O'odham Himdag as a source of strength and wellness among the Tohono O'odham of Southern Arizona and Northern Sonora, Mexico.

The Tohono O'odham are fostering strength and wellness in their community by translating increased economic self-sufficiency and resources derived from gaming into social, health, and educational services which maintain their tribal traditions, thereby providing an effective path toward the maintenance of cultural identity, or O'odham Himdag. Cultural identity serves as a source of client strength and as a protective factor contributing to client wellness. O'odham Himdag describes a way of life, encompassing Tohono O'odham culture. This article is a theoretical exploration of O'odham Himdag as a path toward cultural identity among the Tohono O'odham of Southern Arizona and Northern Sonora, Mexico. It addresses the importance of tribes developing their own services within tribal values and describes O'odham Himdag as a path to health and wellness, with practice examples drawn from the literature and interviews with mental health, health, and lay practitioners belonging to and serving the Tohono O'odham.

Introduction

The Tohono O'odham (pronounced toe-HONE-o Ah-tomb), formerly known as the Papago, reside in Southern Arizona and Northern Sonora, Mexico. Despite being the second largest group of Indigenous Peoples in the southwestern United States in both population and reservation size (Zepeda, 1995), with a main reservation the size of Connecticut (The Papago Tribe, 1972), there is a dearth of literature available to guide social work students and practitioners seeking to learn how to provide culturally competent social work practice and models of service delivery to this group. Other than a set of articles discussing O'odham indigenous community mental health services (Kahn & Delk, 1973; Kahn, Henry, & Lejero, 1981; Kahn, Lejero, Antone, Francisco, & Manuel, 1988; Kahn, Williams, Galvez, Lejero, Conrad, & Goldstein, 1974), the available literature is written from an anthropological, educational, linguistic, or health perspective, or relative to issues of land and water rights.

The O'odham are fostering strength and wellness in their community by translating increased economic self-sufficiency and resources derived from gaming into social, health, and educational services which maintain their tribal traditions, thereby providing an effective path toward the maintenance of cultural identity, or O'odham Himdag. This article presents a brief history of the Tohono O'odham, then discusses the importance of tribes developing their own services within tribal values, introduces the concept of O'odham Himdag, and describes the relationship of O'dham Himdag to strength and wellness. It concludes with examples drawn from a variety of indigenous programs, including services to incarcerated youth, elders requiring skilled nursing facility care, and people living with diabetes which successfully incorporate O'odham Himdag. This article begins to address the need for more literature to prepare social work practitioners and students to work with O'odham Peoples. The Tohono O'odham can serve as a model for other Indigenous Peoples seeking to balance increasing economic self-sufficiency with the maintenance of their cultural identity and traditions.

The Tohono O'odham

In 1936, Ruth M. Underhill, an anthropologist, published a noteworthy memoir, The Autobiography of a Papago Woman, which laid the foundation for our present knowledge of the history and culture of the Tohono O'odham. Along with the Pima, the O'odham are descendants of the Hohokam, or "the people who are gone" (Nies, 1996, p. 49). Father Kino, made the first documented contact with the O'odham in 1698, establishing a mission at San Xavier (Greene, 1998; Kelly, 1963; Underhill, 1936). The Spaniards called the people they encountered Papago, meaning "bean eater" (Volante, 1994, p. 1B). The Treaty of Guadelupe Hidalgo, signed at the conclusion of the war between Mexico and the United States (1846-1848), left the O'odham territory intact; but, the Gadsden purchase in 1854 divided the territory roughly in half between the United States and Mexico (Heard Museum, n.d.; Underhill, 1936).

