Fighting back against diabetes
Story by Jerome Tharaud
Rocky Boy - Blueberry tofu smoothies and pumpkin waffles might grace the menus in Berkeley, Calif., and other trendy meccas of the health-conscious, but they are hardly what most would expect in Montana.
After several years of efforts by a small, dedicated staff at the Rocky Boy Diabetes Program to promote healthier lifestyles on the reservation, those foods are two of the most popular of a rotating menu of 20 breakfast recipes served every Wednesday at the Diabetes Wellness Center at Rocky Boy's Indian Reservation, said Shane Patacsil, a community health representative at the center who also teaches a lunchtime cooking class there every Tuesday.
Diabetics who come on Wednesday mornings see a doctor and get their blood drawn first, and then they eat.
The healthier approach to foods is not so much a luxury here as a necessity. Indian reservations are among the most at-risk populations for diabetes, said Yvonne Hill, the center's diabetes coordinator. According to the American Diabetes Association, about 105,000 American Indians and Alaska Natives have diabetes.
Diana Weaselboy, a diabetic educator and registered nurse at the center, said about 16 percent of Native Americans in the Billings service area of the Indian Health Service - which includes seven reservations in Montana and one in Wyoming - have diabetes.
"They say Hill County is having one of the higher rates of Native Americans with diabetes," said Weaselboy, who began designing the diabetes education curriculum for the clinic in 2001, and has incorporated the Cree language into her lessons.
Weaselboy said there are 312 names on the center's registry, and that about one quarter of those are still prediabetic. But, she said, that number is probably low because there are undiagnosed diabetics in the community.
While Native American communities often need healthy foods the most, they often have the hardest time getting access to those foods, Patacsil said. So the diabetes center worked with the stores in Rocky Boy, and Gary & Leo's IGA and Albertsons in Havre to provide them. Now, he said, almost everything they need - from flourless Ezekiel bread to non-hydrogenated peanut butter - is available.
Patacsil explained this while kneading dough in front of about 10 people in the wellness center kitchen during his Tuesday cooking class. They were still eating bread and low-fat beef stew while he worked.
"What we do is let them eat and then show them how to cook it and tell them why it's good for them," he said. The dough was to make bannock, a dense, traditional bread that has been used by the Indians since they have had flour. But this bannock has a twist: Instead of white flour it is made with whole-wheat flour, and instead of butter, it is garnished with "better butter," a 50-50 blend of butter and canola oil.
"That's 10 times better than regular bannock," he said. "It just has more nutrients."
While Patacsil kneaded, Weaselboy told the class why it's better to use canola oil.
"It's like using Penzoil in your car instead of the Kmart brand. The engine will last longer," she said.
Weaselboy asked the class how many of them have made wheat bannock. A few nodded and said it was good.
"There's so much wheat in here I feel like a pheasant," said Duane Meyers, before asking for some soy milk for his coffee.
"Our main focus of this cooking class is to teach people to cook healthy for their families," Patacsil said. That is important in a culture where extended family members regularly drop in for meals.
"I have 11 kids, so anytime I eat I always expect somebody extra," said Ruby Small, who attended the class. "My son called me today at eight o'clock and said, 'Ma, what are you cooking?'" Small said she is not diabetic, but her husband is.
Dorothy Small, was visiting the class for her fourth time. Small, who said she is diabetic, said she often serves dinner for eight or more people, and that she tries the recipes she learns at the classes out on her family.
"The picky ones eat a little bit, but the greedy ones eat everything," she said.
"Now people are catching on," Patacsil said. "It's getting more popular." He said about 20 people usually show up for breakfasts.
By 1:30 p.m., people were getting into diabetes center vans to head to the Havre community pool for the aqua-aerobics class. The center holds the class every Tuesday and Thursday afternoon.
When children returned to school last fall, they found a drastic change waiting for them. Burns had expanded the menu, limited portion sizes, switched from white bread to wheat bread, and from canned fruits and vegetables to fresh ones. She restricted seconds to "the good stuff" like fruits and vegetables, cut down on cheese and other fatty foods, and got rid of sugary cereals and fried foods. She changed the lunch menus from "heat and serve" meals like pizzas and burritos to foods made from scratch.
The school is even considering following the lead of some other schools in the state and getting rid of soda vending machines.
"There were definite bumps in the road," Burns said. "If you have kids and you try to get them to eat something new, it takes a while."
"All the kids complained and complained, but now it's better," said Winona LaMere, the food service supervisor at Rocky Boy School. "The kids seem to enjoy the food and they're not complaining anymore."
LaMere said that at first it was difficult for the lunchroom staff to get used to cooking from scratch, and that the shift was a strain on the budget.
But, she said, "We'll be prepared for next year now that we know what to expect."
Rocky Boy School head cook Tina Small said there are advantages to the new menus. "The meals are easier to prepare and cook because everything is fresh or frozen, and we don't have to deep fry. It's just a whole lot easier and it's better for the kids. Once they try it, a lot of them like the way the menus are," she said.
"We still have kids complaining, but that's just natural," she said.
The changes are starting to help, Burns said. While she doesn't have statistics on the results of her menus, she said a fifth-grader recently told her he had lost four pounds, and she heard that other kids are losing weight too. Diabetics on the school's staff have told her their blood sugar is lower.
"The complications of diabetes are so severe that if you even prevent one heart attack or help one person keep their kidneys, that means a lot," Burns said.
The center doesn't stop at food. Patacsil said he makes about 25 home visits every week to make sure diabetics are taking their pills and checking their blood sugar, and to get them to come to the clinic.
People who come can also see a full-time physical therapist and use the exercise equipment. There also is a walking club and a smoking-cessation class.
One program asks Rocky Boy students to sign a pledge with their parents promising to turn the television off at least one night a week and do something active, and the center has sponsored round dances and family fun nights.
"Right now we have a few people coming, but we want to get more coming," center physical therapist Jerad Gillen said. "I believe we need to offer more things to the people so they can have the decision on what to do to get more physically fit."
"We look at things that are working and things that aren't working and try to make them better," said Hill, who manages the center's budget and networks with state diabetes coordinators at other Montana reservations.
"I think through continued education and encouragement, eventually they get to where they say, 'Look, I've made a big change,'" she said. "They need to start grabbing on and eventually they'll start changing, and that's what's happening here."
Weaselboy hopes to take the test to be a certified diabetic educator in October. She said that once she is certified, the clinic can get federal reimbursement for its diabetes curriculum.
In April, the center will find out if it has been certified by the Indian Health Service. If it is, it will be eligible to receive Medicare funding.
"I've kind of just grown up around diabetes," she said. "My grandma died from complications of diabetes, and my grandpa has diabetes."
Very few people who have diabetes are working with educators, she added.
"Once you have diabetes, it's a full-time job," Weaselboy said, and that's hard for working people with kids and grandkids. That's where the clinic comes in.
"When you go into Kmart and people come up to you and say, 'I forgot to take my insulin this morning,' that says something," she said. "They know who you are and what you do."