Whirling Thunder Wellness Program
Winnebago Tribal Health Department
Winnebago Tribe of Nebraska (Winnebago, Nebraska)

Contact:
Alicia Reinking

Primary Prevention Coordinator
Whirling Thunder Wellness Program
Winnebago Tribal Health Department
P.O. Box 687, 100 Bluff Street
Winnebago, NE 68071
Tel: (402) 878-2535 Fax: (402) 878-2819
E-mail: upwellness@huntel.net

Established in 1979, and taken under Winnebago tribal management in 1995, the Whirling Thunder Wellness Program combats diabetes and substance abuse by raising community awareness, administering primary and secondary prevention services, and encouraging healthy lifestyles that are consistent with traditional practices. With its focus on prevention, this field-based program is changing individual and community behavior on the reservation and helping to ensure a healthy citizenry for generations to come.

Community health has long been a priority for tribal leaders at the Winnebago Tribe of Nebraska. Having suffered through epidemics of small pox and measles in the 1600s that reduced the population from about 25,000 to 150, the Winnebago have a deep historical understanding of the importance of good physical health. Even as the Winnebago lost almost of their lands to the United States in treaties signed in the 1820s and 1830s, tribal leaders insisted that health care be among the services guaranteed by the federal government for their people. Among them was Chief Whirling Thunder, a champion of community health and wellness who sponsored foot races in the early 1800s.

Despite their belief that tribal strength is directly linked to community health, the Winnebago have struggled with serious health problems over the last half-century. Like many American Indian populations, diabetes has been a destructive force among the Winnebago Reservation’s 2,600 residents. Currently, one third of Winnebago adults have Type 2 diabetes, and incidence and prevalence of diabetes are 7.7 percent and 8.8 percent higher in this population than in the US population at large. Diabetes does not just plague Winnebago adults, however: 48 percent of Winnebago youth have hyperinsulinemia, a predictor of future diabetes.

There has been a concerted effort to treat diabetes on the Winnebago Reservation for more than two decades. In 1979, the Indian Health Service (IHS) established one of its five model diabetes programs on the reservation. The Winnebago/Omaha Diabetes Project operated out of the local IHS hospital and was administered by three community health nurses who served both the Winnebago and its neighboring tribe, the Omaha. Although the Project provided much-needed data collection and improved clinical treatment for tribal citizens with diabetes, by the mid-1990s tribal leaders became attracted to the idea of the Tribe running its own diabetes program – one that would focus on diabetes prevention, be field based (rather than operated out of the IHS hospital), and incorporate community values into its services. As one tribal leader proclaimed, “The Indian Health Service is good at counting up the new cases of diabetes and the bad problems of diabetes like amputations and kidney dialysis. My question is how do we get in front of this problem, to stop it for future generations?”

Convinced that the Winnebago Tribal Health Department could self-manage an exemplary diabetes program, in 1994 the Tribe initiated the process of contracting its share of the Diabetes Project from the IHS under the Indian Self-Determination and Education Assistance Act of 1975 (P.L. 93-638). In 1995, the contract was approved and the Tribe launched the Whirling Thunder Wellness Program.

Housed within the Winnebago Tribal Health Department, the Whirling Thunder Wellness Program’s mission is to “elevate the health and wellness status of Winnebago community members.” With a twelve-person staff comprised of four health professionals and eight para-professionals in the fields of fitness, nutrition, public health, and substance abuse prevention, the Program addresses both diabetes and substance abuse – a dual focus that has been in place since 1998 following a review that found that almost half of the diabetes sufferers have a dual diagnosis of substance abuse. The Program possesses three core objectives: first, to increase and maintain community awareness and focus on the diseases of diabetes and substance abuse; second, to provide culturally appropriate primary and secondary prevention programs and services; and third, to provide programs to encourage healthy lifestyles consistent with traditional practices. These objectives, along with the services and programs that advance them, are reviewed annually by Whirling Thunder Wellness Program staff, the Winnebago Wellness Coalition (a group of health care professionals, representatives of institutional partners, and concerned community members), and the Winnebago Tribal Health Directors.

