Finding Your Way with Diabetes

By Kalvin Valdillez, Tulalip News 

On the evening of March 7, the Tulalip Diabetes Care and Prevention program hosted their first Finding Your Way with Diabetes gathering of the year in the newly constructed conference room at the Karen I. Fryberg Health Clinic. After great success last summer, the interactive course was brought back to help local diabetics get a better understanding of how to manage their diabetes.

Finding Your Way with Diabetes is led by Diabetes Educators, Miguel Arteaga (RN) and Natasha LeVee (PharmD) who guide the participants through an hour and a half long class that includes games, snacks and plenty of laughter. Participants are encouraged to share their stories with their fellow diabetics to give insight into the disease and how it can affect others in both similar and different ways. 

The latest report from the Centers for Disease Control and Prevention (CDC) revealed that Native Americans are still at great risk and twice as likely to be diagnosed with diabetes, but because of programs like Diabetes Care and Prevention, Indigenous Peoples living with diabetes are learning how to responsibly manage their blood glucose levels, eat healthy nutritious foods, and participate in physical activity as well as gain more general knowledge about diabetes. 

“The inspiration behind the class is we we’re trying to figure out a way to provide something for [diabetics] that was kind of like the Wisdom Warriors,” says Miguel. “The Wisdom Warriors is a self-help group where people learn skills and get together like a family, have a meal and share with one another. We wanted somethingthat lets us facilitate discussion between all the people, where they’re all learning from one another and they see that they’re not by themselves. They end up teaching each other, and we just provide some friendly expertise along the way.”

At the start of each class, Miguel and Natasha ask the participants if there are any topics they would like to discuss, compiling a list of subjects to touch upon as the class progresses. The students then use a road map, which looks like a giant board game, for the remainder of the class. The road map provides several games like ‘Fact or Myth’ as well as a variety of discussion topics allowing the participants to engage in healthy conversation regarding nutrition, insulin, medication, types of diabetes as well as their daily successes and struggles as they work their way through the map. 

“The reason why this is in a real colorful format is to give people some talking points,” Miguel explains. “We’re talking about living your life better and we treat it like a road map. That’s why it has the road and multiple stops where we talk about certain topics, later on when we get into nutrition, we’ll talk about places where you can eat, getting fast food and where to find more nutritious foods. We talk about things that happen in real life and the decision process of how to keep ourselves safe. We’re trying to get good information out to people so they’re more empowered and they can make better decisions about how they’re going to live their lives.”

The Finding Your Way with Diabetes class provides an opportunity for local diabetics and their families to find a sense of community. The first class was an intimate gathering where three individuals became acquainted and shared their personal journey. Community member Jim Dunham and Tulalip tribal member Marvin Jones, who both have type 2 diabetes, welcomed newcomer Daniel Charlie to the group. Daniel shared his history, explaining how he was diagnosed with type 1 diabetes a few short years ago. He nearly lost his life due to a rough bout of pancreatitis that put him into a hospital for ten months, in which he was in a coma for over four of those months. Jim and Marvin were both flabbergasted as he described his story. They commended him for fighting for his life and also encouraged him to keep pushing forward, advising him to take it one day at time while also extending their support as he continues living with diabetes. By the end of the class Daniel was embraced with hugs and personal discussion from both the participants and the instructors.

“That’s what it’s all about,” Miguel states. “To provide something that’s more like a self-help group than just telling them information and giving them papers, saying here read this. We want to let people know that they’re welcome, that they have something to share. This is not something that anybody needs to feel bad about, ashamed or guilty about. It’s something that happens and there are certain ways we need to act or skills we need to develop to take care of it. I hope people will read this article and want to be a part of this or if they know someone with diabetes and want to learn more about it, to get their family member here so we can help them have a better life.”

Finding Your Way with Diabetes is hosted at the Karen I. Fryberg Health Clinic every Thursday in March from 4:30 p.m. until 6:00 p.m. The Diabetes Care and Prevention program has an eventful year planned for the community, including several garden days at the clinic and cooking classes with Britt Reed, as well as a new class, Seven Skills to Live with Diabetes, where they will go into further detail about diabetes management. 

If you or a loved one is living with diabetes, Miguel and Natasha encourage you to drop by the Diabetes Care and Prevention program at the clinic so they can answer any questions, provide you with resources and set you up with a personalized plan to help manage your diabetes. For further information, please contact the Diabetes program at (360) 716-5642.

On the T.R.A.I.L. to diabetes prevention



by Micheal Rios, Tulalip News 

On the evening of Thursday, April 14, Tulalip Boys & Girls Club held an open registration for its very own T.R.A.I.L. healthy choices program. Its mission? To teach children the necessary steps to prevent diabetes and pre-diabetes.