The federal government established a reservation west of Tucson in 1916, after repeated efforts to advocate for land title, only to reduce the land holdings in 1917. The area was at last restored to the O'odham in 1926 (Heard Museum, n.d.). The people voted to accept self-governance in 1935 under the Wheeler-Howard Bill (The Papago Tribe, 1972), received the right to vote in 1949, and obtained mineral rights to their own lands in 1959 (DeWald, 1979). In 1986, the tribe changed its name from Papago to Tohono O'odham, meaning "Desert People". Ofelia Zepeda (1995), an O'odham linguist, educator, and poet who has made significant contributions to the relatively new body of literature written in the O'odham language, commented that the name change was "a very strong identity marker for us as a large group" (Volante, 1994, p. 1B).

Today, there are 24,000 enrolled members (Duarte, 2000), including approximately 1,300 who live in the northernmost portion of Sonora, Mexico, with a "barbed-wire-and-wood fence at San Miguel, broken only by the cattle guard" separating the traditional homelands (Innes, 2000, p. A1). The O'odham refer to this as "the gate" (K. Blaine, personal communication, March 14, 2001). Members seeking services on the United States side of the border or wishing to cross into Mexico must present a tribal identification and may be transported by tribal workers (M. M. Francisco, personal communication, May 24, 2001). An O'odham delegation traveled to Washington in June 2001 seeking to make tribal membership the legal equivalent of the state-issued birth certificate or the federally-issued Certificate of Citizenship. If approved, this change would permit the nearly 7,000 members who lack birth certificates and those members living in Mexico to cross the border with greater ease so that they are no longer "obstructed from visiting each other, conducting sacred ceremonies and maintaining their culture" (M. Shebala, personal communication, May 24, 2001).

Economic Development, the Indigenous Principle, and Sovereign Services as Paths to the Maintenance of Tribal Values

Since the beginning of the Indian movement in the late 1960s, there has been "a widespread consensus in Indian country that power over policy decisions involving Indian resources and development directions must be wrested away from the non-Indian bureaucracies and relocated among the Indian peoples and communities" (Mohawk, 1991, pp. 495-496). Agencies such as the Bureau of Indian Affairs and the Bureau of Land Management regulated the land, water, and lives of Natives peoples to the extent that Natives peoples "had practically no real power of ownership over their assets and no authority or ability to mobilize capital and labor--the primary ingredients which make development possible" (p. 495). The Administration for Native Americans (ANA), part of the Department of Health and Human Services, developed a new approach called "Social and Economic Development Strategies" (SEDS) in 1981, in consultation with Native leaders (Administration for Native Americans, 1985). While this new approach promoted self-sufficiency through financial grants and moved the ANA away from funding administrative services and "filling social service gaps" to funding activities "designed and implemented by the tribe", SEDS was ultimately a continuation of Federal control. In the Tribal Self-Governance Act of 1994, Congress recognized "the inherent sovereignty of Indian tribes and nations", literally meaning that "they operate as independent political authorities, governing themselves" (Innes, 1999, November 10, p. 1B). In social work practice with Native American clients, the knowledge base should include an understanding of sovereignty as well as issues such as history and historical trauma, citizenship, and cultural identity (Weaver, 1998).

The notion that "services should be provided, directed, and controlled by the people of the indigenous community that was being served" is referred to as the "indigenous principal [sic]" (Kahn, Lejero, Antone, Francisco, & Manuel, 1988, p. 369). The Tohono O'odham Psychology Service, an indigenous community mental health service, was cited as one of the few examples of services that fully implemented the indigenous principle, as it was staffed and administered by the O'odham people. As a result, the agency staff were knowledgeable about and sensitive to the culture of their clientele. Indigenous services were found to strengthen cultural identity and pride, as well as foster economic self-sufficiency.

The importance of cultural identity and its relationship to program staffing was echoed by Lauri Francisco, Family Service Specialist for the Family Preservation program within the Division of Child Welfare/Department of Human Services of the Tohono O'odham Nation. "[A]ll [of] our counselors are from the reservation, so they've grown up or at least been a part ... of here, of the nation, of the reservation. That really helps in assisting our clients to do the work that they need to do for themselves" (personal communication, March 7, 2001).

