VOLUME 10, ISSUE 1
COVID-19 PANDEMIC:
Taking Action to Save our Elders and Ourselves pg. 14
Service With A SMILE pg. 33
How Can We Find REST IN GRIEF? pg. 30
&
REJUVENATION
Letter from the Publisher
FIRST
NATION Volume 10, Issue 1
The stress of the pandemic and all that is happening in our society is very stressful. Rejuvenation is what we all need right now: A time apart, a rejuvenation of our inner spirit, the soul of our inner thinking. We hope and pray to our Creator that this issue will help you realize a Peace that will carry you through the difficult times and keep you healthy. Stress is a silent killer. A time apart for Rest and Rejuvenation is very important for each of us, our families, and our Nations. You may have noticed the magazine’s name change. In consultation with Alaska Nation leadership back in the winter, we have sought to be more inclusive with the Alaska Villages. While the previous name was chosen in an NCAI Alaska Caucus Meeting at a fall council, we heard there was interest to change the name again. American Indian and Alaska Native is the federal term; we add “Living” in reference to healthy living by our peoples. We hope you like the name and we welcome comments, reflections, and recommendations before it is legally finalized. May the Peace of our Creator fill your offices, homes, and hearts to provide you with health and happiness.
American Indian LivingTM magazine is a bi-annual publication whose content is designed to enhance the health and wholeness of the indigenous populations of North America. It is published by the Native Ministries Department of the Oklahoma Conference of Seventh-day Adventists in collaboration with the Assembly of First Nations and the National Congress of American Indians.
EXECUTIVE PUBLISHER Robert Burnette
Assistant to the President, Oklahoma Conference of Seventh-day Adventists
EDITOR Caroline A. Fisher, M.A. SENIOR EDITORS Jim Landelius, M.A.
Director, Native Ministries Oklahoma Conference of Seventh-day Adventists
David DeRose, M.D. Medical Consultant
HEALTH CONSULTANT Joni Bokovoy, Dr.P.H. CULTURAL EDITOR Jay ganeñˀdo∙doñˀ Meacham LAYOUT / DESIGN Julie Burks
neˀ sgeñ∙noñˀ naesaihwiyosdik goñdahgwih
Robert Burnette Onondaga
COPY EDITOR Joan Rupe
WEBMASTER Stephen Carlile
American Indian LivingTM, Volume 10, Issue 1 PUBLISHED BI-ANNUALLY BY Oklahoma Native Ministries Department of the Oklahoma Conference of Seventh-day Adventists P.O. Box 32098, Oklahoma City, OK 73123 405.721.6110 www.okadventist.org
MARJORIE GREEN IS THE AUTHOR OF “BLENDING TRADITIONS AND MODERN PRACTICES FOR HEALING” FEATURED IN THE AUTUMN 2019 ISSUE. WE REGRET THAT HER NAME WAS OMITTED IN THE STORY.
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Copyright and trademarks for American Indian LivingTM magazine and radio belong to River Birch, Inc., and may not be reprinted or used in any portion without the express written consent from the board of River Birch, Inc. www.aianl.org
contentsvolume10issue1 4
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14 10 MAINTAINING BALANCE:
30 HOW CAN WE FIND REST IN GRIEF?
BY: CAROLINE A. FISHER, M.A.
33 SERVICE WITH A SMILE
THE EXERCISE AND REST "TEETER TOTTER"
BY: KAREN NICOLA, M.A.
BY: DANNY KWON, J.D.
12 VETERANS PRAYER
BY: MARVIN MATHEWS, M.DIV., LMFT
14 COVID-19 PANDEMIC: TAKING
ACTIONS TO SAVE OUR ELDERS AND OURSELVES BY: JONI BOKOVOY, DR.P.H., R.N.
21 ALASKA NATIVES AND THE
SUCCESS OF TRIBAL DENTAL HEALTH AIDE THERAPISTS
34 FOSTERING HOPE IN ALASKA'S
NATIVE AMERICAN COMMUNITIES BY: MYLON MEDLEY.
39 STRENGTH EXERCISES BY: CAROLINE A. FISHER, M.A.
40 RECIPES: EATING TO THRIVE
BY: CHEF EDWIN CABRERA, SHERRI FLYNT, AND ERICA HECHLER
BY: NCAI
26 NCAI & NIHB EVENTS AND RESOURCES
on the cover 4
REST
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Health | Rest
REST EXCERPT FROM CREATION HEALTH/LIFE
“A day out-of-doors, someone I loved to talk with, a good book, and some simple food and music – that would be rest.” ~ Eleanor Roosevelt
R
est is incredibly powerful. It refreshes, rejuvenates, regenerates, and rebuilds the mind, body, and soul. Rest empowers you to function at your best. Optimally, rest includes a good night’s sleep as well as time to relax and rejuvenate daily, weekly, and annually. The true benefits of rest are misunderstood and often unappreciated. The stress and pressures of life can accumulate over time and can create a generalized “dis-ease” with life. Proper rest is a powerful antidote for this common problem. Because our society revolves around its own concepts of “success,” many people have become pressed by work and their personal desires to achieve that “success.” The day is filled with many important and seemingly urgent responsibilities, so rest is easily dropped to the bottom of the list. Yet, many do not realize how much more effectively and efficiently their minds, bodies, and souls would function, and how much more likely they would reach their goals of “success” if they gave themselves the right kind of rest at the right time.
Early to Bed, Early to Rise Getting enough good sleep is important. But how much sleep should we be getting? Studies show that for adults, seven to eight hours a night is best. In the classic Alameda County Study, which included nearly 7,000 people, researchers found that this figure was associated with the greatest longevity. We have seen clearly that restricted sleep is detrimental, but too much sleep can also be detrimental to your health. Researchers discovered that subjects who reported short (six or less F I R I S T N AT I O N L I V I N G
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“Early to bed and early to rise makes a man healthy, wealthy, and wise.” ~ Benjamin Franklin
hours per night) or long sleep (nine or more hours) shortened their lives by an average of nine years when compared with people who slept seven to eight hours per night. New research indicates that the familiar quote from Benjamin Franklin contains a lot of wisdom. Surprising health improvements might be the morning person’s real rewards. Those who go to bed early and get up early have lower rates of heart disease, diabetes, and overall lower death rates than those who stay up late and get up late. God made humans diurnal—made to function during the day. Our bodies are designed to work best when we go to sleep early in the evening and get up early in the morning. Dr. Timothy H. Monk, one of the foremost authorities on sleep, said: “Human beings are built to be daytime creatures. It’s hardwired into our circuitry… when you deliberately try to shift the sleep/wake cycle, it’s like having a symphony with two conductors, each one beating out a different time… your delicate internal rhythms go haywire… you need to treat sleep as a precious and fragile thing.” Monk has found that early risers are more likely than night owls to stick to healthy routines and have better sleep. Larks (early birds) wake up, eat
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meals, exercise, and go to bed at pretty much the same time each day. Night owls, on the other hand, are not so consistent with healthy daily practices. The payoff for early birds is worth getting out of bed for. Regularity in one’s life also leads to healthier eating patterns, such as a good breakfast and less night snacking. This can in turn boost your immune system, fight off colds, improve mental performance during the day, and decrease stress.
