Native American artists use art and storytelling to bring cancer statistics to life

As an internist and health-care economist, Scott Ramsey, M.D., Ph.D., is used to looking at cancer statistics in black and white. Lately, however, he's been seeing them in shades of vibrant red and deep blue.

These are the predominant colors in an acrylic painting by Tacoma artist Chholing Taha that is part of an equally bold effort to educate Northwest American Indians and Alaska Natives, through visual art and storytelling, about the importance of cancer prevention and screening.

"Art and storytelling remains a very powerful means for communicating information among American Indians and Alaskan Natives and may be the best way to educate people in these communities about health behaviors related to cancer screening and prevention," said Ramsey, a member of the Hutchinson Center's Public Health Sciences Division and a professor of medicine at the University of Washington School of Medicine who is conducting research on the use of specific cancer-screening services among tribal communities in Washington, Oregon and Idaho.

Such education is crucial, because while there is no word for cancer in most American Indian and Alaska Native languages, it is the second-leading cause of death for American Indians and the leading cause of death among Alaska Natives.

Because smoking-related cancer is a significant public-health issue in the tribal community, Ramsey enlisted Taha, a certified native artisan of the Cree/Iroquois First Nations, to create a piece of art depicting the dangers of cigarette smoking - and the benefits of quitting - in a culturally relevant, non-threatening way. The pilot project, funded by the National Cancer Institute's Community Networks Program, was made possible by a grant subcontract from the Native People for Cancer Control program based at the University of Washington.

Taha's acrylic "button blanket-style" painting, entitled "Legend of Octopus Woman and Crow," is based on characters from a traditional Coast Salish story. The painting depicts a bright red octopus surrounded by 25 crows. A lone yellow crow is caught in the sea monster's tentacles, symbolizing the one in 25 long-term smokers who will develop lung cancer. Another crow, larger than the rest and pale blue, soars skyward, symbolizing a smoker who kicks the habit and escapes the monster's death grip.

"Lung cancer doesn't affect everyone who smokes, but there is a one-in-25 risk among long-term smokers," Ramsey said. "Chholing's painting pictorially shows that risk and what happens to that risk when you stop smoking."

In addition to bringing statistics to life, presenting cancer information through the symbolism of storytelling and art is thought to be less frightening and intimidating. A common concern among some Native people is the belief that if a person acknowledges a disease or speaks its name, it creates a connection to the disease and perhaps brings it on. "Cancer, in particular, can be seen as a very intelligent, formidable opponent, and so there may be a belief among some healers, out of respect to cancer's power, that you don't call its name casually," Taha said. "Art takes you out of the picture and creates a safe learning environment."

Taha is one of two local Native American artists to receive funding from this pilot project to develop culturally appropriate artistic interpretations of statistical information regarding cancer prevention and screening. The other is Sammamish, Wash.-based storyteller and artist Roger Fernandes, a member of the Lower Elwha Band of the Klallam Indians.

Fernandes created a story and painting based on a traditional Klallam tale about "Slapu the Terrible Monster" that illustrates the importance of dealing with adversity, such as cancer, through "using your brain, working together, changing your ways and asking for help," Fernandes said.

"Doctors give information and data that is linear and literal about cancer biology and pathology, but most people don't understand that. Many people, including Native people, better understand metaphor. If in their hearts they are afraid that cancer will kill them, then all the information in the world won't help. Metaphor and storytelling attends to the emotional and spiritual aspects of dealing with cancer to help make it less scary."

Ultimately the artists, in consultation with Ramsey, will work with relevant Indian health boards and tribal councils to determine the most appropriate and effective ways to present their work throughout Northwest tribal communities. An informal survey also will be taken to gauge viewers' opinions of the works and how they may influence their health behaviors. "We plan to survey people to see how the Native American community responds to this versus the traditional health messages that come from the white media," Ramsey said. "The point here is to make it relevant."

If this initial pilot project is successful, Ramsey hopes to attract additional funding to develop a nationwide network of tribal artists and storytellers who can support the initiative through their own cultural knowledge and talents. "Ultimately we hope to create and disseminate more artistic representations of cancer-risk reduction and screening messages, as well as conduct more formal evaluations of the program's impact on cancer-screening behavior in American Indian and Alaska Native communities throughout the United States," he said.