A 1983 study by Haviland, Horswill, O'Connell, and Dynneson found that Native American college students demonstrated a strong preference for Native American counselors irrespective of presenting problem, noting that the likelihood of using services "increased as counselor preference increased" (p. 267). These findings further support the idea that services to indigenous peoples should be provided by indigenous peoples.

In November 1999, three hundred people representing 50 tribes in the United States and Canada met in Tucson, Arizona for a conference cosponsored by the Tohono O'odham Nation and the Morris K. Udall Foundation entitled "Building American Indian Nations for the 21st Century"(Innes, 1999, November 10, p. 1B). The message to "think like a sovereign" provided a backdrop to this opportunity for tribes to share success stories and "confront colonization" (Innes, 1999, November 13, p. 1B), and was a continuation of a thirty year trend of Native peoples creating sustainable economies and breaking away from federal dependency. Success stories included the use of gaming profits by the Grand Traverse Band of Ottawa and Chippewa Indians in Michigan (Innes, 1999, November 10).

The O'odham invested in gaming operations in October 1993 with the construction of two casinos, with a third on the way, and have reaped an annual revenue of $70 million in profits (Arizona Daily Star, 2000; Duarte, 2001). While still controversial (Arizona Daily Star, 2000), gaming has facilitated the Nation's ability to regain self sufficiency by creating jobs and economic opportunities. Gaming revenues have supported the development of college scholarships, a new nursing home, justice center, and fire stations (Sandal, 1999), and have provided grants to support small business owners and entrepreneurs (Banchero, 2000). In January 2000, the Tohono O'odham Community College opened with 105 students. In 1998, the tribe's Legislative Council earmarked $1.4 million from gaming profits for the college, later committing an additional $71 million over a five year period to support its continued development (Gassen, 2000).

Despite the success of gaming operations, Tohono O'odham Chairman, Edward Manuel, stated that "[T]he casino is not the panacea to our economic development. We need to establish policies that are fair to development. We have enough sovereignty as tribal governments. It's just a matter of how we use that" (Innes, 1999, November 10, p. 1B). Manuel predicted that the O'odham's use of casino profits for indigenous projects such as a reservation nursing home and community college would "entice more members to live, work and invest in their own tribe" (Innes, 1999, November 13, p. 1B).

The social implications of sovereign services operating under an indigenous principle are enormous.

   If Indian nations have the power to make decisions about their future, they
   can choose educational paths which cause their languages, history, arts,
   and culture to survive and can therefore perpetuate the very elements which
   define them as distinct peoples. (Mohawk, 1991, p. 503)

Economic development, the indigenous principle, and sovereign services speak to the importance of tribes developing their own services within tribal values and pave a path toward the maintenance of tribal traditions.

Schools of social work can cultivate the seeds of the indigenous principle and sovereign services to prepare Tohono O'odham social workers at the baccalaureate and master's level by modeling themselves after programs that successfully recruit, enroll, and retain Native students. Social work programs can hire O'odham faculty and staff; recruit prospective students through indigenous gatherings; flag the applications of O'odham applicants; designate a liaison for O'odham students; offer social, financial, and academic assistance including tutoring, emergency loans, and a Native student association; include curriculum and courses addressing O'odham and Native issues; and provide practicum placements in agencies serving O'odham clients (Metscher, Wedel, Dobrec, Wares, & Rosenthal, 1994).