“We are super excited to offer the community a very special hands-on practical prevention program for the kids at the Boys & Girls Club,” stated Veronica “Roni” Leahy, Tulalip Diabetes Care and Prevention Program Coordinator. “This is the first time a large scale collaboration between health clinic staff and the Trails Program staff has occurred. Together, we are offering diabetes prevention education delivered in a cooking class format with nutrition education geared towards kids!”

From 1990 to 2009 the incidence of type 2 diabetes in Native American/Alaska Native youth increased by 110%, according to the Indian Health Service (IHS). Type 2 diabetes has been reported in Native American youth as young as four years of age, and IHS also reports that mortality rates for diabetes are 1.6 times higher for Native Americans compared to the U.S. general population.*




In 2003, the National Congress of American Indians (NCAI), IHS, Boys & Girls Clubs of America (BGCA), and Nike, Inc., initiated a prevention program aimed at reducing the onset of type 2 diabetes among Native youth. The program – On the T.R.A.I.L. (Together Raising Awareness for Indian Life) to Diabetes Prevention – is an innovative combination of physical, educational, and nutritional activities.

T.R.A.I.L. is a 12 chapter program that provides youth with a comprehensive understanding of healthy lifestyles in order to prevent type 2 diabetes. The program is presented with four themes: About Me, My Health, & Being Part of a Team; Healthy Eating; Making Smart Food Choices and My Healthy Community.

Woven throughout the program are self-esteem and prevention activities utilized by BGCA, including contributions from national evidence-based programs such as SMART Moves. Club members draw from Native traditions and history to learn about nutrition, food choices, media influences and the impact of type 2 diabetes.




The program also emphasizes the importance of teamwork and community service. Participants apply decision-making and goal setting skills in the physical activity challenges, and engage in service projects to improve healthy lifestyles in their communities. Community and family members participate in activities with the elementary-aged club members. These motivate members to achieve their goals and promote physical activity. The club sites are implementing the SPARK Physical Education and Nike Let Me Play programs to foster club-wide participation in fun physical activities and games for 60 minutes every day.

T.R.A.I.L. is currently funded at 55 participating club sites located in 18 states. Each of the Native Boys & Girls Club sites received the following to implement the T.R.A.I.L. program:

  • A grant to fund program operations, including a part-time staff person and program training for one year.
  • Evaluated program curriculum, training, and on-going technical assistance.
  •  Access to the SPARK Afterschool Physical Activity Program.

Each club member who registered to participate in the T.R.A.I.L. program received a box of fresh food from Klesick Farms and Haggen Grocery store, and their choice of an apple tree or blueberry bush. These boxes were valued at approximately $50.00 per box.

“The kids will learn how to grow, harvest and preserve fruit, berries & vegetables and we will use them in the meals we prepare together. Plus, they will personalize and develop their own cookbooks with the recipes,” added Roni. “Our collaborative prevention team looks forward to working with your kids and sharing our knowledge and skills with them.”

The T.R.A.I.L. program will hold sessions Wednesdays and Thursdays from 5:00 p.m. – 6:00 p.m. and Fridays from 3:00 p.m. – 4:00 p.m. in the Boys & Girls Club community room.







Contact Micheal Rios, 

Healthy Hearts, Healthy Minds

By Micheal Rios, Tulalip News 

Amongst Native peoples, few things in life are as scary as diabetes. And then, after being clinically diagnosed with diabetes, a person must take many steps to resume a normal life, and in most cases, a more healthy lifestyle. What can be just as surprising as the diabetes itself are the unexpected, nonphysical effects, which are equally threatening to one’s quality of life. Although these effects might make the road to diabetes management somewhat bumpy, experts from the Healthy Hearts team from the University of Washington’s Indigenous Wellness Research Institute are demonstrating that life with diabetes not only goes on, but can get better.

The Healthy Hearts team has been working to understand and address cardiovascular disease in the Tulalip community since 2008. The first study, Healthy Hearts Across Generations, collected surveys from 284 randomly selected participants from the Tulalip tribal membership to examine cardiovascular disease risks and look at what coping strategies were most productive. From 2010 to 2012, Healthy Hearts Across Generations also provided 135 community parents and guardians with culturally influenced classes to promote health in their families.

In 2012, planning began for the second Healthy Hearts study called Healthy Hearts, Healthy Minds. This was launched in 2013 for Natives in the Tulalip area whose diabetes/prediabetes put them at greater risk for heart disease. Healthy Hearts, Healthy Minds provided those who were eligible and wanted to participate with one-on-one wellness counseling to take control of their diabetes self-care. This study came to a close in late February.

Local community resources and input from tribal members were used to develop study materials and programs, which were culturally-adapted and designed to promote sticking with positive, healthy behaviors even when it can be tough in the face of busy schedules and other challenges.