Daily Rest Daily relaxation is important in helping to refresh yourself when stress is high and the demands are great. This relaxation can take many forms. Many people report they need to do something totally different from their normal routine in order to relax. Taking deep breaths of fresh air outside during a work break can help energize the body for the rest of the work day. Fresh air taken deeply into the lungs is a wonderful, vitalizing force. Fresh air has many positive benefits. It is chemically different than the recirculated indoor air that most Americans breathe on a daily basis. Fresh air is actually electrified. It is negatively charged, or “negatively ionized,” by the
oxygen molecule, which is a good thing. There are over five thousand published studies reporting on experiments with ionization. All support the conclusion that, generally speaking, an overdose of positive ions is detrimental to health while extra negative ions, the good ones, are beneficial. The negatively charged oxygen reportedly brings an improved sense of well-being, increases the rate and quality of growth in both plants and animals, improves function in the lung’s protective cilia, decreases anxiety through a tranquilizing and relaxing effect, lowers body temperature, lowers resting heart rate, improves learning in mammals, decreases severity of stomach ulcers, and decreases survival of bacteria and viruses in the air. Even if you can’t get into the fresh air, deep breathing can be beneficial. Long and slow abdominal breathing will reduce anxiety and improve the quality and quantity of sleep. Have you ever had an aching back or pain in your neck when you were anxious or stressed? When you have anxiety or stress in your life, one of the ways your body responds is with muscle tension. Progressive muscle relaxation is a method that helps relieve that tension. In progressive muscle relaxation, you tense a group of muscles as you breathe in, and you
Health | Rest relax them as you breathe out. You work on your muscle groups in a certain order. If you have trouble falling asleep, this method may also help with your sleep problems. A few minutes of progressive relaxation can renew your personal energy on a stressful day. In progressive relaxation, the individual sits in a quiet, comfortable position and starts to breathe deeply and slowly. The mind is focused on a place that brings relaxation and happiness; maybe for you it is a mountain top or favorite vacation spot. The mind seeks to enter into this place with all of the senses: touching, smelling, and hearing with the imagination as the deep breathing continues. While remaining in the imaginary restful environment, the focus then turns to tightening and then relaxing muscle groups. Begin with the hands. Then the arms, shoulders, neck, jaw, eyes, abdomen, back, legs, and feet in that order. Between each muscle group, there should be a pause to review and ensure that the other muscles are continuing to be relaxed. The next muscle group can then receive the focus until all groups have been relaxed. Once the physical and mental relaxation has been achieved, it should be enjoyed for several minutes while assuring that the muscles stay relaxed. Progressive relaxation has been shown to be a great stress reliever. For more information, visit upmc.com/ services/healthy-lifestyles/chronic-stress/ pages/body-awareness.aspx. A period of meditation on something positive and encouraging might be just what you need for renewed energy. For example, meditating on the special personal meaning of a Bible promise can have powerful renewing and peace-promoting effects. Relaxation can come in the form of a daily vacation, “a piece of time when you wholeheart-edly pursue something you truly enjoy.” A daily vacation can be packed into as little as 10 or 15 minutes and still be stimulating and invigorating. Make your daily vacation personal; find something that you have a passion for, such as reading, playing the piano, or talking with your grandkids. Many people can also benefit greatly by what science now calls a “power nap” of
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“What is without periods of rest will not endure.” ~ OVID
about 20 minutes or less. Power naps have been shown to have many benefits, including higher perceived alertness, improved declarative, procedural memory, alertness and performance, mood, physiological activation, and level of alertness. Power naps have also been shown to help modulate or calm emotions. The point is, find whatever daily relaxation works for you, and commit to doing it for at least 10 minutes each day. This is essential to feeling better and will help you perform optimally.
Weekly Rest Energizing our lives with daily, weekly, and annual vacations is essential to our health and happiness. We have an innate, God-given need for a change of pace and a time to “come apart.” This rhythm of life originated with God when He created this earth. In the beginning, He created the world in six days and then rested on the seventh day. And it wasn’t because His physical needs demanded it. He took time to rest simply because He wanted to enjoy the life He had just created. This seven-day rhythm suggests we should honor weekly rhythms if we want to take care of our health. During World War II, Great Britain instituted a 74-hour work week, but soon found that people could not maintain the pace. After experimenting, they found that a 48-hour work week with regular breaks, plus one day of rest each week, resulted in maximum efficiency. During the French revolution, France experimented with a 10-
day week; chaos resulted. Our world operates on a seven-day rhythm. We find this cycle in plants, animals, and humans. Medical research has demonstrated seven-day rhythms in connection with a variety of physiological functions. These include: heart rate, natural hormones in human breast milk and urine, swelling after surgery, rejection of transplanted organs, human and animal cancers and their response to treatment, inflammatory responses, and the drugs we use to treat them. For instance, a patient will tend to have an increase in swelling on the seventh and the 14th day after surgery. Similarly, a patient who has had a kidney transplant is more likely to reject the organ seven days and 14 days after surgery. German scientists call the thing that sets a biorhythm, “zeitgeber” or “time-giver.” The zeitgeber that initiates and maintains the seven-day rhythm is not yet understood, but some chronobiologists think that a regular day of rest might pace it. It is possible that we have a physiologic need to take a specific day off each week. Taking off one whole day in seven brings renewal to the physical and spiritual life. Unlike days, months, and years, this biorhythm has no astronomical marker. There is no plausible explanation for its presence, except that it was built into our physiology by our Creator. The day can be used for many restorative things: to connect with others; it can be great for recreation, reflection, and meditation; and it can be a special time to focus on nurturing one’s spiritual values.
Adapted from CREATION Life (AdventHealth Press, 2014). Used with permission.
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Health | Exercise
Maintaining Balance: THE EXERCISE AND REST “TEETER TOTTER” BY CAROLINE A. FISHER, M.A.
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xercise and activity help boost your mood, your emotional wellbeing, and your metabolism ~ so does rest! Since many of us are now at home isolating or self-quarantining while waiting for the coronavirus to clear, it is natural to want to keep the couch warm and eat comfort food to allay our anxieties. However, eating and watching TV all day will not keep us healthy or productive! What to do to maintain balance? Read on. First the “teeter.” It is very important to keep moving even if you are working or studying from home. You can meet the minimum daily requirements of exercise by choosing among the following activities for at least 15-30 minutes daily (try more if physically able): • Incorporate traditional, Native games into your family routine (try Native Games or these traditional Native games for ideas) • Play chase/tag with children in your yard • Do an aerobic routine with your family in your home (try searching YouTube for “workout”) • Do resistance training (tug of war or bands) inside or in your yard • Play soccer or flag football with your family in your yard • Gardening (planting, weeding, harvesting) • Lift weights in your home • Play Frisbee, catch, etc. with someone in your family in your yard • Set up a net for volleyball or badminton and play a game with family • If you have a swimming pool, swimming or water aerobics are fun • Find specific recommendations for your age and ability at the CDC.
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Health | Exercise
Now the “totter.” We know the importance of exercise, but did you know that it is equally important to rest in between exercise routines? During this coronavirus pandemic, you may have more opportunity for rest than you ever thought possible! Here are some ideas for enjoying a healthy rest in between your exercise routines: • Spend time listening to classical music. Music therapy has been used for over 100 years to help people “address physical, emotional, cognitive, and social needs” according to the American Music Therapy Association (musictherapy.org). Visit musicalamerica.com and scroll down to view links to online opera and classical music sites available 24/7. • Cook meals at home and include your children. There are delicious and healthy recipes included in this issue and many more at adventhealth recipes. Share your family cooking traditions with your younger family members by perusing First Nations recipes. Most grocery stores allow ordering online and pickup from your car so you can stay safe when shopping. • Sleep seven to eight hours a night (9-10 for children up to age 18). Try to avoid napping very long as it interrupts sleep patterns. • Read to your children or to yourself. Dust off your books if you haven’t read them in a while, or hop online to the many audible, online, and downloadable options on the internet. Search for “online books” to find many sources.
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Choice | Veterans
MARVIN MATHEWS
M
arvin Mathews was born in Pryor, Oklahoma, in one of the 14 counties of Northeastern Oklahoma designated as the territory of the Cherokee Nation. His paternal grandmother moved from Georgia to Oklahoma and received land when she was enrolled as a member of the Cherokee nation. Marvin attended grade school, middle school and high school in Pryor through the eleventh grade, and completed his senior year at Ozark Adventist Academy in Gentry, Arkansas. He then attended his first year of college at Southwestern Adventist University in Keene, Texas, and completed a Bachelor of Science from Northeastern Oklahoma State University in Tahlequah, Oklahoma. His degree included a major in accounting, with minors in business administration and economics. Upon completion of his B.S. degree, Marvin was drafted into the United States Army where he was selected to work in human services for the soldiers and their families. He later worked in income tax accounting, and oil and gas accounting. Marvin followed God’s call to get a Master of Divinity degree at Andrews University in Berrien Springs, Michigan, then completed additional course work in pastoral counseling under the direction of Dr. Elden Chalmers, Clinical Psychologist. After receiving
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his master’s degree, Marvin served several church districts as a pastor, where he also utilized his education and interests to counsel with members of the church and the community. Marvin continued his education with counseling course work at Texas Woman’s University and at North Texas State University and received his licensure as a Marriage and Family Therapist (LMFT). He worked as Clinical Director of a partial hospitalization program for 10 years and also ran a private practice. For the past 12 years, Marvin has served our military communities both in the United States and around the world, providing nontraditional and nonmedical model counseling services. He now assists our military members and their families with the realities of deployment and family separation, as well as with life and career goals and with accessing resources and services. Marvin and his wife of more than 40 years have three sons (the oldest is deceased), and two granddaughters, all of whom are members of the Cherokee nation. Marvin and his wife live on land located in Southeastern Oklahoma in one of the fourteen counties designated as the territory of the Choctaw Nation.