Maintaining Cultural Identity: Preserving O'odham Traditions Through O'odham Himdag

Himdag means "our path" (R. N. Ruiz, personal communication, March 13, 2001) or "way of life" (Severson, 1996, p. 1C). Himdag or "Himthag" [sic] refers to "a way of life; a culture; a custom or practice; traditions"; but, as a verb can mean to "be able to walk" (Saxton, Saxton, & Enos, 1998, p. 22). O'odham Himdag refers to "a way of life inclusive of terms such as culture, heritage, history, values, traditions, customs, beliefs, and language (Seivertson, 1999, p. 242). To Angelo Joaquin Jr., director of the Tucson-based Native Seeds/SEARCH and former tribal chairman, Himdag is the "crucial balance between the mental, physical and spiritual health of an individual" (Severson, 1996, p. 1C). The O'odham say it was:

   Given to us as a gift of our Creator, our Tohonno [sic] O'odham Himdag has
   endured through generations. No other Indian Tribe or Nation can claim it.
   It is what makes us Tohonno [sic] O'odham. Within our Himdag, respect is
   strong. This is evident by the respectful terms used in clans relating us
   to the earth and animals. Our dialects separate and yet unite us again
   through the circle of life. In order for our Himdag to be carried on, we
   must care about our heritage and preserve the gift that was given to us
   since time immemorial. Therefore, our Tohonno [sic] O'odham Himdag demands
   respect and maintenance by all who claim it. (Language Policy of the
   Tohonno O'odham as cited in Seivertson, 1999, p. 242)

When the Tohono O'odham Nation voted to incorporate a separation of powers into their constitution, which was viewed by some as the "white man's way", one O'odham consulted a traditional Medicine Man and reserved the Council Chambers so that he could tell the creation story. Although the vote had already taken place, this was done to remind the people of the O'odham Himdag, the O'odham way (R. N. Ruiz, personal communication, March 13, 2001).

Language is a critical part of the Tohono O'odham Himdag. When the first missionaries established schools on the reservation and later when O'odham children were sent away to boarding schools, the O'odham were not allowed to speak their own language. Margie Butler, who teaches the Tohono O'odham language at the San Xavier Mission School said, "The [h]imdag is their culture, their language, everything combined", indicating that the loss of language leads to the loss of the way of life, including the customs, songs, and stories of the O'odham. Jackie Koenig, principal of San Xavier Mission School, commented that the ability of the children to speak their own language in school "has done wonders for their self-esteem". Ofelia Zepeda, an O'odham linguist, said, "If you don't have a language, a lot of basic knowledge is no longer available to you". According to Mary Ann Willie, a Navajo linguist, "When you lose the language, you lose the capacity to participate in activities where the language is used" (Severson, 2000, p. E1).

The Family Preservation Program operates within the Division of Child Welfare in the Tohono O'odham Department of Human Services. It provides individual, family, and group counseling to members and residents of the Tohono O'odham Nation. Group therapy is provided to court-mandated youth residing in a juvenile detention center. Psychoeducational groups conducted through this program incorporate O'odham language as "certain clients ... feel better when it is explained to them in O'odham". The youth often have difficulty putting their feelings into words, so the use of the O'odham language provides culturally relevant words for feeling states that do not necessarily have an equivalent in English. The group process begins with a prayer, then moves into a talking circle in which each youth take a turn to speak, passing a meaningful object from person to person to facilitate speaking. Staff may incorporate smudging, burning, and blessing with sage into the process or may take clients to a traditional medicine man if requested by the client. The use of indigenous workers is seen as a strength of the program. The fact that all of the counselors were either a part of or grew up on the nation assists clients "to do the work that they need to do for themselves" (L. Francisco, personal communication, March 7, 2001).

Yet another aspect of O'odham Himdag relates to the larger community. Tohono O'odham Community Action (TOCA) is a grassroots organization that creates culturally based responses to community problems, including "1) sustainable economic development, 2) a community food system that keeps us healthy, 3) programs which rejuvenate our cultural traditions, and 4) ways of encouraging our young people to become strong members of the Tohono O'odham community" (Tohono O'odham Community Action, 2001, p. 1). Programs include a group for basket weavers, a community food system, an arts and culture program, and a youth/elder outreach program. TOCA's guiding principles include O'odham Himdag, community assets, the material foundation of culture, and community self-sufficiency, recognizing the importance of the maintenance and context of culture as well as economic self-sufficiency. O'odham Himdag is described in program literature as "Wisdom from our past creating solutions for our future" (TOCA, 2001, p. 3).