Just as exercise strengthens the mind as well as the body, awareness and education play an important role in nonphysical healing. Optimal diabetes management is more likely when people understand the nature and persistence of diabetes, and the fact that it is treatable. It’s more than just sharing facts; people also must be taught how to return to healthier lifestyles and avoid the habits that likely contributed to their health issues in the first place. This is yet another way in which wellness counselors are beneficial, providing an evidence-based intervention strategy to help participants succeed with diabetes management.

“Our focus was the wellness mental state. With diabetes, one of the challenges is that you are asked to do so many things to take care of it yourself. You have to change how you eat, you have to exercise, and check your blood sugar, you have to take your medicine, and don’t forget about getting your eyes and feet checked. It becomes very overwhelming for people,” says Rachelle McCarty, Project Manager of Healthy Hearts, Healthy Minds. “If you are really stressed out, then it’s hard to take care of yourself. That’s where our program aimed to help out. We provided participants with one-on-one coaching and very useful tools and information, so they could minimize their stress level to better manage their diabetes.”

Participants were asked to meet with a wellness coach for 10 sessions over a three-month period. Throughout the sessions, participants worked with their wellness coach to identify individual goals they wished to focus on regarding their pre-diabetes or diabetes and stress. They also worked with their coach to complete the Healthy Hearts, Healthy Minds curriculums, which covered a range of topics and skills like problem-solving, adherence, motivation and relaxation training.

Wellness coach Michelle Tiedeman, who has been with Healthy Hearts since 2009, says “What I enjoyed the most was working one-on-one with individuals and seeing them make one small, positive change at a time that added up to better overall wellness. It has been an honor to work with the Tulalip community the past several years. I have had the pleasure to work with some amazing individuals and see them accomplish great things.”

Healthy Hearts sponsored an informational lunch to share results from Healthy Hearts Across Generations in August 2014, and hosted a community celebration on February 2, 2016 to honor Tulalip’s commitment to health and share results from Healthy Hearts, Healthy Minds. You may have also seen them giving out results flyers and booklets at public events, health fairs, and the semi-annual General Council meeting last year.


Here is a sample of some of the findings:

  • 42% of tribal members who responded to the health survey said they do participate in traditional activities like culture night, canoe journey, salmon ceremony, talking circles, and others.
  • 40% of tribal members who responded to the health survey reported that they had high blood pressure, 50% of the men and 32% of the women.
  • 27% of parents reported that they often use their own behavior as an example to encourage their child(ren) to be physically active.
  • 77% shared that they have one or more blood (biological) relatives with diabetes.
  • Those who enrolled in Healthy Hearts, Healthy Minds significantly lowered their depressive symptoms.
  • Healthy Heart, Healthy Minds participants rated themselves significantly better at sticking with their goals at the end of the program compared to the beginning.
  • 70% agreed with the statement, “I have a responsibility to walk in a good way for future generations.”


For help with your diabetes, contact the Diabetes Care and Preventions Program at 360-716-5642. For more information on the projects or results available to date, email the Healthy Hearts, Healthy Minds study at The projects were funded by the National Heart, Lung and Blood Institute, and the National Institute on Minority Health and Health Disparities.


Contact Micheal Rios,


Tulalip health clinic offers diabetes-cooking class

Photo/Micheal Rios

Garlic stalks were harvested from the Wellness Garden and used to create herbal garlic braids for home cooking.


by Micheal Rios, Tulalip News 

On Thursday, July 16, from 10:00 a.m. to 3:00 p.m. the staff of the Tulalip’s Diabetes Care and Prevention Program hosted a diabetes cooking class. The purpose of this class was to learn and talk about the health benefits associated with garlic, onions and sugar free, wild berry jams. To make the class an enjoyable, hands-on learning experience, the participants did some gardening in order to create practical applications for the harvested foods with the assistance of the Wisdom Warriors and some community youngsters.

“Our garlic and onion crops were substantial this year, so we decided to offer a class structured around the harvest,” describes Veronica “Roni” Leahy, Diabetes Program Coordinator, of the bountiful produce found in the Wellness Garden, located behind the Tulalip health clinic. “Garlic is low in calories and very rich in vitamin C, vitamin B6 and manganese. For this reason, garlic is known to boost the function of the immune system and reduce the severity of common illnesses, like the flu and common cold. Other health benefits include relieving arthritic pain and assisting in lowering blood sugar levels for people with diabetes.”



Garlic is a wonderful seasoning to add aroma, taste and added nutrition to your dishes. To make use of its multi-purpose value, class participants were shown how to harvest the garlic, along with other herbs, from the Wellness Garden and then used them to make garlic braids. Braiding the garlic with herbs allows the garlic sufficient time to dry and be readily used at home in a variety of meals.

Around midday, the class took a timeout in order to relish on a healthy lunch of pita bread sandwiches, some smoked salmon compliments of Marvin Jones, and a bounty of fruits and vegetables while enjoying the 80-degree weather and sunshine.

