Native Americans fight their second biggest killer

By: ADRIENNE A. AGUIRRE - Staff Writer | Sunday, October 31, 2004 8:37 PM PST ∞

RINCON INDIAN RESERVATION ---- Last summer Elijah Duro was a typical teenager eating junk food and lounging around the house. Today he's injecting insulin twice a day and fighting to change his life.

Last month, the 16-year-old Pala tribal member joined the 107,000 Native Americans diagnosed with diabetes. According to medical officials, the disease is the second largest killer of Native Americans and many of their children won't make it to elderhood if it's not combated.

"We're seeing more and more of younger people being diagnosed and that's pretty scary," said Corinna Nyquist, a nurse at the Indian Health Council on the Rincon Indian Reservation near Valley Center. "There's a lot of obesity in the (Native American) community and obesity is a major risk factor for diabetes."

Medical professionals in the Native American communities say an economic boom on some reservations has been a culture shock with health ramifications.

"We're seeing less activity in the youths," Nyquist said. "They're playing video games. They're eating snacks and chips. They're doing things that teens do."

Diabetes is a disease in which the body does not produce or properly use the hormone insulin that converts sugars and starches into energy. While the cause of diabetes is still a mystery, genetics and environmental factors such as obesity and lack of exercise play a role, medical experts say.

And the long-term consequences can include heart disease, stroke, damage to the eyes and other organs.

Deven Parlikar, the clinic's executive director, puts it more directly: "When diabetes builds up, (people) retain sugar, get fat and then die of a heart attack."

As more money comes into the reservations, tribal members say they have been better able to fight diabetes. The Rincon clinic recently received a $1.6 million "Journey of the Heart" grant from the Special Diabetes Grant Program of the Indian Health Service, an agency of the U.S. Department of Health and Human Services. The grant targets patients with diabetes and other risk factors for heart disease, promoting healthier and more active lifestyles.

The Rincon clinic serves tribal members on the nine reservations that surround it. Of the clinic's more than 5,000 active patients, 272 of them have diabetes.

To encourage people to get treatment and stay with it, the clinic staff has adapted western medical practices to the Native American ways. The colorful facility is full of Native American artifacts, has a relaxed atmosphere and a flexible schedule.

"The big thing for us is compliance and convenience," said Dan Calac, a doctor at the clinic. "There's a strong sense of community and social coziness... It's comprehensive care in a culturally sensitive manner, in a 21st century facility."

Many of the clinic staffers are local Native Americans, including Calac, who's from the nearby Pauma reservation. His patients say he not only shares their culture but their pain: Calac's father died of diabetes.

"I see him in everyone that comes through the door," he said.

Elijah's mother Diana said the clinics cultural familiarity is what brought her son to the clinic when he experienced symptoms of rapid weight loss and dehydration.

"I wanted to take him to town but he didn't want to go or see someone (unfamiliar)," she said. "I'm really glad we have the program here for the kids... We couldn't do it without Dr. Calac's support."

The clinic's nurses also make house calls and case managers check in on patients.

"That's what everyone who has a chronic disease needs," Calac said. "Calling people up, reminding them to take their medication, asking them if there is anything they need."

The system has paid off for Elijah. On Thursday, the boy got some good news.

"I'm almost off (the insulin)," he said. "(At the clinic) I learned to control myself with all the sugar and things so I don't have to take that much insulin. They said I could be off of it in a month."

Elijah said that he was at least partly motivated by the serious message that he needed to make some changes or face possible hospitalization.

The teen noted proudly that he'd been off Kool-Aid for over a month.

"(Before) I'd just eat whatever was there to eat," he said. "It makes me think twice about what I do now."

Looking at his patient, Calac said, "I told (Elijah) he was a very powerful person because he was here seeking treatment and he will be a leader in that respect. He's a role model to all these other teens I'm trying to get in here."

Contact staff writer Adrienne A. Aguirre at (760) 740-3526 or aaguirre@nctimes.com.

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