Washington State University researcher Dedra Buchwald is involved in studies related to health concerns in several demographic groups.
Buchwald is a professor in the WSU College of Medicine. She’s the director of IREACH, the Initiative for Research and Education to Advance Community Health.
“We are a big unit that is focused on education and research across a number of populations, such as rural, American Indian, Alaska Native, Native Hawaiian/Pacific Islander and other underserved populations nationwide, but especially here in eastern and central Washington,” Buchwald said.
As research teams go, Buchwald’s is a big one. It has about 60 people. Some are at WSU. Others are based at the University of Washington, where Buchwald worked until a few years ago.
“They’re not all faculty. I think we have 14 faculty members now. We have a lot of master’s level people who basically run the program, run the projects," she said. "We’re very proud of the fact that about half of us are minorities and about a third are American Indian or Alaska Native or Native Hawaiian/Pacific Islander. So we really work to bring the populations that we serve into our faculty and staff. We have four Native faculty as well and they have a special relationship with the people and the populations we serve. They tend to have a real passion and commitment for doing that work. These populations are distributed all over the country in small pockets. It’s hard to find a place where there’s tens of thousands of any of these population groups, except maybe rural individuals or rural communities.”
Buchwald’s work frequently overlaps with that of her husband, Spero Manson, a nationally-known researcher at the University of Colorado in Denver.
“He is a medical and cultural anthropologist and I’m an MD and an epidemiologist so we have our disciplinary clashes, but we are also very complementary and it’s really worked out for both the populations that we serve because we bring different perspectives,” she said.
One of their strategies is to create research centers; not necessarily physical places where people work together. It’s more combining people around a specific idea, such as finding new strategies to treat alcohol addiction in Native people.
“For example, in a center that we recently were funded for on alcohol issues in Native communities, we have projects in three different locations," Buchwald said. "We have one site in Alaska and that site works with a treatment program. It’s going to use something called motivational interviewing, which is a form of conversation that activates people to achieve their goals, and patient navigation, which is helping people through in a case management kind of way, get to where they need to be physically and complete forms and those kinds of things, so actually, concrete help. We combine those two and the goal of that program is make sure that individuals who are people who are treated for acute alcohol problems make the transition into chronic care programs that will then facilitate return to a productive, active life. That project is in Fairbanks. And I should note that we always hire local people as part of our capacity building.”
That grant also has a second program with an urban Indian health program in Seattle.
“And then the last project is one that seeks to reduce what we call alcohol-exposed pregnancies. Women who drink during pregnancy, particularly in the first trimester, have increased risk of having a child with fetal alcohol spectrum disorder, which is a range of disorders that affect their neurologic development, their cognitive development and can be an extremely distressing circumstance for a family, particularly one living in a resource-poor environment," Buchwald said.
In this case, the Black Hills of South Dakota. The program targets Native women who are in their childbearing years.
“To try to get them to do one of two things: reduce their drinking, in case they get pregnant, or make sure they take birth control properly,” Buchwald said.
The alcohol abuse project has a second component. It aims at building the capacity of Native people to create their own health research projects.
“We’ve had a training program, it’s called the Native Investigator Development Program, and we just got refunded and we’ve had it for 23 years now," Buchwald said. "There had been a survey at the National Institutes of Health and, of 35,000, what they call principal investigators, those are people who lead a study and they’ve made the application, there were nine American Indians. Five of those principal investigators were with my husband. If you do the math based on how many Native Americans there are in the United States, you should have had 750. We talk a lot about health disparities, but having Native investigators trained is an enormous and maybe even the biggest disparity. Since that time, through our program and others, there are, latest count, 111 Native principal investigators, so we’ve made a lot of progress in 20+ years.”
The alcohol abuse project will give junior-level researchers with their own study ideas up to 40-thousand dollars a year to do work based in Native communities.
There’s a similar focus in another of Buchwald’s new studies, this one looking at Alzheimer’s disease in Indian Country.
“What we did for that center was bring together people who are excellent mentors, either in statistics or study design, Native health. We have a panel of experts on Alzheimer’s disease who can advise us. So we have this whole coalition of people, all of whom are focused on training either people who want to work with Native communities or people who are Native themselves. And in that particular grant, we have quite a few Native mentors, which is really different than how things were 25 years ago when we actually had trouble finding the trainees, let alone Native mentors,” she said.
Not only are Buchwald and her team trying to expand the number of Native researchers to work in Native communities, they’re also working to tailor their research to the communities they’re in.
“Some of our instructions, and these are standard instructions, we use words like ‘scenarios’ or ‘vignettes’ and local people will say ’No, use the word ‘story’. Nobody here is going to understand what you mean.’ So it could be something simple like a few words. It could be something like changing the art work, but not changing the core principles of how an intervention would work,” Buchwald said.
Dedra Buchwald is a professor in the WSU College of Medicine and director of the university’s Initiative for Research and Education to Advance Community Health.