Tohono O'odham Youth Services (TOYS) rejuvenates cultural traditions through a variety of activities designed for youth ages four through twenty four, including a summer bahithaj (meaning saguaro fruit) camp, in which elders teach youth how to harvest and prepare saguaro fruit. The fruits of this labor are fermented, then donated to the Big Fields village for an annual Wine Feast (J. Norris, personal communication, June 14, 2001).

O'odham Himdag encompasses cultural identity and all that is important to the O'odham. It cannot be broken down into component parts any more than one can separate a person from the land, one's heritage, or one's spirituality. In this way, O'odham Himdag is very consistent with systems theory and the biopsychosocialspiritual perspective of the social work profession.

   Wellness Cewagi Summer clouds sit silently. They sit, quietly gathering
   strength. Gathering strength from the good winds. This strength that
   becomes the thunder. The thunder so loud it vibrates the earth. The thunder
   that surrounds us.

   (Zepeda, 1995, p. 26) (1)

   (1) Reprinted by permission of Ofelia Zepeda.

According to the World Health Organization, health is defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (Edlin, Golanty, & Brown, 1999, p. 4). The term wellness was first used by Halbert L. Dunn, a physician, in a 1961 booklet entitled High Level Wellness. Dunn described wellness as a lifestyle approach to elevated states of physical and psychological well-being, incorporating a disciplined commitment to personal mastery (Ardell, 2001). Wellness, as defined by Hurley and Schlaadt, "emphasizes individual responsibility for well-being through the practice of health-promoting lifestyle behaviors" (Edlin, Golanty, & Brown, 1999, p. 4). Areas of commitment related to wellness include "self-responsibility, exercise and fitness, nutrition, stress management, critical thinking, meaning and purpose or spirituality, emotional intelligence, humor and play and effective relationships" (Ardell, 2001). So while health implies a state of being, wellness defines a set of actions or behaviors that lead to a state of health.

Myers, Witmer, and Sweeney (1995) defined wellness as "a way of life which is oriented toward optimal health and well-being in which body, mind, and spirit are integrated in a purposeful manner by the individual with a goal of living life more fully within all spheres of functioning: social, personal, environmental" (as cited in Garrett, 1999, p. 59). Oetting and Beauvais (1991) proposed an orthogonal model of cultural identity which posited that identification with any culture has positive implications for health and social issues (Weaver, 1996).

A study of Native American youth conducted by Weaver (1996) supported the notion that "people can and do identify with more than one culture" (p. 103). While findings did not demonstrate consistent support for the notion that cultural identification has positive implications for health and social well-being and additional research was recommended, the notion was supported in some cases. Weaver concluded that social workers can address the social and health issues within Native American communities by recognizing "the importance of cultural identification and using interventions that do not contradict cultural norms" (1996, p. 103).

The literature on wellness, health, and resilience "assert[s] that individuals and communities have native capacities for restoration, rebound, and the maintenance of a high level of functioning" and that health, resilience, (Saleebey, 1997, p. 243) and health sustenance (Benard as sited in Saleebey, 1997) are communal undertakings. Social support, an important community resource which includes the resources of cultural groups, serves as a protective factor against and facilitates recovery from the effects of stress and crisis (Hill and McCubbin, Futrell, Thompson, & Thompson as cited in McKenry & Price, 2000).