Following the lunch break, the class participated in making sugar free, wild berry jam mixed with chia seeds. Many people are familiar with local berries, but not so familiar with chia seeds. The combination of protein, fiber, and the gelling action of chia seeds when mixed with liquids all contribute to their easy to use benefits.




“Chia seeds, like flaxseeds, are very high in omega 3 fatty acids, and they contain no gluten or grains for those who are on a gluten free diet,” explains Leahy. “Because of their high fiber content, chia seeds have the added health benefits of helping to reduce inflammation, enhancing cognitive performance, and lowering high cholesterol. Also, adding chia seeds to smoothies or yogurt can give people the feeling of being full and satisfied, which helps lower food cravings between meals.”

The joys of gardening can reap great benefits, from tasty, healthy vegetables to just enjoying the outdoors. Pride in cooking with food you helped to grow and harvest counts also. Combine these benefits with proper nutritional education and you have an enjoyable experience that can last a lifetime. For those who missed on this session, there will be future gardening and cooking classes offered. Keep a look out in future articles or ‘like’ our Tulalip News facebook page to stay in the loop.




All photos by Micheal Rios

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Why Obesity and Heart Disease Hit Harder in Indian Country

Woman from the Confederated Tribes of Warm Springs prepares salmon. (Photo: Alyssa Macy)
Woman from the Confederated Tribes of Warm Springs prepares salmon. (Photo: Alyssa Macy)

And how to fix it.

By Francie Diep, Pacific Standard

The Navajo Nation covers 27,413 square miles. Serving that entire area, the territory has just 10 grocery stores. This means that, in order to get fresh, affordable produce, some Navajo Nation residents must drive at least 155 miles round-trip, according to one recent study.

This makes the Navajo Nation, like many other American Indian reservations, a food desert—a region in the United States where residents can’t easily buy fresh, healthy, affordable food. (Because of their setting, these food deserts are unlike those that normally show up in the news, which tend to be in urban centers.) In recent years, American public health researchers and policy experts have done a lot to document the effects of food deserts on people’s health, and to suggest solutions. Yet, in all that talk, nothing quite seemed like it would work for the people Crystal Echohawk and Janie Simms Hipp serve. “The policy levers were off,” Hipp says. “They were not a good fit because of the uniqueness of Indian Country.”

Hipp is an agriculture lawyer who directs a research institute at the University of Arkansas School of Law. Echohawk runs her own consulting firm in Colorado that advises non-profits working on American Indian issues. Together, they advocate for American Indians to gain better access to healthy food, which would in turn reduce rates of obesity, diabetes, and other diet-related ills that run rampant in the Native American population as a whole. Over 80 percent of American Indian and Alaska Native adults are overweight or obese; about half of American Indian children are at an unhealthy weight; and it’s estimated 30 percent of American Indians and Alaska Natives have pre-diabetes. Compare those statistics to American adults in general, two-thirds of whom are overweight or obese, and 27 percent of whom are estimated to have pre-diabetes.

“Oftentimes, when conversations are had with policymakers or philanthropy or public health, people just turn away and say, ‘We don’t know where to start. The problems are too big for us to solve.’ But there’s no shortage of opportunity for real change.”

Conventional fixes probably won’t work. But Echohawk and Hipp have ideas for what will. Together with lawyer-activist Wilson Pipestem, they put together a report for the American Heart Association about how to address the unique burden of diet-related disease that the U.S.’s indigenous people carry. “I think, oftentimes, when conversations are had with policymakers or philanthropy or public health, people just turn away and say, ‘We don’t know where to start. The problems are too big for us to solve,'” Echohawk says. “But there’s no shortage of opportunity for real change.”

Pacific Standard recently talked over the phone with Echohawk and Hipp about what makes it hard to stay healthy while living on reservations and trust lands—what’s collectively called Indian Country—and how a local food movement and cultural programs can make it easier:

What are some examples of policy ideas for reducing obesity that weren’t good fits for Indian Country?

Janie Hipp: I’d served for six years or so with the Bush and Obama administrations at the U.S. Department of Agriculture. I was always struck when policy, at the national level, was really bearing down on food deserts. They talked about encouraging retail food outlets to carry more healthy food products or fresher produce. That’s great, but if you have no retail food outlet, then you’re actually talking about a whole different policy arena that you need to wrap your head around.

Crystal Echohawk: There’s just the assumption that people already had outlets, that they were in urban centers. There’s also the lack of understanding of tribes as sovereign nations and their ability to institute a level of policy change over their tribal citizens. Now, a lot of the policy change that is being advocated is at the state level. But when we really look at the biggest levers of change in Indian Country, we look at the level of tribal government and we also look at federal because of the government-to-government relationship that tribes have with the federal government.

