Tyrone Davis couldn’t hold it.
He had already stopped at a gas station near the Arizona-New Mexico state line and again minutes later at a store in Window Rock, but the bathroom breaks didn’t help.
“I was kind of afraid,” the burly 39-year-old Navajo says.
The next morning he could barely move. His bowels were twisted into painful knots, his urine was dark red and a trip to the emergency room appeared inevitable.
After a battery of tests, doctors told Davis he was diabetic. He had just become the latest statistic in the long-running epidemic sweeping the Navajo Nation and other tribes.
Doubled among Indians
Despite years of efforts by federal health officials and millions of dollars for treatment, the number of Indians with diabetes has more than doubled over the past decade to more than 107,000 cases.
“While diabetes is a nationwide epidemic that affects anybody at any age, we know minorities face a disproportionate burden. For American Indians, we have the highest burden,” says Dr. Kelly Moore, a clinical consultant with the Indian Health Services’ national diabetes program.
Debilitating and sometimes deadly, type 2 diabetes — the type linked to obesity — is the most common form. It impairs the body’s ability to produce or properly use insulin and can lead to kidney failure, blindness and heart disease.
Tribal health officials have made strides in treating diabetes since the disease was first recognized as a problem among Indians in the 1970s. Back then, the focus was on treatment.
Focus on prevention
Former IHS director Dr. Michael Trujillo used to give talks about diabetes, calling it “the latest scourge of the Indian population,” much like tuberculosis was a century ago.
During his 10 years as director, diabetes was always a part of budget talks, department meetings and hallway conversations with tribal leaders. Still the number of cases grew.
Now the focus is on prevention.
Armies of health workers, tribal leaders and families are shifting the battle from beyond the clinics to the airwaves, schools, tribal offices and kitchen tables.
“The disease as we know it really has no cure right now so it has to be lifestyle changes,” says Marie T. Allen, director of the Navajo Nation Special Diabetes Project.
The project — one of 300 programs across Indian country that receive special federal funding for prevention efforts — is teaching Navajos about diabetes and how to avoid it. More than half of the diabetes projects have developed community walking programs and about six out of seven offer diabetes education.
Navajo health officials are putting out native language radio ads about healthy foods, posting billboards promoting exercise and sponsoring annual conferences on everything diabetes-related. They also dispatch specialists to schools and chapter houses to share cooking tips and screen potential patients.
IHS is also working with health care providers to teach tribal members about healthier lifestyles through tradition and Western-style medicine.
Fast food, TV, video games
The prevention programs don’t provide quick fixes, but Allen says they are an important step in changing attitudes and restoring healthy traditions. Her eyes light up as she talks about the days when she rode a horse bareback to herd the family’s sheep. Those were the days Navajos took care of themselves by staying active and eating well.
Now, she says, life revolves around fast food, television and video games — a dangerous combination that can lead to obesity and eventually diabetes.
“We’re in this valley and we want to work on it and come out of it and make a change so that we’re eating healthier and we have healthier communities,” she says. “That’s our whole goal and we can’t do it alone.”
In Albuquerque, the University of New Mexico is teaching Indian women about nutrition and exercise in a four-year study to see if education helps prevent diabetes. The campus in Gallup is offering courses designed to turn health workers into diabetes prevention specialists. Santa Fe Community College has started a classes for diabetics on good nutrition and exercise.
Davis was reaching 300 pounds, his clothes were enormous and the weight of possible complications from his diabetes was heavy. With encouragement from his wife and a little discipline, he now finds his old T-shirts are three times too big.
“I felt I could overpower (the disease),” he says. “It was something I wanted to do for me and my family.”
Every Navajo seems to know at least one person with diabetes. But despite the bad news, health experts say their efforts are making a difference. More people are getting screened, exercising and watching their diets.
Georgia Perez, one of the UNM diabetes prevention teachers, remembers when people didn’t want their fellow tribal members to know they had the disease.
“It was a very hush-hush thing,” she says. “They didn’t want to be seen in a diabetic clinic. They didn’t want to be seen out walking because they were afraid of being labeled. At least now, that stigma is gone.”