Social workers approach clients from a strengths perspective, a humanist perspective grounded in the assumptions that humans have the capacity for growth and change and have "many capabilities, abilities, and strengths" (Early & GlenMaye, 2000, p. 118). According to Saleebey (1996), the strengths perspective:

   demands a different way of looking at individuals, families, and
   communities. All must be seen in the light of their capacities, talents,
   competencies, possibilities, visions, values, and hopes, however dashed and
   distorted these may have become through circumstance, oppression, and
   trauma. (p. 297)

The Code of Ethics (National Association of Social Workers, 1999) states that "[s]ocial workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures" (p. 9). Oetting and Beauvais (1991) indicated that "cultural identification should serve as a source of strength and potency" and "be correlated with general well-being and positive personal adjustment" (pp. 671-672). A key research implication was that "identification with any culture may serve as a source of personal and social strength" (p. 678). The strengths perspective can also facilitate client empowerment as "[t]he role of the social worker is to nourish, encourage, assist, enable, support, stimulate, and unleash the strengths within people" (Cowger, 1997, p. 62).

Weaver noted that "[c]ultural traditions among... [indigenous] people are important strengths that are often overlooked" (1996, p. 103). Among the Tohono O'odham an elder "sways gently to the rhythm of his blessing chant, shaking homemade tin can rattles", which "summons 'strength and power'" (O'Connell, 2000, p. 1B). The word `strength' in an O'odham sense would translate into the ability to push, lift, or pull, since the word comes from the English language. "With death and loss and grief you need strength; but, it shows itself as a form of resiliency ... you would be just moving on as a product of the strength" (K. Blaine, personal communication, March 14, 2001). Strength can help one move from a bad place or a bad emotion. Traditional practices such as praying can be a source of strength, a way of moving on. Smudging, involving a Medicine Man who prays and uses the breeze from a moving feather to blow smoke toward a person or persons, is traditionally practiced in large ceremonies or for an individual, and is considered a healing practice. Sage, cedar, or other indigenous plants may be used for the ceremony. The healing is a path to strength.

O'odham Himdag as a Source of Wellness

Words and concepts relating to health and wellness are a part of the O'odham language. Kuadk, a noun, is a "chant used for diagnosing illness" (p. 35). Ap'ethag is an O'odham word meaning "well-being" (Saxton, Saxton, & Enos, 1998, p. 110). "That's what's going to make us well", such as the Medicine Man, running, or the medicine. "If we do these things, it's part of our wellness" (R. N. Ruiz, personal communication, March 13, 2001). Ha api dag translates as "wellness" (P. Ruiz, personal communication, March 14, 2001). These words may be spelled or pronounced differently depending upon the dialect spoken. Since O'odham Himdag reflects a delicate balance between the mental, physical, and spiritual health of an individual, losing touch with the path of Himdag can lead to imbalance in biopsychosocialspiritual health.

The O'odham hold beliefs about health and illness which differ from the causal theories of Western medicine. A "belief in the power of words, thoughts, and actions `pervades' the O'odham concept of illness" (Dufort, 1991, p. 105). The O'odham believe that "thinking, talking, and acting in negative ways can result in sickness which is experienced immediately or latently. Transgressions resulting in illness and/or misfortune need not be intentionally done" (p. 108). Parents and family members feel an "ever-present" sense of "responsibility for causing (and preventing) serious illness in their children" and believe in the possibility of "attribute transfer", in which talking, thinking, or doing something related to an undesirable characteristic could actually bring it on (p. 108). The depth of this belief will be determined by the level of the family's acculturation. The notion of family as cause or prevention would suggest that the use of family level interventions would be effective in work with the O'odham. The medicine man, also referred to as mahkai, can determine the cause of the illness or condition in a diagnostic dream. The mahkai then provides a ritual by which the individual may be rid of the problem; but, just like Western medicine, the individual must follow the instructions correctly and completely for the healing to take place. The mahkai may use his power for good or evil purposes.

The O'odham believe in pathways between the spiritual and material world. "Traditional beliefs are such that it is not unusual for dead relatives to try to contact the living" (Kahn, Lejero, Antone, Francisco, & Manuel, 1988, p. 372). A young O'odham woman told her social worker that, "My grandmother came to see me". Aside from being aware that any female relative might be considered her `grandmother', the worker was open to the possibility that the visit was from a deceased grandmother, which turned out to be the case. The O'odham don't "try to explain the unexplained". They "accept it" (L. Francisco, personal communication, June 4, 2001).

