Tuesday, 6 October 2009

Better Together, a new Innovation for Diabetes Care and Prevention among UmonHon Indians of Nebraska

Better Together, the UmonHon Tribe Diabetes Programme’s Version of MoPoTsyo in Phnom Penh, Cambodia.

Of all my visits to Cambodia, the most fruitful one was the visit in October 08, exactly one year to the day, when I met Maurits van Pelt of MoPoTsyo Peer to Peer Health Education Centre in Phnom Penh, Cambodia. When I listened to him explain the model, I could intuitively recognize a man who was innovative and knew what works in the Cambodian Context. I realized that it will work in an International context as well.

It has taken me one year to implement a model loosely modeled on Maurits’s working model in Cambodia. Before I begin, thank you, Maurits.

Natives of America, from now on referred to as Indians, have other advantages over Cambodians and also the general population of USA.

They have clinics right where they live, usually in rural and isolated parts of the country. And they have access to doctors and educators and specialists. They also receive medications free of charge. Yet their health status remains one of the poorest in that rich country, the reasons are much more anthropological than medical, I shall dwell on it another time.

I had chosen Mr. PM, close to 70 years of age, as my Peer No 1, in this phase of educating Families with and without Diabetes who live in the Omaha Indian Reservation in the village of Macy in Nebraska, USA. He has had Diabetes type 2 for fifteen years and has been overweight for most of his life.

I had first met him about five years ago, just before he had aortic valve replacement. At that time he was on a long list of medications. In March of this year, he had decided to make dramatic changes in his way of living, for, as he said: I was sick of being tired and sick. I was short of breath and couldn’t walk up a light incline.

He weighed 264 lbs (120kg). He also knew that any diet he choose would make him loose a few pounds the first few days of trying so he decided to keep tab on his intake and be careful to create this lifestyle for him as of 1 April 2009. He was on a long list of medications. For Diabetes, he was on Metformin 500 mg twice a day ( his GP had wanted him to take 1000 mg three times a day but he was afraid of hypoglycemia and refused to follow the advice). He was also on Lantus Long Acting Insulin 50 units twice a day and Gabapentin for his diabetes related Neuropathy. He was on medications for Hypercholesterolemia, Gastro Esophageal Reflux, multiple medications for Hypertension. He had discussed with his natural therapy advisor about diet and was told that he like many others in this country was addicted to carbohydrates and that he should slowly wean himself off Carbohydrates. By chance he ran into a book at a second hand bookstore, it was titled: Carbohydrate Addict’s diet and found the advice to be much to his liking.

Tired of being sick, with his blood sugars running in the high 200s with an A1C of 11.4%, he would slump on his sofa two hours after eating, without energy for anything substantial. It was the blood sugar increase on his regular diet, then the medications kicking in and soon after wards a rebound rise of blood sugar and a flat feeling.

He began watching what he ate. He educated himself about HFCS, and the many other very dangerous chemicals in the food. One day he was told that he may be a Carbaholic when his dietary habits were analyzed. He got hold of a book called The Carbohydrate Addict’s Diet and began changing his dietary habits.

Rob Sweetgall is a prevention expert who lives in Idaho. He has the distinction of having walked across the USA several times and he has fashioned walking sticks which aid people with their walking. We had given PM a gift of these a year and half ago, and now he began using it, realizing that his upper body is also being used while walking around his village with the two walking sticks.

Soon he noticed that the sagging muscles of his upper arms were becoming tight and the scale on his bathroom revealed that he was beginning to lose weight. He became an avid reader of natural medicine and complementary medicine and began supplementing his nutrition with Cinnamon and Fish oil, among others.

He began keeping a log from 1 April 2009. His goal was to lose about one pound per week but do it on a consistent basis. By 15th April 2009, his weight was down to 241 lbs and he was able to drop Metformin. In the weeks following, his weight chart shows: in lbs, 238, 234, 229, 227, 224. He realized that when you begin a diet or nutritional change you can expect a rapid weight loss and then it becomes a steady loss. By the ninth week of his new Life Style Therapy, his weight was down to 224 lbs and he was able to stop his Insulin. 12th week, 216; 16th week, 209; 20th week, 204; 24th week, 202 and now on the 27th week of his Life Style Modification Therapy his weight was done to 200 lbs, a full 64 pounds from when he contemplated these changes and a full 50 pounds since he began keeping detailed records.

And on 5th October 2009, when he presented his efforts to two groups of families of Indians, he showed his medications. From the long list of medications he was taking, right now he is not taking any medications for his Diabetes (remember this is after 15 years of various intense pharmacological manipulations including once Metformin 1000 mg three times a day!). He is coming off his Metoprolol, which he was taking 50 mg, two tablets twice a day and now he is down to ½ a tablet twice a day. He was prescribed Hydrochlorthiazide25 mg which he plans to stop as well.

Among our patients with Diabetes, we use Lisinopril or other ACE Inhibitors for renal protection, since Indians like other indigenous peoples have very delicate kidney metabolisms.

He talked in detail about his diet, since him like our patients lives in a small village with very limited access to good food. The small audience sat there with rapt attention. It was so good to hear that something like this is possible, the negative thoughts that affect you is relieved a little bit when you live in such a “diabetogenic Toxic Environment”.

From the two families, I identified, two other possible Peer Educators, a 29 year old who was diagnosed as having Type 2 Diabetes just on 17th August 2009 and another 32 year old mother of three who is very serious about her health and of those of her children and is determined to control the hyperglycemia and hypercholesterolemia with natural and social methods of combating this ever increasing illness among the Indians.

So, it was a good beginning. We had Mila, the Filipina chief cook at this rural Indian clinic, prepare some healthy food: pancit, adobe, homemade banana bread among others. So our participants realized that good food choices don’t have to be boring! We also gave each one of them a book: Eat this and Not that, it is about making better choices at the supermarket.

Apart from my colleagues at the Tribe who helped me organize this, which now becomes a monthly event when I visit them, I would very much like to thank Maurits in Phnom Penh for his inspiration and my two moral helpers: MM in Paris and MC in Kuala Lumpur...

A heartfelt Thank You. Today you have helped me assist these ancient people of the Americas!