Rosze Barrington believes that the secret to family health, for all of us, lies hidden in the strand of time.

As a nurse practitioner working with American Indians on reservations in Arizona and Oregon, she uses the power of ceremony and ritual to help young mothers-to-be focus on their link to seven generations of their ancestral past, and the seven generations to come.

When she began work at Portland's Indian Health Clinic in 1993 with a federal grant, Barrington's goal was to improve prenatal care, and to lower the rate of fetal alcohol syndrome and the number of drug-addicted babies. But pregnant Indian women, especially those with drug and alcohol addictions, were avoiding prenatal care.

Barrington discovered that older women were telling the younger women to avoid the clinic. "Indian women have traditionally been the caregivers and the guardians of health, so they prefer health-care providers to be women," says Barrington. Also, their memory was long?of real or rumored abuses by the Indian Health Service.

"The Indian people I worked with were put off by all the bureaucracy. As one of the women told me, 'If I hear the word no, I won't come back, because it is shameful for me to question authority.' Telling people, 'This is your disease' and handing them a flier and a prescription, is very impersonal."

Barrington then began to make changes.

First, she lengthened the typical visit from a few minutes to as long as an hour?something virtually unheard of in the era of managed care. "I knew that when I was treating one patient, I was treating 50?my patient as well as the circle of family and community members surrounding that woman," says Barrington, whose recent lectures to San Diego health providers were sponsored by the University of San Diego and the Veterans Administration Hospital.

"Working with Indian people, I have been moved by their sense of connection in time," she says. But many young Indian women, particularly in urban areas, have been disconnected from their ancestral past. All many of them know is their immediate history, the abuse or addiction of their parents. "Without a sense of the past, they have little sense of a future."

So she enlisted the help of Oregon's older Indian women, including some tribal elders. She asked them to form a women's healing circle at the clinic.

As part of the healing circle, the women make a cradle board?a traditional American Indian child carrier, a board with cloth and lacing and visor to shield the baby's eyes. According to some tribal traditions, it gives the infant a sense of direction in life. The mother-to-be sits with the circle, helping to prepare the board. The women "put their prayers into the board," as the older women tell stories of strong Indian women of the past.

"As the group talks, a nurse midwife and I?we also participate?weave medical information about prenatal care into the conversation."

Then comes the "remembering ceremony."

"We place the pregnant woman's hand on her belly, and our hands over her hand. Or, if the father of the child is in the room, we place his hand on hers and our hands on top of his. Then I ask the woman?or the two parents?to commit to helping this child know who it is, to quit drugs, alcohol and cigarettes, to stop any domestic violence."

She asks the mother, and the father, to acknowledge the fact that healthy babies are not created overnight?and that the healthiest of children take generations to create.

She asks the woman to announce who she is, that she is a proud and strong Indian woman, committed from this day forward to help this baby and the next seven generations of children to know who they are and what they stand for. "When we place our hands on the mother's belly, time and space stand still. The generations merge into one moment."

The approach appears to work, according to a study done by the clinic for the federally funded Center for Substance Abuse Treatment. Of 42 women enrolled in prenatal care, only two women continued to use alcohol and drugs after the first visit. None of the women gave birth to babies pre-term, and none of the babies was born "small for gestational age," as Barrington puts it. "I don't want anyone to think we're doing magic," she says. "It's not magic, it's science. But a broader definition of science."

Barrington recently left the Indian Health Clinic to open a private practice at Portland's Center for Natural Medicine. She believes the approach is appropriate for a wider circle of parents?"You could take the word Indian out of this." To find our place in time, she says, to know ourselves seven generations into the past, and to care for our children seven generations into the future, is to live a dream of power and health.