Native Americans are ten times more likely to develop diabetes than any other group in the United States. Over 50% of all Tohono O'odham adults have adult-onset diabetes, "the highest rate in the world" (Tohono O'odham Community Action, n.d., p. 1; Heard Museum, n.d.). In the decade of the 1990s, the O'odham had a higher diabetes death rate than any tribe in the Western United States (Mendoza, 1998). Diabetes has "ravaged [the] tribe, taking lives and limbs" (Mendoza, 1998). Type II diabetes (noninsulin-dependent) strikes half the O'odham over 35 years of age (Severson, 1996). "The numbers of diabetics are going up and the ages are going down" according to Mary Antone, a community health representative on the Tohono O'odham reservation (p. 1A). The number of children with Type II diabetes rose from one to 18 in thirteen years and the percentage of diabetic mothers, statistically more likely to have diabetic children, doubled in a seven year period. 1993 statistics from the Indian Health Service demonstrated that the O'odham had the "most diabetic pregnancies per capita". In 1997, 20 percent of 350 pregnant women were diagnosed with diabetes before or during pregnancy (Mendoza, 1998, p. 1A).

The Healthy O'odham Promotion Program (HOPP) is designed to provide primary prevention, education, nutrition, and fitness services to "promote healthy lifestyles" (Tohono O'odham Department of Human Services, 2001, para 1). Rosita Nora Ruiz is an O'odham elder living with diabetes and the aftermath of a kidney transplant. She has served as a presenter at an annual community wellness conference focusing upon the rates, consequences, and treatment of diabetes. Ruiz tries to educate "in language the O'odham will understand", indicating that the O'odham are a "very visual" people. Ruiz also serves as chair of a dialysis patient advocate committee, serving tribal members in southern Arizona and Mexico. "We don't see the boundary as others see it ... it's artificial. It's not of our making". The tribe plans to build a dialysis unit on tribal lands which have already been blessed in preparation for construction (R. N. Ruiz, personal communication, March 13, 2001).

Angelo Joaquin Jr., director of the Tucson-based Native Seeds/SEARCH, said, "Our elders are telling us that getting diabetes is a side effect of losing touch with the O'odham way of life" (Severson, 1996, p. 1C). To recapture the path to wellness requires a return to the O'odham Himdag, which includes the use of traditional foods, running and walking, and a renewed relationship with the land and each other. Traditional foods protect against diabetes. After I'itoi created the people, he "gave them all the edible plants of the desert and taught them how to prepare each one" (Greene, 1998, p. 15). Tepary beans have a coating containing pectin, prickly pear pads have mucilage, and mesquite pods have gummy fibers, all of which are natural substances which slow the digestion of sugar. Once dietary staples, these foods have been replaced by highly processed, low fiber, and fatty foods of a Westernized diet (O'Connell, 2000, p. 1B). The Tohono O'odham Food System program recognizes that the consumption of traditional foods including tepary and mesquite beans, cholla (cactus) buds, and chia seeds decreases the severity and rate of diabetes (TOCA, 2001, p. 1).

Traditional people get up in the morning, run, and greet the sun. To a traditional person, running is a "part of fulfilling their spiritual needs" (Severson, 1996, p 1C). The focus is not on exercise, "It's on spirituality--the health benefits just come along ... In our himdag, there is no distinction between humans and animals and plants. You have a relationship there that was present since the world was created" (p. 1C).

