Murdo McDougall has a disease that didn’t exist for his people when he was born 78 years ago. Now diabetes affects one in seven, or nearly 500 people (including youth and children), in his community of Garden Hill, an Oji-Cree First Nation on Island Lake in a remote corner of northeastern Manitoba. Some, like McDougall, manage to live with it successfully. He has kept it at bay for 25 years by sticking to what he calls “a traditional lifestyle,” continuing to fish, which he does commercially, and keeping active in his church, Henry Fiddler Memorial United.
McDougall’s nephew Clarence, the transportation co-ordinator for the Garden Hill nursing station, also has diabetes. Clarence is 54 and thin as a rake. He has established a regimen where he spends every evening at the Wa-Wa-Tay Fitness Centre, two tidy and spotlessly clean rooms in the local high school filled chock-a-block with exercise equipment set up by the local Aboriginal Diabetes Program. Clarence also makes it a point to eat his vegetables, “even if I have to swallow quickly to do so,” he laughs.
But the McDougalls are the exception. “Diabetes is killing us,” is the blunt assertion of Eric Wood, manager of the local community health program. Murdo and Clarence are controlling their diabetes through exercise and nutrition. Failure to control, though, produces devastating consequences. In the nursing station where Wood has his office, an entire wing has, since 2004, been given over to seven dialysis machines.
A lot is known about diabetes at Garden Hill. A decade ago, it was one of five First Nations to be studied intensively by Dr. Stewart Harris of Western University’s Schulich School of Medicine and Dentistry. In Harris’s 2010 report, 323 among the 3,000 people in Garden Hill were listed as having the disease. The average age of diagnosis was 40.6; 34 percent of the diabetics suffered chronic kidney disease; 11 percent had coronary artery disease; eight people were on dialysis; eight had suffered amputations of lower limbs; and four had gone blind.
During my visit this past spring, Larry Wood, the local Aboriginal Diabetes Initiative worker, told me that all the stats have gone up. The number of Garden Hill residents diagnosed with diabetes has now grown to 470; the age of onset has dropped ever younger; and 25 (or 43 if the three neighbouring reserves are included) are now on dialysis.
It is hard to put a positive or even hopeful spin on what diabetes is wreaking among First Nations across Canada. The situation can really only be framed as a scourge comparable to the plethora of other afflictions — medical, social and cultural — that have befallen Indigenous peoples since European contact and colonialism.
About 640 million people have diabetes worldwide, prompting the United Nations to call it “a global threat” and some media outlets to dub it “a tsunami.” Never mind that the disease has been around for a long time. About 3,500 years ago, Egyptian physician Hesy-Ra listed remedies to combat “the passing of too much urine.” For a few millennia, contracting Type 1 diabetes was a death sentence. Then in 1923, Dr. Frederick Banting and three other Canadian medical researchers discovered ways to make extracted insulin available for injection.
A few decades later, scientists distinguished between Type 1 and Type 2 diabetes. In Type 1, the pancreas fails to produce insulin — without injections, the patient would die. In Type 2, often associated with obesity or aging or both, the pancreas either produces insufficient insulin or the body struggles to put it to proper use. Type 2 diabetes can be controlled through strict lifestyle interventions such as exercise, weight loss and nutrition. Failure to control it can result in things like blindness, limb amputations and kidney failure (requiring dialysis or a kidney transplant). People in their 60s and 70s are at greatest risk for contracting the disease, though diabetes diagnoses have been on the rise for children in Canada since the 1980s.
For reasons that specialists are still working to understand, some population groups are at substantially higher risk. A 2014 study by the U.S. Centers for Disease Control and Prevention confirmed what has been common knowledge for about three decades: that Type 2 diabetes is found in much higher concentrations among Native Americans, African Americans and Hispanic Americans. Forty percent of Arizona’s Pima Indians have diabetes — the highest rate in the world.
