about 45 participants that actually completed about 95% attendance all 16 weeks. We did this basically by a couple of different means, one was the incentive version where they got a small gift or a small token for attending every week, along with the lunch, which included at sometimes cook books, cooking utensils, measuring cups, different things they could actually take back to their house and use in a nutritional way to try and cook and eat better.

10:25   We also teamed with the Just Move It program and the Nike Incentive program that Nike is currently doing with native communities out there. And we were able to purchase incentive items through Nike to actually give out to participants, to encourage them to walk and do fitness activities, and that was a big plus. Each participant had a goal that they came up with within the first two, one or two weeks. And we had about 80% of the participants who actually met that goal at the end of the 16 weeks. So it was a huge success for us to look back and look at the preventive work that we did during that time and the number of participants that actually attended on a regular basis through the 16 weeks.

11:22  Part of the presentations that were done again were mostly done were actually done through our diabetes department and through our wellness department. We had a couple of medical providers that actually came over and did some medical presentations. And we teamed with Oregon Pacific AHAC Program through Oregon State University and actually had a student, a Master’s in Public Health student come over and did presentations through the 16 weeks on nutrition and fitness, too. Those are a lot of ways we are looking at our prevention model here through our diabetes program

12:05 We are also doing a lot of monitoring of our diabetes patients part of that is monthly diabetes support group that we do that is well attended. We also cook a nutritional meal for the diabetes support group and every month a different topic is discussed, that ranges from nutritional, to mental health, to physical fitness to general health issues, and we have various presenters that come in every month and do those presentations that includes not only our own staff but staff from other medical providers in the community. That is mostly a lot of the preventative activities that we do here at the tribe.

13:15 I was trying to think of the other activities that we have kind of done. Our diabetes nurse does home visits. Our promotional specialists do home visits so we are really tracking and trying to really track and provide assistance to our diabetes population that we have, which again it is a smaller percentage and it is our hope that through prevention, we are trying to keep that percentage down for our tribal members in this community.

13:55 That is the main goal. I think we have taken not only in our diabetes program but here at the health center a very wholistic view of a person’s health and we have tried to incorporate not only again here in the health center those services, but on the tribal community level those type of services, and really started looking at families and individuals in a wholistic way and how we can all work to the common goal together instead of independently.

14:34  And in the case of the young boy in the Head Start program, we were actually able to reach outside of the tribal community into the school district and incorporate them, and the local aquatic center and incorporate them into our plan for the boy. To this point, I should report on the young boy and he had actually lost 30 points and his energy level has come up and his overall actual health condition improved and that is what we are hoping to continue with him where we someday get him where he will living a healthy lifestyle.

15:21 I don’t know, I was trying to think of other things in our diabetes program. I’m trying to think of a prevention model.

15:50 That is pretty much the, I guess, the special things we do outside of the normal tracking of our patients through out medical clinic and our providers through their visits. The one thing we really wanted to try to incorporate.. .

16:12 Chips is a good example because he has done he has done it on himself and taken the responsibility on his own. But not all patients do that. And a lot of times it takes that extra push outside of your medical provider, your doctor or your nurse, so we have really tried to have that message relayed in several different ways. So if someone doesn’t necessarily connect with their doctor, they might connect with the education person they are working with, or the social service person they are working with, even the tribal human resource person that they might be getting a job.

17:00  And that has been the big push to get everyone to say the same thing and to really promote prevention and the healthy lifestyle. And we have been somewhat successful in doing that here. It has been a struggle to get everybody on the same page, but I think we are making that progress and as we continue to incorporate the entire tribal community into that mode, I think then we will get that support out there that normally individuals don’t get. And if you are someone that needs a lot of support, that is what can make you successful.

17:38 I know Chips has been involved with our Diabetes Support group and some other activities, but I also know he has had the will power to do a lot of that himself. He goes out and rides his bicycle and tries to eat better and tries to do the things he needs to do to take care of themselves, but not all of our patients are like Chips and has the will power that he has, and we want to insure that we are able to provide them with the support that they need to be provided with.

18:16  We actually formed a kind of a Healthy Lifestyle committee here at the tribe and that was how our Healthy Lifestyle Balance, or 16 week program kind of evolved was from that committee where we brought individuals from every department together to really look at what we could be doing different in the tribe to promote healthy lifestyles. And that was the kind of integration piece that we brought together.

18:49  Not only our health care providers, our education department, our communication, Smoke Signals newspaper, our tribal newspaper had a representative, our actual human resources department for both the tribe and for Spirit Mountain Casino came, thinking that they could actually be involved with our employees, and the tribe employees about 1800 individuals,  so it was a way of really working together and trying to pull resources together to not only serve our patient population here, but the tribal membership and the tribal work force along with our social services department, our housing department, and some other areas, and from that one of our big successes was the Healthy Lifestyle Program, the 16 week program.

19:45  And we are currently looking at another major activity that we can incorporate into the community out here and again taking that community role and that community picture of promoting it at that level, and not at the individual level, but the support of that level.

