Clinical Dietitian in a Rural Setting
Valora Tom, Navajo, RD,
is a clinical dietitian at the Tuba City Regional Health
Care Corporation. She spends about three-quarters of her
time caring for ambulatory patients and one-quarter of her
time caring for hospitalized patients. Most of her patients
are Navajo, Piute, and Hopi.
Tom and her beloved dog, KoKo, who is known to the Tuba City community because he is always by Tom’s side during public health education events and community volunteer activities
Tom says that it’s challenging for local residents to prepare and serve healthy diets. Most of them, particularly the elderly, have no refrigeration, electricity or running water. Food is expensive at the one little, local grocery store. The larger grocery stores are one to two hours away by car. Growing food locally is also almost impossible because of the exceptionally dry land and the scarcity of water. Because of their many challenges, the local people eat a lot of canned foods and fast foods. Many people fry such foods as bread, potatoes, spam and corned beef. Tom is encouraging them to do more baking, grilling. and broiling.
When Tom is counseling patients, often the patient’s spouse and the grandma and children join her and the patient. “We have a big family discussion about making healthy choices. I tell people that I can tell them about nutrition, but it’s up to them to decide whether to continue down the same road or make a change. Change won’t happen over night. You have to take little steps at a time.”
“I also recommend exercise,” she says. “The Navajo way, traditionally, was to wake up when the sun rose, stretch and then run. The philosophy behind this was that you were running toward a new day, full of opportunities and challenges. You were preparing yourself to tackle anything head on.”
Little Valora Tom with her maternal grandmother
Long Time Interest in Science and Medicine
“My family is originally from Beclabito New Mexico, which is equal distance between Shiprock and Cortez.” says Tom. “When I was in second grade, my parents wanted better opportunities for the family, so we moved to Cortez, Colorado. However, every weekend my parents took us back to our grandparents on the reservation. My grandparents taught us our traditions and our culture.
“I was always interested in science and medicine. In preschool when we were asked to draw ourselves as a professional, I drew myself as a doctor, wearing a white coat with a red cross on my chest. During high school I spent three summers in the University of Colorado Upward Bound Program based in Boulder, Colorado. While studying there, the other participants and I lived like we were in college. We lived in a sorority house, and during schools sessions we were taught by professors. It was there that I got more involved in the sciences.
“Graduating from college was always important to me because most of my family members are not college graduates. I wanted to make them proud of my achievements because I thought of my achievements as their also.
“I entered Ft. Lewis College as a pre-med student. However, I changed my major to general biology and then to molecular and cellular biology. I was intrigued by the infiniteness of the molecules and cells within the human body. I also had a heavy load of chemistry and math classes. I remember being the only Native person in my classes. I’m so appreciative that my professors were very supportive and challenged me as much as they could.”
Over a two-year period, starting during her final year of college, Tom lost her four grandparents. Both of her grandmothers and her maternal grandfather passed away because of the complications of diabetes. “Their loss compelled me to help my Native people, particularly to help prevent diabetes,” says Tom.
Tom was aware that her grandparents had not receiving optimal care: “When I used to go with my grandparents to their healthcare appointments, health educators would give them a handful of handouts with a lot of words on them. These handouts made little sense to my grandparents because they didn’t have much of a formal education. They needed someone who could explain to them and demonstrate for them what to do. My grandparents weren’t willing to speak to people of another culture. They felt it was a little intrusive. I felt that if the health professionals were like my grandparents, my grandparents would have been able to open up to them.”
In the autumn following her college graduation, Tom worked for two years as a bilingual paraprofessional in an elementary school. (Tom is actually trilingual because she speaks English, Navajo, and Spanish.) In this school, Tom helped the Spanish-speaking children learn to read in English. Tom remembers, “When I asked the cooks at the school why the kids were so rowdy, they said, “The kids are bouncing off the walls because of what we’re serving them. Val, you’ve got to come in here and do something.”
Val wasn’t sure how to help. She started having potlucks for the students. She asked each student to bring something from his or her culture and talk about it and write about how it was made. Val realized that she was having a positive impact on her students’ lives, but she wanted to do more.
She knew that she loved food and science and wondered how she could combine these interests. In researching this question, Tom discovered Texas Women’s University, which she says has one of the best programs in nutrition and dietetics. She applied to the program and was accepted. Although she had to help some students there learn that Native American Indians don’t still wear loincloths and live in teepees, she felt accepted and learned a lot. She also taught her professors and cohorts about her Native traditions by incorporating the Navajo culture into the presentations she gave and the papers she wrote.
Southwestern Dietetic Internship Program
Tom did her dietetic internship at the Southwestern Dietetic Internship Program. “It exceeded my expectations,” she said. “I would highly recommend it.” During the first part of her internship, Tom was based at Phoenix Indian Medical Center where, under the supervision of preceptors, she interviewed and cared for patients. My preceptors watch me interview the patients. When we stepped out of the room, the preceptor would say, “What happened? What does this person need? We’d look up the labs and medications and piece every thing together. Then we’d come up with a plan.
At the rural part of the experience in Kayenta on the Navajo Nation, Tom saw many traditional people wearing moccasins and velveteen dresses and shirts. “One tall man wearing a velveteen shirt and moccasins came up to me and shook my hand. My preceptor explained that many local Navajo elders welcome people to their home land. The Navajo elders also saw me as part of their family. They called me “shiyazhi”, which means “little one” in the Navajo language.” Being called “shiyazhi” touched Tom because her grandparents had called her “shiyazhi”.
When Tom returned to Phoenix, in addition to working at the hospital, she joined a preceptor in visiting Native communities around the Phoenix area. “I gave nutrition presentations at the senior centers,” she said. “The people there were very open. We joked and laughed a lot. The preceptors are very well known in these communities. I realized that building good relationships within the community is very important.”
Tom completed the internship and is now working hard, sharing her gifts and skills with her people.
This article was originally published in the Summer, 2009 issue of Winds of Change. Tom updated the article in February 2010. (The cover artist is William Rabbit, Cherokee.)