Need for better communication with First Nations to treat diabetes, say service providers

Eric Plummer, December 5, 2017

This week the Nuu-chah-nulth Tribal Council takes its mobile diabetes clinic on the road to provide screening and education. Pictured is Mowachaht Muchalaht Hereditary Chief Michael Maquinna receiving an assessment from Pearl Dorward, who formerly served as the NTC's First Nation advocate nurse. (NTC nursing photo)

British Columbia — 

When it comes to communicating the risks of diabetes, the effectiveness of the message depends on how it’s delivered, according to those who work closely with Nuu-chah-nulth-aht.

This month nurses with the Nuu-chah-nulth Tribal Council are taking their mobile diabetes clinic on the road, providing screening and education at urban gatherings on Tuesday Dec. 5 in Campbell River and Dec. 14 in Nanaimo.

“We’re hoping to see some people who have diabetes and perhaps catch some people who have diabetes and don’t even know it,” said the NTC’s health promotion worker Matilda Atleo.

She believes that there are significantly more Nuu-chah-nulth people with the disease than what the NTC nursing department has in its records, due to some members accessing health services elsewhere and a habit among others of avoiding being assessed.

“A lot of people have not been tested, so you have a lot of pre-diabetics in the communities,” said Jeanette Watts, the NTC’s nursing manager. “Nursing observations are that we do have a lot of people at risk for diabetes.”

But communicating this risk to patients has not always worked. Atleo is personally familiar with this from her late husband, George Watts, who had diabetes for 40 years. As one of the founders of what became the Nuu-chah-nulth Tribal Council, George Watts was an influential politician – but communication wasn’t as effective during trips to the doctor, said Atleo.

“He was one of those bull-in-a-china-shop kind of guys. He met with government people, ministers...he knew how to deal with them, he could talk to them,” she recalled. “But when it came to going to his doctor, the doctor would just scold him and say, ‘You’re not looking after yourself’.”

“The Island Health approach has not worked,” added Jeanette Watts, noting that in the past the agency’s approach has not registered positively with Nuu-chah-nulth people. “You’ve got to be ready to hear what the person’s story is. When you go to a diabetic clinic at Island Health, they’re not set up that way. They’re set up with a classroom setting - that triggers people to residential school.”

A better relationship with health providers will be needed to curb the increase in diabetes Indigenous Peoples across the province are experiencing. This rate has grown from nine per cent in 2005 to 10.7 per cent currently, said Dr. Shannon McDonald, deputy chief medical health officer with the First Nations Health Authority. Eight per cent of non-indigenous people in B.C. have diabetes, which also shows a slight increase over the last decade, she said.

While diabetes can lead to higher blood sugar levels, the disease brings a host of other health risks, including stroke, heart disease, kidney problems and even impotence.

“The more you know, the more you can control,” said McDonald. “A lot people have been able to revert back to that pre-diabetes state quite successfully by becoming more active, eating differently and taking care of the stress in their lives.”

The doctor sees health benefits in a lifestyle closer to pre-colonial times.

“We have to be, in many ways, back to the old ways where we’re eating real food, eating off the land and being more physically active,” McDonald said. “That doesn’t just mean taking the kids to hockey, it means getting up and going for a walk.”

This is more easily said than done for those living in Vancouver Island’s more remote communities, where year-round fishing is no longer possible and the closest grocery store with produce and fresh meat can be hours away. As a result, many residents in coastal communities stock up on non-perishable food high in preservatives when they can get to a supermarket.

“People have to realise what’s in those foods,” said Atleo. “They have that long shelf life - just think about how your body deals with that.”

In some ways Nuu-chah-nulth people are still adjusting to a modern diet that was unknown to past generations, notes Watts.    

“The traditional way of eating has changed drastically, and it hasn’t been that long,” she said of the transition from what the ancestors lived on. “The way they ate was way different than now. The bannock, the bread, the flour products, those are all things that were brought in.”

“I think that a lot of our people don’t realise that carbohydrates convert to sugar,” added Atleo.

Another issue is the time needed to prepare healthy food. As families struggle to keep up with ongoing costs, nutrition often isn’t at the top of the priority list, said Atleo, who would like to see Nuu-chah-nulth nations have their own health promotion workers.

“People often buy the more affordable and readily accessible food that has a high sugar content,” she said. “Because of all the dynamics, all the challenges people have, that’s not a priority for them when it comes to eating healthy. They want to make sure they have enough money for their rent, lunch for their kids, food on the table. That’s the priority.”

These modern demands can bring stress, which also contributes to diabetes, notes McDonald.

“Stress hormones can cause us to react differently physiologically,” she said. “There’s a fair amount of evidence that weight gain, especially the kind of weight gain that we see around the middle, is a particular risk, and many of us First Nations and aboriginal folks tend to carry our weight in that area.”

Atleo sees the need for a more holistic method in attending to diabetes risks. Besides diet and exercise, this incorporates a person’s mental, emotional and spiritual connection to themselves and the environment.

“We need to change our approach,” said Atleo. “It’s not just about eating and physical activity, it’s all those other things – everything is connected, we need to go back to that.”