20:05  One of the tribal activities that wasn’t sponsored by the health center, but was a diabetes program by the human resource center and that was a walking challenge that we incorporated and we had several employees who every lunch hour and every break hour went out and walked through walking courses that we had designated here on the tribal grounds. And recorded their mileage off their pedometers that we had given them. And at the end of the summer, we had a big contest of who walked the farthest, and a Healthy bbq that we put on and so now we are seeing other departments start take on the same role that we are doing here, which is different but it supports the general mission of what we are trying to do to encourage that healthy lifestyle.

21:19 The gym now has a fitness center, a small fitness center that is open for tribal members and actually some community members and some tribal employees. They are just now incorporating a recreation department to start doing more recreational activities for the tribal member groups that are out here.

21:47  Our big push right now is to develop a swimming pool and incorporate a swimming pool and a therapy pool into the plans. About a year ago, we had our small diabetes group that we took over to the aquatics center over at Dallas and that was very beneficial both on the physical side and on the social side of getting out and doing that. Our clinical director here at the health center is a strong advocate of warm water therapy and has been really pushing the tribe to develop a swimming pool area and so that is our next real big push out here.

22:40  We are also trying to really support the recreation program that the tribe is developing and we are  trying to play a major role in working with the whole range of ages from the Head Start children all the way up to developing programs for our elders in that department. And so that the whole lifestyle gets changed out here and we don’t necessarily don’t just concentrate on just one age group, but we have activities for a person of any age and ability to do which would range from doing chair aerobics with our elders which we do at our meal site right before our meals at our senior meal site, all the way to the exercise classes we are doing with our head start kids and the whole range in between so that has been a big push and we can be a part of the development of the tribal recreation department.

23:55 It is exciting and again I think the staff over here at the health center are really in a prevention mode. And we’d much rather prevent the onset of diabetes than treat diabetics. And that is our goal is really prevention, not only in the diabetes program, but every area of the health center and that has been a major change in the last couple of years here at the health center.

24:40 I think that is about it. I just would encourage ... I think one of the things people could do, and I say this when I talk to our community gal here at our general council meetings and I actually got the opportunity speak at the Government to Government summit with the State of Oregon and  I actually challenged the Governor on this, but I challenge individuals to make one small change in their life that is positive. Sometimes, as individuals, we try to make a major change in our life and too many times we are unsuccessful in doing that, but if we can make one small change in our life and have a small success at that whether it is reading a book every day, or spending time with your children, or smiling or trying to eat better or exercise or however big or small it is to you, but if we can make that one change and be successful we can carry that on and make major changes in our life and be more successful and I always try to challenge people to do one thing in their life they can change and be positive in their life and go for that and look for support, and look for the will power, and usually they can become successful.

26:29  We did this, I did this a year and a half ago at a general council meeting and I actually had a young adult come up to me a year later and say I quit smoking and you challenged me to do something and that is what I did.”  So if I can encourage someone to do that. That was what he needed was encouragement to just start something. That is something positive and that is very preventive, and as native people I think we can do that and incorporate our native values into it. That is the other piece that always seems to be missing and that is our cultural piece and what that means to us.

When I spoke to the Governor I was given a list of things to talk about but as a native people myself, I said, we seem to go in our own directions so I am going to talk about the things I want to talk about and not what I was told to talk about. And earlier in that meeting the NARA drum group sang a song and some tribal leaders from the Umatilla reservation sang a song and I said as a native person, myself, when I hear the drumbeat and the singing, it almost brings chills sometimes and happiness throughout your body to hear and feel that drum beat, and that is prevention. That is prevention to the ninth degree and that is what we need to get back to is that healthy lifestyle. That singing and drumming is prevention, health care prevention. To lead a traditional healthy lifestyle in our own life and hopefully somebody out of that meeting will take that challenge and be successful and build on that.

29:00  One of the things that out here at Grand Ronde that has not been a big enough piece in the health care setting out here, is the cultural piece, and that is something that we are trying to integrate and incorporate into our health care practice out here. We look at that strong in our alcohol and drug programs and at the mental health area that has been a strong piece, but in our other areas, it hasn’t been as strong and we are looking at how we can work with our cultural department here at the tribe to incorporate some of those values and what we do here with prevention. One has been awareness of what those traditional values were and what they mean and tobacco is one that is used all the time. Tobacco is part of the traditional values of most native communities, but tobacco wasn’t used in the way it is used today and we need to get back to those values.

30:24  Domestic violence wasn’t a traditional value in native communities, and we need to promote that and get back to those values and bring that awareness back to the community which can help to prevent those issues and help that prevention piece, and we are looking at how we can really kick off more of those awareness activities that will not only be cultural specific to this tribe, but will be preventive to lead a more positive lifestyle in their own specific traditional way.

30:19  And that is a struggle, that has been a big mission of mine, I guess, and an ongoing mission of mine, to incorporate the cultural aspect more into what is typically is a western health center we see throughout a lot of Indian country. There have been some very successful tribes that have done that and that is our goal to integrate that piece into the health center. 32:01