Because of the strong ties between diabetes, substance abuse, and lifestyle behaviors, the Whirling Thunder Wellness Program works closely with Winnebago youth to establish healthy lifestyle habits that will carry over into adulthood. For example, during peak “risk hours,” the Program administers a robust set of healthy options. From 3:00 to 5:00 p.m. Monday through Thursday, Program staff immerse children from kindergarten to eighth grade in exercise, athletic events, dance classes, nutrition courses, and culture and language education. Recognizing that Winnebago youth may fall into unhealthy habits during the summer months, the Program organizes a number of cultural programs – such as teaching youth how to grow and harvest Indian corn – and administers the Whirling Thunder Youth Sports Program. The Sports Program, which involves parents and other adults as coaches, includes swimming, basketball, soccer, bowling, golf, baseball, softball, boxing, martial arts, cross-country, and track and field.

In addition to these after-school and summer programs, the Whirling Thunder Wellness Program administers several other critical services for Winnebago youth. For one, the Program screens for diabetes, diabetes risk factors, and substance abuse related risk behaviors. With parental consent, the Program measures children’s height, weight, blood pressure, waist/hip ratio, body composition, blood sugar levels, and undertakes Acanthosis Nigricans grading and fitness testing. Also, since 1998 the Program has operated the Kidz Café, which provides healthy meals and snacks to community children during the summer months. Each day at the Kidz Café, children are served skim milk, fresh fruits and vegetables; three days per week, they are served a bison meat entrée (for example, bison tacos and bison lasagna); bison is a traditional food which is lower in saturated fat and cholesterol than beef. Undermining the notion that kids scoff at healthy meals, the Kidz Café is quite popular: In the summer of 2001, more than nine thousand healthy lunches were served to community children. The Kidz Café has become so popular, in fact, that over seven hundred healthy lunches were purchased by adults that same summer!

The Whirling Thunder Wellness Program offers an equally impressive range of activities and programs for Winnebago adults. It provides screening for diabetes and diabetes risk factors. It encourages its clients and the community at-large to use the state-of-the-art Whirling Thunder gym. Every six to eight weeks, the Program offers adult health promotion campaigns – such as “Reach for the Stars,” “Pow-Wow Trail to Fitness,” and “Health for the Holidays” – which motivate adults to keep on track with their personal wellness routines by offering creative and healthy group activities. To encourage the community to develop healthy eating habits, a registered dietitian makes regular cooking demonstrations and the Program operates the Healthy Choice Café, which like the Kidz Café, serves nutritious meals. The Program also works with the elderly. For example, “Seniors on the Move” provides elders with health screening, nutrition education, arts and crafts activities, as well exercise programs twice a week. Whirling Thunder Wellness Program staff also make trips to the local nursing home every six weeks.

Among the services that the Whirling Thunder Wellness Program is most proud of is “Team Up Winnebago…Defeat Diabetes,” an innovative diabetes treatment program that consists of a two-day intensive diabetes education conference held at an out-of-town hotel. “Team Up” brings together clients to listen to speakers and engage in “talking circle” discussions with peers and community health professionals about effective diabetes self-management. Forty-one diabetes patients have completed the “Team Up” program with remarkably positive results. In three, six, and twelve-month follow-up contacts, patients have lost weight, decreased their diabetes medication dosages, improved their lipid levels, developed healthier nutrition habits, exercised, and most importantly, maintained supportive contact with each other and Program staff. In a recent Washington Post article, one participant praised the “Team-Up” talking circles for offering support and a sense of hope: “The best thing the circles taught me is that we don’t have to die from diabetes. Now I know my family has a chance.”

Since assuming control of its diabetes program in 1995, the Winnebago Tribe’s Whirling Thunder Wellness Program has been extremely powerful force in motivating the community to embrace healthy behaviors and reduce diabetes risk factors. In 2001, over 1,200 Winnebago adults and youth were screened for diabetes and diabetes risk factors The Program’s after-school and summer athletic programs have attracted hundreds of hours of participation, and the Kidz Café and Healthy Choice Café have served thousands of healthy meals. These efforts are showing promising results: A recent study conducted at the University of Nebraska suggests that the Winnebago Tribe is winning its battle against diabetes by reducing risk factors such as obesity. Specifically, the study examined weight gain among participants in physical activity interventions sponsored by the Whirling Thunder Wellness Program and found that the increase in weight was dramatically less for youth who participated in the programs than those who did not. Anecdotal evidence supports these results. In 2000, organizers of a Program-sponsored foot race ran out of extra large T-shirts; in 2001, organizers of the same event couldn’t give away the extra large T-shirts. Tribal leaders, citizens, community health professionals, and Program staff are thrilled with their progress and they are committed to building upon their success.

