Recently while I was sick with a bacterial infection and Peace Corps was putting me up in a hotel in Managua (aka: an air-conditioned oasis with wireless internet, hot showers and cable TV), I watched an episode of a program called “Losing it with Jillian.” Jillian Michaels, a personal trainer who got her start on the popular show, “The Biggest Loser,” is now starring in her own show, trying to change America’s bad diet and exercise habits one person at a time. Her no-fooling -around and drill sergeant style has gained her quite a reputation, and in the episode that I watched, she was on a Yavapai-Apache Indian reservation trying to mobilize the “nation” to fight diabetes.
It’s no secret that type II diabetes is a large problem among the Alaska Native and Indian population of the U.S., and Jillian seemed motivated to single-handedly eradicate it. She had started working with a handful of obese Indian women; doing daily workouts and helping them change their diet. The camera panned across a hot desert spotted with cacti, then you saw these large women come into view, trotting obediently alongside Jillian. Their faces strained in effort as they lifted heavy weights to do squats. Jillian’s strong voice barked at them, “no giving up!”
Jillian and the women organized a town hall meeting to discuss diabetes with a guest doctor who specialized in the disease. They walked house to house handing out flyers the day of the event inviting the whole reservation. When the meeting time came however, only a handful of participants were in the seats. “I just don’t know what to do to get these people to listen!” she complained.
The next day, Jillian was walking with one Indian woman who was her main “change agent,” and began to break down about how difficult her challenge seemed to be. Jillian’s goal was to first change this one woman, and then try to change the Indian nation. The Indian woman had a four year old son who was already obese. “Why are people so apathetic?!” Jillian implored, “I mean, do you even want to change?!” The Indian woman walked submissively by her side with her eyes downcast. “You’re feeding your child JUNK!” Jillian continued, “It isn’t even food! What is so hard about saying no?? Is it hard to say no to heart disease, to diabetes, to cholesterol, to a doughnut? To what?!” In Jillian’s mind, these people were voluntarily killing themselves through their lifestyles and it was like she was flashing a big red stop sign in front of them, but they were just ignoring it.
An “Aha!” moment came when the Indian woman finally spoke up. She was in tears. “I don’t know how to change!” she began. “No one every taught me. This is all I know. You need to help me, teach me. It’s hard!” Jillian finally softened her tough demeanor and resolved to help the woman and to try and help the community. They continued on their walk.
Watching this episode, the other Peace Corps volunteers sharing my hotel room and I were dumbstruck. Observing Jillian trying to effect change in this Indian reservation was so similar to our experience here in Nicaragua working in community health behavior change. We arrive with excellent tools and resources and so many ideas and aspirations; we are going to actually DO something here! We are going to change lives for the better! Then reality hits. Behavior change is hard. People may not show up to meetings, they may tell you they want to change, but they may continue their old habits. One thing is the knowledge that a behavior is wrong, but another is helping to motivate actual action to change that behavior. Watching Jillian was like watching a poor, misguided, greenhorn Peace Corps volunteer. “With an attitude like that, you won’t last long here!” my friends and I laughed as we watched Jillian fret and complain. It was also hard to see the Indian woman break down emotionally – she did have a strong desire to be healthier and change her habits, but when you’ve grown up learning certain behaviors your whole life, that change will not occur overnight or be easy.
Condom use, diet change, exercise, hand washing, cleaning habits, and common myths about diseases are just a few examples of the types of behaviors that we seek to change here in Nicaragua. The aerobics class I teach in my community was packed for the first few weeks, but then as time wore on and women saw that it was actually difficult to do exercise and lose weight, attendance tapered off. I can teach one hundred women how to cook with soy meat, but the real test comes when they’re at the corner store deciding what to make for lunch that day. After a hand-washing class, students might wash their hands regularly for a few days, but then they forget if those habits are not reinforced by their families.
At times, I also get frustrated with the slow-moving change here (but, nowhere near Jillian-level freak-outs at my community members). When you really want to make a difference, you can feel useless when you don’t see immediate results. I guess that’s why Peace Corps is two years, not two weeks.