Tribal health center offers custom care, trust

DALLAS – The back room of the Urban Inter-Tribal Center of Texas looks more like a shoe store in the mall than a health care clinic. Orange boxes full of Nike sneakers line the wall.

But you won’t find these Nikes in stores. They are made of beige buckskin-like fabric, with shoelaces that thread through the colors of a medicine wheel. At the toe, three small triangles join to form a triangle, symbolizing the North Star.

The cost of such sneakers can top $100. But the clinic gives them to patients with diabetes for free. They’re an incentive to come to get treated, and are designed to prevent foot amputations due to diabetes, a common ailment among American Indians.

The free Nikes are a good example of how the clinic has adapted its practice of medicine to suit its clientele.

The sneakers are “an awesome deal,” says Don Shelton, 73, of Fort Worth, an avid walker who estimates he’s worn out 30 pairs of the shoes since beginning treatment at the center in 2000. Every first Friday of the month, Shelton – now “pretty much retired” and a volunteer Santa who has appeared in Petco and vacuum cleaner commercials – attends nutrition classes at the clinic.

Shelton, a member of the Citizen Potawatomi Nation, first came to the center upon learning he had diabetes, reasoning that an American Indian clinic would know how to manage the disease. He said he was right.

“They understood the history of the American Indian and how they react to diabetes,” Shelton said.

The center has modern facilities – gleaming white counters, reclining examining chairs and medical equipment everywhere – and programs specifically targeted to American Indians. It fills a significant health care need for people like Shelton. Located near Dallas’ Medical District, the center provides basic medical and dental care, as well as a pharmacy, to members of the 566 federally recognized tribes who live in Dallas. If not for the center, they would have to travel hours to the free health care at tribal facilities.

One of 34 such clinics nationally, the Urban Inter-Tribal Center is funded mostly by federal dollars through the Indian Health Service, a federal agency.

It also fills a cultural gap. American Indian heritage shines through in the little details, like the tribal artwork on the walls and the crops in the new community garden, where the “three sisters” have begun to grow – corn, beans and squash, arranged so the beans can grow up the cornstalks, which form a natural trellis.

“What we do offer that you won’t find in any other community health center is cultural sensitivity for American Indians,” said Angela Young, the administrative director of the center and a member of the Choctaw tribe. “We have, in our population, historical trauma that passed down from generation to generation, and it’s still just as real today as it was back in the 1800s for many of our family members.”

That means knowing to ask when a patient comes in whether they’re using any kind of traditional healing, such as roots and herbs or the sweat, a ritual ceremony that involves fasting, prayer and a heated lodge. Those herbs, Young said, could interfere with medications the clinic prescribes.

The center is uniquely positioned to understand how problems such as diabetes intersect with traditional American Indian life. Take fry bread – a meal of white flour fried in lard and topped with ground beef and beans – that many people grew up on.

Made of the ingredients given out by the federal government, it’s composed of foods diabetics are supposed to avoid: white flour and oils.

At the nutrition classes at the diabetic clinic, Shelton learned a recipe for a more healthful fry bread, made with better-for-you oils. “Not like your grandma’s fry bread,” he said, “but it’s good for you.”

For a group that Young describes as “meat-and-potato-type-of-eating people,” fry bread is an example of how history is a part of current health issues the center has to address. Tribes couldn’t always grow fruits and vegetables to supplement those reservation commodities – especially if they lived in the desert, Young said.

Dr. Rodney Stapp, the center’s CEO, said issues such as diabetes, heart disease, high blood pressure and high cholesterol – all health problems facing American Indians today – are deeply mired in historical injustices.

He said the reservation system pushed a hunter-gatherer society into a more sedentary farming lifestyle, introduced flour into what was previously a vegetable-based diet, and distributed substandard food. Feeling trapped on reservations, Stapp said, left many American Indians depressed, even suicidal. Mental health problems, alcoholism and smoking and tobacco use are also found at high rates among American Indians, according to the Centers for Disease Control and Prevention.

Stapp became a doctor to address such problems. A member of the Comanche tribe, Stapp, 54, said he grew up in Oklahoma mostly without electricity or telephone access. After starting his career in the corporate world, he decided to go to medical school. He began at the center as a volunteer doctor.

“Our roots are we started in the same situation: grew up eating commodity foods and depending on the tribe for things. And the tribe was depending on the government. It’s not a good way to live.”

The historical treatment of American Indians also translates into a wariness of government facilities, including hospitals, Stapp saidy. Young dubbed it “the trust factor.”

The center has about 4,000 active patients, Stapp said.