Health issues tackled with traditional relationships

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CROW AGENCY, Mont. - Alma Knows His Gun McCormick sliped in and out of
speaking the Crow language as easily as she navigated the isolated roads
that weave through Crow Agency. Both are important qualities for her role
as project coordinator for the Montana State University-based project
Messengers for Health on the reservation.

Messengers for Health is a three-year-old program that educates Crow women
about cervical cancer in a manner that is both comforting and traditional.
McCormick leads 22 Crow women trained in cancer outreach. They call on
friends and relatives to dispense the most contemporary information and
encouragement in the same way Crow women have learned about health and life
for centuries - through tribal women they trust and respect.

The Messengers are trained by Suzanne Christopher, professor at Montana
State University's Department of Health and Human Development and principal
investigator for the Messengers for Health program.

The American Cancer Society recently funded the program for another five
years with a $1.52 million grant.

While a few years ago the words "cancer" and "cervical" were verboten,
discussions on the importance of screening are now commonplace. That's
important, considering that Northern Plains Indians have a statistically
higher mortality rate from cervical cancer than their white neighbors,
according to the Indian Health Service.

"Women here are beginning to feel empowered, comfortable enough even to
schedule their own [cancer] screening appointments," McCormick said of the
influence of the Messengers, who provide information and words of
encouragement in many locations including homes, churches, the sweat lodge
and grocery stores. "They are beginning to know the importance of a Pap
test. We are overcoming barriers. Women are opening up, even admitting that
they haven't had a screening, or even asking a question about their
husband's health or about domestic abuse."

"Screenings are vital because most women who develop cervical cancer do not
have symptoms, and when it is found early [by a Pap test] survival rates
are almost 100 percent," said Christopher, who has been working quietly at
the Crow Agency for more than nine years developing a program that would
best benefit the women of the tribe.

Christopher first began her research by meeting with Crow women, including
Sara Young, a member of the Crow tribe and MSU's former director of the
American Indian Research Opportunities program. Christopher learned that
fear was a barrier to cancer screening and education on the reservation.
Even if fear could be overcome there were other hurdles, such as lack of
transportation or lack of childcare.

That didn't even begin to address the problem of lack of female health care
providers and a perceived lack of confidentiality at the IHS.

When they met, McCormick was a single mother of three working for a state
breast and cervical cancer prevention project that was in an early stage of
development. Different in appearance and approach, the two women were
bonded by passion for their work. McCormick is a tall, spiritual woman with
an infectious Crow sense of humor who became involved in cancer work after
her 1-year-old daughter died of a neuroblastoma.

Christopher, the scientist, is short, gentle and adept at listening.
Christopher asked McCormick about training some of the Crow women to serve
as lay health workers.

"She told me about this idea she had and I told her I thought it just might
work," McCormick recalled.

Christopher applied for an American Cancer Society grant three times before
she received part of an $800,000 grant from the estate of the Margaret Ann
Wise, formerly of Butte, for a project focused on cervical cancer.

"I don't see this just as a cervical cancer program," Christopher said.
"The grant is so much bigger than that. This program gives women
information on many health topics and sends the message that it's important
for women to take care of themselves so that we can be there for our
families."

When it came time to finding Messengers, Christopher and McCormick surveyed
Crow women about the sort of women they went to when they needed advice.
What were these women like? How old were they? Eventually, they considered
44 names of Crow women nominated by others as natural helpers in their
communities. She and McCormick trained the first 25 Messengers for Health
in July 2002.

In the last two years, Messengers have taken their testimonial of health to
hundreds of their neighbors' doors, churches and grocery stores. Each is
paid $60 a month and meet with Christopher and McCormick the first
Wednesday of each month to share strategies for outreach, discuss problems
they've encountered and receive further education and information.

"They have covered everything from men's health to nutrition and domestic
violence," Christopher said. "I'm getting as much as I'm giving."

McCormick said her work has grown steadily, and she sees evidence daily
that the work of the Messengers is making inroads.

Future directions for the group, as decided by a community advisory board,
will include working with the IHS on cultural competency issues.

As another sign of progress, McCormick points to the Messenger's first-ever
float in last summer's Crow Fair. McCormick said it was a golden day as the
Messengers for Health received hugs, waves and other positive recognition
from the Crow community.

"It was just something that made me feel so good at how far we've come,"
McCormick said. "We have been able to encourage women for health and for
other things. We are working for a good purpose."