I saw that the Navajo Nation this year instituted a tax on junk food. It also made fresh fruits and vegetables tax-free. I can’t imagine a state doing that. New York City tried to institute a sugary-drinks tax and it failed.

CE: There’s immense opportunity for real change in Indian Country. What Navajo Nation did, I think, is just one example. There are just so many more opportunities aside from a tax.

What’s one of your favorite ideas for improving healthy food access in Indian Country?

JH: The vast majority of the foods that are raised for human consumption on our reservations leave the borders of the reservation. If the levers are pulled in such a way that feeding people healthy, local food comes first, before you feed folks outside of those reservation boundaries—you can do both—then we are within reach of having a major shift in our health. And oh, by the way, [by selling locally grown food locally] we also can build strong rural and remote economies.

Why does all the food leave?

JH: What is lacking in all rural communities—it’s not just Indian Country, but the lack is more profound—is the infrastructure necessary to do the harvesting, grading, packing, storage, freezing, all of those things that allow you to store and move food around more locally. Re-building those infrastructure pieces, or building them outright, is an important piece that can’t be ignored.

What’s wrong with growing food on tribal land and having that shipped out, and then having something else shipped in, instead?

JH: Being able to retain as much healthy local food around our communities as possible is going to lead to fresher produce being available to us. On the meat side, that’s been a phenomenon for years, where livestock is raised on our reservations, but they leave the reservation boundaries and, in many cases, never return. Or they make a circuitous route across the U.S. before they get back. Think about the cost associated with that. All you have to do is go into a grocery store close by any of our remote reservations and you will noticeably see the cost of food is much higher, and that’s not even talking about Alaska.

Why do you think American Indians have higher rates of obesity and diabetes than Americans in general?

CE: Poverty is a root cause. It’s a lot cheaper to go to McDonald’s and order stuff off the Dollar Menu than it is to go in and buy fruits and vegetables in a store when you’re looking at many families that are surviving on one paycheck and feeding a dozen people.

Another important component is how we’re addressing historical trauma within Native American people. There’s been increasing research out there linking trauma to health disparities. When you look at the history regarding Native Americans, of forced removal, of genocide, the boarding schools, it’s layer upon layer of trauma that Native American people, over generations, have sustained

Tulalip Bay Wellness Garden and Trail, bringing practical application to diabetes program




by Micheal Rios, Tulalip News 

When it comes to diabetes, Native Americans are clearly at greater risk compared to non-Natives. The incidence and prevalence of diabetes within the Native community have increased dramatically as traditional lifestyles have been abandoned in favor of westernization, with accompanying increases in body weight and diminished physical activity. Consider these sobering statistics from the U.S. Department of Health and Human Services’ Indian Health Service:

2.2 times higher – likelihood of Native Americans to have diabetes compared to non-Hispanic whites.

68% – percent increase in diabetes from 1994 to 2004 in Native American youth aged 15-19 years.

95% – percent of Native Americans with diabetes who have type 2 diabetes.

30% – estimated percent of Native Americans who have pre-diabetes.*

The extent of diabetes in Native communities today demands public health programs that incorporate specific cultural adaptations for individual tribes. Enter the Tulalip Health Clinic’s Diabetes Program and its ‘grow your own fruits, vegetables & edible flowers’ campaign.

In the spring of 2013, Veronica “Roni” Leahy, Diabetes Program Coordinator, embarked on a mission to bring practical application of diabetes prevention into the everyday lives of Tulalip tribal members by creating a Tulalip Bay wellness garden and trail.


Tribal employees volunteer their time to plant apple Rios
Tribal employees volunteer their time to plant apple trees.
photo/Micheal Rios


“Our goal for this garden is diabetes prevention,” explains Leahy. “One of the ways you fight diabetes is good nutrition and exercise. We have a vegetable garden which supports good nutrition and a wellness trail for our exercise. It’s practical application. We offer natural foods you can grow. We have berries, like gooseberries, huckleberries and raspberries. We have fruits, like Oregon grape, apples and pears. Plus, we are growing edible flowers as well.

“Our plan here is to have as much community involvement as possible in creating this space. We have elders who have been a huge part of this project from the very beginning. We’ll continue to focus on the elders and community as we further develop this area. That’s why we call it ‘grow your own fruits and vegetables.’”

Volunteer elders work hard almost every day in creating new additions to the health clinic gardens. Tulalip elder Sandy Swanson is one of those dedicated volunteers.

“I’m out here every day because I enjoy gardening. I worked with Roni on this project since it first started at Hibulb Cultural Center,” says Swanson. “I worked there in the greenhouse and garden beds for two or three years. So when we started down here, I thought this would be good because it’s closer to my home and work at the Health Clinic. I was a nurse for 50 years and just retired last year. I’m 75 now so I putter around here and water and plant and help keep this area clean. I come down and help plant the peas and apple trees.


