2016 Culture of Health Prize Winner

A Small Community With Big Ambition 

Through tall cedar and fir trees on Eagle Hill, Charlene Nelson can spot the distant homes of the Shoalwater Bay Indian Reservation. If all goes as planned, those dwellings will someday move to this higher ground. Tribe members have voted to relocate their community to protect their families from tsunami hazards. “The health and safety of our tribal members are my primary goals,” explains Nelson, the tribal chair. 

The will to survive and thrive propels the Shoalwater Bay Indian Tribe. The federally recognized tribe has 373 members, of whom 84 live on the remote reservation in Pacific County, Wash., 150 miles southwest of Seattle. Although small in size, the tribe has big goals to improve and maintain the physical, social, emotional and spiritual health of its people. The community promotes healthy behavior and active living; invests in the lives and well-being of its youth; and tends all residents’ medical, dental and mental health needs with its wellness center.

The tribe’s approach to life, fed by its rich and deep history, reflects the core values of the RWJF Culture of Health Prize. “Our elders and our ancestors taught us that health is a holistic thing,” explains Earl Davis, a former Marine and a master woodcarver. “It’s not just whether you get up and exercise and eat right. It’s taking care of your mind, taking care of your body, taking care of your spirit and taking care of everything around you.”

Formed 150 years ago, the 1-square-mile reservation is located in a crook of coastline where tribes from the Pacific Northwest used to gather to trade. Much of the area is wetland or tidal plains with little room for the tribe to grow. Flooding and extreme erosion are constant threats. A neighborhood just north of the reservation on Highway 105 has seen houses and beachfront swallowed by the sea. In 2013, the U.S. Army Corps of Engineers rebuilt a mile-long dune barrier to protect the reservation. But everyone knows that even that would be insufficient to withstand “The Big One”—an anticipated offshore earthquake that could trigger a catastrophic wave within minutes. Up and down the coast of Washington, other communities have taken steps to relocate to higher ground in response to stepped-up tsunami planning in the Pacific Northwest. The Shoalwater tribe has purchased land on Eagle Hill, using funds from tribal businesses, including a small casino, a restaurant, a motel, a gas station and a convenience store. It also has constructed a multi-purpose building, 55 feet above sea level, that doubles as an evacuation center in case of a tsunami, earthquake or flood.

Video still taken from RWJF-produced video: https://www.youtube.com/watch?v=-_AKpUZBVNU

Shoalwater Bay Indian Tribe

Although small in size, the tribe has big goals to improve health.

Our elders and our ancestors taught us that health is a holistic thing. It’s not just whether you get up and exercise and eat right. It’s taking care of your mind, taking care of your body, taking care of your spirit and taking care of everything around you.

Earl Davis, community member and former Marine

All the members of the tribe take emergency preparedness very seriously. On a recent summer morning, hundreds of neighbors took part in a “tsunami and health walk,” which started at the reservation’s gym next to marshes and wound its way along a path to Eagle Hill Road and the new evacuation center. Along the way, participants, from toddlers to seniors, learned what to do and where to go in the event of an earthquake-triggered wave as high as 50 feet.  

The tribe’s sharpened focus on community health began in the early 1990s after tribal women experienced a perplexing increase in the frequency of miscarriages and infant deaths. Epidemiologists from state and federal agencies conducted investigations but came up with nothing conclusive.

With the very future of the tribe in jeopardy, the experience proved to be a turning point. At the time, the closest tribal clinic was 70 miles away at another reservation. Motivated to improve the health of its community, the tribe started a small clinic in four rooms at the tribal center. The clinic’s success led to the opening in 2005 of the larger, stand-alone Shoalwater Bay Wellness Center, which provides medical, dental, behavioral health and substance abuse services not only for tribe members, but for all neighbors. “It’s a great step forward,” Nelson says.

The view from "up the hill" where the Shoalwater tribe plans to move. It will likely be a 15-to-20 year process.
Community members walk the mapped evacuation route to take if a tsunami were to hit.
Woodcarver Earl Davis specializes in Salish style carvings.

Evidence of the tribe’s improving well-being is measured in the number of young people: 40 percent of residents on the reservation are under 18. Nelson recalls being “thrilled” with the first few births. “It was wonderful,” she says, “because we hadn’t had babies and suddenly we had babies. Lots of them.”

The Shoalwater tribe sees life within the frame of seven generations: The current generation, they say, is shaped by the experience of people three generations before and tasked with setting the course for three generations to come.