Choice | Veterans
VETERANS Prayer
Our Great Father and Creator of all things, may Your perfect ways be established in Earth. May You abundantly supply the needs of our Native American service men and women and their families. Forgive them for their mistakes. May they follow in all Your right paths. WE APPRECIATE THE NORTH AMERICAN NATIVE MEN AND WOMEN of the United States of America
who are putting their lives on the line to protect our nation and the wonderful freedoms we enjoy. We thank our Creator for making this great land available for us and our families to enjoy. We pray that the eternal truths and wise laws and counsel of our Creator will guide our brave men and women and their children and extended family members. We pray that these will guide them to success, joy, and peace. In the midst of their responsibilities and busy schedules, may they have time for adequate rest, an important key to maintaining health of body, mind, and spirit. Adequate rest plays a big part in relieving stress of any kind. Conversely, not knowing how to deal with the stressors of life makes it difficult to get the kind of rejuvenating rest each of us needs. May they understand
that there are three very important areas of life, success in which is essential to their success, happiness, and being able to experience true rest. Number one is our relationships with our Creator, our families, our friends, our co-workers up and down the chain of command, and the relationships in the community where we live. Number two is our work, our career, our education, and other life goals; and our ability to provide well for those we love the most, those to whom we are the closest, and those who depend on us. Number three is loss issues – not only our own losses, but losses sustained by family members, friends, colleagues, co-workers, and mentors. Losses can occur in any of the three important areas of life mentioned above and can include loss of health, work,
finances, special people; on our own part, or sustained by those who are very close to us and important to us. Let’s be an encouragement to our Native American service men and women and their families. It does not seem right that while they are putting themselves in harm’s way to protect our free society, as well as to bless other nations, they would lose their own families and those that they care about the most in this world due to the stress and separation associated with deployments, and the misunderstandings that often result. Often in this life we have traditions, customs, and practices that actually obscure the profound meaning of the great principles of life. May the great Creator help us sort this out so as to bring blessings, true rest, and abundant living to all of us. And may this prayer abound to HIS glory and honor.
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COVID-19 PANDEMIC:
Taking Action to Save our Elders and Ourselves JONI BOKOVOY, DR.P.H., R.N.
Y
ou have heard about a new virus in the coronavirus family, first identified in China in December 2019, which caused an outbreak of deadly respiratory illness that the World Health Organization (WHO) named COVID-19 in February 2020. On March 11, WHO declared COVID-19 a pandemic due to the more than 118,000 cases of this virus in over 168 countries, territories and areas. This virus continues to spread rapidly and now countries are focusing on decisive ways to prevent further spread. Italy and Spain have been severely hit by this disease, causing their healthcare system to be over capacity. They have nationwide curfews and have asked everyone except essential workers to stay home. The United States implemented similar measures across most states. Sadly, as of April 16, 2020, the United States is leading the world for number of cases and deaths from COVID-19. Information about the COVID-19 virus continues to change as more is known about the virus both anecdotally and through research. Treatment protocols continue to change as possible treatments are tested and vaccines are being developed to build immunity towards the virus. Check this site for details about treatments and vaccines: https://www.healthline.com/ health-news/heres-exactly-where-were-at-with-vaccines-andtreatments-for-covid-19#Treatment.
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The death rate is highest for people over age 65 and almost one in five people age 80 and older will die if infected. High mortality rates also impact anyone with altered immune systems, and those suffering from one or more diseases. Many of those who have died from this virus were obese individuals, or had diabetes, heart disease (high blood pressure, heart failure, coronary artery disease) or asthma, or were smokers. What is the best way to make sense of all the information, including what is shared on social media? How can we protect our indigenous populations, American Indians and Alaska Natives? The COVID-19 virus has spread to tribal communities. As of April 16, 2020, Indian Health Service reported 1,212 COVID-19 cases within the system, including 1,042 members of the Navajo Nation, of which 41 died. Navajo Nation is the largest reservation in the United States. Tribal leaders are working with the federal government, public health, state, and local partners to respond to this pandemic. Since our elders are so valued and are most at risk of death should they contract the virus, they are asking us to do all that is within our power to prevent the spread of this deadly virus.
Health | Healing
"How can we protect our indigenous populations, American Indians and Alaska Natives?"
WHAT ORGANIZATIONS SHOULD YOU TRUST?
Stick with reliable sources of truth such as the Center for Disease Control and Prevention (CDC), World Health Organization (WHO) and the National Congress of American Indians (which points to evidence-based resources and highlights advice specific to indigenous communities). • Centers for Disease Control: https://www.cdc.gov/ coronavirus/2019-ncov/index.html • World Health Organization: https://www.who.int/ emergencies/diseases/novel-coronavirus-2019 • WHO live disease map of the “Novel Coronavirus (COVID-19) Situation: https://experience.arcgis.com/exper ience/685d0ace521648f8a5beeeee1b9125cd • National Congress of American Indians: http://www.ncai. org/news/articles/2020/03/13/ncai-update-and-coronaviruscovid-19-resource-webpage • National Indian Health Board: https://www.nihb.org/public_ health/coronavirus_disease_2019.php
HOW DOES IT SPREAD?
• Usually spreads from person-to-person by close contact by mucous droplets from sneezing or coughing. • May also spread through airborne transmission, when tiny
droplets remain in the air or on hard surfaces even after the person with the virus leaves the area. • Diagnosed with a laboratory test.
WHAT CAN YOU DO TO PROTECT YOURSELF AND YOUR FAMILY IF YOU HAVE SYMPTOMS?
If you are mildly sick, stay home. Hospital emergency rooms are currently at maximum capacity. To get tested, contact your healthcare provider, local hospital or public health department. Avoid contact with people, stay in touch with your physician, and don’t use public transportation. Within your home, isolate yourself from your family and pets. https://www.cdc.gov/coronavirus/2019ncov/if-you-are-sick/steps-when-sick.html
PROTECT YOURSELF.
• Treat everyone like they are contagious – “social distancing.” This is good practice. Individuals may not exhibit symptoms while carrying the virus and can easily spread it. The recommendation is to keep a distance of at least six feet between individuals, although be aware that a sneeze or cough can send droplets up to 10 feet away. The CDC now recommends that everyone wear a mask, even if only a homemade cloth one. This will help protect others from your coughs and sneezes. For the best protection, use an F I R S T N AT I O N L I V I N G
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N95 mask (which prevents 95% of large and small particles, including viruses), though right now they are difficult to obtain and are prioritized for frontline healthcare workers. Even if you are young and healthy and have no symptoms, you can spread the virus that could kill those you love and others in your community. Scrub your hands with soap and water and do it often for at least 20-30 seconds. This continues to be the best defense to stop the spread of viruses among individuals. A meme that has been circulating on social media best describes how: “Wash your hands like you just chopped a jalapeno and need to put a contact in.” Washing your hands is especially important if you've been in a public place (grocery store, hospital), or after you blow your nose, cough, or sneeze. Alcohol-based sanitizers may also be used if they contain at least 60% alcohol. Rub your hands together for a minute or so until they feel completely dry. Avoid touching your eyes, nose and mouth. If the virus comes in contact with your eyes or mucous membranes, you can get infected. Stay healthy and build your immune system. A few simple health habits, done daily, can do wonders for your immunity. Here are a few things I am doing. I am exercising by walking at least 10,000 steps each day, approximately five miles. I get seven to eight hours of sleep a night, turning off all electronics at least an hour before bedtime. I drink 1 liter (around 1 gallon) of fresh water a day. If that seems like a
lot, start with at least 6 – 8 glasses of fresh water daily. As I am overweight, I have also been avoiding anything with sugar and am eating a simple, low calorie, plant-based diet. The only supplement I take is Vitamin D. (https://www. healthline.com/nutrition/vitamin-d-coronavirus) • Visit https://www.cdc.gov/coronavirus/2019-ncov/prepare/ prevention.html for detailed instructions.
WHAT ARE THE SYMPTOMS?
Symptoms develop within 14 days after you have been exposed to the COVID-19 virus, and include dry cough, fever, and respiratory distress such as shortness of breath. A sore throat is often the first sign of infection.
HOW QUICKLY WILL THIS PANDEMIC END?
That depends on each of us and our neighbor’s response to our leaders and scientists. If we wash our hands, stay at home for now, limit social contacts, limit large gatherings, the virus will eventually stop affecting individuals and the infection curve will flatten (versus spike) and the pandemic will end more quickly. Do your part. Save an elder. Save your life.
Joni Bokovoy, Dr.P.H., R.N., is an epidemiologist and public health expert who lived through several cholera epidemics during her childhood in Ethiopia. From a young age she learned the value of good hand-washing and hygiene along with social distancing to help prevent the spread of disease. She is passionate about saving lives and ending suffering, particularly in communities that face health disparities. She is a member of the Cherokee nation.
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NATIVE • • • • • • • • • • • •
w e N
HEALTH
DIABETES HEALTHY WEIGHT TOBACCO ALCOHOLISM HEART DISEASE CANCER SUICIDE DOMESTIC VIOLENCE ORAL HEALTH SEXUALITY & YOUR HEALTH BEHAVIORAL ADDICTIONS BALANCE OF LIFE
PROGRAMS ARE HOSTED BY GINA GUIBOCHE AND EDWARD DUNN
NATIVE New HEALTH is an innovative series of health programs designed for
Native people by Native people. This series addresses a number of health topics of special concern to Native People: diabetes, heart disease, cancer, depression, suicide, tobacco, alcoholism, drug abuse and more. Each episode has been designed to generate discussion, and to assist the viewer in making positive lifestyle choices.