New garden boxes have been established for the various fruits and vegetables. Photo/Micheal Rios
New garden boxes have been established for the various fruits and vegetables.
Photo/Micheal Rios


“This garden is for the people so anyone can come help out and be a part of this. People come and work with us on these gardens, we’d like to have more people, but many work so we understand. The main theme is to be able to teach about healthy home-grown fruits and vegetables where they are safe to eat, store stuff is so processed and shined up with chemicals. You have to wash all your fruits and vegetables from the stores these days.”The Tulalip Health Clinic’s Diabetes Program is determined to teach the tribal membership how to live a healthy lifestyle that minimizes the risk of diabetes and welcomes any and all community volunteers to become a part of the wellness garden. The next ‘grow your own fruits and vegetables’ event with be on Friday, May 29 from 9:00a.m. – 3:00p.m. at the Tulalip Bay wellness garden and trail, located on the west side ofthe Tulalip Health Clinic.


View of the Wellness Trail as it leads to the garden. photo/Micheal Rios
View of the Wellness Trail as it leads to the garden.
photo/Micheal Rios


For more information about the Diabetes Program, the wellness garden, or opportunities for volunteerism please contact Roni Leahy at or 360-716-5642.




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Telehealth Project Aims To Improve Health Care Access for Inland Empire Tribes

By Lauren McSherry, California Healthline

A health care system serving nine American Indian tribes in the Inland Empire is using telehealth to reach patients in remote areas and address rising rates of diabetes, a particular problem among American Indians.

Riverside-San Bernardino County Indian Health serves nine tribes in the expansive Inland Empire region of Southern California. The region encompasses nearly 30,000 square miles, an area the size of Vermont and New Hampshire combined. Patients who live in rural parts of Riverside and San Bernardino counties must travel long distances for health care. Those who live near the Colorado River and in cities such as Needles and Blythe, which lie along the Arizona border, sometimes must travel several hours for specialty care.

“If you think about that vast expanse with an urban corner, it makes all the sense in the world to have all forms of telehealth,” said Mario Gutierrez, executive director of the Center for Connected Health Policy. “Telehealth has always been thought of as a rural tool.”

Indian Health is the largest tribally owned health care system in the state and one of the largest in the West, aside from the Navajo Nation and some tribally owned systems in the Northwest, said Bill Thomsen, chief operations officer. There are more than 50 health systems serving Indians in California, he said.

The health system exclusively serves Indians belonging to nine tribes in the Inland Empire and their eligible dependents. The health care system has seven health centers and 14,000 patients, Thomsen said.

In recent months, Indian Health has rolled out a telehealth project, which is initially focusing on endocrinology to combat high rates of diabetes among tribe members. In San Bernardino County, for example, 13% of American Indian adults suffer from diabetes, and nearly 80% are overweight or obese, according to Healthy San Bernardino County.

“Native Americans are the largest diabetic population in the world,” said Karen Davis, Riverside-San Bernardino County Indian Health’s clinical services director.

Overall, Indians face a scarcity of health care resources and unusually high rates of asthma, diabetes and heart disease. American Indians are 177% more likely to die from diabetes, according to Native American Aid.

Pulmonology, cardiology, gerontology and dermatology will be addressed in the project’s subsequent phases.

The project focuses on specialty care because 45% of the Indian health system’s patients don’t have health insurance, restricting their access to certain medical services, Davis said.

“The value that we have seen is increased access to care, which ultimately affects outcomes,” she said.

Gutierrez said that because of the region’s shortage of specialists, the endocrinology project can have a big impact because it is crucial to diagnose diabetes early and control it, he said.

“The earlier you intervene, the more likely you are to avoid debilitating effects — loss of limbs, eyesight, all those complications that can be prevented,” he said.

‘A Model for the Rest of the State’

Steven Viramontes, clinical applications and telemedicine coordinator for California through the federal Indian Health Service, said implementing telemedicine in rural areas is a “no brainer.” It addresses cultural considerations in providing medical care to American Indians and improves access for patients who would otherwise not be able to receive certain specialized medical and psychiatric services.

“They are taking this on in a stepwise fashion,” he said of the health system’s telehealth project. “And I think that can serve as a model for the rest of the state.”

Davis said cultural awareness is a particularly important component of the project. Patients prefer receiving care through the Indian Health system, rather than seeking specialized care outside of the system, she said. She added that building trust with patients is important.

“We want people who can interact with the patient in an appropriate and sensitive way,” she said.

Diabetes treatment must address cultural influences, such as diet and lifestyle, and providing treatment through a tribal health system ensures much better compliance and understanding among patients, Gutierrez said.

“It’s not just diagnostics,” he said. “It’s education.”

Coordination of Care

Davis said one of the reasons she has become such a proponent of telehealth has to do with improved efficiencies and savings through better coordinated care.