This view is why Earl Davis teaches children the traditional Salish style of woodcarving, so they can pass it on to their own children. And it is why he leads Shoalwater tribe members on an annual seafaring canoe journey that connects them not only with their own culture, but with the customs and traditions of tribal neighbors from the Pacific Northwest, Canada and Alaska. This year, thousands of paddlers from all over the region converged at the Nisqually Reservation near Olympia, Wash. Men, women, teens and children from Shoalwater tribe were invited to join their neighbors from the Chinook Indian Nation to paddle together in a dugout canoe for eight days and 200 miles.

The seven-generation view of life is also why the Shoalwater tribe looks towards Eagle Hill and a new chapter for the tribe among the pines.

“The main reason why we want to move up the hill is because we don’t want our kids to have to go through the worry and stress that we’re going through now,” says Joel Blake, a fifth-generation tribe member who has two children ages 5 and 3. “We have to offer them a place that’s safe.”

A boy hula hoops during a block party.

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A Lost Generation

Too many babies are buried in the small cemetery on the Shoalwater Bay Indian Reservation.

An inordinate number of miscarriages, stillbirths and infant deaths in the 1990s left a deep scar within the Shoalwater tribe but also strengthened members’ resolve to do something about it. “It’s sad,” tribal chair Charlene Nelson says of the lost children, “but it’s always inspiring because they have given us a strength to go forward and make it better.”

From 1988 to 1992, 10 of 19 pregnancies ended in miscarriage, ectopic pregnancy, stillbirth or the death of the baby within a year of birth. State and federal epidemiologists studied the problem but found no single cause, other than the glaring lack of healthcare access.

When efforts to convince the Indian Health Service to open a full-scale clinic failed, the Shoalwater tribe tribal chair at the time, the late Herbert “Ike” Whitish, went directly to Capitol Hill to press the tribe’s case.

In the end, the federal health agency contributed medical equipment, but the tribe had to take out two loans to build a full-service wellness center. Today, the Shoalwater Bay Wellness Center, which opened in 2005, offers medical and dental services, behavioral-health counseling, addiction treatment and nutritional guidance. The dental clinic employs two full-time dentists who see as many as 30 patients a day from the reservation and surrounding region. A nutritionist conducts classes twice a month and incorporates traditional tribal foods into her teaching.

Since 1992, 42 children have been born on the reservation. Lynn Clark, a tribal elder whose niece and nephew died before they turned one, said the experience has “led us to a better place.”

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Bracing for ‘The Big One’


If you live in the tsunami hazard zone of the Pacific Northwest, you brace for disaster.

About 100 miles off the coast of Washington is the “Cascadia subduction zone,” where pressure between two of the earth’s plates could cause an earthquake, sending a wall of seawater slamming into the coastline.

Twenty years ago, Washington state stepped up its tsunami preparedness and began reaching out to coastal communities. At the Shoalwater Bay Indian Reservation, tribal elder Lee Shipman took on the task of emergency planning. She participates in Federal Emergency Management Agency-sponsored drills on how to manage a tsunami emergency and prepares tribe members for how to react.

The mythology of the Shoalwater tribe is filled with stories about great floods and earthquakes, says Earl Davis, who runs cultural programs. “I never got the sense in any of those stories of fear or terror,” he says. “It’s always, the water rose and this is what we did.”

Today, that narrative would include regular instruction on how to react in the event of an earthquake and tsunami. A large number of tribe members have CPR training. The youngest ones are taught to “drop, cover and hold on” if they feel an earthquake and to hurry to high ground if they hear the tsunami siren.

Video still taken from RWJF-produced video: https://www.youtube.com/watch?v=IJptkuBrgv0

Preparing for Climate-Related Threats

Tony and Mechele Johnson join the rest of community for a meal following the Health Walk.
The community meal brings together a diverse group with many ages and ethnicities.

Today, that narrative would include regular instruction on how to react in the event of an earthquake and tsunami. A large number of tribe members have CPR training. The youngest ones are taught to “drop, cover and hold on” if they feel an earthquake and to hurry to high ground if they hear the tsunami siren.

With federal funds, the tribe has built a multi-purpose center on higher ground, equipped with a full-service kitchen, a generator system and a back-up computer server for the tribal government. Outside the center sits a new mobile command unit with a built-in satellite system to handle communications during an emergency.

The goal is to make everyone feel safer and more resilient—from residents on the reservation to neighbors in towns like Tokeland, Wash., or visitors to the tribe’s casino and restaurant. The Shoalwater tribe's commitment to fostering a sense of shared well-being and community is infused in all their efforts. “If they're down here and something bad happens,” says Joel Blake, the tribal treasurer, “we'll take care of them and they'll have a place to go.”

Wellness is Always on the Agenda

Wellness Is Always on the Agenda

Under a century-old wood canoe suspended by wire from the ceiling, seven people sit at a round table with a full agenda of health matters to discuss for the next hour. But first, Charlene Nelson, the Shoalwater Bay Indian Tribe’s chair, asks everyone to pause.