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Health | NCAI
ALASKA NATIVES AND THE SUCCESS OF TRIBAL
Dental Health Aide Therapists BY: NATIONAL CONGRESS OF AMERICAN INDIANS
BACKGROUND
Many tribal nations are experiencing devastating oral health disparities. As sovereign nations, they are searching for innovative solutions. Alaska Native tribes have found a solution in their use of Dental Health Aide Therapists (DHATs) and DHATs have become a beacon of hope in providing an effective and innovative public health policy solution. Geographic isolation, historical trauma, and workforce shortages provide a barrier for adequate oral healthcare for many American Indian and Alaska Native (AI/AN) communities. However, in 2004, a group of Alaska Native students trained in New Zealand and became Alaska’s first DHATs. Today, DHATs provide access to mid-level dental care and prevention services for Alaska Native people living in isolated communities across the state. Even more impactful, this program provides a model for tribal nations across the country to address oral healthcare and provide access to underserved and rural populations in a culturally competent manner.
UNDERSTANDING THE PROBLEM
AI/AN people have a higher prevalence of dental caries, more commonly known as
tooth decay, in all age groups as compared to the general population, with many AI/AN children experiencing dental caries before the age of two. AI/AN preschool children have the highest level of early childhood caries (ECC), as compared to their nonNative peers, with a rate of more than four times that of white non-Hispanic children.i If left untreated, ECC can have serious consequences by affecting a child’s growth, causing immense pain and potentially lifethreatening infection, and diminishing a child’s overall quality of life. Within Alaska and across the country, geographic isolation, lack of transportation, shortage of dental clinics, and high costs limit AI/AN access to oral preventive services such as fluoride varnish, fillings, and other common dental procedures. In 2014, more than 2.4 million Native Americans lived in counties with dental care shortage areas, which causes long wait times and often the inability to be seen for non-emergency procedures.ii Tribal communities have long struggled to retain dentists, most of whom are non-Native. According to the American Dental Education Association, American Indian and Alaska Natives make up only 0.1% of the dental workforce.iii For AI/ANs, it is more than likely
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that their dentist is not AI/AN, and does not understand the local tribal language, culture, history, and community.
TRIBAL SOLUTIONS AND LEGISLATIVE HURDLES
These challenges began to change in 2005 when Alaska Native health programs added DHATs to their successful system of health paraprofessionals through the existing Community Health Aide Program (CHAP). A DHAT is a mid-level provider, similar to a Physician’s Assistant, who is formally trained to provide routine and preventative dental care services, including fillings, denture adjustments, and other procedures while practicing under the general supervision of a licensed dentist offsite. For more than 90 years, the DHAT model has been used worldwide with benefit to communities. The DHAT model builds community capacity and creates jobs by training community members to become
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DHATs. Because DHATs are working within their home community, provider turnover is reduced, and continuity of dental care and prevention services is increased. While Alaska Native tribal nations and organizations have been at the forefront of developing this culturally competent system aimed at improving positive oral health practices for their people, challenges still exist in expanding this successful program across the entire United States. In 2010, the Indian Health Care Improvement Act (IHCIA) was permanently reauthorized as part of the Affordable Care Act, and this legislation authorized the expansion of the CHAP program nationally. However, a major limitation in the legislation required state authorization for the use of DHATs.iv As a result, tribal nations across the country are advocating to their state legislators to promote their right to utilize DHATs and address their citizens’
Health | NCAI
oral health needs. Outside of Alaska, only 13 states have authorized the use of DHATs, and eight states are considering allowing DHATs.
CONCLUSION - MOVING FORWARD
In Alaska, the use of DHATs over the last decade has filled a gap where dentists or other dental health providers are not available. DHATs work as part of a dental team under the supervision of a dentist and are a central part of the communities in which they serve. In Alaska, DHATs have served 45,000 individuals, and many of the elementary schools that they serve have started cavity-free clubs. In 2006, the Swinomish tribal nation used its sovereignty to create its own licensing standards before the state passed its own legislation in 2017. As a result, the Swinomish dental clinic has increased its patient load by 20% since 2016, and increased complex rehabilitative care by 50%.v While much work has been done to expand the use of DHATs across the country, it will take a united effort to achieve true oral health equity in our communities. Governments, tribal leaders, advocates, and families all share in the responsibility to eliminate health disparities in underserved communities. Alaska Native tribal nations have provided the example for us to follow – now it is up to us to ensure that this generation will be the last to suffer from the lack of culturally competent oral health care services.
i "The oral health of American Indian and Alaska Native children aged 1-5 years: results of the 2014 IHS oral health survey." Indian Health Service data brief. Rockville, MD: Indian Health Service. 2015. ii The Oral Health Crisis Among Native Americans. Pew Trust, Research and Analysis Fact Sheet. July, 2015. iii Valachociv, R.W. Current demographics and future trends of the dentist work force. Available at: http://www. nationalacademies.org/hmd/~/media/Files/Activity%20 Files/Workforce/oralhealthworkforce/2009-Feb-09/1%20 -%20Valachovic.ashx. iv SCA 1616l (d)(2)(B), (d)(3)(A) (2010) v Cladoosby, B. "Indian Country Leads National Movement to Knock Down Barriers to Oral Health Equity." American Journal of Public Health, 107(S1) (2017) S81–S84. https://doi.org/10.2105/AJPH.2017.303663
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NCAI Events 2020 - 202 2
► 2020 Annual Convention & Marketplace Oregon Convention Center, Portland, OR Nov 8, 2020 - Nov 13, 2020
► 2021 Annual Convention & Marketplace Sacramento Convention Center, Sacramento, CA Oct 9, 2021 - Oct 15, 2021
► 2021 Executive Council Winter Session Hilton National Mall, Washington, DC Feb 21, 2021 - Feb 25, 2021
► 2022 Executive Council Winter Session Hilton National Mall, Washington, DC Feb 13, 2022 - Feb 17, 2022
All events reflect dates and information on the NCAI website at press time.
Go to http://www.ncai.org for more event information.
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A M E R I C A N I N D I A N & A L A S K A N AT I V E L I V I N G
R E SOU R C ES
NCAI COVID-19 Data - Situation Summary The National Congress of American Indians (NCAI) Policy Research Center has tracked publicly available data on COVID-19 cases and deaths in Indian Country during the pandemic. View our latest NCAI COVID-19 Data - Situation Summary documents at https://bit.ly/2zvyExc. NCAI COVID-19 Resources for Indian Country Website The National Congress of American Indians (NCAI) hosts a COVID-19 Resource Website that includes the following content: • Administration and Legislative Updates, including policy and stimulus funding information • Resources on COVID-19 from trusted sources • Information on how you can get involved, including donating to our COVID-19 Response Fund To access the NCAI COVID-19 Resource Website, visit COVID-19. NCAI Financial Relief for Tribal Nations Affected by COVID-19 With the continued spread of the novel coronavirus (COVID-19), NCAI is committed to supporting Indian Country and lifting up our communities as we continue to combat this global pandemic. NCAI is awarding $5,000 to various tribal nations that have been affected by this pandemic through NCAI’s COVID-19 Response Fund for Indian Country. Applications will be reviewed on a rolling deadline until available funds are exhausted. For more information on the COVID-19 Relief Fund or to make a donation, please click here. NCAI Contact: Christian Weaver, Vice President of Development, cweaver@ncai.org
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NIHB Events 2020 - 2 02 1
► POSTPONED: National Indian Health Board 11th Annual National Tribal Public Health Summit CHI Health Center, Omaha, NE ► National Indian Health Board 37th Annual National Tribal Health Conference Dena’ina Convention Center, Anchorage, AK September 14-18, 2020
All events reflect dates and information on the National Indian Health Board website at press time.
Go to http://www.nihb.org for more event information.
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R ESOU R C ES
COVID-19 Contact The National Indian Health Board is committed to serving Tribal Nations in response to the coronavirus outbreak. We welcome your requests and feedback. Contact Courtney Wheeler at cwheeler@nihb.org or 202-507-4081. Tribal COVID-19 Resources To aid Tribes to build on successes and support each other in the collective effort to mitigate the impact of the pandemic on Indian Country, the National Indian Health Board (NIHB) is seeking to create a pool of resources which Tribes can access when planning or implementing their own COVID-19 response. Please share with us any tools, operational plans, guides, policies, communication products, etc. that has helped your Tribe combat this pandemic. To submit any materials or resources or ask questions, please email Courtney Wheeler (cwheeler@nihb.org). Indigenous Knowledge of Blood Lead Level Testing NIHB is working in partnership with the Centers for Disease Control and Prevention (CDC) to increase the capacity of rural and non-urban Tribal communities for identifying and addressing elevated blood lead levels in Tribal children. To accomplish this, NIHB seeks to engage Tribal representatives and health professionals in 20-minute key informant interviews. Protecting children from exposure to lead is important to lifelong good health. If you are interested in this opportunity, please contact Sara Zdunek at szdunek@nihb.org or 202-507-4077. Smallest Warriors, Our Strongest Medicine: Overcoming COVID-19 This children’s book from the Johns Hopkins Center for American Indian Health addresses the potential mental health impact of the coronavirus pandemic on children by re-telling the story, My Hero is You. The Center convened a Native American collaborative to adapt the story and commissioned a Native youth artist, Joelle Joyner (Kauwets’a:ka/Tsalagi/ Pikuni), to create new illustrations. Read more here. F I R S T N AT I O N L I V I N G
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Health | Healing
How Can We Find
REST IN GRIEF?
