Sharing the Message of Health, Fighting Chronic Disease in the Crow Nation: A Q&A
When her young daughter died of the rare cancer neuroblastoma, Alma McCormick, M.A., wanted to channel her pain and experience toward helping others. She started working with a small project, encouraging other women in the Apsáalooke (Crow) Nation to get screened for cancer.
Through this work, she met Suzanne Held, Ph.D., a researcher from Montana State University. That meeting in 1996 sparked a longstanding community/academic partnership to address health disparities in the Crow Nation. Their initial project helped destigmatize discussions on cancer and increased cancer screenings among Crow women. It was so successful that the pair founded the nonprofit organization Messengers for Health to continue providing and expanding their services.
Ms. McCormick and Dr. Held were nationally recognized in 2018 as leaders in community-based participatory research (CBPR). In CBPR, researchers and community members are equal partners throughout the research process. But what this means in practice can be hard to grasp for researchers and the public alike. To show what CBPR means on the ground, we sat down with Ms. McCormick to discuss how she and Dr. Held are addressing chronic disease through an NIMHD-funded project.
Messengers for Health originally started with a focus on cancer screening. Why did you expand to include chronic disease?
Around 2015, Suzanne said she’d like to do research with us again, but on whatever we felt we would like to address. She never said, “Well, I see there’s a high rate of diabetes,” although she is well aware of the issues of our community. She came and had an open discussion with our board. Our board decided on trying to improve self-care. Many of our people have diabetes or are dealing with several conditions, like chronic pain, and are struggling to manage them. They struggle to change their diet; they struggle to exercise.
How did you determine how you would help people manage their chronic illness?
I interviewed 20 people who have a chronic condition and were either Crow Indian or married to a Crow Indian. I asked them a big, open-ended question: “Could you share with me about your health from the time you were young until now?” And they just shared.
Then I asked about historical trauma and current trauma. I always say we opened up a can of worms. But it was a good can of worms, because really that was the key. From what has happened and has been passed down through the generations, many of our people are struggling today with substance use and other issues.
The introduction of commodities such as canned meat and pasta, brought into our communities because we were living in poverty conditions, was actually not good for us at all. But we had to eat that, and I grew up eating commodities. We also had the wild game, chokecherries, the buffalo berries, and pheasants, too. The implications of commodities, along with just modern society with the fast food and processed foods, has been detrimental to our health.
That was all brought out as people shared their stories. It was emotional. These people shed tears. And I shed tears with them.
After you listened to the stories, you had to design a program to help people with their health problems. What kind of program did you design?
From our conversations, we knew it was going to take a Crow person with a chronic illness themselves who is managing well and is resilient to talk with others, because in our culture, advice is wisdom. Elders share their experience; that’s how children are nurtured and reared. So we titled this project “Báa nnilah,” which means “go, give advice.”
The mentors bring people together to share words of advice in support groups. They facilitate seven sessions called gatherings held every other week. But the mentor is not taking the lead or doing all the talking. People are growing and learning together.
We recruited and trained five women and five men to be mentors. They recruited 200 people total, who were randomly divided into two groups. The first group started the sessions right away, and the second group waited before starting them.
What kinds of topics were discussed at the gatherings?
The topics came out of the stories from the interviews: learning what a chronic illness is, improving my conversation with my medical provider, and nutrition and physical activity, as well as beginning to address and know what historical trauma is.
We didn’t address historical trauma to look at the negative impact that it’s made on us, but to know that we have the strength to forgive, overcome, and heal. We don’t have to allow what happened to us historically and what is happening to us today to affect us. We can be healthy. We talk about forgiveness and talk about hope being a powerful medicine. We used our Old Man Coyote stories at the beginning of each of these sessions, because those stories add humor, but there’s always a moral and a lesson to be learned.
At the seventh session, it’s a big celebration. And they develop their action plan, which we call “counting coups” instead of “setting goals.” In our culture, when you took something from the enemy during wartime, you counted coup, and it added to your right to be called a warrior. They could count coups by touching the enemy with their hand or coup stick and come away unharmed. So counting coups is about making goals for ourselves to enable us to fulfill our role. It says we are now riding into battle with our health. And we look to find more ways we can count coups in this battle.
I know you are in your last rounds of data collection to evaluate the program, but what have you been hearing from participants so far?
One person said, “This program brought me out of my depression.” There’s been a common response of, “I know I’m not alone.” Another participant said, “This has given me a better understanding with my spouse,” because they both have health conditions.
People also said that they lost weight and are drinking less pop now. They’re drinking more water. They’re trying to eat healthier. And they’re doing it as a family. So we started something here. And there’s more to be done.
What are the next steps for Messengers for Health?
We found that people need inner healing—that’s the root. The emotional, the mental inner healing that our people need has to be dealt with first, before they can even begin to take better care of themselves. And so we’re actually applying for a small pilot grant right now to address mental health.
Our desire is not only to sustain what we’re doing but to share it with others, so they don’t have to reinvent the wheel, because these issues that I’m talking about aren’t just specific to the Crow Nation. These are the same issues that many other tribal nations are facing in their communities.
Finally, what would you say made this community/academic partnership so successful?
Suzanne has her heart in it and considers me an equal as well as our people. There was mutual respect, and she understands that we in our community have expertise, knowledge, and resources. By bringing that together with the expertise of research, we can make something good happen.
Posted November 12, 2019