Both Indian and non-Indian governments and health care providers can learn a great deal from the Winnebago Tribe’s Whirling Thunder Wellness Program. Four factors stand out as being especially instrumental to the Program’s success.

The first is the Program’s comprehensive, community wellness-based approach to dealing with the problems of diabetes and substance abuse – chronic diseases with significant behavior components to their etiology and treatment. Unlike many diabetes and/or substance abuse programs that concentrate solely on clinical treatment, the Whirling Thunder Wellness Program’s focus on community prevention is changing individual and community behavior, a transformation that recent research suggests is more effective in treating diabetes than prescription medications. Consistent with the idea that multidimensional problems require multidimensional interventions, the Program combines multiple medical programs with creative nutrition awareness and physical exercise programs. Further, since the Program is tribally managed, the Winnebago Tribal Health Department is able to infuse culture into its services – which makes the Program distinctly Winnebago and thereby increases the relevance of the program in the eyes of its constituents.

A second factor that bolsters the effectiveness of the Whirling Thunder Wellness Program is its use of data. Indeed, the most impressive social service programs in Indian Country and elsewhere recognize that data collection and analysis can be powerful tools. At the Whirling Thunder Wellness Program, staff collect data that can help them track progress and results for every Program activity and service. They monitor changes in diabetes risk factors and indicators for individual children and adults. They undertake community-wide assessments of substance abuse and diabetes prevalence. They track participation in Program-sponsored events so that they gain a better understanding of what kinds of activities are most likely to generate participation among specific target populations. And they keep count of how many meals they serve to identify and evaluate eating behaviors. Armed with such information, the Program and its advisory body (which meets each year for a Program review) are able not only to evaluate the Program’s success in preventing and treating diabetes and substance abuse, but also to tailor services to best meet community needs. That the Program recently created a “data/management analyst” position is a testament to its commitment to continuous quality improvement.

Just as the Program appreciates the connection between data collection and effective service delivery, so too does it recognize that quality tribal management demands highly skilled staff – the third factor that undergirds the Program’s success. Since taking over management of its diabetes services in 1995, Program staffing has grown from one physical/diabetes educator to a twelve-member, highly skilled multidisciplinary team. The Program also invests in staff development. Staff members are encouraged to obtain additional training and certification as well as higher education, and through a partnership with Little Priest College, Program staff can take courses for continuing education credit. Additionally, the Program offers training for its youth and adult participants, which has in turn strengthened Program operations and provided new employment opportunities for tribal citizens. Through an array of Program-organized certification programs, tribal citizens have become – and work as – certified lifeguards, pool managers, pool operators, community cooks, and sports coaches.

The Whirling Thunder Wellness Program’s strategic use of partnerships, both within the Tribe and with outside entities, is a final noteworthy factor in its success. The multidisciplinary and cross-generational nature of the Program’s work necessitates productive inter-agency relationships. Toward this end, the Program works closely with other tribal departments, the Winnebago Wellness Coalition, and the tribal health directors to coordinate services and ensure a consistent message of health promotion and diabetes prevention. The Program also maintains fruitful relationships with outside entities. For example, the Program is involved in strategic planning discussions at the local IHS agency, which now works with the Program to increase its outreach activities and to learn how to incorporate culture into treatment. A partnership with the University of Nebraska and the University of Arizona is enhancing the Program’s ability to evaluate it’s programmatic effectiveness. These and other partnerships – with Head Start, the Winnebago Bison Program, the SEVA Foundation, Little Priest College, among others – enable the Whirling Thunder Wellness Program to deliver and coordinate a wide range of community services.

The Whirling Thunder Wellness Program is combating one of the most pressing and pervasive problems in Indian Country. Its success in establishing a self-governed health service that has, in culturally appropriate ways, altered lifestyles and reduced diabetes risk factors offers hope to other tribes addressing this epidemic.

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