The health system is expanding its pilot project to include more clinics and specialists. The initial project linked three clinics with an endocrinologist who works for a separate Indian health system in Santa Barbara. Through the project, a primary care doctor or nurse and a patient can video conference with a specialist.

Primary care doctors can learn from the specialists by observing how they interact with certain health issues, and when they encounter a similar case, they can handle it more effectively, she said. The health system has found that costs drop because continuity of care is improved and duplication of services and tests is avoided, she said.

In addition to remote locations in the region, another challenge for the health system has been the Inland Empire’s shortage of primary care doctors and specialists, Davis said. Telehealth helps the health system circumvent that problem.

Gutierrez said this type of coordination of care is in step with the medical home model of care. Medical records can be kept in one place, and the primary care provider retains a full record of coordination with the specialist, he said.

Support Growing

While the implementation of telehealth has lagged for financial, regulatory and technological reasons, support for telehealth has been gaining momentum in recent months. Congressional backing for financial provisions for telehealth appears to be growing. In April, a number of senators expressed support for expanding telehealth. Also, an unprecedented number of telemedicine bills are awaiting action.

While California has not led the nation in telehealth implementation, it has remained in the middle of the pack. The American Telemedicine Association gave the state an overall “B” grade for its telehealth delivery and an “F” for its Medicaid coverage of telehealth rehabilitation and home health services, according to a report released May 4.

In California, one obstacle has been access to high-speed broadband in rural areas, Gutierrez said. Another has been cost. A lot of health centers don’t have the money to invest in technology and training, he said. However, he expects that health care reform will drive the adoption of telehealth as health systems move away from the fee-for-service model.

Viramontes sees telehealth as the future. He believes it can benefit Indian health systems across the state. Not only is telehealth a useful tool in rural areas, but it also brings people together to share skills and knowledge, he said.

“We see an opportunity here,” Viramontes said. “This is where we are headed.”

Taking charge of our health

Rocky Renecker has his blood-pressure readings explained. Photo/Micheal Rios
Someone has a little fear of needles. Luis
Hernandez has his blood drawn for the A1C diabetes screening. Photo/Micheal Rios


by Micheal Rios, Tulalip News

Despite growing awareness, men usually take a back seat approach to maintaining their health. We will shy away from seeking advice, delaying possible treatment and/or waiting until symptoms become so bad we have no other option but to seek medical attention. To make matters worse, we refuse to participate in the simple and harmless pursuit of undergoing annual screenings.

Enter the Annual Men’s Health Fair held at the Tulalip Health Clinic on December 12. This year’s health fair provided us men the opportunity to become more aware of our own health. With various health screenings being offered for the low, low price of FREE we were able to get in the driver’s seat and take charge of our own health. Cholesterol screening, prostate screening, diabetes screening, and dental screening were among the options for men to participate in. Along with all the preventative health benefits of participating in these screenings, as if that was not reason enough, they gave out prizes and a complimentary lunch to every man who showed up.

At 16.1 percent, American Indians have the highest age-adjusted prevalence of diabetes among all U.S. racial and ethnic groups. Also, American Indians are 2.2 times more likelyto have diabetes compared with non-Hispanic whites (per Clearly we are at a greater risk when it comes to diabetes, making it all the more crucial to have glucose testing and diabetes screenings performed on an annual basis. For those men who attended the health fair, they were able to quickly have their glucose (blood sugar) tested with just a prick of the finger.


Rocky Renecker has his blood-pressure readings explained. Photo/Micheal Rios
Rocky Renecker has his blood-pressure readings
explained. Photo/Micheal Rios


“The blood glucose test is a random check. Random is good, but doesn’t give you all the information which is why we do the A1C testing. It’s just nice to know if you are walking around with high blood sugar. This is a good way of saying ‘Hey, you need to go see your doctor.’ It’s not a definitive diagnosis,” said Nurse Anneliese Means of the blood sugar test.

Taking diabetes awareness one step further, an A1C test was available, by way of a blood draw that would also be used to test for high cholesterol.

“A1C is a diabetes screen. A1C is more of a long term indicator of glucose control as opposed to a regular blood glucose screening, which is here and now.  A1C tells you what your blood glucose has been doing for the past 3 to 4 months,” states lab technician Brenda Norton.

How often should we have a diabetes screening performed? “Everyone should be checked once a year,” Norton said.

According to the Centers for Disease Control and Prevention (CDC), heart disease is the first and stroke the sixth leading cause of death among American Indians. High blood pressure is a precursor to possible heart disease and stroke. High blood pressure is also very easily detected by having routine checks of your blood pressure taken periodically.

Nurse Tiffany Lee-Meditz states, “Measuring your blood pressure basically gives us a non-invasive look at your heart health. It can tell us if your heart is too large, if its beating too fast, if its pumping enough blood for the flow to get to all of your tissue and organs, and it can tell us if we need to look further. It can also tell us the health of your vasculature or your vessels, and if we need to look further into that.”

