Time and Trust

Blakely Brown, a researcher in UM’s Department of Health and Human Performance, has spent years visiting reservations across Montana to establish programs to combat Native American obesity and diabetes.

UM researchers work to find solutions with Native communities

By Alex Strickland

A pair of UM researchers has become a regular sight in some of the most remote communities in the United States, both in the Lower 48 and the far north. Blakely Brown, a professor in the Department of Health and Human Performance, and Desirae Ware, a program manager with the Center for Environmental Health Sciences, have spent years traveling to rural Native American communities in Montana and Alaska to pursue unique research opportunities and help foster programs to make a difference in these places.

Their research areas differ, but both ascribe to a fundamental truth of working with indigenous populations: No matter how good the data, no matter how ingenious the solution, there is no substitute for time and trust.

Some scenes from community garden projects led by Brown, who is pictured in the middle.Around (and around) Montana
to Fight Diabetes and Obesity

Brown is seriously committed to spending as much time as it takes on some of Montana’s more remote reservations. Since she started working with the Rocky Boy’s, Crow, Fort Belknap and Blackfeet Indian reservation communities in 2003, she’s totaled one vehicle and seriously damaged another while traversing Big Sky Country’s icy roads in winter.

Brown recently earned two National Institutes of Health (NIH) grants to work on western Montana’s Flathead Reservation.

“It’s a great comfort to my family that my work with tribal communities is nearer to Missoula. I’m home more often now,” she says of the closer-to-home projects with Flathead Tribal Health and Salish-Kootenai College. “But part of the success of our work is that it’s not about the tribe coming to us, it’s us going to their community, meeting people interested in partnering on the research and spending time there.”

Brown has found plenty of community interest to combat the childhood diabetes and obesity epidemics on Montana’s Indian reservations, where the academic and tribal research partnerships have explored an approach that actively involves the entire family instead of just talking to the youth.

“The tribal communities we’ve worked with over the past 10 years are very receptive to the community-based participatory approaches used in our work,” she says. “A common thread for all communities is to want your kids to have a better life than you did.”

Regardless of how much a community might want to get involved, without a researcher spending the time to learn the specifics and nuances of health disparities in that spot, their work might be all for naught. When Brown’s work helped secure grant funding to establish community gardens in north central Montana’s Rocky Boy’s Reservation, it seemed like a straightforward path to bolster the community’s supply of fresh produce. Volunteers built beds, and vegetables were planted. Then a big problem reared its head: a serious lack of water. That led to several discussions with tribal water managers, UM environmental studies faculty and others with expertise to maximize existing water resources for the gardens.

Eventually it was agreed that teaching community gardeners how to install a basic drip irrigation system was the best way to maximize what little water was available to make the project a success.

“Without the participatory process, the community isn’t able to educate outside researchers on what’s happening,” Brown says. “We try to sit down in person with elders and cultural experts to learn from them what will or won’t work. You can’t get that from a book; you have to learn from their oral history and knowledge.”

The challenges are considerable. Obesity and diabetes rates among Native Americans are two to three times the national average for non-Native populations, and many obstacles exist in rural locations that contribute to the epidemic. Poverty, unemployment and lack of access to fresh, healthy foods and timely health care, combined with simpler issues such as spotty internet access create an environment where getting ahead of the problem isn’t easy.

“We can spend our time teaching kids to read a food label,” Brown says, “but if we don’t figure out how to consistently and creatively engage more of the community, our work will fall short and have little impact.”

Brown’s work has been bolstered during the past decade thanks to strong partnerships in each community, particularly with tribal government health officials and tribal colleges like Salish-Kootenai College on the Flathead Reservation and Stone Child College on the Rocky Boy’s Reservation. The research has been funded by grants from the NIH, Indian Health Service, the Robert Wood Johnson Foundation and the U.S. Department of Agriculture.

“Grant writers from reservations are now reaching out to us for data and assistance for grants,” she says. “Some of the students we’ve met in these rural communities have worked with us on various projects. This gives them an opportunity to learn more about research and feel more comfortable coming here to finish up their education.

“It’s always a juggling act, but after 10 years we’ve built a certain amount of trust,” Brown says. “That could never happen with the ‘helicopter approach’ of researchers dropping in, collecting data and then leaving.”

Ware (top) prepares to embark on a dog sled ride at minus 20 degree Fahrenheit during a research trip to Alaska, where she trained students in a remote community to use an aerosol monitor.Making Science Fun in the Far North

Though her community-based approach to research is a far cry from the “helicoptering” Brown describes, UM researcher Desirae Ware can be forgiven for taking a “small plane” approach – it’s literally the only way in.

Ware and UM Associate Professor Tony Ward have spent a chunk of each school year in some of the most remote places anywhere in North America: Alaskan Native communities that are reachable only by small plane or seasonal ice roads. There, they’ve examined air pollution and respiratory issues in children, a project for which they were awarded a $1 million grant as part of the American Recovery and Reinvestment Act – one of just 200 projects funded from a pool of 20,000 applicants.

Rural Alaska might not seem like a candidate for having air pollution problems, instead conjuring images of pristine open space. But wood-burning stoves, dust from dirt roads, burning trash and indoor mold problems exist in many communities. These air pollution issues also may contribute to a population of children with lower-respiratory problems in numbers far above the national average.

To find out why, Ware looked directly to those affected: the young students.

“There isn’t much research on indoor air quality in these places,” Ware says. “So we were looking for a way for kids to have fun with science and do something of interest to them while getting this important data.”

Getting teachers and students to not just participate in air-quality studies, but to actually perform them, nets data while keeping the community invested in the project and, perhaps most importantly, showcases science in a way that might be hard to come by in rural Alaska. The students’ work culminates with community presentations – or a presentation for multiple communities in a central location in the case of particularly small spots – where local health or environmental officials come along to show kids where their work can lead them.

“We have had employees from an environmental health department or similar agency come along and talk to kids about, ‘This is a job right here in your community that pays well and with the right training, you could do it,” Ware says. “It showcases that science is fun, but it’s also a path they can pursue for a career.”

While rebuilding homes with mold problems or replacing wood stoves would be prohibitively expensive far out in the Alaskan tundra, Ware and Ward are looking at lower-cost options for improving indoor air quality and respiratory outcomes. For example, a study that Ward, UM’s Curtis Noonan and colleagues wrapped up last year looking at filtration options shows promise as an intermediary step. Their previous work also has led to a new five-year grant funded by the National Institute of Environmental Health Sciences to investigate how targeting wood stoves can improve indoor air quality and decrease lower-respiratory tract infections in children in these communities.

“Sometimes it takes 15 flights to get from Missoula to a couple of these communities, with weather delays and the unpredictable winter in Alaska,” Ware says. “But this community-based approach isn’t about collecting data on residents, it’s about working with local people.”

For more information email blakely.brown@mso.umt.edu or desirae.ware@mso.umt.edu.

Desirae Ware (left), a researcher with UM’s Center for Environmental Health Sciences, and community coordinator Susie Walter visit households to complete air quality and respiratory health surveys.

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