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Native Mystery 

A unique partnership finds health answers on the reservation

A silent killer lurks in Indian country. It is the thief of lives, and for doctors, a medical enigma wrapped in a deadly riddle. But now a unique partnership is helping unravel that mystery.

For years, Native Americans boasted the nation's lowest cancer rates. Not anymore. Even as rates in the rest of the nation are dropping, the incidence of cancer among Native Americans is actually climbing--to the point where it's now almost double the national average. At the same time, Indians contracting the disease are much more likely to die from it.

Understanding why this is happening involves far more than just medicine. It also means breaking through walls that exist between Native American culture and the rest of society; on the reservation, there lingers a well-earned suspicion of outsiders who bustle in and start dictating answers.

And so it became obvious that another approach was drastically needed to understand why Native American cancer rates were going through the roof.

Health experts came one step closer to that answer four years ago, when the Native American Cancer Research Partnership was formed. Armed with a $7.5 million federal grant, the organization dispatched researchers and coordinators to build ties with rural reservation communities.

This progressive consortium involves the UA's Arizona Cancer Center and Northern Arizona University, with funding from the National Cancer Institute. But most importantly, the partnership includes the tribes themselves.

Their approach is three-pronged--outreach, research and education.

Under this mantle, teams are sent to the reservation with powerful information and a zeal for understanding stubborn health problems. Meanwhile, another long-term goal is boosting the number of Native American health-care professionals in cancer research and clinical oncology.

Most efforts to date have been directed toward the vast Navajo reservation in Northern Arizona and New Mexico, where studies of uranium mining's health effects are underway.

Dr. Louise Canfield is a UA professor of biochemistry and public health, and the cancer center's lead partnership investigator. She says nurturing relationships with reservation residents is incremental and organic by necessity.

"We haven't gone out and said, 'We're from the government; we're here to help you.' We don't go out and impose our solutions on the communities. That doesn't work. Frankly, you and I would not like it, either. It's like someone coming in and decorating your house without your knowledge."

Instead, the partnership "tries to be an ear to the communities," she says, "to find out what people want. In our first three years of relationship-building, we needed to convince people that we didn't have an agenda, that we were really trying to make a difference."

With that relationship also came information about preventing illness and promoting healthy living, Canfield says. "But we were mostly trying to build trust. We weren't out there trying to get people to give us blood samples. We were out there talking about education and children. That was much easier to do and better-received."

One of the ways the partnership builds that trust--and creates lasting improvements--is by helping train new generations of young people. The center has created UA academic programs geared toward Native American communities, and about 40 students are enrolled at any given time.

Over the past four years, 132 students have gone through the medical program; 95 of them were Native Americans. Many have gone on to nursing or medical school. "All the students come in saying they want to go back and help their people," Canfield says. "And young people are the hope for any community."

That goes a long way toward developing the necessary trust and communication. But there's also an added advantage, in that it helps connect Native American students to the university. That's been a perennial problem at schools like the UA, where many students from reservations have a tough time adjusting to life on a huge college campus in the middle of a bustling city.

But within a program connected to their homelands, the students not only have a greater potential for staying in school, but the opportunity to go back and serve their people.

That is crucial to places like the Navajo nation, where much of the cancer is believed to be linked to uranium mining that took place for decades. The partnership is addressing the lasting impact through a pair of studies. One looks at the chemical "genotoxicity" of uranium--how it can damage DNA and what impacts that has at a cellular level. The report also looks at how uranium sparks mutations.

Another study looked specifically at interactions between persistent exposure to uranium and changes in cells that could lead to cancer.

Then comes the hands-on approach. Sally Ann Joe can tell you all about that. She's director of the Navajo Nation Breast and Cervical Cancer Prevention Program, headquartered in the tribal capital of Window Rock. "We have an agreement with (the partnership) that opens the door to a lot of collaboration that we're doing with one another," she says. "They have given us technical assistance, and summer interns to do studies. It's very important for us."

Joe's program has 14 staffers, including a case manager and data-entry clerks at reservation medical centers operated by the federal Indian Health Service. "We take care of all the abnormal pap smears and mammograms that are done in the hospitals," she says.

Back in Tucson, the program continues to evolve, says Dr. Canfield. So do the challenges. For example, right now, "our physicians are establishing a virtual colonoscopy program," Canfield says, "where people can be screened at distant sites, and it's read in real-time at the Cancer Center."

But like everything with the partnership, the task is being done with reservation residents, for reservation residents. "We are doing more work directly in the community," Canfield says. " We listened to the needs of the communities. We ask what a community might need, and how can we broker that?"

Four years after it began, this unique partnership may have answered that question.

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