There is much that remains eternal in the world of the Crow during the grasshopper days of summer.
Chokecherries sweeten in the July sun, as they have since the Crow first came to Montana centuries ago. A cricket chorus bursts from the brittle grass that lines the old highway from Hardin to the Wyoming border. Children squeal and splash each other with plumes of cool water from the Big Horn River. And, as they have for generations, groups of women sit in the shade and joke.
But it is in those woman-to-woman conversations that there is a significant change. Words once considered taboo in the tribe -- "Pap," "cervical cancer" and "uterine"- now are common in the seamless mix of Crow and English banter.
Cervical cancer, once a quiet and deadly epidemic among the Crow, is now discussed openly.
That phenomenon is widely credited to the Messengers for Health on the Apsaalookee (Crow) Reservation, a 6-year-old, all-female Crow health cooperative and Montana State University research program.
Composed of 35 Crow women, and co-led by tribal member Alma Knows His Gun McCormick and Dr. Suzanne Christopher, a professor and researcher in the MSU Department of Health and Human Development, the Messengers have been so successful in shifting health patterns on the Crow Reservation that the program is now regarded as one of the best community-based research programs in the country.
"The Messengers have been a model for us," says Dr. Ronit Elk, director of Scientific Programs for the Cancer Control and Prevention Research at the American Cancer Society in Atlanta. "I don't know how many conferences I've brought Alma and Suzanne to show how scientific and community partnerships can work, how trust can be developed in a community.
"When they finished their presentation there is inevitably stunned silence.followed by wild applause," Elk says.
But the everyday work of the Messengers rarely feels like enthusiastic applause. In fact, for years McCormick, Christopher and the Messenger women have worked with a quiet and dogged determination to change reservation health patterns. They have faced hurdles, including recent statistics that say cervical cancer screenings have not increased significantly at area Indian Health Service Facilities, despite five years of Messenger efforts.
Christopher said she is disappointed, but not surprised by these statistics.
"With health intervention programs, we first look for know-ledge change and attitude change, and then later on comes behavior change," she said. "That's the progression for health education. And our pre- and post tests indicate we have seen changes in knowledge and attitudes on the Crow."
Christopher said that random surveys of women on the reservation taken before Messengers began, and again three years later, showed statistically significant increases in knowledge about cervical cancer, Pap tests and comfort of women discussing cancer issues. Those are among the reasons Messengers has received increasing national recognition.
"Why Messengers is so important is not only because they are helping us detect cancer early, but that the message of health is brought to the community by members of the community," says Elk, who oversees the American Cancer Society's $1.52 million grant that now funds the Messengers. "This (method they use) is totally the future. To me, there is no other way."
The backbone of the tribe
Messengers hand out a variety of health information in Crow communities.
"Women," McCormick says, "Women are the backbone of the Crow community. Cure the women and you cure the community."
McCormick talks as she unpacks two canvas totes with the essentials of a cancer education booth posted near the doorway of the Lodge Grass community health clinic.
It is the hottest day of the summer. A couple of hours later the thermometer will top off at 112, and the air-conditioned lobby of the small Indian Health Service satellite clinic in Lodge Grass is packed with men and women of all ages, most of whom are watching Martha Stewart on a television mounted to the wall.
In a matter of two minutes, McCormick deftly drapes a battered folding table with a brilliantly patterned Pendelton blanket, tapes a Messengers for Health banner across the front, and stacks cancer education brochures across the top. She places the centerpiece -- a flesh-colored plastic model illustrating the progressive destruction of cervical cancer -- off to one side. She is open for business.
McCormick, the Messengers for Health project coordinator, is assisted by Carol Howe and Regina Stewart, who are both members of the Messengers for Health team as well as residents of the close-knit Lodge Grass community, a few miles north of the Wyoming border.
Howe and Stewart snag female friends from the television, as well as relatives who filter in and out of the clinic. They ask about family members and community activities, then point them to McCormick's booth. There, McCormick loads them up with brochures, forms and health care information.
The women nod and ask questions about cervical cancer and breast cancer. McCormick tells them that if cervical cancer is detected early it can be cured. If not, it can be fatal. She signs up several for annual checkups. In about an hour, the trio packs and heads to the local health club and then to lunch at the senior center, where their Messengers dance is repeated.
"I guess what we do doesn't seem very exciting," McCormick says. "But it works. I've seen a big change here."
The litany of cancer education
McCormick has repeated the small litany of cancer education on her home reservation thousands of times in the last six years.
Tragedy brought the outgoing McCormick to this field of health work. A direct descendent of Pretty Shield, a legendary Crow medicine woman, McCormick has been
dedicated to cancer prevention since her 1-year-old daughter died of neuroblastoma two decades ago. A single mother with three children, McCormick soon began traveling the state working for a state-run breast and cervical cancer program. In 2000 she was selected for Glamour magazine's "100 Women at Their Best."
McCormick met Christopher in 1996. Shortly after, McCormick began working with Christopher on the beginnings of what would become Messengers for Health. Based out of a tiny portion of an ancient trailer parked on the grounds of Little Big Horn College in Crow Agency, she says she is blessed.
"I give credit to God that I have been placed in this position to help do His work," says McCormick, who is known on the reservation as "Ozzie," short for "Ostrich." That was the nickname her mother gave her when she was small.
"I had long legs and was skinny with this puffy hair sticking up," McCormick says apologetically. "The name's stuck." Shortly after giving her daughter an unlikely name, McCormick's mother died and McCormick was raised in the traditional ways by her grandparents.
"That's who taught me Crow," she says. "I'm lucky, because I use (the Crow language) a lot with my work."
