Barbara Finkbonner worries about the health of her people on the Lummi Indian Reservation. Every year, it seems they grow heavier and the children less active. In her homeland in northwestern Washington, she wants to help her people combat the growing obesity problems and the stark lack of mental health services, which are common throughout Indian country. And she’s worried about the long-standing issues like alcohol abuse and diabetes.

Finkbonner started work at the Lummi Tribal Health Center in 1976 while a high school student, tending to medical records. Dr. Bill Freeman, a doctor there, said she was destined for greater things and nudged her toward a medical training program at the University of Washington, which she entered in 1981. Today she directs the Lummi health center and consequently is the reservation health leader.

“He was the one who mentored me,” Finkbonner said. “I don’t believe I’d be where I am without him.” Now more than 20 years later, Finkbonner finds herself again in the company of her mentor. With her guidance, Freeman could be on a path of helping many Northwest tribes prevent diabetes through two recently awarded grants.

After 12 years as director of the Indian Health Service (IHS) Research Program, Freeman retired in January 2002 and returned to the Northwest with his wife, Carolyn Robbins. They both love the Northwest, and the move put his wife, an Aleut, closer to Alaska. When he visited Northwest Indian College (NWIC) near Bellingham, WA, to see if there was room for him, the administrators hired him.

Freeman assumed he would be teaching as he made the transition from a federal agency to a tribal college. He wanted to reassure his new co-workers that he was no federal big shot. “I was concerned about coming on too strong,” Freeman admitted. Instead, the short-staffed college immediately set him to work writing grants and soon named him NWIC Director of Tribal Community Health Programs. Administrators and board members encouraged Freeman to apply for other federal grants to get the tribal college involved with improving the health of tribes throughout Washington, Oregon, and Idaho.

Freeman quickly secured two grants tied to diabetes, both focused upon curriculum development. Under a Center for Disease Control grant administered by the American Indian Higher Education Consortium (AIHEC), the college is developing a pilot college-level diabetes course, incorporating diabetes education in other courses, and conducting a summer institute for diabetes educators. Under its five-year grant from the National Institutes of Health, NWIC is working with seven other tribal colleges to develop a K-12 science curriculum built around diabetes, which will be distributed in the fifth year.

TEAMING UP. Barbara Finkbonner and her mentor, Dr. Bill Freeman, have joined forces to lift the burden of diabetes from Indian communities. Photo by Jon Brunk

“The intent is to teach kids about diabetes to reduce the epidemic,” Freeman said. “The knowledge by itself doesn’t work. People may have the knowledge but need tools and incentives to change.” NWIC has always responded to the community’s needs. Freeman said he was impressed with the concern over health issues from the instructors, board members, and administrators. He found the NWIC staff anxious to learn more and tap his federal experience. The education has been reciprocal: The community continually teaches him.

Finkbonner said Freeman consults with her frequently. “He’s sincere about raising the level of health care for Indian people,” Finkbonner said. She knows that her old mentor is more versed in research than in people. At the college, he has diverse opportunities to work with people. Unlike many administrators, Freeman is acquiring first-hand classroom experience since about a third of his time is spent teaching. While he has not had any formal training in teaching, he learns what works from the students. In the classroom, he experiences the Lummi community in a new way, not as a physician or guest at a cultural event. “It is entirely a different kind of conversation,” Freeman said. “I am not their physician seeing them in an exam room dealing with a medical problem.”

Freeman turns to the older Lummi students to help teach the class. “The elders can talk about what life was like growing up 70 years ago on the Lummi reservation before there was diabetes,” Freeman said. Living along the coast, the tribe’s traditional diet was provided mostly by the sea.

Through his learning process, Freeman has found new ways to share his knowledge, which he is testing in the classroom this fall. This will influence the curriculum the college is developing. He has learned to use weekly essay assignments to see if students understand the material and its implications for their community. For instance, he may ask students to take the role of a health clinic director and explain to the tribal chairperson how diabetes impacts the body.

Now that Freeman has made a crossover to a smaller-scale job, he has seen firsthand how under funded the tribal colleges are. “I just didn’t realize that when I was in the Indian Health Service,” Freeman said. More than ever Freeman appreciates the need for colleges chartered by tribes to respond to their own communities’ priorities.

With the National Institutes of Health grant, the opportunity to link schools and organizations will be a powerful force for positive, permanent changes, he said. “This is an opportunity for the tribal college to work closely with their communities and tribes on a major problem.”

Rob McDonald, an enrolled member of the Salish and Kootenai, is a higher education reporter in Spokane at The Spokesman-Review. He’s been writing for daily newspapers since 1991.