There are all kinds of surveys and statistics. Among the more jarring facts is that in Canada, seven percent of Indigenous women over the age of 15 have been diagnosed with diabetes, compared to three percent for the rest of the female population, according to Statistics Canada. The rate of diabetes increases with age: 24 percent of Aboriginal women over the age of 65 have diabetes compared to 11 percent for the rest of older women in Canada.
Until about 1950, Type 2 diabetes was rare among Canada’s Indigenous peoples. Since then, it has increased to about double the national rate, and in some communities, it has reached three to five times the average. (Type 1 diabetes remains rare among Canada’s Indigenous peoples.) Winnipeg’s Dr. Michael Moffatt, who began his career in the 1970s among the Cree of northern Quebec and the Dogrib of the Northwest Territories, recalls no cases of diabetes at all when he was a young physician. Later, when he became head of Manitoba’s Northern Medical Unit, supervising hospitals in Churchill, Norway House and Rankin Inlet and overseeing fly-in doctors to isolated First Nations, “I started encountering it everywhere.”
The $5.2-million dialysis unit in Garden Hill, Man., has seven dialysis machines, which can support 18 patients. Photo by Larry Krotz
A big question is: why? One theory, widely circulated for a time, had a
genetic basis. The hypothesis, called “thrifty gene,” held that over
thousands of years living off the land, Indigenous hunters had survived
cycles of famine and feast by facilitating efficient fat storage during
times of abundant food. In modern times, however, abrupt lifestyle
changes and the abundance of food — particularly high-fat, high-sodium
processed foods — render that genetic trait a disadvantage. For people
already predisposed to relative hyperinsulinemia, upper body obesity,
insulin resistance or beta cell exhaustion with impairments in insulin
secretion, adding an unhealthy diet and a lack of exercise can pave the
way toward diabetes. There is resistance in some quarters to any
explanations based on genetics or race. However, most scientists accept
that genetics and ethnicity play some role.
Many of these
lifestyle changes are the result of colonialism. The report of the Truth
and Reconciliation Commission argues that residential schools caused
social problems that have led to health disparities. For many First
Nations, being sent to residential school marked the first time their
diets changed drastically — typically from wild food to meals high in
carbohydrates. Murdo McDougall adds that Garden Hill families stopped
planting their own crops when the community switched to a cash economy
(with family allowances) and children, who would otherwise have helped
tend the gardens, were sent off to residential school. The community
store, at that time still run by the Hudson’s Bay Company, became the
predominant source of food, including junk food.
have stuck to their traditional lifestyles, outcomes have been
different. Dr. Jim Carson, another Northern Medical Unit doctor, tells
the story of a 40-year-old Inuit man suffering from the disease when he
was observed in late summer. “He went off on his trap line, returning in
the spring 40 pounds lighter and diabetes-free. The coke, candy bars
and chips of his sedentary existence had been replaced by ‘country food’
— wild game and broth soups — and the exercise of his trapping work.”
The Pima Indians of Arizona have the highest rates of diabetes, while
their cousins across the border in Mexico, who have stuck to a more
traditional existence, have numbers that are in line with non-Indigenous
Diabetes in First Nations people has been the
concern of Western University’s Dr. Harris since he was a young graduate
in the 1980s and based in Sioux Lookout in northwestern Ontario. One of
the First Nations in his territory, Sandy Lake, now has a 35 percent
prevalence of adult diabetes. Harris points out though that during his
working life, not only diabetes but all chronic diseases have shown an
up-tic. “Massive change to the lifestyle and environment unmasked or
facilitated the emergence of cardiovascular disease. Cancer rates are
skyrocketing in First Nations populations.”
Diabetes is an
expensive disease. The Lancet and PharmacoEconomics recently estimated
its annual cost at $1 trillion. In places like Garden Hill, health care
is the biggest industry. So many people required dialysis — and had to
go so far to obtain it — that the provincial government paid $5.2
million for its dialysis unit. Patients from neighbouring reserves, St.
Theresa Point, Wasagamack and Red Sucker Lake, fly in and out for their
sessions by helicopter.
