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Tribal Health
Kwawachee Counseling Center
A department of the Puyallup Tribal Health Authority
Kwawachee Counseling Center is here to help with the community's behavioral health needs. Kwawachee means “helping hands” in Coast Salish. We have many helpful professionals who provide counseling services, prevention services, group classes, case management, and cultural services.
 In order to begin services you must complete a screening interview. Walk-in times for screenings are listed below, or you can call to schedule an appointment.
Monday 8:00 am – 11:00am
Thursday 1:00pm-3:00pm
Friday 8:00 am-11:00am
Group Classes scheduled to take place this fall include:
- Stress Management
- Anger Management
- Grief and Loss
- Positive Indian Parenting
- Girls' Health and Wellness
- Healthy Solutions
- Day Treatment
For more information on any of our services or to schedule an appointment
please call (253) 593-0247. We look forward to hearing from you!
Children's Dental Health
If you have a new baby in the family, you may not realize how important
it is to care for your child's teeth. Although baby teeth will be
replaced with permanent ones, baby teeth are critical for proper
chewing, speaking, appearance and holding space open for permanent
teeth. Without proper care, some children can develop serious tooth
decay or infection.
People usually think of a newborn baby as having no teeth, but
the twenty baby teeth that will grow in the next two and a half
years are already present at birth in the baby's jawbones. At birth,
the crowns of the primary teeth are almost complete, and the chewing
surfaces of the permanent molars have begun forming. Start good
oral hygiene practices soon after the baby arrives home.
Cavities can destroy teeth of an infant or young child. They develop
when a baby is frequently breast fed on demand or receives milk,
formula, fruit juice or soda as a pacifier or comforter especially
at bedtime.
You can prevent decay of the baby teeth by:
- Establishing good eating habits with foods from the five main
food groups: fruits, vegetables, meat, grains, and dairy.
- Limiting between meal snacks
- Teaching your child to drink from a cup as they approach their
first birthday
- Wiping your baby's teeth and gums with a clean washcloth or
gauze pad
- Brushing with water as soon as the baby's first tooth appears
and using a pea-sized amount of fluoride toothpaste at about eighteen
months.
- Visiting the dentist by the child's first birthday. Talk about
the visit in a positive way. Explain that the dentist is a friendly
doctor who helps you take good care of your teeth.
Dr. Rodriguez
Puyallup Tribal Health Authority Diabetes
Newsletter
Welcome back ot our story of Willow who was recently diagnosed
with type 2 diabetes. She now faces some new decisions about her
health. Will she follow her doctor's advice and go to Community
Health Services to get a blood gluclose monitor? Will she commit
to vistis with a nutritionist and diabetes nurse? What would you
do in her moccasisns? Let's return to Willow's world as she tries
to find her own path to wellness.
I don't want to have diabetes! It was like a slap in the face when
I pulled that referral out of my purse. What more bad news do I
need to hear - do I really need those appointments? I know I sound
like a whiner, but I'm not! I have faced difficult challenges in
my life and am a strong Indian woman for it. Right now my life is
so busy, I know I should at least call and find out how long it
will take. It's just that I'm so confused about what to do, and
one thing for sure is that I don't want to poke my finger! My heart
is just not in it, (sigh) but I guess I'll find out soon enough.
I looked closely at the referral paper, and had noticed my doctor
had written that I had type 2 diabetes, is there another type of
diabetes? I thought there was only one type of diabetes, what does
type 2 mean? Does this mean I'm really sick?
When I phoned the Community Health number 253.593.0232.ext523,
the receptionist was able to get me right in to see the diabetic
nurse. I came to learn that I would also receive my glucometer after
meeting with the nurse. After hanging up the phone began to get
scared about seeing the nurse. I wondered if she would tell me that
I needed to lose weight. I've been heavy for most of my life and
remember what it was like in grade school when the kids would make
fun of me and call me fat names. I've always struggled with my weight,
it seems like when I'd lose some weight on those diets I'd just
put the pounds right back on plus some! I hope the nurse won't even
talk about food! I don't want anymore diets! Maybe I can get the
onitor and leave. Well, I made the myself show up for the appointment,
the receptionist checked me in and updated my information, all before
I sat down!
She reminded me from now on to bring my monito to all clinic appointments.
Shortly there after, the diabetic nurse came to greet me and take
me to her office. She politely introduced herself and offered me
something to drink. I suspect that she was trying to put me at ease,
perhaps she sensed that I was a bit nervous. The nurse had a lot
of questions for me, she wanted to know who in my family has diabetes,
what I know about the disease, how I felt about my diagnosis, (
I didn't tell her I felt sad, depressed, anxious, angry, and stressed-out)
I told her that my mom has had diabetes for about ten years, and
doesn't talk about it that much, so I really don't know all that
much about diabetes. I did finally confide in the nurse that I was
actually scared, and that I did know a lot of Indians in the community
that had the disease.
