FLAGSTAFF – Native Americans for Community Action, a nonprofit agency in Flagstaff, provides health services primarily to Native Americans of Flagstaff and Coconino County, both on and off the reservation. These photos, taken in NACA’s wellness center on Oct. 24, look at what NACA is doing to tackle the issue of diabetes within the Indigenous community. According to the U.S. Department of Health and Human Services Office of Minority Health (OMH), American Indians are almost three times more likely to be diagnosed with diabetes than non-Hispanic white adults.

Morgan Farley, a Navajo diabetes health coach at NACA, outside NACA’s wellness center, where community members get diabetes management and prevention services. Many studies show that obesity puts people at a higher risk for having diabetes. The NACA program focuses on increasing patients’ physical activity and encouraging healthy eating habits, while also emphasizing the importance of traditional and cultural wellness practices. According to the Centers for Disease Control and Prevention, 89.8% of adults aged 18 and older diagnosed with diabetes between 2017 and 2020 were classified as overweight or obese.

Esther Cadman, a Navajo patient at NACA, in the wellness center before her workout. Cadman, who was diagnosed with Type 2 diabetes in 2016, said in the beginning it was really depressing and she felt there was no hope. “I found NACA because I needed a place to help me monitor diabetes and it was through them that I found out about whole-food plant-based eating, which I incorporated into my life,” Cadman said. “NACA has really helped me manage my eating, manage the medications, manage my exercise and even counseling.” She said most of her symptoms have gone away or gotten a lot better since coming to NACA, including feeling less thirsty, not having any more numbness in her legs and getting better sleep.

Vegetables from the NACA community garden in a basket in the wellness center kitchen. Farley said before colonization, Native Americans had their own culture, traditions, grew their own food, hunted, did a lot of physical activity and were very self-reliant. Farley said U.S. government control of Native American communities influenced how their ancestors lived; many traditions were lost, their language and culture changed, and their ancestral diets were replaced with canned and preserved foods. She said this lifestyle change caused historical trauma that has led to diabetes becoming prevalent in the Native American community. “Before colonization there weren’t really diseases like diabetes, so reclaiming our culture, teachings and ancestral foods is really important,” Farley said. “We emphasize and share Native American culture and teachings by connecting it to health and wellness, going back to how our ancestors lived before. It can be very healing, both physically and spiritually, to be involved culturally.”

Native tea sits on the counter in the wellness center’s kitchen. One way NACA tries to incorporate more Indigenous culture into its practices is through a community garden, where people can come together and harvest plants and vegetables. An article in the Journal of Geriatric Cardiology shows that many studies support the role of a whole-food, plant-based diet in reducing insulin resistance, maintaining a healthy body weight and lowering the risk of Type 2 diabetes.

Jordan Mockta, right, an exercise physiologist from the Hopi-Tewa tribe, conducts a personal training session with Cadman. “They (diabetes patients) need to incorporate nutrition more. Obviously movement is going to help you lower that weight but nutrition has a big role in that as well,” Mockta said. “Being able to shy away from the colonialistic eating habits, you know preserved foods, and going into more organic foods, even doing home gardens and being able to allow traditional harvesting practices is important.”

Mockta, Farley and Cadman participate in a group workout session using TRX straps to build strength and flexibility. According to the CDC, being active makes your body more sensitive to insulin which helps manage diabetes and helps control blood sugar levels.

Mikki Charlie, a Navajo client at NACA, joins the group workout session. Charlie said that her mother has diabetes, and despite her own good result from a genetic test a year ago, she remains proactive in making dietary and lifestyle adjustments for prevention. Charlie said she trains with Mockta twice a week and implements the holistic practices she learns at NACA into her everyday life. “I’ve been feeling really really good for the last seven months coming here. I’m glad to come here, that way I know I have somebody to greet me and spend that one to two hours with me. It really helps me sleep better, wake up better and be motivated,” Charlie said.

Maribel Rodriguez, a health educator at NACA, in front of the NACA wellness center. Rodriguez said she graduated from Northern Arizona University as a certified health educator specialist and has been working at NACA for the past three months. “I always heard really good things about NACA, like being local, and so I saw that they were hiring and I decided to go for it,” Rodriguez said.

Farley checks Rodriguez’s blood pressure, demonstrating the Know Your Numbers service NACA offers to its patients and the community. Farley explained that they engage in community outreach, setting up booths at local fairs to provide on-the-spot blood sugar and blood pressure checks for passersby.

A blood sample is taken to check blood sugar levels. Farley said it is important to know your numbers so you can determine what steps you need to take for your health.

Farley fills out a Know Your Numbers card with blood pressure and blood sugar measurements. Rodriguez said the card also includes space to note the person’s last meal “because sometimes that can affect your blood sugar or blood pressure and then we have them take it home. Sometimes we recommend they go to their provider if it’s really high because we can’t diagnose, we can only recommend. It’s super fun to go out and do. We try to get people knowledgeable on their numbers because a lot of people don’t take them regularly.”

Madison Dreifuss, an exercise physiologist at NACA, leads a group workout session in the gym at the wellness center. According to the U.S. Census Bureau, American Indians and Alaskan Natives make up 27.1% of the population in Coconino County, making them the largest ethnic group in the area after whites. Dreifuss said that even though she is not Native American, she has learned a lot by living in Flagstaff and being a part of NACA’s practices. “I look to my neighbors and I only want to help those around me and how that extends into the community,” Dreifuss said. “With all that I’ve learned from my teammates and from the education that I’ve been provided, I am so appreciative of the approach that includes full mind, body and spirit. It involves community, nature is always at the forefront and it gives us a bigger connection to each other, to the world around us. If anything it just affirms why this was taught. It’s quite wonderful.”