Wednesday, 26 August 2009

Native Americans, Diabetes and Happiness in their Clinic

Indian Faces one day at the Clinic. 26 August 2009

A colleague who lives in a nearby town, said, At the party last Friday, I met so and so, they would love to see you, they cant understand why you just stopped seeing them, ten years ago..

A party of petite bourgeoisie in this isolated part of the world, where they tell each other who wonderful their lives are, sequestered into their own insecurities, show and tell kind of existence.. what do I do with them?

I am sorry, when I come to the Indians, I have only just enough emotions to share with the Indians, and they give me a lot so I really don’t have anything left over to share..When I am with the Indians in the USA, I am very reluctant to mix with the Non Indians of this country, however nice they are, I don’t want to be dragged into their world of worries and concerns, so different from the people I have come to serve.

Look one day at the Clinic of the Indians: I have learned so much personal history of so many people.. let me try and recollect..

77 year old Lakota, met and married the Omaha tribal member, lived in LA where she had her three daughters, now all three daughters are nearby. She is on Dialysis, going on eight years, she was telling me about optimism and acceptance of life. When I told her my sister was undergoing chemotherapy for cancer, she said, tell her to be strong and be positive.

When I said good bye to her, she said, I have one request, could you please send me a post card from Paris?

I remembered, when I first started working with this tribe, I was living in Jamaica and when I returned home from my work here, I used to spend hours writing post cards to the people I had met on that trip. What a pity in this world of Face Book and emails.. No, I wont fall for that excuse, I will send her a post card of tour Eiffel to her..

Her two daughters came to see during different hours. So quickly they filled me up with their individual lives, because they knew that I had already placed myself in their world . I am the doctor who is a friend of their mother.. this trust can be utilized to achieve the results of treatments. Only a naïve person would believe that in most of the chronic diseases, just the pharmaceuticals will achieve the desired outcomes.

A 17 year old who had been prescribed medications, brought it in. Indians are brutally honest and tend not to lie. If you ask someone, are you taking the medications prescribed for you, they tend to answer: no, doctor, I have not been taking any of the medications you gave me two months ago. Perhaps that could explain the blood pressure of 180/120 mm Hg and a blood sugar close to 300 mg/dl.. and all of 17 years old.

I saw his 15 year old sister later on, and she is following the same road. Forget about family history, the physiology of diseases, this definitely a social phenomenon. In this tribe like many other tribes, the behavior is so influenced by the unspoken rules of the tribal ethics.

Their mother was with them, a lady not even 45 years of age but already in a wheel chair because of the right sided stroke she sufferd a few years ago. A very cute young child was with them and they were all laughing and making the consultation room ring with joy..

At 11 am went to the school in the nearby village where most of the students are Indian. The principal is a very pleasant woman and they had just hired a new school nurse. We talked to them about our projects of prevention of diseases among the school children especially Obesity. And made plans to come on my next visit to check all the students for their growth, height and weight and any unnatural body habitus!

Lunch had been prepared by the Filipina who met this Indian sailor in Subic Bay in 1988 I think, married him and here she is , almost an Indian herself. No one thinks of her other wise. She mentions that she would like to take her daughter aptly named after the Mexican national saint and her husband to a newly opened Chinese buffet in the nearby town. I made arrangements for that. She always takes care of me and once in a while visitors to the house where I stay here, the Blue House, are treated to Filipino delicacies.. chicken adobo, pancit etc..

Working in the clinic, there are so many interactions with various people working there. It is almost as if you are on a holiday in an exotique location. The helper at the kitchen, who wanted to know whether I have children at every port. The resident of the nursing home attached to the clinic wanting to know why I am covering my face with a mask, are we that smelly? She laughs..

Then there are my colleagues, the same two women I have worked all these years I have been with the indians. Incredible coincidence indeed.. and we have become good friends and when they have questions about medical care in the family or the news about their children or grandchildren to share, I am informed. Also when their family members meet me, in or outside the clinic, it is always a little intrigue about this foreign friend who speaks a little differently, who dresses a little differently and who is always travelling and sending post cards!

Those of us who work with poor people and try to provide medical care at the best of our ability. As Pablo Neruda had written: it is only the rich think that poverty breeds character. It is not as if the medical care you can get in these isolated parts of America, whether it is Bismarck North Dakota or Sioux city, iowa are anywhere comparable to decent clinics in the developed world, they are expensive and they are not compassionate and downright damaging to your health.. such are the examples we see, the dodgy health care given to our patients, the Indians, who once owned the entire land and now disposed and poor and unable to afford the system that has been hoisted upon them.

The afternoon is marching on, the hours are full of conversations and chatting, with various peoples, some of whom happen to be patients as well.

The video of the day was taken of a man, coming to be 70 years of age, who just a short five years ago, was a walking advertisement for American Health. He had embodied every single disease of the civilization. I got to know him around that time, and to use an American term, he was truly a medical basket case: diabetes, hypertension, heart disease, vascular disease, obesity and an array of over 16 different medications prescribed by a slew of practitioners who looked at his organs with their scotomatous medical gaze.

He sought to lead a spiritual life and read voraciously about various philosophies and his wife was a mental health counselor and they lived in a nearby village. I asked him, while I filmed him with the camera which had been lent to me by my best friend in Asia, how did you manage to control your blood sugar so well?

He began; about five years ago I was tired of being a poster boy for Obesity. I was 260 pounds and had been given three oral medications and two types of insulin for high blood sugar and four medications for blood pressure.

I was dieting and then not dieting, loosing a few pounds and gaining some back and putting some more on, the typical Yo Yo diet ! then I decided that if I ate Protein for breakfast: eggs; a salad for lunch and then some fish/chicken salad for dinner, may be I will loose weight. Since he was reading many self help books, Cinnamon and its effects on diabetes caught his eye. Soon his blood sugar began falling down, he began loosing weight and one by one he was able to abandon his medications for diabetes, in fact currently he is on no medications at all. He dutifully checks his blood sugar and they are incredibly within a narrow normal range and he continues with cinnamon and also a variety of herbs. His blood pressure is under good control and the number of the medications there also has decreased. He is going to celebrate his 70th birthday with a happiness he thought was not possible. We had given him as a gift a pair of trekking sticks that Robert Sweetgall used on his walks across America. When you use those sticks for walking an extra 20 per cent of effort is transferred to the upper body and a greater expenditure of energy. Our patient loves those sticks and goes for a walk, one mile or so a day to the swings of the trekking sticks.

He is on no medications for his diabetes (remember he was on three oral agents and two types of insulin, what was going through the minds of the doctors or nurses when they loaded him up with all these?). he feels good and enjoys his newly found freedom in health.

I suggested to him that he get together people he knows in his village, for weekly sessions on health where he would be the peer teacher. There has been much interest in my recovery he told me.. good luck, and thanks for the inspiration and when you have the group together, I will come over one evening when you are meeting, and talk to you about whatever you want to hear.. my philosophy of heath and disease and the immediate actions to take back control over your own bodies.. don’t surrender it doctors, nurses, pharamacists and worse still, the nutritionists!

Oh I didn’t mention about the Indian adolescent with Type 1 Diabetes ( somewhat rare), I visited him at the school. Time to rest a little bit…..