Honoring Tradition to Support Tribal Health

Twenty-five years ago, the future of the Shoalwater Bay Indian Tribe was in jeopardy. Today, they are looking at seven generations: back three generations, the present, and forward three generations. Here is how they are ‘pulling together’ for health.

My tribe sees life within the frame of seven generations: The current generation is shaped by the experience of people three generations before and tasked with setting the course for three generations to come.

That’s why I summoned the stamina needed to paddle a canoe for eight days last summer in a tradition that binds our generations. I joined thousands of men, women, teens and children from my tribe—Shoalwater Bay Indian Tribe—as well as our neighbors from the Chinook Indian Nation, to paddle together in a dugout canoe for 200 miles. It was an annual journey with deep roots in our culture and history. I learned what it really means to pull together. You get into a rhythm with your team, and you move forward.

That’s what we’re trying to do for our community’s health, too.

Shoalwater Bay Indian Tribe is small, fewer than 400 members. Less than a quarter of us live on our reservation in southwestern Washington. And about 25 years ago we weren’t even sure our tribe had a future. From 1988 to 1992, nearly half our pregnancies ended in miscarriage, ectopic pregnancy, stillbirth or the death of the baby within a year of birth. State and federal epidemiologists who studied the problem found no single cause, other than the glaring lack of health care access.

Things have finally changed for the better. Years of advocating with the Indian Health Service and two loans later, we opened a full-service wellness center in 2005 which addresses the physical, mental, behavioral, and dental health of tribal members and those in surrounding communities. Health has improved to the point that we’ve had over 40 children born on the reservation since 1992. We’re also planning to move the entire reservation to higher ground, away from the threat of Tsunami-flooding in our current lowland location.

And we’re pulling together to create policies that entrench better health in our community, using our culture as a compass. Now in the fourth year of an initiative funded by the American Indian Health Commission for Washington State, which works with all tribes in Washington, we are one of the first tribes to adopt the commission’s “Pulling Together for Wellness” model. It applies tribal knowledge to a process of building partnerships for health, assessing needs, taking action, and evaluating results.

Bring Experts to the Table

Key for a small tribe like ours has been bringing together experts who can guide us in our journey toward better health. They include representatives from the Washington Department of Health, the director of Pacific County’s health department, a University of Washington nutrition researcher, a maternal health expert, and a master gardener.

These experts are helping us shape policies aimed at three goals: promoting healthy eating, boosting physical activity and preventing commercial tobacco use among tribe members. From them, we’ve learned about Complete Street's policies that aid physical activity and safety, best practices in commercial tobacco-use prevention, and how to develop nutrition guidelines for the tribe.

This collaboration has moved us past identifying problems and toward envisioning a pathway to action. Knowing the right people will also help us implement new policies and find funding.

Engage Youth in Shaping Solution

But working with experts is just one step. New policies have to work within the historical and cultural context of our tribe. In keeping with our view of binding generations, we’ve enlisted our youth so they too understand the stake they have in their community’s future.

For example, our first priority in preventing commercial tobacco use was raising the age of purchase to 21. We arrived at this goal by engaging our young people. To do that, we hired an expert to teach a one-day course last summer where Shoalwater teens learned about the ramifications of smoking at a young age.

Our youth initially wanted to limit smoking to elders, believing that “they deserve to do whatever they want.” Then they considered setting a minimum age of 26, since they learned from the course that brains develop until this age. But we finally reached a consensus to limit tobacco purchases to 21 years and over, since there is already a movement in Washington to enact such a policy statewide and some studies suggest it helps prevent smoking.

We’ve also engaged the broader community in similar processes. We created a resolution for our food sovereignty that acknowledges the role of our Tribe’s traditions in the food we produce, eat and serve. We now have nutrition guidelines for meetings and events that highlight practical steps we have been taught through our nutrition classes and incorporate our ancestors’ traditions. We have a large team of community and staff members who meet monthly on wellness issues. And we share information throughout our tribal government, making sure all departments—from public safety to education to housing to social services to the Wellness Center—are involved in our progress on all aspects of health and wellness.

Embrace Healthy Traditions

Our overall health priorities and goals have led us to develop a challenge statement: improve the health of tribal members by embracing the healthy traditions of our ancestors. In other words, we’re changing the norm from being tethered to video games, cell phones, and desks. We aim to recreate a living culture and work the traditional ways of our ancestors back into what we do today.

Take our resolution on Complete Streets—an approach to transportation design that takes into account all modes of transit, from walking and biking to driving and public transportation. We’re incorporating traditional plants along walkways to bring back food sources, such as blueberry and huckleberry bushes, fruit trees, and roots. We also plan to include cultural art, such as murals and carved benches, along routes, making people’s passage enjoyable and colorful and reminding us of our ancestors.

Our food sovereignty ordinance will promote access to traditional foods, improve knowledge about gathering and processing of native foods, and document traditional foods and recipes.

Our yearly canoe journey is also a source of cultural activities—from the carving of canoes to rowing on the journey itself to dancing traditional dances each night—that boost physical activity and improve mental health.

For me, the benefits of participating in the journey went far beyond those eight days. After the event, the organizers presented me with a ring for completing the journey and gave me ten rules to live by, including this one: Never harm yourself or others. As we pull together for health, I always keep those words top of mind.

Shoalwater Bay Indian Tribe’s efforts to improve health for all of its residents earned them a 2016 Culture of Health Prize. Learn how your community can apply to become a Culture of Health Prize winner.

About the Author

Jamie Judkins is grant program coordinator for the Shoalwater Bay Indian Tribe of Washington. She is the descendent of Chief Charley of Shoalwater Bay and Willie Frank Sr. of Nisqually. She co-facilitates the Shoalwater Bay Tribe’s Pulling Together for Wellness team activities serving under the mentorship of Chairwoman Charlene Nelson.