It seems as though their health can get into pretty bad shape.I
think of this one, he goes to dialysis three times a week. And this
one lady that I met in the waiting room lost her vision. I don't
want that, I love to bead and make baskets. I need my eyesight.The
nurse explained that most Indians have type 2 and that it is important
to eat my meals on a regular basis throughout the day. I also learned
that its the Pancreas that produces insulin and that insulin helps
the sugar (from our food) get into the cells. She also gave me a
booklet to take and read, called Native Americans and Diabetes.
She taught me more about how my diabetes pill (meteformin) works
in the body. I can't remember all of what she was saying ( because
I was sstressed-out) but what I did hear made more senseto me. She
said the best time to take my pills would be at meal times, breakfast
and supper.
The nurse reviewed the common metformin side effects, nausea, vomitting,
diarreah, bloatting, gas, decreased appetite, and metallic taste
in the mouth. She explained that it often takes time for the body
to adjust to the metformin. And that I'm to call the clinic right
away if I feel unusually tired, have trouble brerathing, feel dizzy,
have unexplained muscle pain, or if Isudddenly have a slow irregular
heartbeat.These could be symptoms of lacticacidosis and this could
be life threatening. As if I wasn't scared enough! The nurse explained
to me tht by knowing more about care and disease, including my medications,
that I'll be better able to manage my diabetes. The nurse asked
if I had any questions aboput our conversation before sehe took
me to the person who would teach me abour monitoring my sugar. She
said to not be surprised if questions popped into my head when I
left. She encouraged me to keep a journal and to write down any
and all questions that I have, and to bring it with me to my next
vist.
In case I had any questions or concerns between vistis she gave
me her business card with phone number. Next I was introduced to
the monitor lady,( please forgive me, but I can't remember her name,
but she was really kind to me too!) As a parting shot, the nurse
asked me to check my sugars twice a day. Fasting blood sugars and
two hours after my biggest meal, what am I a pin cushion? The monitor
lady said that checking twice a da would give the nurse more information
on how my medicatiom is working with my food . Makes sense I guess?
The lady went over the mechanics and use of the monitor and te finger
poker, ( lanacing device is the term she used). She set the time
and the date in the monitor, the monitor will record the blood sugars,
time, and date automatically. Then it was time for me to check my
own blood sugars. YIKES! She first had me wash my hands, ( Important
to have clean hands as well as to decrease risk of incorrect test
results).
She then taught me to let my hand hang down so that there would
be a good supply in the fingers. She showed me how to load the poker
( lancing device). I picked my sight and stuck my finger. And do
you know what? It didn't even hurt! My reading was 230, she said
that it was kind of high and that they would like to see it around
150 after meals. I had just eaten lunch and just started my medicine
so it wasn't working strong yet. The nurse said it might take a
little time before my medicine starts to bring my blood sugars down.
What were the numbers again? Did she say my fasting should be 180,
NO that's wrong, she said it's supposed to be below 140... I think.
Oh, I know! It's written in the back of the booklet the nurse gave
me. Whew! It's target range of 80-140 for fasting and 140-160 two
hours after eating the big meal.
The monitor lady said I did a good job checking my sugar, she said
that I could pick up extra supplies in the Pharmacy or in Community
Health. Before I left she asked if I had any questions about monitoring
sugars, and I told her I felt confident that I could do this. If
by chance I was to forget anything I knew that I could always call
my nurse. We went to the front desk and made another appointment
to see the nutritionist (registered dietitian) in two weeks. Checking
my blood sugars is not nearly as scary as I thought it would be,
and plan on going back to learn more about myself and my health!
I invite you to please stay tuned to my next visit to the nurse!
APRIL DIABETES NEWSLETTER - MY STORY WITH DIABETES
Please meet another friend named Skye, he is a fictional characer
who haas lived with diabetes for ten years. My name is Skye and
I've had diabetes for. . . . it seems like forever. When they told
me "you have diabetes," ti came as a complete shock. Growing up
I was very active and atheletic, I liked basketball and baseball
and never overweight. Back then I liked to shoot hoops with the
guys several times a week, kinda funny how people show up whn a
basketball is around. Now I know the risks for getting diabetes
and I am aware of how many folks have diabetes.
