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Indigenous Diabetes

Diabetes is the scourge of civilization. A disproportionate number of people living in the most advanced societies suffer from it.

But the people who suffer the most are the original inhabitants of the lands that the Western societies occupied. Whether they are the Native Americans, people of Canada’s First Nations, Australia’s Indigenous population, or other conquered peoples, the result everywhere has been the same — lots of diabetes.

The reason why is no mystery. The conquerors destroyed the indigenous cultures, often intentionally but with what they thought were good intentions. By punishing students in native schools for using their own language, by attacking native religion, and by extolling the wonders of Western food, the victors hoped to integrate the defeated into mainstream culture. Instead, they marginalized the defeated from both their own culture and from that of the West.

Decrying their food choices of the defeated misses the point, as Sousan Abadian elucidates in her Harvard University Ph.D. dissertation. The point is that they suffer what she calls “collective trauma.”

Craig Lambert interviewed her for his brilliant article, “Trails of Tears, and Hopes,” for the March-April 2008 issue of Harvard Magazine. You can read the PDF of the full article online.

“The social and economic conditions we are seeing — the violence, suicide, addictions, endemic poverty, alcoholism — are to a large extent the symptoms of trauma,” Mr. Lambert quotes Ms. Abadian as saying. “If you attack symptoms separately without attending to the underlying condition, other symptoms will show up. Right now, in many parts of the world, people are doing bits and pieces of what needs to be done to address poverty and violence….But all these efforts will fall short if you aren’t also channeling resources into addressing trauma.”

The extremely high rate of diabetes among many traumatized cultures likewise stems from their collective trauma. Just as the trauma they suffered was collective so too must be the healing.

“Collective healing involves much more than healing individuals and relationships,” Ms. Abadian says. For these once functional societies to work again they must selectively revive their traditions and cultural elements.

Cultural renewal isn’t about bringing back everything from the past, she says. For example, the practices of slavery or polygamy would not be tolerated. And cultural elements new to some indigenous peoples, like sweat lodges and sun dances, which have already spread from one people to another, may be meaningful to still more.

Certainly, indigenous people will have to change food customs foisted on they by the dominant culture. I remember when people at the Taos Pueblo introduced me to the “native specialty” called fry bread.

It never existed in American Indian history, says Suzan Shown Harjo, the president and executive director of the Morningstar Institute, a national Indian-rights organization. “Fry bread began its life as a cobbled-together food from U.S. government rations, a way to keep from starving when government occupation kept tribal members from consuming their native foods — elk, buffalo, corn, beans, and squash.”

Yet, as traumatic as the cultural disruption and its multi-faceted aftermaths that Native Americans have suffered in the United States, another people have suffered far more. These are the Indigenous Australians. They comprise only 2.5 percent of Australia’s population, about 517,000 people, far fewer than the number who lived there before the European settlement of the continent in 1788. And the Indigenous Australians face an even greater challenge than the Native Americans because they are even more isolated.

Helping the Indigenous Australians is a challenge that I hope to accept. I am planning to join my friend David Forbes to work with the Combined Universities Centre for Rural Health in Geraldton, Western Australia. Right now we are working to obtain funding, and my work there could start as early as next year. How long it will continue is anyone’s guess.

We will use the latest technology to reduce the impact of diabetes on the most isolated of the 200,000 indigenous Australians. Using telemedicine to help control diabetes among distant people has been a major interest of mine ever since I experienced Dr. Joe Prendergast’s outreach 11 years ago and wrote about it for the website of the American Diabetes Association.

We know that we can’t address the scourge of diabetes in isolation from dealing with the collective trauma that Indigenous Australians suffer. We also know that our work must be integrated into a multi-disciplinary approach led by Indigenous Australians themselves. We know too that we don’t have all the answers and are soliciting advice from anyone with experience working with communities anywhere who have suffered collective trauma.

What I learn in Australia will certainly be applicable to other such communities and vice versa. I plan to report here on our efforts.

This article is based on an earlier version of my article published by HealthCentral.

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