I
t was the end of a six-week grief support group called Grief Options. As the attendees reflected about what they each experienced, I found it interesting that over half of the group mentioned their appreciation for the group dynamic. “It really comforted me to know I wasn’t alone,” was the repeated comment. For many, the isolation of grief had added significant pain to their already broken heart. The group in the Grief Options meetings found support from one
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BY KAREN NICOLA, M.A.
another. They found strength and courage. They also found rest from their pain as it subsided through the healthy grief choices they learned to make. What are we to do when we go through difficult seasons in our lives? So often our pain and suffering cannot be understood by others. They might wish we would stop being sad. They would rather we pretend or save our sorrow for another time, preferably when they are not around or when the culture approves. Have you felt this? Do you feel alone in your loss?
DID IT HAVE TO END THIS WAY?
I once heard the legend of a Warrior Chief and his beloved wife. Sadly, the Chief died in an important battle against evil. However, instead of honoring his death by raising their baby to follow justice and goodness, her grief overtook her. Rather than gaining strength from her community and finding hope in healing that comes to the broken hearted, she chose the unthinkable. Before anyone in the tribe could stop her, this widow,
Health | Healing 3. The last healthy option is to forgive. When we make this choice, our souls find the deepest level of rest in our grief. Let’s look at these healthy choices more closely.
SPOKEN PAIN
Our body is not designed to carry the stress of grief pain. The chemicals it produces are helpful for survival, but not for thriving or healing. This will require a choice or action on our part to release the stress. When we talk with trusted people in our community it helps us to release the stress from built up emotions. It is important to know the person you are sharing with will not cast judgment on you. They just need to listen and show they genuinely care. If there is no one you can safely talk with, talking aloud in nature and to the God of nature is another option. Will you find the time to be in nature? Will you speak to it of your deep sorrow and pain, your longing in your heart for the person who meant so much to you? Will you leave your hurt with the soil of the earth, trusting the next season of rain to wash it away? Will you breathe it out of your body and know the wind will carry it away and look to God to bring healing?
WRITTEN PAIN
crazed with grief, climbed the nearby mountain and hurled herself and her baby over its edge. This young widow and mother did not know she could grieve with hope, healing, and rest from her sorrow and suffering.
THERE IS A BETTER WAY
I must tell you: the Creator is near to comfort and to heal. As we are open to believe this potential for the deep ache in our lives, it can help us become aware of other healthy choices we can make in our grief.
1. Talking with someone who will listen without judgement is very useful. Our spoken pain can also be expressed in nature. There we find that nature and the God of nature is big enough to carry our pain and give us rest. 2. Releasing the pain through our written words also relieves the tension or stress of emotions, thoughts, questions, doubts, and fears that get too crowded in our hearts or minds.
I used to encourage my grief coaching clients to journal or write, but I don’t do that anymore. When we write, it often feels like a school assignment. Broken hearted words on paper have nothing to do with school. Our broken hearts are messy, unorganized, unpredictable, and random. Therefore, our words on paper must reflect that same disorganized pattern. I suggest focusing more on free writing ~ simply putting pen to paper because it is when we put our stuff on paper by describing the way it feels inside of us, real healing can begin to take place. We experience relief and rest in the process. If you have never put your grief on paper, please give it a try. It is one of the best healing tools that is equally free and available to all people.
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FORGIVEN PAIN
To experience the deepest rest from the sorrow of our grief, we must work through our blame, regrets, and guilt. Carrying that baggage with us for the rest of our lives robs us of peace and joy. It may very well be the most profound cause of substance use and abuse. When we cannot and do not engage in the hard work of living to forgive, we damage ourselves. When we live with that kind of damage, we begin to hurt others around us. The Native Wellness Institute provides some excellent advice: “Forgiveness is another difficult phase for those who are grieving over a tragic, unexpected death. During grief of this type, a lot of blame is laid in many directions. Before the mourner will be able to finish grieving, they will need to forgive those that they have been blaming for the loss. Sometimes it is the person who died. Sometimes it is the boyfriend or girlfriend who they think caused it. Sometimes it is God, and they lose faith, or get angry with God. Sometimes the griever blames himself or herself, like there was something they could have done to prevent it. Whoever, or whatever, they feel is at fault must be forgiven or the grief will continue to haunt them.”1 When we choose to forgive another, it never condones the wrong or hurt that was caused. It will never excuse his or her behavior. What it does do is set us free from the resentment, bitterness, hatred, and the desire for revenge that hurts us worse than the one we are withholding our forgiveness from. Please talk this through with someone you trust. Please pray it through with God who knows how much forgiveness cost Him and yet God still originates forgiveness toward all.
REST IN YOUR GRIEF
There is rest of soul and spirit when we forgive and accept forgiveness. There is rest when we share our burdens with God and others who care. There is peace of mind
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Rest in Your Grief There is rest of soul and spirit when we forgive and accept forgiveness. There is rest when we share our burdens with God and others who care. There is peace of mind when we release our words in nature or on paper. These are a few healthy grief choices that will bring rest and healing in your grief. If the Chief’s widow had practiced healthy grief, she could have raised a mighty new leader in her tribe. Making the choices for healthy grief are worth it for one’s self as well as for the future of the community.
when we release our words in nature or on paper. These are a few healthy grief choices that will bring rest and healing in your grief. If the Chief’s widow had practiced healthy
grief, she could have raised a mighty new leader in her tribe. Making the choices for healthy grief are worth it for one’s self as well as for the future of the community.
https://www.nativewellness.com/uploads/4/6/7/8/4678037/griefandlossagendahandoutpacket.pdf. Used with permission.
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Health | Dental Care
SERVICE WITH A
SMILE
BY DANNY KWON, J.D.
A
partnership between Life and Health Network (Life and Health) and Caring Hands Worldwide (Caring Hands) brought many smiles to residents of Eugene, Oregon, including many Native Americans, in November 2019. Life and Health was able to operate dental and vision services thanks to donors, volunteers, and with dental equipment provided by Caring Hands, a non-profit located in Oregon that started offering mobile dental clinics four years ago. Prior to this, they operated dental trucks with two dental chairs per truck that served as a mobile dental office. Caring Hands provided the dental equipment and the Daniel Miguel Foundation provided the optometry equipment. At the clinic event, Life and Health deployed a unique registration software that allows the detailed record-keeping of each patient throughout their visit and treatment.
More than 100 volunteers including 11 dentists, seven hygienists, three optometrists and one endocrinologist provided flu shots and health counseling. The Oregon Dental Board was particularly helpful to the volunteers. In all, the Life and Health Free Clinic at Eugene was able to serve 384 patients over two days with 255 dental (over 400 procedures) and 159 vision patients. A medical doctor saw 10 patients and administered 77 flu shots at the clinic and provided lifestyle counseling. The mission of Life and Health is to help everyone achieve balance in the “physical, emotional, and spiritual domains” of their life. “Our goal is to inspire and engage the global community to achieve that balance by living healthier and more abundant lives,” (lifeandhealth.org).
"The mission of Life and Health is to help everyone achieve balance in the 'physical, emotional, and spiritual domains' of their life"
Restorative work done by the dentists include this person who had all of his cavities filled and teeth restored using composite.
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Health | Hope
FOSTERING HOPE
in Alaska’s Native American Communities BY: MYLON MEDLEY
A SOCIAL WORKER NURTURES CHILDREN FROM ISOLATED, IMPOVERISHED VILLAGES WHO NEED SAFETY, STABILITY, AND COMPASSION.
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Health | Hope
I The Evans' six children (four biological and two adopted) pose during the holiday season.
Shoni and Michael Evans Provided by Shoni Evans
understand you want to be a foster mom,” said a woman who’d knocked on the Evans family’s front door in a small community in Alaska. “I . . . maybe,” replied Shoni Evans nervously. “Well, these two babies need a foster mom,” the woman said insistently. Evans had seen these native babies before with their foster mom at the local Adventist church she attended. But during this reintroduction the woman holding them brought them into the Evans home and laid them on their couch along with medical equipment. “They had been stepped on and had punctured lungs. They were not in good shape,” said Evans. The woman left to send a health-care provider to teach Evans how to care for the babies’ tremendous needs. Later that evening Evans’ husband returned home from work. “I left and there were two [babies]. I come back, there’s four. What did you do?” asked Shoni’s husband. “Aren’t they precious? We’re going to be foster parents,” Evans replied. This was not what the newlyweds had planned on, considering they were fresh out of Southern Adventist University with two small babies and mounting bills. They’d recently moved from the Collegedale, Tennessee, area to Bethel, Alaska, where Michael was given the opportunity to be a pilot for Grant Aviation, a regional airline that operates in the state. Because of conflicts with work scheduling and Sabbath observance, Michael took a job with Bering Air, which was based in Nome, a town in western Alaska right below the Arctic Circle. Nearly two decades ago the couple joined the small Adventist community that nurtured them and welcomed them in various ways, including the unexpected visit with the doubly unexpected gift.