The summer before I was diagnosed, I was at a Pow Wow and one of
the booths offered free screening as part of the diabetes awareness
campaign. I come to find out that a lot of Indians, and Hispanics,
get diabetes. One of the workers asked me questions about my family
history, at that time nobody in my family had the disease. The only
risk factor I had was that I was an Indian. Man, was she persistant
with the screening! I let them test me, and my blood sugars were
normal, just like I thought it would be! That's why it came as such
a shock when I was diagnosed just six months later.
I had been tired a lot lately, but thought it was just because
of all the extra hours I was working. You see I am a fisherman and
when the fish are runnning you put in as many hours as you possibly
can. I've been doing this since I was in high school, and fishing
is in my blood. Finally I couldn't take it any longer and had to
go to the clinic. I complained to the doctor that I was tired all
the time. He asked if I had symptoms such as blurry vision, increased
thirst, frequent urination, or any cuts that weren't healing right.
I answered no. I haven't had my eyes checked in years and it had
always been 20/20 anyways. But now that he mentioned it, I do notice
that when I read the newspaper it is a little blurry, but I chalked
that up to just being tired and getting a little older. I mentioned
to him that I was screened at the Pow Wow and that my sugars were
normal at the time.
I was advised that even though I was screened, that diabetes could
show up anytime. He said it would be good idea to run some blood
tests. He came back to tell me that my blood sugar count was 450.
I didn't know if that was good or bad, come to find out that it
is not good and rather high, that it should be somewhere between
100 - 125. How could this have happened to me? Is all I could keep
asking myself. I thought I took pretty good care of myself, I eat
healthy foods most of the time, and am active at work and at home.
Looking back on it I guess I was in denial. The doctor wanted me
to start on medication right away to bring down my sugar count.
But my denial and I left the clinic several years ago and didn't
look back for several years Remeber I told you about the fishing?
Well, I continued to fish the river for awhile and one day while
I was on the bank bare footed I stepped on a piece of glass without
knowing it! I didn't feel any pain and it wasn't until I was putting
on my shoes and notice blood, that's when I realized I had a problem.
I cleaned my foot when I returned home, but the infection had already
started. The next day I went to the clinic and the doctor that examined
me asked me how long I've had neuropathy. I didn't know the numbness
in my feet actually had a name. He explained that diabetics who
have consistantly high blood sugars develop this condition in their
feet and hands along with other complications. When the doctor went
to remove the piece of glass, about the size of a pony bead, I didn't
even require a shot to deaden area! I was started on antibiotics
and instructed on how to clean and dress the wound. In spite of
treatment, the wound didn't heal and was referred to a specialist,
an infection doctor. At this point I was pretty scared that I might
lose my foot, so I made sure that I made all of my appointments.
I was told that I would require stronger antibiotics and change
my dressings more frequently.
Man, it seems like I was always at that doctors office! During
this time my blood sugar level rose to 500 and was started on insulin
by my doctor at the clinic. I was told that the high sugars interfere
with the healing process. Also, the sooner that I could get the
sugars under control and start eating healthier foods, the better.
I didn't want to be on insulin, but if taking shots would help with
the healing of my foot, then I was all for it. He also suggested
that I start seeing the diabetic nurse on a regular basis and start
learning how to monitor sugars on my own. I thought that's just
great, that's all I need is more appointments! The receptionist
from Community Health called to set up an appointment with the nurse.
I explained to her that I was already busy with my other doctor
appointments. She even offered me a home visit! I didn't want a
nurse coming over to my house, so I made an office appointment.
Needless to say, I didn't make it to the appointment. Then she
started to call the house several times and left voice messages,
in fact she even stopped by the house and left a card with a note
to call her. That was the day that I received some bad news. I tried
to take care of myself with the shots and the infection doctor appointments,
but the infection won, it had gotten into the bone. Unfortunatley,
he had to remove the foot, he said if I was to have waited any longer
that he would have to cut off more than just foot.
Man! Remember that I told you about my denial? If only I had done
things differently when I first found out about the diabetes. There's
nothing I can do about the past, but, I can prevent further damage
to my body. My foot amputation has healed and I no longer have to
see the infection doctor. I still see my regular doctor at the clinic
and I am giving myself insulin several times a day.
I eventually met with the nurse and was shown how to use the monitor.
My sugars are now down into the 200's. I guess we have to learn
to appreciate the small victories when we are dealing with diabetes!
At my last appointment my doctor mentioned switching me to some
other type of insulin. It's supposed to work better than what I'm
currently using. But the soctor wants me to see the diabetes nurse
first. I'm not sure if I'm ready to take that first step. I am just
now getting to things, why change?
Stay tuned. . . . .Will Skye meet with the diabetes nurse? Or will
he find other reasons to delay the visit?
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