The trans-NIH American Indian/Alaska Native (AI/AN) Health Communications and Information Work Group hosted a half-day workshop for NIH communications staff on "Creating Collaborations: Partnering with Tribal Community Health Representatives for Health Research and Education." Community Health Representatives (CHRs) are a cadre of 1600 tribal employees nationwide who serve as lay health educators and patient liaisons. Launched in 1968 by the Indian Health Service (IHS), the CHR program is based on the concept that indigenous Tribal health workers familiar with Native languages, customs and traditions are especially well adapted to serve the Tribal community. Bridging the gap between community members and health care providers, CHRs provide a wide range of health and social services, for which they are trained. Tribes contract with the federal government to provide CHR services that best meet their Tribal communities' needs, resulting in great diversity in services. Emphasizing CHRs' adaptability and resourcefulness in the rural, remote communities they serve, Cathy Stueckemann, National Director of the CHR program at the Indian Health Service, reflected that "Give CHRs duct tape, and they can do anything."

Photo caption (left to right): Dione Harjo, assistant director, Community Health Representatives (CHR) program; Cathy Stueckemann, CHR national director; Mimi Lising, NIAMS multicultural communications coordinator; Jean Pino, CHR coordinator; Jeannette Yazzie, area office coordinator (AOC); Melany Cueva, program coordinator Alaska Native Tribal Health Consortium; Dr. Janet Austin, NIAMS office of communications director; and Georgia Butler, AOC.

Dr. Anselm G. Davis, Jr. (Navajo/Choctaw), former Executive Director of the White House Initiative on Tribal Colleges and Universities, opened the meeting with a stirring blessing. Singing a Pueblo sunrise song to the steady beat of a drum, Dr. Davis encouraged participants to bring open minds, creativity, energy and enthusiasm to the workshop and to continue to work together to build bridges between cultures.

The workshop was aimed at increasing understanding of the vital role that CHRs play in developing, implementing, and disseminating health information and education programs to Native people. Dr. Melany Cueva of the Alaska Native Tribal Health Consortium described the development of the "Bridging the Divide" cancer education program in consultation with CHRs. This culturally respectful curriculum, taught to and used by CHRs, utilizes participatory techniques such as games, storytelling, role play and reader's theater to teach tribal members about cancer prevention, screening, and treatment. The techniques of role play and reader's theater are "grounded in storytelling as culturally respective way[s] to invite people to consider possibilities to engage in dialogue and conversation."

Ms. Jean Pino (Zia Pueblo), a CHR coordinator from the Five Sandoval Indian Pueblos in New Mexico, described her involvement in both cancer and heart disease education. Ms. Pino cited the lack of culturally appropriate materials and programs and transportation issues as a few of the barriers to care in Native communities, particularly in cancer screening and early detection. She also shed light on some Native cultural beliefs surrounding cancer, including the belief that cancer is contagious and that "if I talk about [cancer] I will bring it on to myself.." Another issue that proved to be a constant challenge was to convey an abstract concept like cancer, which did not exist as a word in the Zia language, into concrete language that patients could comprehend.

The workshop concluded with a panel discussion that included the keynote speakers and IHS Area Office Coordinators who provide consultation and technical assistance to CHR programs regionally throughout the country. Audience questions mainly focused on how to develop tailored materials for Native people, given the diversity of traditions, cultures, and sometimes languages among the more than 500 Federally-recognized tribes. Panelists recommended using photos of nature and of Native people in street clothing rather than in ceremonial dress to allow tribal communities to adapt the materials to include their own identifiable symbols and graphics.

An NIH Videocast of this event is available at: http://videocast.nih.gov/Summary.asp?File=15111.