WASHINGTON - The view of food is changing. Throughout America and the world, as epidemics of diabetes and other often lifestyle-based diseases chart their destructive courses, the notion grows that food can be seen as medicine. The question of whether an individual's diet is good medicine or bad medicine will help to determine susceptibility to disease.
A similar change is at work in the concept of hospital architecture. As diet comes to be regarded not as ''just food'' but as medicine, hospitals are regarded more and more as not ''just buildings,'' but as healing facilities. Gary J. Hartz, director of environmental health and engineering for the IHS, said long-standing IHS guidelines state that ''acceptable architecture'' must suit the particular function of the building, its mission, its geographical environment and the cultural birthright of the tribal citizens who will be served there.
''They see it as a place where care can be given,'' Hartz said. ''A comfortable environment can help the healing process.''
Accordingly, said IHS architect Joe Bermes, the tribe always establishes a cultural arts committee at the outset of any IHS hospital construction project, whether IHS will run it or the tribe under contract with IHS. The committee will shepherd the actual construction of a building that may dominate the local landscape in what are most often small towns.
''Aside from the actual purpose of the building ... they're the most significant building that has been built there, sometimes ever, and will be for the next 50 years.''
The cultural priorities that emerge from the committee will be integrated into the physical features of the building, including its wall and
hallway art, as well as its layout and design, Bermes said.
An obvious example, because it's a feature common to so many tribes, is that a health care facility must face east, toward the rising sun. Beyond that, one of Bermes' favorite examples is at Sisseton-Wahpeton, where the Santee Dakota association with forest and woodland led to corridors that open out into circular rest areas or ''clearings.'' Similarly, a Rosebud Sioux Tribe hospital, situated west of the woodlands in a more plains or prairie setting, has contours suited to a long horizon and sloping roof lines that almost slide into the low prairie.
''I particularly admire the Hopi facility,'' Hartz added, ''not only as you come up on it but as you go into it'' - the surrounding mesas, the subdued desert colors and the very stones of the landscape find an apt reflection in the architecture and decor.
Thomas Sweeney, IHS director of public affairs, had an entry of his own in Clinton, Okla., where the IHS health center facade mimics the coloration and strata of nearby Red Rock Canyon. The building takes its shape from the historical winter camp in the canyon of the Cheyenne and Arapaho tribes.
But the facility at Metlakatla in Alaska, envisioned by the tribe in part as a tribute to its Tsimshian culture, had rain forests, polar seas and a volcano to consider in fitting an architectural structure to its culture. It was a hard road, even between the tribal project team, the indispensable assistance of the IHS, Juneau-based architects, and a Sitka construction company that bored through 26 feet of the ubiquitous muskeg (a kind of peat moss of the far north, valued at Metlakatla for absorbing 12 feet of annual rainfall and so fending off floods) to volcanic rock that would anchor the foundation. The Metlakatla homeland - the only reservation in Alaska, according to service unit director Rachael Askren - is an island atop a volcano. The building's interior boasts slate flooring, suggestive of a volcano, while interior glass gives an idea of great waters and cedar paneling recalls the forests.
And if the narrative line of the architecture and design should ever wear thin ... well, here between land's end and the edge of the seven oceans, health is never a secondary narrative anyway. A neuropathy center is especially helpful for the island's 80 diabetics, Askren said. An IHS Special Diabetes Program grant is helping them to purchase proper eyeglasses and the ''Nike Air Native'' exercise shoe, while improved care and tracking of cases has made additional inroads against the disease.
Of the 30,000-square-foot facility on 11 acres that replaced one of less than a fourth its size, Askren said, ''It has given patients more one-on-one with their doctors in a larger environment. ... This building is beyond what I could describe in its importance, beyond a monetary value. For us, it has turned out to be our true place of healing. It contributes every day to everyone.''
For many years to come, she might have added.