Madeline Francisco chairs a committee responsible for the planning, development, and building of a new skilled nursing facility on the Tohono O'odham reservation. This 60 bed unit is expandible to 120 beds and incorporates elements of O'odham Himdag of importance to the elders who will soon make it their home. O'odham have planned and will staff and administer the facility, following the indigenous principal. Non-O'odham professional staff will be hired as needed. Housing and daycare will be provided as an inducement for employees to work at the distant location. The building design respects O'odham Himdag and was derived from input from the elders. The elders wanted to be able to "smell the rain" and see the sunlight, so the facility was designed as a half circle with spokes going out from it and plenty of windows so that each resident would be able to watch the sunrise and the sunset, and smell the rain. Family members had difficulty visiting elders housed in Tucson area nursing homes, as it sometimes took two-and-a-half hours travel each way. The new facility will provide space for family members to spend the night. There is a chapel; but, also a place for a traditional medicine man, or mamakai. The floor of the facility entrance has a large inlaid squash blossom design on the floor, a common design element in O'odham basketry (DeWald, 1979). The entrance is designed to face Baboquivari Peak (M. M. Francisco, personal communication, May 24, 2001), the site of the creation story of the O'odham. I'itoi, Elder Brother, created the Tohono O'odham by bringing them "from the earth through a sacred cave nestled in the foothills of the Baboquivari Mountains" (Greene, 1998, p. 15). Basic conversational O'odham will be taught to staff who do not already speak O'odham, to encourage use of the language with the elders.

Conclusions and Recommendations

Cultural identity is an important aspect of individuals and communities which must be considered by a culturally competent social worker. The Tohono O'odham concept of O'odham Himdag includes and enlarges upon cultural identity, encompassing a "way of life" for the O'odham, a gift of the Creator. This way of life includes a crucial balance between the mental, physical, and spiritual health of an individual, family, and community. Wellness is inextricably bound to O'odham Himdag, is communal, and tied to traditions and ceremonies. The elders warn that being out of touch with one's Himdag leads to illness, as it creates an imbalance in the biopsychosocialspiritual health of an individual. Those very traditions promote physical wellness through diet, exercise, and connection to the land, even though intended toward spiritual healing. The people gather strength, singing down the rain, singing songs to pull down the clouds. For it is the people that bring the clouds, the clouds that bring the rain, the rain that heals the soul and regenerates the earth. The clouds, like the O'odham people, "sit quietly and gather strength" (Zepeda, 1995, p. 26).

The O'odham are a poetic people whose language is populated with simile and metaphor. The man in the maze, one of the cherished symbols of the O'odham people, represents a man looking for a deeper meaning of life. To find this meaning, "he must pass through the maze and all of its pathways" (Adams, 1978, p. 263). For the O'odham, the path to meaning can be found in O'odham Himdag.

O'odham Himdag is a rich ground which, if cultivated by social workers, indigenous and otherwise, is a source of strength and wellness. Social workers can incorporate and respect the traditional beliefs and practices of Indigenous Peoples, utilizing them alongside the contributions of Western medicine and thought. In this way, social workers may serve as a bridge between the nurturing and sustaining cultures and facilitate the maintenance of tribal traditions. Schools of social work can incorporate strategies to recruit, enroll, and retain Tohono O'odham students to facilitate the provision, direction, and control of professional social work services for O'odham, by O'odham, utilizing the indigenous principle.

As a people, the Tohono O'odham have cultivated increased economic self-sufficiency, transforming the profits from gaming into economic development activities and services which follow the indigenous principal. The result is a harvest of critical social, health, educational, cultural, and economic services meeting the needs of the community while maintaining tribal traditions and preserving O'odham Himdag. Economic development that follows the path of tribal traditions fosters wellness and balance for the entire community. While additional research is needed, including the evaluation of outcomes of programs utilizing traditional O'odham practices, this article provides a beginning step on the path toward describing the ways in which O'odham Himdag can strengthen social work programs and services conducted by and for the Tohono O'odham.

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Teri Knutson Woods, MSW Arizona State University College of Public Programs School of Social Work/Tucson Component Tucson, AZ 85754

TERI KNUTSON WOODS
KAREN BLAINE
LAURI FRANCISCO
Arizona State University/Tucson Component