Ka Wai Ola - Office of Hawaiian Affairs, Volume 10, Number 7, 1 July 1993 — Different people, same problem [ARTICLE+ILLUSTRATION]

Different people, same problem

lndigenous peoples from Alaska to Oeeania gather to tackle diabetes epidemic at lnternational Conference on Diabetes and Native Peoples

by Patrick Johnston Native peoples of North America and the Pacific have distinct cultures and live in vastly different environments but have had almost identical experiences with Type II, or non-insulin dependent, diabetes (NIDDIM). The disease was virtually unheard of before the arrival of Europeans, stayed that way until the middle of the 20 century, and now has reached epidemic proportions in some communities. (Type II, or maturity onset diabetes, is generally associated with middle and old age and obesity and ean be effectively treated with diet and exercise.) Health professionals from New

Zealand to New Hampshire eame together to discuss the problem at the Second International

Conference on Diabetes and Native Peoples conference held in May at the Ala Moana hotel in Honolulu. Sponsored in part by OHA and the Wai'anae Coast Comprehensive Health Center, the conference brought together over 200 diabetes experts and focused on the eommon problems that communities share and how to deal with them.

Modern lifestyle a key factor Conference participants agreed that the modern sedentary lifestyle and high fat and caloric diet adopted by native people were primarily responsible for the abnormal increase in the rates of diabetes among native popula-

tions. Donnel Etzweiler, president of the International Center for Diabetes in Minneapolis said, "As a result of changes in lifestyle and diet brought on by life in reservations there has been a dramatic increase in diabetes levels

in native American communities." Alethea Kewayosh, coordinator of Diabetes Programming at the First Nation Health Commission

in Canada pointed out, "These days there's not a lot of opportunity for native peoples to do physical activity. People have become sedentary eoueh potatoes." "People are fat and getting fatter," said Dorothy Ghodes, director of

the Indian Health Service Diabetes program in Albuquerque. Etzweiler also said that genetics likely played an important role.

"Native peoples were originaIly hunters and gatherers and experienced many periods of feast and famine. This could have led to the development of a gene that would sustain life and help store fat during times of fasting.

The stabilization of modern life would make this gene a liability because it would make it easier for native peoples to gain weight. Overweight people are more likely to become diabetic. None of the speakers blamed

the problem completely on genet-

ics. Most agreed diet, lifestyle and genes

combine to make native peoples especially vulnerable. Statistics presented

at the conference showed how susceptible native peoples are to diabetes. In Hawai'i the rate for diabetes among native Hawaiians is over

two times the national

average. In some tribes in the Southwest close to 70 percent of the population is diabetic. Nauru island in the south Pacific has the highest national rate of diabetes

in the world.

(Ed. note: Experts are divided on whether native people are genetically more predisposed to get diabetes. Critics note that if a non-native person leads a sedentary lifestyle with a poor diet he or she is just as likecontinued on page 16

"As a result of changes in lifestyle anel diet brought on by life in reservations there has been a dramatic increase in diabetes levels in native Amenean eommunities." Donnel Etzweiler

"People are fat and gettingfatter."

"Maybe in our quest for education we left behind some crucial knowledge."

"It is our problem and we should use eommunity strength to solve it."

Dorothy Ghodes

A.J. Felix

Althea Kewayosh

Diabetes conference

continued from page 5 ly to get diabetes as the native person.) Present attempts to control disease. Rates of Type II diabetes have shown a remarkably consistent pattern across the Pacific and North America in the past 50 years as modern diets and lifestyle have dramatically changed the way people eat and live. As a case in point, Ghodes mentioned the Navajo tribe in the Southwest where, in 1900, there was only one reported case of diabetes. In 1987 some areas reported levels as high as 70 percent of the population. A number of speakers pointed out that the dramatic increase in chronic diseases like diabetes eame about at the same time rates of infectious disease were on their way down. This was due to the effective implementation of an infectious disease control program and the virtual non-exis-tence of a chronic disease heahh program. "We have to leam how to take care of chronic diseases," said Ghodes. "We've done well on infectious diseases but very poorly on diseases like diabetes." A chronic disease health care program would help native people get proper treatment and provide education to help them avoid becoming diabetic. Another problem with the typieal heahh care system is the eultural gap between the native per-

son and heahh worker whieh makes effective communication between the two groups difficult. Kewayosh said that older native people find hospitals frightening, don't understand the terminology and feel alienated by the experienee. She related a story of how a heahh worker tried to describe a pancreas to a tribe in northern Canada that did not have a word for the organ in their own language. The heahh worker eventually told them it was long, shaped like a wiener and located below the stomach. Her description only confused them further. The same problem was true of researchers who, in the past, communicated to community leaders neither what they were doing nor the results of their work. Kewayosh said, "We no longer accept that type of attitude. Researchers have to do things properly. They have to meet with community leaders, tell them what they are doing then tell them the results." The solution Initial European impressions of native peoples in the Paciftc and North America were remarkably similar. Just as Cook recorded that Hawaiians appeared to be a nation of strong, slim people, in the late 1400s native Americans were described as being "healthy, with mid-sized, strong bodies and relatively few disorders." Indian treatments of external injuries continued on page 1 7

Diabetes conference

continued from page 17 were considered "rational" and they had avoided most of the plagues of Europe. A. J. Felix, Tribal Chief from Prince Albert, Ontario, said at the conference that it is now time to look back to the culture of native peoples to solve the present crises. "It is unfortunate that sometime ago our medicines, our language, our history were not good enough. Today we are in a dilemma. Maybe in our quest for education we left behind some crucial knowledge." Speakers generally agreed that the key to future prevention and treatment lies in the community, its education and its ability to implement heahh care programs. Kewayosh explained, "The development of our own program is significant. It is our problem and we should use community strength to solve it." Implicit in this was the need to make the program culturally sensitive and attuned to the needs of the community. "We want to use more eommu-nity-based health workers and develop culturally relevant edu-

cational materials," said Ghodes. As an example of this Ghodes mentioned a program in the Southwest where the community worked together to organize fitness and diet programs. Another example is the outreach program at the Wai'anae Coast Comprehensive Heahh Center whieh uses native Hawaiian health workers to assist diabetics in the community. Speakers also stressed the need for native communities to work together and share the information and experience they have working in their communities. "There are a lot of programs but people work in isolation," Kewayosh explained. "We need to share. We have to build and we have to support eaeh other." The diabetes conference ran for three days and included a series of workshops and panel discussions. Other activities included early morning walks and "hulacise" and receptions the first and third nights. The first reception was hosted by OHA and the Wai'anae Coast Comprehensive Health Center and included a welcoming presentation by OHA chair Clayton Hee.