“Take a deep breath,” she says. “Let it happen. Take joy in what we’re doing.”

Once a month, the Pulling Together for Wellness group meets to discuss ideas for improving the tribe’s health and well-being. The American Indian Health Commission for Washington State—which works with all tribes in Washington—launched the initiative. Shoalwater tribe members were among the first to adopt the model, says Jan Ward Olmstead, a public health specialist for the commission.

Three years ago, the tribe formed a wellness coalition, creating a framework to discuss physical, emotional, spiritual and social health. “It’s where conversations are starting,” says Jamie Judkins, a member of the group.

Before drafting an action plan, the coalition enlisted teens to conduct a health survey. The move was intentional: Tribal elders wanted younger members to feel as if they, too, had a stake in their community’s future. Pairs went door-to-door to interview families about tobacco use, physical activity and access to nutritious food. The teens reported their findings at a community dinner and were asked for their ideas. They suggested ways to improve and link pathways for walking and biking and advocated for policies to prevent tobacco use.

“The challenges of the community were illuminated, and they could see themselves in that data,” Olmstead says. “It really set a clear path as to what direction the coalition would want to go in terms of their strategies.”

The challenges of the community were illuminated, and they could see themselves in that data. It really set a clear path as to what direction the coalition would want to go in terms of their strategies.

Jan Ward Olmstead, American Indian Health Commission for Washington State public health specialist

How Culture Can Inform Prevention

"We have 10,000 years of history and culture in this area, and in the last 150 years, it’s almost been completely wiped out,” says Earl Davis, who coordinates cultural programs for his tribe.

As a child, Earl Davis loved to go with his father to the homes of tribal elders and listen to their stories. “He always thought it was real important to hear what they had to say before they passed,” Davis recalls.

His fascination with the past led Davis to work on restoring the cultural heritage of the Shoalwater tribe. “We have 10,000 years of history and culture in this area, and in the last 150 years, it’s almost been completely wiped out,” says Davis, who coordinates cultural programs for his tribe. “I feel like there’s a lot of ground to be made up for.”

In a shed on the reservation, Davis teaches young members how to shape logs and planks into images and characters from the legends he heard as a child. Other members teach basket-making or show children how to identify edible plants in the wild.

For Shoalwater tribe youth, a rite of passage is the summertime canoe journey that draws thousands from tribes in Washington, California, Oregon, Alaska and Canada. This year, Shoalwater tribe members joined neighbors from the Chinook Indian Nation to paddle in their canoes, covering 200 miles in eight days. The epic journey started at the Skokomish Reservation on the Hood Canal and ended at the Nisqually Reservation near Olympia, Wash., on Puget Sound.

Like so many communities, the Shoalwater tribe wrestles with how to keep youth from engaging in risky behaviors, such as drinking and using drugs. Members increasingly emphasize connecting youth to their native culture as a way to anchor them. “The best prevention factor in Indian country is culture. Period,” says Tony Johnson, the tribe’s manager of education programs.

The canoe journey, an experience that is not only physically but emotionally and mentally challenging, binds the generations. “With that comes self-esteem and pride, which is hard to come by,” Johnson says. “You cannot overstate it.”

A Place Where Neighbors Are Welcome

Jamie Judkins speaks for her tribe when she says, “We may be small, but we do big things.” That includes building a wellness center, a gymnasium, a library and a new multi-purpose center. It also means serving lunches to seniors in the tribal center’s cafeteria.

Whatever it does, the Shoalwater tribe puts out the welcome mat for neighbors from surrounding communities.

“Everything we do here, we include everyone in the community,” Judkins says. About 500 people live in Tokeland-North Cove section of Pacific County, Wash., where the Shoalwater Reservation is located. The nearest towns of any size are almost 20 miles away.

When the reservation opened a new gymnasium, commercial fishermen from Tokeland asked whether they could use the workout equipment and weights. They were invited to join for free.

A multi-purpose center is one of the various buildings used to promote wellness.

Even the tribe’s small police force is integrated into surrounding communities. Through agreements, its five officers have the ability to act in the same capacity as sheriff’s deputies inside Pacific County.

The tribe also considers neighboring towns in its emergency planning. When the multi-purpose building on Eagle Hill Road is finished, it will double as a shelter and emergency command center. It was designed to accommodate the entire region, not just families living in the 1-square-mile reservation.

“We’ve always had the approach that we need to include everyone within our service area,” Judkins says.

The Shoalwater Bay Indian Tribe community cuts off the small port of Tokeland from the main highway. “We’re out in a very rural location,” Judkins adds. “We feel responsible for those people down there, too.”

Officer Souvenir educates the public about the Command Center.
During Health Walk days, youth also work on community projects such as landscaping.