Messengers for Health

FormalPara Key Points

• Messengers for Health is a non-profit Apsáalooke organization that addresses community health issues in a culturally appropriate way.

• Messengers for Health is guided by eight statements, all beginning with “We believe.” These statements are the backbone of the program’s success and community trust.

• Our community-based participatory research focuses on issues that are decided by and important to our community. We conduct research that serves our communities. Any data gathered through our research directly benefits the community.

Messengers for Health (Messengers) is a non-profit organization (NPO) located on the Apsáalooke (Crow) Reservation in Montana, USA. Our mission is growing, fostering, and supporting trusted and respected community leaders to improve the health of Apsáalooke men, women, and children using solutions that respect and honor Apsáalooke strengths, culture, stories, and language. We utilize traditional methods of knowledge transmission, harness cultural strengths, and value the guidance, knowledge, and expertise of our community members. Messengers has an Apsáalooke Executive Director, Apsáalooke Executive Board, and Apsáalooke staff.

The Apsáalooke Nation is in southeastern Montana. The reservation is rural and encompasses approximately 2.3 million acres, including the Wolf, Pryor, and Big Horn mountain ranges. As Chief Eelápuash (Chief Sore Belly) said, “The Crow Country is in exactly the right place. Everything good is to be found there. There is no country like the Crow Country.” Many Tribal members speak Crow as their first language, demonstrating the strength and maintenance of the culture. Apsáalooke means “children of the large-beaked bird,” referring to the raven. Apsáalooke people are known for the strength of their clan system and their strong family ties.

Messengers began as the community arm of a community-based participatory research (CBPR) project, in partnership with faculty and students from Montana State University–Bozeman (MSU), which is 200 miles from the reservation. Initially, research grants came into the university and community members were employed by the university as project staff. However, over time, Messengers established integrity, trust, and strong support in the Crow community. In 2009, to strengthen the community aspect of the partnership and with an eye toward growing and sustaining services in the community, we met with leaders of several NPOs and an NPO development professional to learn how we could become an NPO. We understand that many CBPR partnerships include NPOs. However, few NPOs are located on reservations. With a lot of assistance, we submitted paperwork to the state of Montana and received our non-profit status in 2010. We do not know of another Indigenous CBPR partner that has successfully taken these steps and we are very proud of this accomplishment.

As an Apsáalooke NPO, Messengers has the liberty to address community health issues in the most culturally appropriate way. For example, we added a men’s cancer-screening program, a transportation program, and a health-promotion program to our activities. Grants can come directly to us, or we can receive a subcontract to partner with the university or other institutions. Community members who are involved in the program’s administration have developed strong leadership skills and are viewed as leaders by others. In a Tribal community, people know each other well and watch each other to see their actions. The community has watched Messengers and its members evolve over time into an NPO with integrity that benefits the community.

The partnership between the community and the university grew slowly, with care and intention. Over time and from our experiences, we developed a series of statements that illustrate our partnership processes. These statements are the backbone of our success and why we are viewed with integrity and trusted in the community as a health resource. Our statements begin with “We believe.” We support these statements of belief with actions that match our words.

• 1. We believe strengths, solutions, and expertise are in the community. All the programs we develop use Apsáalooke cultural strengths, such as Báa nnilah (which means “the sharing of advice” and is also the name of our health-promotion program). We understand that solutions to health issues come from culture.

• 2. We believe in research that is focused on issues decided by and important to the community. We have an Executive Board that decides which topics are important. The board guides our partnership and, with their knowledge, expertise, and wisdom, ensures the CBPR process adheres respectfully to the cultural protocols of the Apsáalooke Nation. The board began informally in 1996 and was formalized in 2001. It has seven members, all of whom are enrolled members of the Apsáalooke Nation with a sincere interest in improving the health of the Apsáalooke people.

• 3. We believe in research that is in service to communities. We work to sustain programs that are effective. Instead of programs that are developed, implemented, evaluated, and discontinued through the research-grant cycle, we search for funding to continue running effective programs. An example is our recent chronic illness self-management program, which was developed, implemented, and evaluated through a randomized controlled trial funded by the National Institutes of Health. Once we saw that the program was effective in helping community members, we partnered with the Rocky Mountain Tribal Leaders Council and others for funding to continue hosting program gatherings in the community.

• 4. We believe in research where any data that is gathered benefits the community directly. When we began our work, we were told of researchers who came into the Apsáalooke community, gathered data, left, and were never heard from again. Our approach was different: we let every community member who completed a survey or interview know that what they shared would directly benefit the community. We hold community meetings to let Tribal members know how their information was used to develop programs, and we develop accessible handouts that show how community information is used to develop Apsáalooke-specific programming.

• 5. We believe in research that financially benefits Tribal communities and universities, with an emphasis on community benefit. Having community members as staff members who make fiscal decisions enables Messengers to make the best use of funds. For example, we help participants to program meetings and provide food for them. Having the funds located in Messengers instead of the university allows for greater fiscal control and strengthens our organization, leading to the management of larger grants.

• 6. We believe in research where community and university researchers are partners and the community is in the driver’s seat. As mentioned above, our Executive Board decides the direction of our research projects. We continually keep in mind that university partners are engaged in service to the community, the members of which are valued as experts.

• 7. We believe in research that builds everyone’s capacity. Both community and university partners grow and learn through our work. We actively seek opportunities for all partners to learn new skills and have new experiences. We want the partnership experience to support everyone to become stronger and more capable. We especially see this in our students, most of whom are Indigenous and are supported in our partnership. We have seen numerous students go on to succeed at school and in their careers.

• 8. We believe in publications and presentations that are done together with community and university partners. All of our writing is done in partnership, line by line, word by word. We jointly edit for clarity and agree on all content. Together, we make sure that the content accurately reflects our work and is accessible to the general public. Whenever possible, community and university partners present together, fully displaying our true partnership. An important outcome of this approach is that the community’s voice is seen and heard clearly in our publications and presentations.

One example of our work is a program to address the low rate of cancer screening among women in the community. We adopted a lay health advisor approach and worked with the community’s trusted women—those to whom others turn for support and advice, who are trusted, and who have integrity. We called these women Messengers, and their role was to visit with their family members and friends about women’s health and specifically about well-women visits and cancer screening. We met with the Messengers through an annual retreat and monthly support and educational training. We conducted pre- and post-tests with random samples of community women and found statistically significant increases in cervical cancer knowledge, comfort discussing cancer issues, and awareness of cervical cancer and the Messengers for Health program. As solutions to health disparities must be sustainable, our non-profit organization continues to apply for and receive funding to provide outreach services to assist women—and now men—to receive important cancer screening.

Over time, we have been able to successfully advocate for the local community. Messengers works with businesses, government entities, individuals, and organizations to build healthy communities and lifestyles. The Legislative Branch of the Crow Tribe fully supports Messengers’ work, and a Tribal Resolution (LR09–02) of approval and support is in place. We have built working relationships across multiple and diverse public and private sectors. These are strong and healthy relationships where we act as a bridge to bring people together across multiple sectors, synergistically building a healthy community. This has never existed before. We are seen as a “go-to” resource for bringing people and organizations together. For example, when there was an outbreak of Methicillin-resistant Staphylococcus aureus (MRSA) in the community and individuals from the Centers for Disease Control and Prevention came to address it, they turned to Messengers to help them effectively coordinate their efforts for the best chance of success. Recently, staff from the local Indian Health Service reached out to us to partner in their efforts toward diabetes prevention and service to community members with this diagnosis. They heard about our program and the trust the community has in us, and they knew that the best way to be effective in their work was to partner with us.