Education targets Native American population
Lessons on prevention leads to lifestyle change
About five years ago, Carol Maller, MS, RN, CHES, left her job as patient education coordinator for the Veterans Administration Medical Center in Albuquerque, NM, a position she had held for 15 years. She now works in community health education as a grant coordinator for Southwestern Indian Polytechnic Institute (SIPI), where she oversees four awareness and prevention education grants for diabetes, AIDS, substance abuse, and hepatitis C.
"I work primarily in tribal communities, both with the college students on campus as well as outlying tribal communities in the state of New Mexico. The thrust of everything I do is with Native American people," says Maller.
In addition to overseeing four health care grants, Maller writes grants as she sees new opportunities for additional funding or to expand health education among her target population. She reports directly to the chair of the special programs department at the Southwestern Indian Polytechnic Institute.
"I use my medical background to run these projects, but I am not situated in a clinical environment so my past connections and networks are invaluable," she says.
Maller has a nursing license, a master's of science degree in community health education, and she is a certified health education specialist. In addition to these degrees, Maller has 30 years' experience in a clinical setting. During her time with the VA system, she worked on the AIDS project, which was a patient education initiative for the prevention of this disease. Also, she gained a lot of insight on chronic illness such as diabetes as chronic lifestyle diseases are prominent among veteran patients, she says.
The diabetes grant she oversees focuses on creating diabetes curriculum for grades K-12 and is funded by the National Institutes of Health. She works with seven other tribal colleges across the United States, with her portion of the project focusing on middle school children.
"I have several middle school pilot projects in Native American communities throughout New Mexico. Our goal is to get the message out about the prevention of type 2 diabetes and to work with students on making healthier choices in the areas of activities and eating. We want them to bring the message home," says Maller.
The AIDS, substance abuse and hepatitis C grants all work with the SIPI student population. The message on healthy and appropriate lifestyle choices is delivered by peer educators who have undergone training. Peer educator training is a successful model used across the United States, says Maller.
"We train our peer educators, who are students, and then they train other students because students listen to students," she explains.
The amount of staff Maller oversees depends on the resources within the grant. The diabetes grant provides funding for a full-time program assistant. The AIDS grant funds a full-time health educator, and this individual is able to help with education for the substance abuse and hepatitis C prevention programs as well.
In a recent interview, Maller, who also sits on the editorial board of Patient Education Management, discussed her job, her philosophy on patient education, the challenges she has met, and the skills she has developed that are helpful in her profession. Following are the answers to the questions posed:
Prevention makes a difference
Q: What is your best success story?
A: I really enjoy working with the students, and in terms of success, you can see you are making a difference.
For the diabetes grant, our curriculum is a social studies unit for the fifth- and sixth-graders, and the emphasis is lifestyle and environment. It is put together as a mystery, with the students getting a letter from an individual looking for his or her roots. In order to answer the letter, the students have to look back at what lifestyle and environment was like in the 1920s. It gives them a chance to compare how things used to be vs. how they are today and how that impacts health.
It is done in terms of the way we eat today, fast food vs. growing your own food, and activity. The students start to see how the changes have made a difference in our lives today.
The students get to be investigators and interview people in their family. The solution comes from them and they start to see it rather than it being a one-way, didactic presentation.
Native Americans like to learn through storytelling and this builds on that, as the children go back and get the stories from their ancestors. It is wonderful to see the difference it is making in terms of their understanding.
Q: What is your area of strength?
A: Prevention is the drive I am using now. In a clinical and hospital setting it is usually too late for prevention because the event has already happened. While working in a hospital I always felt, "If only we could get out there and somehow divert people and prevent some of these things from happening through education and awareness." We always tell the students they can make a difference and we do know type 2 diabetes can be prevented or delayed. AIDS, substance abuse, and hepatitis C can be prevented by looking at behavior and making the right choices.
Q: What lesson did you learn the hard way?
A: Prevention is such a positive approach to health care; it is just so uplifting. When you are in a medical environment, a medical health care facility, it is more of a doom and gloom aspect of managing one's health and when doing prevention you are with healthy people and it is very positive.
When people have an acute event that brings them to the hospital, they want to make changes, but then they go back home to all the habits and the environment that put them at risk. When you are working in prevention education, people are not at the crisis point yet and they are going through stages of change, making decisions about altering their lifestyle, and it is easier to work with them. There is not the complexity of a new diagnosis and people feel a little more in charge of their life.
Q: What is your weakest link or greatest challenge?
A: In my situation, it is funding limitations. We are always looking for funding to support the initiatives we feel we can carry out. It is having the vision; then being able to put it on paper to get the funding. There are monies earmarked now for minority initiatives, but grants are very competitive.
Native American communities are lumped with all the other minority groups and we all compete for the same dollars. A number of institutions hire grant writers, and that is all those people do, whereas I write grants in addition to running the grants.
Q: What is your vision for patient education for the future?
A: Consumer-directed, consumer-led, consumer-driven education. The more you can put the power with the individual the more success you will have. It has to come from within each person; it can't come from providers wagging their fingers.
People start to see the solution and how to change behavior. It comes from within; they want to make the change, instead of someone on the outside telling them they have to change the way they eat. The more it comes from within, the more successful they will be, because it is their choice and not the choice of a health care professional.
Q: When trying to create and implement a new form, patient education materials, or program where do you go to get information/ideas from which to work?
A: I find the Internet invaluable for everything, whether the most current patient information or on-line sources for health information for lay people. I am always so impressed on how everything is getting better and better, more user friendly, easier to understand. I use the Internet a lot both in grant writing and grant administering when looking for health information.
Sources
For more information about prevention education or funding programs via grants, contact:
- Carol Maller, MS, RN, CHES, grant coordinator, Southwestern Indian Polytechnic Institute, Albuquerque, NM. Address: 11909 Rocksberg St. NE, Albuquerque, NM 87111. E-mail: [email protected].
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