A STATEWIDE CRISIS
In recent years Alaska’s rate of children in foster care has remained more than double the rate of the lower United States, according to a 2018 publication by Alaska Children’s Trust.1 In 2016 alone, 2,810 children were in the Alaskan foster care system. Further, while Alaska Native American children make up about 20 percent of all children in the state, they accounted for about 60 percent of all children in foster care from 2006 through 2013, according to a 2014 study conducted by the Institute of Social and Economic Research2 of the University of Alaska—Anchorage. The numbers have captured the attention of Alaska’s leaders who consider it a “crisis.” This served as the foundation for the signing of the Alaska Tribal Child Welfare Compact3 Between Certain Alaska Native Tribes and Tribal Organizations and the State of Alaska on December 15, 2017. Many of the 229 federally recognized Alaska Native American tribes committed to supporting the state’s Office of Children’s Services and other agencies with the goal of preserving native family structures
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Shoni and four of her children enjoy the July 4th holiday. Provided by Shoni Evans At the NEST homeless shelter in Nome, Alaska, one of the places Shoni Evans helps out, residents eat a meal together. Provided by Shoni Evans
and creating more healthy environments for children to flourish. Socioeconomic ills broadly affect Alaska Native American communities that are scattered throughout the state—some are as far north as the Arctic Circle, others can be found among the Aleutian Islands of Alaska, an archipelago scattered westward in the Pacific Ocean and stretching toward the International Date Line. The disparities relate to education attainment, poverty, and household income, according to a 2017 report by the Alaska Native Tribal Health Consortium.4 The disparities are particularly felt among Alaskan Native Americans under the age of 20, who make up a third of the native population. Of the 10,000 children living in the state’s highpoverty areas, 9,000 are Alaska Native American.5 Because of the isolated nature of the villages, there are geographically based systems called “hubs” that provide access to a variety of resources and services, including hospitals, grocery stores, and
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airports. Nome, where Evans lives, is a hub for Alaska’s Norton Sound region. “We have a town of 2,300 people. We’re beyond the road system, we have to fly everywhere. As a hub, our town serves 19 smaller villages. These villages can be anywhere from 25 people to our largest one of 750,” said Evans. “There’s extreme poverty in the villages. Some don’t have infrastructure for water and sewer. In some of our villages, it’s like a Third World country.” Evans is a family service social worker for a children’s home that is part of the Nome Community Center. The home serves as an emergency shelter for up to 10 children at a time. The center, equipped with staff of 16, can take children as young as infants all the way to 18-year-olds. She has nurtured more than 300 children during her nearly 20 years of working with the home. Under their care the children go to school and engage in a wide variety of activities from dog-mushing to swimming in the ocean. “We usually get called from state social
workers. The children staying in our home can come from any one of those 19 villages. We can get called anytime, day or night,” said Evans. “We bring them into the home. We feed them. It’s always one of the first things . . . we give them lots of hugs and assurance that they’re in a safe place now. We love them. We hold them. We pray with them. We sing to them. They learn about Jesus through our staff. We want them to have a happy life.” Most of the children stay between three and six months. Allowances are made for longer stays if a healthy, permanent home is not located quickly. Evans and her staff aim to place children in their own villages, if possible. “The children are amazing. They’re resilient, but there’s such a drug and alcohol problem out there. There’s a hopelessness,” said Evans. “The children struggle because they have nowhere to go. They see that their future is the drug and alcohol [abuse] that they see while growing up in their villages.”
Health | Hope
"The children struggle because they have nowhere to go. They see that their future is the drug and alcohol [abuse]. . . . " Haley, the Evans' adopted daughter, poses with her dog team. One of Haley's hobbies is mushing. Provided by Shoni Evans
PLANTING SEEDS
Evans cherishes every interaction with every child she comes into contact with through her work. She believes lasting impacts are born in those moments. “I can give some hope to these children— even those I meet for a brief moment. God allows me to have some in my arms for five minutes, while we’ve been able to have others for 18 years. It doesn’t matter how long we have them. God allows us to plant a tiny seed of hope within their hearts.” Evans’ deep well of compassion is drawn from her own experiences from childhood and adolescent years. “I’m adopted by an amazing family, so adoption has always been close to my heart. I want to give these children what my adoptive family gave me,” said Evans. Growing up, she struggled with a learning disorder and had trouble excelling in the classroom. “School never came easy. Friends never came easy,” Evans said. “My first year in college I totally failed.”
During her second year of college she had a professor who helped her realize that her failures could be used as a blessing for others. “Shoni, you can do this. I believe in you, and you can help children like you because you have been there. You have felt it. You understand,” recounts Evans of her conversation with the professor. With newfound determination, and the assistance from the same professor who would also edit her papers and help her study for tests, Evans was able to complete college. From that initial conversation, she knew she wanted to dedicate her life to helping children.
MEET HALEY
A shining example of Evans’ commitment to helping Alaskan Native American children is through the adoption of her youngest daughter Haley. Evans knew Haley before Haley came into the world. She had worked with Haley’s biological mother and developed a friendly relationship with her. When Haley was born
10 weeks premature, Evans’ husband served as a medevac pilot to get the mother and Haley to Anchorage for medical care. Haley was two pounds eight ounces at birth and had drug addictions because of her mother’s drug use. She spent five weeks in the neonatal intensive-care unit (NICU). Evans planned to adopt Haley, and had arranged for her mother to still have a place in her life. “She was an amazing young woman, I grew to love her,” said Evans of Haley’s mom. “She had a lot of struggles with drugs and alcohol. She had talked to us and had consented to go to rehab.” Evans said the young woman had her family’s full support and thanked God for the enthusiasm directed toward recovery. But shortly after calling Evans to share her desire to go through rehab in an effort to have Haley fully back in her life again, Haley’s biological mother committed suicide. “It was very hard,” said Evans. “After her mom passed away, her grandfather would come see Haley about every afternoon. He
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Alaska Children’s Trust, “Alaska Family and Community,” static1.squarespace.com/ static/586370cec534a5dbdedba846/t/5c68 661f085229f287660e67/1550345794451/ KIDSCOUNT-Family-Community-Report. pdf, accessed Jan. 30, 2020. 2 Diwakar Vadapalli, Virgene Hanna, and Jessica Passini, “Trends in Age, Gender, and Ethnicity Among Children in Foster Care in Alaska,” iseralaska.org/static/legacy_ publication_links/2014_12-TrendsInAgeGe nderAndEthnicityAmongFosterChildrenInA laska.pdf, accessed Jan. 30, 2020. 3 “Alaska Tribal Child Welfare Compact Between Certain Alaska Native Tribes and Tribal Organizations and the State of Alaska,” Dec. 15, 2017, static1.squarespace. com/static/586370cec534a5dbdedba846/t/5c 68661f085229f287660e67/1550345794451/ KIDSCOUNT-Family-Community-Report. pdf, accessed Jan. 30, 2020. 4 Alaska Native Tribal Health Consortium Epidemiology Center, “Alaska Native Health Status Report,” Second Edition. August 2017, anthctoday.org/epicenter/ publications/HealthStatusReport/AN_ HealthStatusReport_FINAL2017.pdf, accessed Jan. 30, 2020. 5 Alaska Children’s Trust, “Alaska Family and Community,” static1.squarespace.com/ static/586370cec534a5dbdedba846/t/5c68 661f085229f287660e67/1550345794451/ KIDSCOUNT-Family-Community-Report. pdf, accessed Jan. 30, 2020. 1
loved her. He’d sit in my big rocking chair and rock her. It was absolutely a beautiful thing. But he wasn’t healthy enough to take care of her.“ Haley’s grandfather passed away when she was three months old. He was the last family member who would have been able to take her.
MIRACLE CHILD
Haley had severe medical issues that stemmed from complications surrounding her birth. She was born with a hole in her heart and needed a heart and lung machine until she was 9 months old. She also had twisted bowels, and impaired vision and hearing on her right side. She needed to be medevaced three times in her first year of life because her heart had stopped beating or she had had difficulty breathing. Evans was adamant that Haley remain connected with her extended family, who loved her but were unable to take care of her. Haley’s aunt—her biological mother’s sister—was the person who
approached Evans about officially adopting Haley. “I wrapped my arms around her and said, ‘Eva, you’re not losing a niece, you’re gaining a sister.’ We have always raised Haley that way,” said Evans. Haley is now 10 years old. Most of her health issues miraculously resolved themselves over the years, which has stunned her health-care providers. She’s in the fifth grade and is homeschooled by Evans, and assists her mom at work by playing with the babies living in the children’s home. Haley also takes every chance she can to mush with her team of dogs. Haley is blessed to be part of two loving families—her biological family and her adoptive family, which is made up of Shoni, her husband, Michael, their four biological children, and two adopted children, including Haley. “God healed her for a purpose,” said Evans. “I don’t know what that’s going to be, but it’s going to be a lot of fun to sit back and see why Haley is who Haley is.”
