Keeping Good Hearts at Bad River

Keeping Good Hearts at Bad River

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The first part of this series can be read here. This is the second article in a series of three.

The room hums with the sound of mechanical kidneys beeping, whirring and buzzing.

Archie Shinaway is hooked up to one of the dozen hemodialysis stations at FMC Dialysis Clinic in Ashland, Wis. He is among many regulars at the clinic from the nearby Bad River Indian Reservation, home to 1,500members of the Bad River Band of Lake Superior Chippewa, along Lake Superior.

Like others sitting back in the vibrating, heated easy chair for the draining four-hour dialysis treatment, Shinaway’s kidney failure is a consequence of type 2 diabetes. Shinaway’s only hope of ending this debilitating process is a successful kidney transplant.

Working against Shinaway is that American Indians have the lowest rates of kidney transplants and donations compared to other ethnic groups, said David Baldridge, director of the National Indian Project Center in Albuquerque, N.M. The problem, Baldridge said, is that so many potential donors and recipients are just too overweight to go under the knife.

Fortunately, the Bad River Heart Watch program has helped Shinaway lose 86 pounds, enough for his physician to clear him to undergo a kidney transplant. The Shinaway family has been awaiting “the call” saying that a matching donor has been found for his operation, to be done at the University of Minnesota’s Fairview Hospital in Minneapolis.

The Bad River Heart Watch program is one of 30 Healthy Heart pilot projects funded across the United States created by the Indian Health Service’s Special Diabetes Program for Indians (SDPI). Aimingto decrease the risk of cardiovascular disease, another major diabetes complication, it has touched more than 100 hearts since it began six years ago.

Although the Healthy Heart projects won’t yield definitive results for two or three more years, previous prevention efforts have already shown promise, said Stephen Rith-Najarian, a medical consultant to the Indian Health Service (IHS). Preliminary data show that between 1999 and 2004, American Indians and Alaska Natives experienced an 18.5 percent reduction in new kidney failure cases — making them the only ethnic group to see a significant decrease in this serious condition, he said.

Unlike the new elder center, which was a big-ticket structure built in recent years, the building that houses Heart Watch is more like the rest of the buildings here: a modest, small, prefabricated structure with an old coat of peeling light-blue paint. Just through the front door is a dilapidated reception area that seldom seems staffed.

Mike Murphy, the case manager for Bad River Heart Watch, heads the four-person project team. He said that in its first six years they have kept at least eight people off dialysis, saving about $70,000 in medical expenses per person per year, and have helped many others lose weight and have better glucose control.

Bad River Heath Watch’s quarterly community event called Journey Toward Wellness is immensely popular, and hundreds of people come out for the free health screenings, feast and information.

The program also built a small fitness center in an unused office of the community center, and 150 community members have asked to use facility.

Murphy meets once a month for a year with those willing to put in the work, and then once a season after that. They discuss such things as weight, blood pressure, diet, exercise, cholesterol and smoking cessation. Also, Murphy explains care for feet, eyes and teeth, all of which can be damaged by diabetes.

“We're like a plumbing shop, if you will,” Murphy said. “We keep your pump and pipes working.”

Heat Watch meetings aren't like the impersonal visits patients often experience in other medical settings. Murphy listens to what's going on in their lives to learn about underlying issues causing participants to overeat, abandon their exercise program or start smoking again.

For patients who don't need--or want--to open up, Murphy sticks to a review of their numbers. Those who do share what’s happening to them sometimes tell Murphy harrowing stories.

During a recent appointment, he met with Mary, an elder who had stabilized her diabetes over the past 15 years and controlled it well but had recentlyexperienced a stroke. When Murphy asked about stress that might have contributed to the stroke, she described her efforts to get one of her young relatives out of a toxic home situation.

The child had been born addicted to drugs. The girl told Mary she was now being molested by a man living with the family. Unable to persuade area authorities to intervene, Mary said the situation was tearing her up inside.

Murphy said Mary’s story, while disconcerting, isn't unique. Compared with much of what comes through his office, he said, “that was light.”

By providing a safe space in which to talk and giving people healthy ways to deal with stress, Heart Watch is trying to counteract the some of the widespread social problems at Bad River, such as poverty, joblessness and alcoholism and other drug addiction — that feed into the diabetes epidemic.

This article was conceived and produced as a project for New America Media’s Ethnic Elders News Fellowship, supported by The Atlantic Philanthropies.