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Canku Ota

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(Many Paths)

An Online Newsletter Celebrating Native America


June 29, 2002 - Issue 64


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Learning about 'the Rez'

by Carla K. Johnson Staff writer Spokesman Review
PLUMMER, ID -- Each of the three young nursing students has a stethoscope draped around her neck. They're trying to be inconspicuous on this morning at the Coeur d'Alene Tribal Wellness Center.

But they feel so white.

"You kind of feel like the minority here," says 23-year-old Lisa Spitzer.

"It's an eye-opener, for sure," says Megan Larsen, also 23.

Spitzer, Larsen and the third student, Taryn Reynolds, 22, all graduated from Spokane's Shadle Park High in 1997 and will graduate from the Intercollegiate College of Nursing in December.

This is their first time on the Coeur d'Alene Reservation, even though they grew up in Spokane, 50 miles from here.

Their weeklong visit to "the Rez" completes a nursing school summer class on the culture and health issues of the Plateau tribes. They and seven other nursing students spent the past three weeks listening to a dozen guest speakers including tribal attorneys, nurses and traditional healers.

They tasted roots and herbs, smelled burning sage. They heard the tribes' histories. Their teachers hope they've learned to slow down and listen to patients.

Nine of the students are white; one is Native American. This week, they visited reservations of the Colville, Spokane, Nez Perce and Coeur d'Alene tribes.

Robbie Paul coordinates Native American programs for the nursing school. She helped plan the class.

"The question that keeps coming up from the students is, `How can I work on the reservation (as a white person)?' We tell them it depends on how you listen," Paul says. "If you listen with your heart and you're quiet and you develop that trust, you can do it."

With a national nursing shortage, these students will have many job choices upon graduation. Whether or not they choose to work in reservation clinics, they are likely to meet Indian patients if they stay in the Northwest.

Knowing something about reservation life, knowing ways of showing respect to elders will serve them well, their teachers say.

Firsthand observation
Diabetes is one of the Plummer clinic's top 10 diagnoses. Among Plateau tribes, the rate of diabetes is three times that of the general population.

One theory holds that American Indians adapted over thousands of years to a seasonal diet of fish, game, roots and berries. They retained fat during feast times so they would not starve during famine. Today, the threat of famine is remote. It's been replaced by the equally deadly threats of obesity and diabetes.

The 4-year-old wellness center, part of Benewah Medical Center, combats modern sedentary lifestyles and high-fat diets in many ways. A model for rural health care, it was one of 16 national tribal programs honored two years ago by Harvard University's Tribal Governance Awards Program.

The $5 million center has a five-lane swimming pool, gymnasium, running track, saunas, jacuzzi and steam rooms. It also has conference facilities and a day-care center.

On this day, the students will observe the center's monthly diabetes clinic, which began in November.

Patients get a blood test and an electrocardiogram; learn about foot care, nutrition and exercise; are screened for depression; and schedule appointments with eye and foot doctors.

The students follow Riley into an office to meet with a patient named Ken. He is an older man, dressed in jeans, a button-up shirt and a ball cap that says "Spokane."

Riley pulls on latex gloves while Ken removes a shoe and sock.

"I check to see if there's any neuropathy," she explains. Neuropathy, or nerve damage, is a complication of diabetes, showing up first as tingling, pain and numbness in the feet. Diabetics can lose all feeling in their feet, leaving them vulnerable to wounds, infections and, in the worst cases, amputations.

"Ken is a high-risk foot," Riley says. While she talks, she checks one of Ken's feet for pulse, warmth and hair growth, signs of good circulation.

She prods his sole, checking for numbness. Her gentle sense of humor keeps the exam friendly.

"You almost kicked me with that one," she kids Ken.

Turning to her desk, she begins marking a chart. Her pen ticks off pluses and minuses on a diagram of a foot.

"So you mark the spots of feeling?" nursing student Spitzer asks.

"And where he doesn't have any feeling," Riley adds.

Riley gives Ken a pair of non-binding socks made for diabetics. She reminds him and the students of other good ideas: no sandals because you might pick up a pebble and not feel it, no heating pads on the feet to prevent burns.

The students notice the approach here feels slower and more thorough than what they're used to off the reservation.

"They want to take care of the patients, not just get them in and out," says Reynolds.

Versatility on the Rez
Of the 10,000 people enrolled as patients at the Coeur d'Alene Tribe's medical center, at least half are non-Indian, says the tribe's spokesman Bob Bostwick. The tribe also employs many non-Indians. With 1,300 employees, the tribe is one of North Idaho's largest employers.

To get a better feel for this community, the students climb into a car with Linda Osterberg for a tour of the reservation. Osterberg, who is white, is one of two drivers for the medical center. A resident of Tensed, Idaho, population 90, she is a former school bus driver and a former ambulance driver.

"You have to do a little bit of everything to live out here," she says.

She shows the students the recently mothballed plant that once turned bluegrass stubble into particle board, and a year-old sawmill that is doing well enough to hire. She recommends the tribal casino's buffet for lunch.

Seventeen miles down the road in DeSmet, they see the old brick boarding school established by the Jesuit missionary. Osterberg briefly mentions tribal elders' unpleasant memories of the boarding school.

On the way back to Plummer, the students chat about their high school memories, and the difference between the words "lush" and "plush." "Lush" comes to mind because they're awed by the rich green of the reservation's farmland and forests.

Osterberg, the clinic driver, knows these roads well. She spends hours with patients while taking them to appointments with medical specialists in Spokane, Coeur d'Alene and St. Maries.

To make better use of her time, the center recently sent her to an Indian Health Services diabetes conference in Bismark, N.D. There she learned enough about diabetes management and nutrition to reinforce what patients learn at the clinic.

Increasing a clinic driver's knowledge of health issues is a grassroots approach that works, says nutritionist Brenda Bodner back at the wellness center.

Bodner gives the students a quiz. She sets up a display of food labels from packaged, prepared dinners. She asks them to identify which product has the most carbohydrates, the most calories, the most saturated fat and the best value.

She created the display, not so much to teach label reading, but to discover how her patients shop for food.

One man told her he looks at the photos on the labels and rejects foods with bacon and other high-fat ingredients.

"Some people are illiterate, or low-literate, so all the labels in the world aren't going to help them," Bodner says.

There's no one right answer to this quiz, the nutritionist says. Some patients want to reduce fat in their diet, some look for the best value.

Again, the message is learning to listen. The students have heard it repeated in different ways during the four-week course. Listening will make their nursing skills more likely to work, wherever they end up practicing.

"It doesn't matter the color of your skin or where you're from," says one of the students' teachers, associate professor Ruth Bindler. "It's whether you take the time and are interested in the patient as a person."

Plummer. ID Map
Maps by Travel

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