Mylon Medley is an assistant director of communication for the North American Division of Seventh-day Adventists.. This article was reprinted with permission and originally appeared in the April 2020 issue of Adventist Journey magazine.
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Health | Exercise
STRENGTH
Exercises BY CAROLINE A. FISHER, M.A. The following exercises can be done to strengthen your hips, legs, upper body and back. Start slowly and try to make each movement smooth.
A. STAND “UPS”
• Sit on the edge of a chair with a back but no arms. • With feet about 12 inches apart, look straight ahead. • With your arms at your sides, slowly rise to standing without using your arms or hands. • Slowly sit back down without using your arms or hands. • Repeat five times.
B.
To strengthen your upper body:
WALL PUSH-UPS
• Stand approximately two feet away from a wall. • Place your hands against the wall at shoulder height. • Slowly bend your elbows, so your chest is nearer to the wall, while keeping your body in a straight diagonal line. It’s okay if your heels come off of the floor a little bit. • Pause, then slowly straighten your elbows and return to your original position. • Repeat five times.
C. To strengthen your hips and thighs:
SEATED MARCH
• Sit upright but do not lean on the back of the chair. Hold on to the sides of the chair seat. • Lift one leg with your knee bent only as far as is comfortable. Slowly place your foot down on the floor. • Repeat with the opposite leg. • Repeat march five times using controlled, smooth movements.
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Health | Recipes Eating to thrive means cooking tasty food that is also nutritious! Traditional foods are some of the healthiest foods. Cooking with our families strengthens our traditional ways while providing the best nourishment to help prevent chronic conditions. The following recipes use earth's bounty to create part of a delicious meal.
REC
IPE ONE
Italian Mushroom SEASONED POLENTA
Polenta, and cakes made from it, are dishes enjoyed in Italy for centuries—not bad, considering they didn’t have corn until it arrived from the New World in the 1500s. But grains slow simmered into a porridge are a hearty and flavorful dish, especially when combined with mushrooms and a dash of red pepper for spice. The combination of polenta and mushrooms in particular is potent, boosting each other’s antioxidant health benefits. Try this recipe using coarse, stone-ground grits and lemon thyme with a bit of freshly-grated lemon zest for a bright, toothy variation. PREP INSTRUCTIONS: Yield: 8 (1/2 cup) servings Prep Time: 5 minutes RECIPE INGREDIENTS: 1 ½ teaspoons olive oil 1 cup mushrooms, sliced ¾ teaspoon fresh thyme, minced ¾ teaspoon fresh garlic, minced ¾ cup polenta, dry
Cooking Time: 7 minutes Total Time: 12 minutes
2 ¼ cups water 2 tablespoons fresh parsley, chopped A pinch of nutmeg ¼ teaspoon red pepper flakes
INSTRUCTIONS: • Follow the prep technique next to each ingredient. • In a medium size skillet sauté mushrooms, using water to avoid burning. After mushrooms are cooked, add thyme and garlic; cook until the aroma is released. Set aside. In a medium saucepan, bring the water to a boil and slowly add the polenta, stirring continuously as it starts to thicken. Add the seasoning and fold in the mushroom mixture. Remove from heat and serve or place into a shallow dish and refrigerate for later use. After complete cool down you can shape it as desired, sear it, or grill it. CREATED BY Chef Edwin Cabrera Copyright © AdventHealth Press Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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F I R S T N AT I O N L I V I N G
Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories 71.16 fat 0.93g sat fat
0.13g
cholesterol 0mg sodium 33.11mg carbohydrates 14.13g fiber 1.66g sugars 0.19g protein 1.85g
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Health | Recipes
RE
CIPE TWO
Andalucian-Spiced GARBANZO STEW
Flavors of Andalucía by way of Portugal and North Africa infuse this simple chickpea stew with exotic tastes and aromas. With high protein and fiber content, and exceptional levels of iron, magnesium and amino acids, chickpeas are a near-perfect low-cholesterol food. No need to soak beans or grind spices when even the most available ingredients result in a flavorful and filling dish that is easily customizable to your tastes. Use smoky or sweet paprika, spicier mixes of chili powder, or add chopped fresh tomatoes or a few handfuls of fresh spinach and a squeeze of lemon to create a new dish every time.
PREP INSTRUCTIONS: Yield: 7 (1 cup) servings Prep Time: 7 minutes RECIPE INGREDIENTS: 1 tablespoon olive oil 1 ½ teaspoons paprika ½ cup sofrito 1 ½ teaspoons chili powder 2 tablespoons tomato paste 1 teaspoon ground cumin
Cooking Time: 15 minutes Total Time: 22 minutes
1/8 teaspoon ground cumin or 1 bay leaf 2 teaspoons dried oregano 2 (28 oz.) cans garbanzo beans, low sodium ¼ cup fresh cilantro, chopped ¾ teaspoon fresh garlic, chopped
INSTRUCTIONS: • Follow the prep technique next to each ingredient. • In a stock pot over medium heat sauté sofrito in olive oil with the garlic, oregano, bay leaf, and tomato paste. Add garbanzo beans and fold in the spices. Simmer on moderate heat for 20 minutes. Remove from heat and fold in the chopped cilantro. CREATED BY Chef Edwin Cabrera Copyright © AdventHealth Press
Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories 202.96 fat 7.65g sat fat 3.27 cholesterol 12.70mg sodium 218.99mg carbohydrates 20.75g fiber 3.33g sugars 11.39g protein 5.62g
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Health | Recipes CIPE THREE E R
Creamy Mascarpone Polenta WITH SQUASH RIBBON SPAGHETTI
Ciao, bella! This molto Italiano dish turns pasta on its head by putting the actual pasta below the “noodles.” Made of thin ribbons of yellow and green squash, mingled with that strangest of gourds—the spaghetti— and supported by a creamy and indulgent mascarpone polenta. Think cheese grits, Neapolitan style. PREP INSTRUCTIONS: Yield: 8 servings Prep Time: 20 minutes
Cooking Time: 50 minutes Total Time: 1 hour, 10 minutes
RECIPE INGREDIENTS: For the Three-squash Spaghetti: 4 cups spaghetti squash, cooked (about 3 lbs. whole) 2 teaspoons fresh garlic, minced 1 ½ cups zucchini squash, seeded and thinly sliced 1 tablespoon fresh basil, shredded 1 ½ cups yellow squash, seeded and thinly sliced For the Mascarpone Polenta: 1 ½ cups skim milk ½ teaspoon marjoram ½ cup water ½ teaspoon rubbed sage
½ teaspoon fine black pepper ¾ cup carrots, julienned 1 teaspoon Italian parsley, chopped ¾ cup plum tomatoes, seeded and diced a pinch of kosher salt ½ teaspoon olive oil
1 cup polenta 1/8 teaspoon cayenne pepper a pinch of nutmeg 3 tablespoons mascarpone cheese
INSTRUCTIONS: • Follow the prep technique next to each ingredient. Preheat oven to 350˚ F. • Cut spaghetti squash lengthwise; remove seeds. Place squash face down in a roasting pan; add water to cover at least ¼ inch of the squash. Place in the oven; cook for 35-45 minutes. Remove from oven and scrape the inside. Set aside. In a heated skillet, add the olive oil; sauté the zucchini, yellow squash and carrots, adding water to create steam. Add the diced tomatoes and garlic. Fold in the spaghetti squash, fresh herbs and spices. • For the Mascarpone polenta: Place the liquid ingredients and spices in a small saucepan; simmer over medium heat. Slowly drizzle polenta; whisk constantly until it thickens. Add the mascarpone cheese; mix well. Serve mascarpone polenta with three-squash spaghetti. CREATED BY Chef Edwin Cabrera Copyright © AdventHealth Press Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories 230 fat sat fat cholesterol sodium carbohydrates fiber
7g 0.79g 0mg 341mg 34g 11.12g
sugars
7g
protein
12g
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Health | Recipes
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CIPE FOUR
Italian Bean, Vegetable, AND PASTA STEW
Pasta fagioli (pronounced “fah-ZHOO-lee) literally means “pasta and beans”, and is a traditional stew/ soup of Italy and Sicily. Traditionally made with short tube-like ditalini pasta, it is very forgiving of style and requires just a “macaroni” type pasta. And feel free to use any canned beans available—Italians typically add white cannellini or the lovely pink cranberry beans they call borlotti, but any beans other than seasoned black beans will work. The combination of proteins in the beans and pasta, along with the squash and potatoes, makes this a complete meal.