When I visited, I learned that the
dialysis unit was mandated to support 18 patients. That turned out to be
not enough. Twenty-five are on a wait-list and have had to move to
Winnipeg to obtain their treatments there. It costs between $95,000 and
$107,000 a year to provide a patient with dialysis, not to mention the
costs to treat the many complications of the diabetes — vascular
problems leading to amputations, nerve damage, blindness. Though not all
of the nearly 500 people with diabetes in Garden Hill are in need of
expensive levels of care, ultimately many of them will be. Recruiting
and keeping trained staff for the dialysis unit is an ongoing challenge,
as is finding a secure system of reliably pure water. The unit is
periodically shut down as a result of chronic water quality issues.
with the economic costs of diabetes come social and psychological
costs. The disease disrupts families, stirs anxiety, causes physical
suffering, and shifts a patient’s energy and activity away from family
and the community and toward his or her own health.
isn’t the only problem facing Garden Hill. The community has all the
challenges we’ve become used to hearing about from isolated First
Nations. It depends on winter roads to bring in supplies, and warm
weather this year rendered the road chancy. The band government is in
financial default and under third-party management. Unemployment is
high, and disaffected youth have formed at least two gangs.
Desjarlais has been working on diabetes for her entire career. The
First Nations woman trained as a nurse 30 years ago in her home
community of Swan River, Man. Desjarlais, since 2007, has been regional
diabetes co-ordinator for Health Canada’s First Nations and Inuit Health
Branch in Winnipeg. Her job is to oversee and support 64 local diabetes
workers (like Garden Hill’s Larry Wood) on every Manitoba First Nation,
as well as meet regularly and provide encouragement and resources to
the diabetes co-ordinators of Manitoba’s seven tribal councils. The
objective for the next 10 years, she says, is to “slow down the rate of
complications, lower diagnosis rates. It’s going to take a long time,
but we need to see those numbers.”
When Desjarlais herself was
diagnosed 13 years ago, she recalls, “I was floored.” The shock made her
understand the predicament of her patients. “Because of my nursing
background, I have more information than the normal person. But when
you’re living with diabetes, you have all the same emotions; the fact
that I’m a diabetes educator doesn’t mean squat. I knew I was going to
have to live with this, adjust my diet, learn moderation — that’s a big
word for me now — get past my ‘woe is me.’” She started walking every
day as a regimen of exercise.
Many of those living with diabetes
in Garden Hill, along with the family members and health workers who
support them, are getting past the “woe is me” to find solutions that
will improve everyone’s health.
Through the Aboriginal Diabetes
Initiative and the efforts of its employee, Larry Wood, the Wa-Wa-Tay
Fitness Centre is fully equipped. Provincial government funding was used
to erect a barn for the community to raise a thousand chickens and to
purchase tillers and seeds to grow community gardens. Grade 10 students
have become mentors to Grade 4 kids, working with them to get exercise
and prepare healthy snacks. The local Northern Store is in the fourth
year of using federal subsidies to lower the prices on perishable foods
such as milk and fruit. At neighbouring St. Theresa Point, health
workers arrange cooking classes, walkathons, nutritional bingos and
initiatives to bring nutrition awareness to the local store. It is all
positive and all desperately timely.
Desjarlais, like Murdo
McDougall, believes there also needs to be a return to emphasis on the
land, Native medicine and cultural wholeness. “Aboriginal people need to
look at our teachings and traditions of caring for ourselves, care for
our bodies,” she says. “We need to take back our Indigenousness, go back
to our gardens, back to the land as when we were healthy. When we
worked hard and our kids played outside instead of couch surfing, we
were healthier. Processed food, smoking — we need to step back and see
what we can do. This isn’t just one thing, diabetes, this is everything.
We need to work with families and elders. It’s going to take us a
while, but we need to do that.”
Looking into the future, it takes
courage to see beyond more expenses, shortened lives and misery.
Fighting diabetes among Indigenous people will require constant
vigilance along with the sense that victory, though slow, is possible.
Larry Krotz is a journalist in Toronto.