Along with the various health screenings being offered there were information booths available that ranged from alternative health care options in the local area, ways to have cleaner air in your home, and methods to change eating habits as to live a heathier life. There was a booth where we could have our grip tested, a method used for assessing joint and muscle fatigue. Another booth offered us the opportunity to have our BMI (body mass index) and body fat percentage measured. Wondering if you need to cut back on those weekend treats? Or if you need to start leading a more active lifestyle? Well if that BMI was too high and you didn’t like what your body fat percentage was, now you know the answer.

Face it, as we get older, we all need to become more aware of the inevitable health concerns that may one day affect us. The possibility of having to deal with high cholesterol, high blood pressure, diabetes, or the possibility of prostate cancer looms over us all. The only way to avoid such health concerns to heighten our awareness of these preventable conditions. Health educators empower us to be more proactive about our health by getting annual screenings, detecting issues early, as well as seeking medical treatment before a simple, treatable issue becomes life altering.


 Tribal member Mike Murphy having an oral cancer screening performed.Photo/Micheal Rios
Tribal member Mike Murphy having an oral cancer screening performed.
Photo/Micheal Rios


To all of the men who attended the Men’s Health Fair, Jennie Fryberg, front desk supervisor for the Tulalip Health clinic, issued the following statement, “Again thanks for all the men that came out today. Thanks for taking care of your health, and thanks for the staff that helped me today and made today a huge success for our men. Thanks again.”

Tulalip Health Watch’s “Diabetes” examines the disease and preventions

By Mike Sarich, Tulalip News



According to the U.S. Department of Health and Human Services and Indian Health Service, Native Americans are at a 2.2 times higher risk for diabetes than their non-Indian counterparts. Between 1994 and 2004 there was a 68 percent increase in diabetes diagnosis in American Indian and Alaska Native youth, aged 15-19 years old.

Tulalip Health Watch’s “Diabetes” examines what diabetes is, how it is diagnosed, and what your part is in preventing this disease, which has taken Indian country with epidemic proportions. Medical professionals from Tulalip Karen I. Fryberg Health Clinic provide information on testing, treatment, and prevention. Also, a tribal elder defines how diabetes has affected his life, and how he is proactive in the treatment of the disease.

Starting Monday, August 11th on Tulalip TV Channel 99, and streaming on


Research program helps diabetics lower stress levels

By Brandi N. Montreuil, Tulalip News

HHHM teamTULALIP- Healthy Hearts, Healthy Minds is a research program focusing on Native American cardiovascular disease (CVD) and diabetes patients residing on the Tulalip Reservation, or within 20 miles of the reservation. Their goal is to lower stress levels in patients resulting from CVD and diabetes management.

The program is taught through weekly sessions over a 3-month period, and is individually focused.  Participants are required to have a medical diagnosis of CVD, diabetes, or pre-diabetes. Culturally sensitive curriculum features coping skills and self-care techniques based on diagnosis requirements.

“Research found that Natives have this problem with CVD and diabetes. They are at a really high risk for getting these disorders. The idea is to try to find out what it is that is making them more at risk and to find an intervention,” said June LaMarr, program’s community principle investigator.

While the program does not treat diabetes patients as the Tulalip Diabetes Program offered at the Tulalip Karen I. Fryberg Health Clinic does, the project coordinator Michelle Tiedeman explains collaboration between the two programs ensures all healthcare concerns are addressed in patients.

“Their program focuses on the diabetes portion, we are addressing those symptoms of stress resulting from diabetes self-care management. The idea is we are hoping to lower those levels in order to increase those diabetes self-care behaviors that are needed to maintain glucose levels,” said Tiedeman.

In each session participants can expect help identifying stress triggers and develop tools to reach goals relating to diabetes care. Participants are requested to complete a base-line assessment, which includes a fasting blood draw, brief physical assessment, and a survey questionnaire, before starting their first session.

There is no cost to participate in the program, but participants are provided a small incentive for participating and can earn up to $190 in gift cards and checks.

“We are looking for people who are experiencing some type of stress in managing those diabetes self-care behaviors. We are trying to help them learn ways to feel less overwhelmed by everything they are asked to do, and help them basically fall into a healthy routine with their diabetes,” said Tiedeman. “We don’t want people to think they can’t participate in both diabetes programs, we want ours to be viewed as an additional service. Because it is a research project, we are hoping that the program is found effective, so we can look to the future and maybe offer something more sustainable in the community.”

Healthy Hearts, Healthy Minds is funded by the National Institutes of Health and National Institute on Minority Health and Health Disparities. For more information in participating in the program or the program itself, please contact 360-716-4896 or email


Brandi N. Montreuil: 360-913-5402;