PREP INSTRUCTIONS: Yield: 8 (1 cup) servings Prep Time: 20 minutes
Cooking Time: 25 minutes Total Time: 45 minutes
RECIPE INGREDIENTS: 1 ½ tablespoons olive oil ½ cup butternut squash, chopped ½ cup celery, diced 2 cups northern beans, drained and rinsed ½ cup yellow onion, diced 1 ½ cups, fresh tomatoes, diced 1 teaspoon fresh garlic, minced 2 ½ cups low sodium vegetable broth 1/3 cup carrots, diced
¼ cup green onion, chopped 1 bay leaf ¾ cup green beans, snipped and cut 1 inch long 1/8 black pepper ¾ cup zucchini squash, chopped ¾ cup potato, chopped ¼ cup fresh basil, shredded ½ cup dry pasta shells
INSTRUCTIONS: • Follow the prep technique next to each ingredient. • In a medium size stock pot add olive oil and sauté the celery, onions, carrots, garlic and bay leaf. Fold in the potatoes, butternut squash, green beans, pasta, northern beans and tomatoes with the vegetable broth. Bring the soup to a gentle boil, cover and lower the heat to a low simmer, cook for 15 minutes. Add the rest of the ingredients and simmer until squash is tender but firm. CREATED BY Chef Edwin Cabrera Copyright © AdventHealth Press Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories
135.47
fat
3.32g
sat fat
0.41g
cholesterol sodium carbohydrates
0mg 154.91mg 22.39g
fiber
5.99g
sugars
4.56g
protein
4.53g
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Health | Recipes RE C
IPE FIVE
Italian Orange
AND CRANBERRY POLENTA Polenta is a grand Italian tradition enjoyed for lunch, dinner and yes, breakfast. Think of the texture of grits, cream of wheat, even oatmeal, then add the nuttiness of cracked corn polenta, low in calories and gluten-free. Cooked until the savory flavors of cranberry, orange and sweet apricot marmalade are soaked into every chewy little grain. Watch the pot carefully while it cooks, and stir often. The reward is a filling and delightful start to the day.
PREP INSTRUCTIONS: Yield: 4 (3/4 cup) servings Prep Time: 4 minutes
Cooking Time: 7 minutes Total Time: 11 minutes
RECIPE INGREDIENTS: 2 cups 1% milk 1 ½ teaspoons honey 1 tablespoon apricot preserve, sugar free ¾ cup polenta, dry, fine ¼ teaspoon kosher salt
3 tablespoons dried cranberries ¼ teaspoon orange extract or 1 teaspoon orange zest
INSTRUCTIONS: • Measure ingredients. Set aside. • Combine wet ingredients together. • In a medium size sauce pan bring milk to a rapid simmer and drizzle the polenta slowly to avoid clumps. Lower heat and add the rest of the ingredients. Whisk constantly until the polenta is cooked through.
Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories
200
fat
1.27g
sat fat
0.78g
cholesterol sodium
6.10mg 173.96mg
carbohydrates
41.18g
fiber
3.83g
sugars
11.94g
protein
7.12g
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Health | Recipes REC
IPE SIX
Southwest Pepper,
SQUASH AND CARROT HUEVOS Give breakfast a Southwestern flair with this easy omelet. Chipotle and chili pepper provide a warm spiciness, while cumin and zucchini is a natural taste union. This omelet is so chockfull of vegetables it will make a perfect start to the day or a healthy low-fat, high-fiber lunch item, and it is hearty enough to save and serve as a cold side dish. For quick individual servings, try pouring the egg mixture into a cooking spray-prepared muffin tin and bake for 5 minutes until set. PREP INSTRUCTIONS: Yield: 4 servings Prep Time: 5 minutes RECIPE INGREDIENTS: ½ cup yellow onion, diced ¼ teaspoon ground chipotle ¼ teaspoon ground cumin ½ tomato, diced ½ teaspoon chili powder 5 large eggs
Cooking Time: 10 minutes Total Time: 15 minutes
½ cup carrot, shredded ¼ teaspoon kosher salt ½ cup red bell pepper, diced 1 tablespoon cilantro, chopped ½ cup zucchini squash, diced nonstick cooking spray
INSTRUCTIONS: • Preheat oven to 350˚F. • Follow the prep technique next to each ingredient. • In a small skillet sauté the onions, peppers, zucchini, carrots and spices with nonstick cooking spray, except the tomatoes. When vegetables start to caramelize, (adding water if necessary) beat the eggs with the salt and cilantro. Fold into the sautéed vegetables. Place the tomatoes on top and cook on the stove until the bottom of the eggs start to set. Transfer the pan to the oven and bake for 8-10 minutes or until golden on top.
Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories
117.08
fat
6.11g
sat fat
1.98g
cholesterol
232.50mg
sodium
278.05mg
carbohydrates
6.19g
fiber
1.38g
sugars
3.55g
protein
8.87g
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Health | Recipes CIPE SEVEN E R
Three Bean Chili WITH CORN
So full of flavor and packed with a nutritious trio of beans, colorful and sweet corn, and a generous addition of spices, here’s a chili that will sustain the crowd and is a complete meal by itself. The trio of beans adds a healthy portion of protein and fiber. For an extra burst of deep flavor, cook the onions first over moderate heat until they are a rich caramelized brown before adding other ingredients.
PREP INSTRUCTIONS: Yield: 15 (3/4 cup) servings Prep Time: 15 minutes
Cooking Time: 20 minutes Total Time: 35 minutes
RECIPE INGREDIENTS: 1 tablespoon olive oil 1 cup tomato sauce 2 cups yellow onion, diced 1 ¾ cup garbanzos beans, low sodium, drained and rinsed 1 ½ green bell pepper, diced 1 ¾ cup black beans, low sodium, drained and rinsed 2 tablespoons fresh garlic, minced 1 ¾ cup pinto beans, low sodium, drained and rinsed 1 teaspoon fresh thyme, chopped
1 ½ cup sweet corn, drained 2 teaspoons chili powder 1 teaspoon kosher salt 1 teaspoon ground cumin 1 cup water 1 tablespoon dried oregano ¼ cup cilantro, chopped ¾ teaspoon ground chipotle pepper ½ cup fresh parsley, chopped 6 cups canned diced tomatoes in juice
INSTRUCTIONS: • Follow the prep technique next to each ingredient. • In a large pot, sauté onions, garlic and green peppers with the herbs and spices. Fold in the tomato product and mix well. Add the beans, salt, and water. Cover and simmer until flavors are well blended, about 20 to 25 minutes. Garnish with the fresh herbs. CREATED BY Chef Edwin Cabrera Copyright © AdventHealth Press
Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories
136.41
fat
2.49g
sat fat
0.28g
cholesterol sodium
0mg 624.69mg
carbohydrates fiber
23.73g 7.60g
sugars
3.27g
protein
6.42g
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Health | Recipes CIPE EIGHT RE
Tuscan Bean STEW
Here’s a bright and flavorful stew with an Italian flair. Cooks in Tuscany traditionally slow-cook beans in a clay pot called a fagioliera, a vessel that became popular after Columbus brought beans to Europe from the Americas, along with tomatoes and potatoes. So this is actually a New World recipe! There’s no need to clean up a clay pot; stovetop cooking will bring out these marvelous flavors just as well. More beans and vegetables can be added to leftovers (if there are any) for a delicious never-ending soup.
PREP INSTRUCTIONS: Yield: 8 (1 cup) servings Prep Time: 10 minutes RECIPE INGREDIENTS: 2 cups yellow onions, diced ¼ teaspoon crushed red chili flakes ¼ cup carrots, diced 2 cups, can diced tomatoes in juice 1 tablespoon fresh rosemary, minced ½ cup kidney beans, drained and rinsed ¼ teaspoon ground bay leaf 1 cup garbanzos, drained and rinsed
Cooking Time: 25 minutes Total Time: 35 minutes
1 tablespoon dried oregano 1 cup cannellini beans, drained and rinsed 2 tablespoons tomato paste 2 cups low sodium vegetable broth ½ teaspoon kosher salt ¼ cup parsley, chopped 1 tablespoon ground paprika
INSTRUCTIONS: • Follow the prep technique next to each ingredient. • In a stock pot, sauté the onions and carrots with the herbs and spices in a little water to create steam and release their flavor. Fold in the tomatoes, beans, and broth, and bring to a soft boil for 5 minutes. Lower to simmer and cook 20 to 25 minutes. Remove from heat and add fresh parsley. CREATED BY Chef Edwin Cabrera Copyright © AdventHealth Press
Excerpted from Simply Healthy: The Art of Eating Well, Diabetes Edition by Chef Edwin Cabrera, Sherri Flynt, MPH, RD, LDN, and Erica Hechler, MS, RD, CDE (Orlando: AdventHealth Press, 2019). Used by permission. Available from the publisher at AdventHealthPress.com.
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Health | Recipes
CATEGORY TAGS:
gluten-free high fiber high protein low calorie low carbohydrate / low sugar low cholesterol low fat / low saturated fat low sodium vegan vegetarian whole food plant based whole grain cholesterol-free diabetes-friendly peanut-free tree-nut free whole food plant based
NUTRITIONAL DATA: calories
125.18
fat
0.96g
sat fat
0.13g
cholesterol sodium
0mg 488.82mg
carbohydrates
23.17g
fiber
7.72g
sugars
4.98g
protein
6.42g
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