Background:
In spring 2010, the Tahoma Indian Center (TIC) began offering a nutrition clinic through the auspices of the Washington State Department of Health Office of Primary Care and Vibrant Horizons. TIC is a day shelter for urban Native Americans. Many who visit TIC are homeless and/or have a history of recovery. Each month for two hours, individual guests at TIC have the opportunity to participate in voluntary nutrition and wellness classes.
The key strategy to assist those at TIC engage in positive lifestyle changes is to share simple, accessible, manageable, and culturally relevant ways to improve their health. The experience becomes tangible for participants through discussion of traditional and modern diets, showing how diet contributes to diabetes and modern diseases, validating how their dietary traditions suffered through acculturation, and demonstrating ways to make dietary and lifestyle changes that positively affect health and make sense to Natives in a way that validate their heritage and traditional knowledge.
The delivery style is respectful, cautious, unobtrusive, and follows subtle and nuanced norms of interaction that have been learned from personal experience and careful observation through spending time in Native American communities.
Article:
In June 2010, I was asked by the Washington State Department of Health Office of Primary Care to contribute to implementing a holistic free clinic at TIC that would support and educate the presenting population around their medical, dental, and wellness needs. The vision was to mitigate pervasive chronic conditions such as diabetes, high blood pressure, poor oral health, fear of mainstream providers, and lack of access to essential services.
My role would be to provide a monthly wellness class that would include healthy lifestyle discussions and personal coaching to educate and support the health of the participants. The classes were launched in the month of June with seven attendees. During the classes participants are provided with an educational platform where nutrition, traditional diets, diabetes, healthy lifestyles, and fitness exercises are discussed and demonstrated.
The regular patrons at the center have now become used to my presence for the two hours a month I spend with them. Even if they don’t attend the class, they are welcoming, even playful and tease me about eating lots of vegetables or ask if I want some of their soda. These signs of familiarity and humor are encouraging evidence that they have accepted my presence and role, and that my activities represent no threat to them. Only on the basis of such acceptance can the information and suggestions presented be respectfully considered and embraced as hopeful or valid.
There are a handful of regulars that attend the classes. Many are either recruited by other participants or happen to be sitting at the table where we gather for class. The space at TIC is a relatively small single room where many activities might be taking place at the same time. Often, many patrons will be watching TV. Sometimes they will be watching a program and listening to the class at the same time and when something is said that peaks their interest it might prompt an unexpected question or a humorous comment. These are indicators that they are paying attention even if they seem to be engaged in other activities. Some individuals are only visiting the center, so there’s just one chance to make a difference.
Significant and notable health improvements have been experienced by many of the class participants. Each month, there is always another story of an individual who heard something that was shared during class and that prompted a lifestyle change. Their friends and relatives also benefit. When participants take their learning home, make it their own, and see results, they become excited and want to share what they have learned with their loved ones. Below follow some of their stories.
A 70-year-old woman who had much difficulty regulating her blood sugar levels due to type 2 diabetes began to make changes based on what was discussed during class. She often would wake up in the middle of the night with very low blood sugar and a few times had to go to the emergency room. After she learned how foods affect blood sugar and what to eat to support proper blood-sugar regulation, she began making empowered decisions with her food choices. She has since lost over 20 pounds (to the time of this writing), hasn’t had a middle-of-the-night blood sugar crisis, and her blood sugar levels, that once averaged dangerously high, have stabilized within the normal range.
A middle-aged woman attended just the first two classes that were offered. When she arrived to the center as class was finishing a couple months later, she happily and eagerly shared that she stopped drinking soda after the first class she attended. This same woman sat during class sipping on a 32-ounce bottle of diet soda while we discussed the bio-chemical effects of drinking soda. When asked how she was doing, she said that she stopped drinking soda cold-turkey, lost 30 pounds without trying, and her energy improved. She also stopped giving her grandson soda and high-sugar drinks, and mentioned that he stopped asking for soda and now asks for water.
On another occasion, a young man in his early thirties happened to be sitting at the class table when class started, so we invited him to stay. Each month after that first class, he eagerly attended every class. At the January 2011 class, he enthusiastically shared he had started going to the YMCA to work out, stopped drinking soda, and was eating better. (TIC has a partnership with the Tacoma YMCA two blocks away where they give passes for free admission from 1-3pm each weekday.) He shared that he lost over 30 pounds, felt better and had more energy, and that his self-esteem had improved. Each month, he shares with the group how he continues to feel better, loose weight, and get physically stronger.
One man in his late thirties participated in his first class just days after he was diagnosed with type 2 diabetes. He happened to show up to the center half way through class. It was a wonderful opportunity for other participants to play an active role in sharing what they had learned over the past several months and share their own success stories. We discussed how blood sugar is regulated, what causes diabetes, and ways to best support his health. When class ended he came up to me, shook my hand and said, “You’ve saved my life.” When I returned the following month and saw him, he mentioned that he had been making many of the changes we discussed. Then, he pulled out a handout I had given him from his pocket. The handout listed dietary and fitness recommendations. He said he carried it everywhere and looks at it every day to make sure he’s staying on track. In only a month, his health is already improving and he is well on his way to overcoming the type 2 diabetes diagnosis.
I received a call a few weeks ago from a participant that attended just one class. She happened to be visiting a friend, who is a regular patron of the center, the day that class was being held. After class I gave her my contact information in the event she had any questions. She called a few times and asked for more information on gluten-free diets and healthy fats. A couple weeks ago, she contacted me to say that she had recently visited her doctor and was told she lost 9 pounds. She was excited to share that she was feeling better, loosing weight without effort, trying new foods, and generally enjoying herself more.
The overall improvements that have been experienced by class participants at TIC and those in their sphere of influence, while notable, are difficult to quantify. Although there have been pounds lost, improvements in blood sugar numbers, and less need for medication, we cannot calculate a number to demonstrate improvements in personal energy, happiness, or self-esteem. How can one quantify what it feels like to go to bed knowing there is no need to fear waking up in the middle of the night with a blood sugar crash? How can we measure the effects over time the impact in the life of a grandson whose grandmother started giving him water instead of soda during childhood?
Aside from the numerous health improvements that class participants at TIC have experienced, they feel a sense of community with the class regularity and support. They know there is someone in their life that is reliable and genuinely cares for them. We laugh and share comfortably with each other. In our own way, we are a family who, like any other, wants the best for each member and those we care about.
This program has restored life back to many individuals who were seeking some sense of hope, a change, even transformation. They come to TIC for one of the few meaningful things they could get in an urban setting away from their own—a sense of belonging. In that familiar and comfortable setting, it is likely that it became a lot easier to make a difference than if they had received similar information from a pamphlet or at a mainstream provider outlet. They took hold of an opportunity that was offered to them and made the change.
Renewal in the face of uncertainly and isolation for many participants at TIC seemed like a far reaching possibility at first. From personal experience, those involved in this effort knew that if we could gain trust and develop a sense of mutuality, even love, perhaps a lot more than expected might be possible—it was. These successes at TIC are an invitation for us all to give back to the community in a meaningful way that supports the greater good of everyone. Hopefully, they also constitute a replicable and scalable model that can be practiced in additional places with other key populations.
Contact Information:
Jenelle Strine, LMP, NTP
206-290-4774
jenelle@vibranthorizons.com


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Jenelle
Strine is a health and lifestyle expert in Seattle who loves to share her passions
with others. She works with individuals and teaches classes on
nutrition, fitness, healthy lifestyles, and the mind-body connection to
help transform the lives of others. 
