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Mark Butterbrodt, M.D.

Native power prevents diabetes

It didn’t take Dr. Mark Butterbrodt (BMF’92) long to realize he couldn’t improve the health of his community from his exam room at the Porcupine Clinic on the Pine Ridge Reservation in South Dakota. “The real action is in the community. There are wonderful people here, and they’ve taught me more than I taught them.”

With Oglala Sioux Tribal Health Educator Mary Tobacco and other tribe members, Butterbrodt helped establish the Reservation’s first fitness center. He credits Tobacco as instrumental in getting him out into the community from the beginning. “I once spent an afternoon at a booth talking to people about quitting smoking. I probably accomplished more than sitting in the Clinic pushing pills,” he said.

Tobacco said, “Health is improving and attitudes about it are changing. I saw a vacant building, and Dr. B. helped us raise money to buy it and turn it into a fitness center. It was one thing to educate people about good health, but they also had to have someplace to go. Even the dirt walking track gets a lot of use now. Now we have 500 people a month coming through the center.”

Doomed to diabetes?

“Diabetes is not inevitable” said Butterbrodt. He had studied diabetes and its relationship to the thrifty gene hypothesis (that nomadic people store fat more efficiently than others) at the University of Minnesota School of Public Health during his Bush Medical Fellowship. Through this study, he became convinced that non-insulin-dependent diabetes might be prevented by community-based efforts to positively change lifestyles in the areas of exercise and diet.

Upon arrival at the Indian Health Service’s (IHS) Porcupine Clinic on Pine Ridge in 1995 he immediately took up the cause of combating the disease with the Lakota people. He brought with him a $10,000 grant from the University of Minnesota to initiate a program to screen children to find those at high risk for diabetes. He also worked with Tobacco to design an information component for schools and families. At the end of two years, 25 percent of the students he screened were identified as high risk, and the project became a major catalyst for a federal grant from the Pathways Project, a prevention program now managed by the Clinic.

Butterbrodt explained, “After school-based screenings, taking heights and weights, we made home visits to high-risk kids but worried that their parents might feel worse if we thought their kids were going to get diabetes. We wanted to be supportive to the parents, especially when lifestyle changes could avert the disease. We went to the IHS and did a presentation for parents telling them that it’s not inevitable and giving them actions to take. But there is often a fatal attitude about it. People in the community were terrified. Home visits would make them cry. But our message was one of hope. We can prevent it if we can get back to an active lifestyle, better diet, avoid convenience foods and alcohol.”

The IHS was not interested in pursuing diabetes prevention at that time, but the community was. The tribal people got the program going by expanding the screening to include the entire Reservation and by helping Butterbrodt form linkages with the local leadership. Tobacco said that Butterbrodt impressed her at first because he was so certain that diabetes could be prevented. “All the other talk about diabetes was pessimistic, about end-stage disease. He said that you’ve got to get to the kids. He’s always fighting for the kids.” She made it a point to introduce herself to Butterbrodt after his presentation, and they’ve been working together for the past 10 years.

“The accumulation of evidence was there,” he said. “They wanted to take on the problem as a community. They got the pop machines out of the schools, banned smoking in many places and encouraged more exercise. I can see progress every day.”

So does Tobacco. People see her in local restaurants and are proud to point out their healthy food choices. She stages annual events to promote physical activity and build awareness around health and prevention issues such as basketball tournaments for AIDS education, a marathon and a triathlon. Methamphetamine use is also becoming a problem on the Reservation. She’d like to see Butterbrodt, currently an IHS employee, work full time for the tribe so he could devote “more time to wellness and less time to disease.”

Change begins

“The parents here really want to know how their child is doing,” Butterbrodt said. “They know about risk. When I started talking about it, the generation that has diabetes was the first to step forward to keep the next generation healthy.” Isolation is a problem. Many children never get to the Clinic and those who do may only be seen a few times during their childhood. He gave as an example a 200-pound Lakota 10-year-old with very high blood pressure. The boy needs to exercise, but he also has asthma. Therefore, the school lets him sit on the sidelines rather than exercise. Butterbrodt would like to establish clinics in the schools so that children such as this boy could get better coordinated health management. “Often I only get one shot at things in the Clinic. If you went to the school, you’d have him as a captive.”

Butterbrodt considers his relationships with the Lakota people as his most valuable asset in his work on the Reservation. He was officially adopted into the tribe a few years ago and that gave him the standing in the community necessary to be effective. “Lakota people operate on family and kinship ties. We are all family here and if you are trying to incorporate positive change into a community, you need to work within that framework.”

Dr. Mark Butterbrodt (BMF’92) grew up in Watertown, South Dakota. After graduating from Harvard with a degree in English literature, he studied medicine at the University of South Dakota in Vermillion, receiving his medical degree from the University of Minnesota in 1977. He did his pediatric residency at the University of Iowa and became a commissioned officer in the U.S. Public Health Service in 1980. Active duty in the U.S. Public Health Service took him for a while to the Pine Ridge Reservation in South Dakota. At the time of his 1992 Bush Medical Fellowship, Butterbrodt worked for Hennepin County Medical Center. He used his fellowship to study asthma rates among the children of people living in the inner city and in areas of rural poverty, exploring ways to screen and effectively manage asthma in these populations. Butterbrodt adapted his screening and management techniques to the prevention of diabetes. He moved to Pine Ridge, “naively assuming it would take three to six months to put a study in place on the Reservation” and stayed. “It just kind of grows on you,” he said. Now he’s an assistant basketball coach and a frequent guest on KILI, the local radio station. “The traditional music, after hearing it for so many years, it’s just as moving as Beethoven’s Sixth. Once you get beyond the surface, the appearance, you can see the beauty of the culture.”

From Giving Strength May 2006

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