The other half of success
Providers say the Indian Health Service facility in Crow Agency has benefited from the Messengers' work. Photo by Kelly Gorham.
Suzanne Christopher does not speak Crow, but she listens to it well.
In fact, listening is one of Christopher's most acutely developed scientific skills. That is important, because Christopher is a specialist in a field of science called community-based participatory research. Instead of scientists coming to a community and conducting research developed somewhere else, community-based participatory research involves community members in all aspects of a project. It is a brand of science that is similar to Christopher in temperament: quiet but dynamic, leaving glitzy headlines for others.
American Cancer Society's Elk says that observing the Messengers and assessing the success of their work has proven to her that their techniques are the best way to work in communities.
"When the community has a stake in the project, when everyone in the community has a role to play, the project works," Elk says.
While the Messengers' approach was refined on the Crow, it was born far away, in Christopher's hometown of Menomonee Falls, Wis. Christopher's family attended a Catholic parish founded on principles of social justice and led by an activist priest, Father Fran Eschweiler.
"I was born learning that this is how you work with people," Christopher recalls. "It's not hierarchical."
Christopher has degrees in health promotion and wellness from the University of Wisconsin-Stevens Point and a master's from Purdue University. Her doctorate in health behavior and health education is from the School of Public Health at the University of North Carolina in Chapel Hill, a leading institution in the field of community-based participatory research.
"So (community-based participatory research) is in my blood. I believe it is the only way to work," Christopher said. "You don't go to communities and tell people what to do. You ask them what they need and how we can work together."
She first visited the Apsaalookee soon after she came to MSU in 1995. The State of Montana announced small grants to communities to develop effective ways of outreach. Six of the seven grants were for larger cities, but one was for the Crow Reservation.
At about that time, the U.S. Department of Health and Human Services/Indian Health Service statistics indicated that cervical cancer mortality rates in the Billings area were the highest among IHS programs nationally.
McCormick arranged a gathering of Crow women, which Christopher attended, at Hardin's Purple Cow restaurant. Christopher took furious notes on a restaurant napkin as the women talked about tribal health needs and attitudes.
"Those women sort of set what Messengers would be," Christopher said of the 1996 meeting.
"I always tell the story of how Suzanne went to Alma's house in Hardin and literally watched and listened for two years as Crow women came and went," Elk says. "Most (researchers) don't have the patience. They just want to tell you what to do. But Suzanne totally got it."
In 2001 Messengers applied for and received an initial $768,000 grant from the American Cancer Society. It has since been renewed for an additional $1.52 million.
McCormick and booth at the Indian Health Services facility in Crow Agency.
McCormick, with her savvy and leadership, and Christopher, with her science and drive, recruited and trained those Crow women who were already natural mentors in the tribe. Their work would be quiet and steady, done in grocery stores, around kitchen tables, in the waiting room of Head Start -- places where women met and talked.
From the beginning, the Messenger mission has been to educate Crow women about early detection of cervical cancer -- important, because according to the most recent data from the Indian Health Service, rates of cervical cancer mortality were significantly higher for American Indian and Alaska Natives than in all races combined. Additionally, rates were particularly higher for Northern Plains Native women.
Perhaps the largest hurdle to increasing cervical cancer screenings on the Crow has been a mistrust of the Indian Health Service, which occurs on many reservations. Messengers combat that fear by volunteering to be in the room during examinations to explain and comfort wary women. They drive women to their checkups and find programs that pay for checkups if women choose to use private health facilities.
"Messengers for Health has been a fundamentally important program in terms of education of the Crow people " said Dr. Deborah Sogge-Kermani, a family physician at the Indian Health Service in Crow Agency. Sogge-Kermani, one of about a dozen physicians at the facility, has worked on the reservation for eight years and has been a member of the Messengers' advisory board since its inception.
"(Messengers) has worked particularly well in terms of empowering (Crow) women to take responsibility for their own health."
Last year the Messengers set education of the physicians and staff at Indian Health Service as their annual goal. The group thought that if the doctors and other providers understood Crow viewpoints toward illness, health and healing, they would be more effective in treating them. The result was a video, "Medical People Take Good Care of Us," that explained the Crow use of chanting and praying, smudging and the tobacco culture. Produced by Gene Brodeur, now retired from MSU and Montana Public Television, and Eric Chaikin, a graduate of MSU's Science and Natural History Filmmaking program, hundreds of Crow showed up at the DVD's debut in May.
Perhaps the greatest accomplishment of the program is its use of woman-to-woman communication. This traditional way of sharing information is important in a community where newspapers, television, radio and Internet use is inconsistent. The technique soon may be expanded statewide.
Christopher and her MSU colleagues, Linda Hyman, Sara Young and Mike Babcock, learned this fall that they will receive a $6.5 million grant from the National Institutes of Health to expand the Messengers' brand of community and campus partnership work to the rest of Montana's reservations. The grant will support a Center for Community Based Research for Native Communities at MSU and link Montana researchers with communities in areas of health interest that the communities desire. Christopher would like to use part of that grant to develop a program for men's health on the Crow Reservation.
The additional funds will help Christopher train more MSU students in community-based participatory research. This summer 11 students, mostly Native American, interned with Messengers. Vanessa Watts, a graduate of MSU who has worked with Messengers since its inception, is nearly done with her Ph.D. at Harvard University School of Public Health.
"We are overcoming barriers, I'm certain of that," McCormick said as she set up yet another booth at the Indian Health Service facility in Crow Agency. "Our program has developed trust. Women can talk about (cancer) now. We started something good here. Now we need to do more work."