Better education needed.

Windspeaker Contributor

A 1992 study from the Diabetes Research and Treatment Centre in Manitoba reports that among Aboriginal peoples the prevalence of diabetes is conservatively estimated at three times the provincial average. Now, seven years later, the number of Aboriginal people with diabetes is four times the national average, reports Canadian Press.

With medical diagnosis and technology at such an advanced level, how can the percentage be going up?

"What is needed to turn these statistics around is on-going educational programs in each community," said Carmen Moonias-Lavoie, RN, BSCN, and a certified diabetes educator.

Moonias-Lavoie has worked in diabetes prevention and care for five years in northwestern Ontario. As well as working in Thunder Bay, Ont., every few months she goes into isolated communities. Some of the problems she sees there include a lack of continuity in medical care, language barriers between medical staff and patients, and communication gaps between urban medical advisors and staff on the reserves. All of these things impact the management of a diabetic person's condition.

"We find a lot of amputations in fly-in communities because they do not always have transportation agreements for patients coming to the city for tests and treatment," said Moonias-Lavoie. People with diabetes require a close check of their feet and legs because the blood circulation is poor to these areas.

Prevention is a large part of any diabetes program. Moonias-Lavoie teaches her clients about the importance of a healthy diet, but eating properly is difficult when there are no fresh fruits or vegetables available.

"Sometimes, the shelves are bare," she said. When the right foods are available they may be too costly. She also talks about some traditional foods. She said that people love Pah quay shi ghin nah boo, flour dumplings and loose flour sprinkled over meat. She suggests people eat this in moderation because it is too high in starch and protein.

"The diet in rural communities is not well balanced," she said, and adds, "the diet of some Aboriginals in the city is not good either. They may only eat one or two meals a day and this is not good to keep blood sugar within a normal range."

Moonias-Lavoie uses a special pamphlet that she developed as a tool in her work. It tells the story of a woman with diabetes and covers information on diet, exercise, blood sugar levels, and keeping diabetes under control. "Allowing people to see what they can do to look after themselves is better than just telling them," she said.

There is an article published in The Diabetes Educator, the March/April 1999 edition, that also promotes storytelling as a positive educational tool for Native communities.

Diabetes can affect the eyes, heart, blood vessels, kidneys, and the feet, but these problems happen slowly and silently.

"One of the problems with diabetes is that it is not visible," said Moonias-Lavoie. "It is hard to understand and the terminology is difficult." She is pleased to see that communities, such as Sioux Lookout, are starting walking programs and grocery tours where participants learn to read food labels for nutritional information. Other communities, like Sandy Lake, are developing school programs about healthier lifestyles in the hopes of curbing the number of First Nations people with diabetes.

Three elements have brought on the increase of diabetes since the 1940s. Traditionally, people walked to get wood, pick berries, hunt, or just get from one place to another. Now there is motorized transportation and people are less active. Wild foods were leaner and more nutritious than today's store-bought foods. Another part of the health puzzle seems to be how people deal with problems or change.

Traditional ways of coping, including spiritual rituals, have sometimes been replaced with unhealthy activities such as alcohol or drug use. To prevent diabetes, regular physical activity, nutritious, well-balanced meals, and finding healthy ways to cope are a must.

Moonias-Lavoie said more education and better care on a continuing basis are needed before there will be a decrease in diabetes in the Aboriginal community.