The power to change our lives and our communities begins with changing our destinies. For most, this means changing our lives through education. Our elders recognized this need more than 100 years ago.

Most of us have heard innumerable times from tribal leaders and our parents that “education is the ladder.” Education is more than a ladder – it can be a cataclysmic force, such as the recent admission of seven American Indian medical students to the University of New Mexico’s School of Medicine in Albuquerque. Most medical schools don’t admit more than one American Indian student per year, if any. This history-making event represents an enormous change in one U.S. medical school that will likely change the culture of the school itself, the perspectives of the student doctors in training there, and the practices of the physicians there. Certainly, it will make the lives and experiences of the students that follow much easier.

Most importantly, these seven student doctors will work to improve the health of our American Indian communities. These remarkable seven will make an impact like few others before them. These seven are made stronger by the two physician assistant students also admitted to the University of New Mexico. In a workforce population that is compromised through attrition, disillusionment, retirement, burnout, workplace discrimination, and other factors, the number of American Indian physicians is small relative to our need.

Yes, we are fortunate to have hundreds of American Indian physicians, but we are spread throughout the U.S. at universities, private practices, specialty care centers, research institutions, tribal clinics, and the IHS. After 18 years of being a doctor, I still meet patients who say I am the first American Indian doctor they’ve ever met. They are stunned to learn there are more than 75 Navajo physicians and many tribes have graduated at least one physician from among their tribe.

So, to have our numbers augmented by seven in one starting class is an astonishing event. As a single splash in a lake makes ripples that affect its every shore, these student doctors will have an impact on the entire American Indian population.

The expectations remain high – to perform well, to be a good role model, to survive the training process. American Indian doctors-in-training need help in bearing this load, as do all of our youth in bearing the burden of expectation. We can help with encouragement, being liberal with our praise and admiration, our prayers, and other offers of support.

What did it take for these seven students to get admitted to medical school? A clear purpose led the way. Perhaps role models and mentors made the difference. Making choices and sacrifices that would lead them to their goal was without a doubt necessary for their success.

These steps are similar to the steps we take in setting a goal for weight control, diabetes control, and other health-related goals. We set our goal, make decisions and choices, enact behaviors that will make the desired difference, and we re-evaluate and revise our plan as we move forward. We make healthier food choices, set aside and prioritize time to be active, we call upon supports and resources to assure consistency in our actions, and if we “fall off the wagon,” we pick ourselves up and throw ourselves back at the objective. We learn and build confidence from this process.

Inevitably, some steps don’t always succeed, and at points along the way, re-evaluation and reworking one’s plan has to be done. In addition, it is critical to recognize and break patterns that repeatedly do not serve as healthy approaches to our goal. In this way, we work steadily to change our destiny.

How do we decide on a goal in the first place? Examining our values and motivation are what leads to specific goals. Values are what we hold most precious to our lives on a very deep or core level. For some, that may mean improving the health of families and communities; our communities that will ultimately improve all of our lives for the better. In working with people with diabetes, virtually without exception, my patients’ values include “being healthy in order to live a long life with my family.” This theme is echoed in the diabetes patient education materials for American Indians developed by the National Diabetes Education Program. Visit www.ndep.nih.gov for these free materials including self-management toolkits with guides to action planning.

Our new American Indian medical students made decisions about studying instead of partying or idling away their time; they chose to study science and math – not easy subjects for many, but essential to reaching their goals. The students chose to complete tedious paperwork and to study for the medical entrance exams in order to make it all possible. Their steady achievements required discipline, purpose, goal setting, action planning, and self-evaluation. Yes, it is hard work but its rewards are enormously enriching.

These steps are the ones required in achieving any set of goals including health-related ones. If you have not started in earnest, start today.

Charlene Avery-Lieb, M.D. is a Navajo physician working in Albuquerque, N.M. Dr. Avery serves as chair of the National Diabetes Education Program American Indian Work Group and is president-elect of the Association of American Indian Physicians.