Positive reinforcement
Hearing about the fact that Eeyou Istchee has an exploding Type 2 diabetes problem, that more cases are always on the rise and that there is a myriad of health complications that result from it are an everyday reality in the Cree communities.
How could it not be when just about everyone in the communities either knows someone who has diabetes or is perhaps suffering from it themselves?
According to Katherine Morrow, from the Public Health Department of the Cree Board of Health and Social Services of James Bay (CBHSSJB), new information will soon be available on the prevalence of diabetes within Eeyou Istchee that will not only depict the point since diabetes has been on the rise but where it could be in 25 years if Crees continue along the same path.
Morrow explained that while the data was no shock to anyone at the CBHSSJB who sees patients coming through the health system on a daily basis, when looking at the statistics on paper, the results were alarming.
The CBHSSJB’s new findings will show that:
• In 1983, 2.4% of adults over 20 years old had diabetes, and they were mostly older people
• Today, 25 years later, it is 22.1% of adults over 20 years old
• In another 25 years, if nothing is done, about 40% of adults will have diabetes. Crees will be among the world leaders in diabetes prevalence.
• Around 84% of adults, and 50% of all teenagers, carry too much weight. This is a major risk factor for developing Type 2 diabetes.
While this report is not due out until December, the CBHSSJB has already embarked on a new Public Health campaign to target the diabetes crisis differently, moving beyond simply addressing it as a medical issue. The new philosophy is going under the moniker of the Maamuu Nakahehtaau (Let’s Stop It Together) project. Its goal is to end the diabetes epidemic that has now touched four generations of Crees by involving everyone possible in the Cree nation.
Obtaining this ambitious goal however is going to take a great deal of effort and even more awareness about the situation which is why a resolution was needed to be passed within the Cree nation.
Going back to where this project started, prior to this summer’s Cree Nation Annual General Assembly, Sol Awashish, the CBHSSJB’s Chronic Disease Agent, decided to propose a resolution but wanted to make sure that he garnered the attention of everyone there from Chiefs to the heads of entities.
He decided to embark on a walking project over a several week period that saw him walk the accumulative distance between Mistissini, where he lives, to Nemaska, where the AGA was being hosted.
“It was a call to action and so he emailed all of his friends on his contact list and he started walking every day, many kilometres, towards covering the distance between Mistissini and Nemaska and that’s what he did,” explained Morrow.
Morrow said during his daily walks to complete the 378-km virtual walk, many would join Awashish to get some exercise and take part in the experience; she described it as almost a pilgrimage. Even Crees from other communities began their own walks in light of Awashish’s efforts to see if they too could accumulatively walk 378 km to benefit their own health. From there Morrow said the movement snowballed.
On the day of the AGA, Awashish walked the final kilometres from just outside of the community so that he could complete the journey at the AGA. He then proposed the resolution to ensure that the entire Cree nation would hear his call for support in the battle against diabetes.
At the AGA it was resolved that the Grand Council of the Crees/Cree Regional Authority would support the Maamuu Nakahehtaau campaign that calls for all Cree entities to implement and support public policies to maintain a healthy lifestyle. Among other things, it calls for the Cree to welcome the Maamuu Nakahehtaau team into their communities for diabetes prevention planning sessions and for all of the local entities, churches and private businesses to send their own high-level delegates to participate in these strategy sessions.
“The only way we can interrupt the progression of this epidemic is through a broad approach where every Cree entity, everyone in a position of leadership and everyone in the community has a high level of awareness and is part of the solution. But it is going to take everybody working together to turn this trend around,” said Morrow.
What the CBHSSJB would like to do is begin these planning sessions within each community and act as a facilitator for each community and entity to incorporate every aspect of the Cree nation into the problem solving.
The idea would be to create a roundtable in each community where solutions could be looked at from every angle and with the participation of every stakeholder at a one-to-two-day local health summit.
“We are trying to bring everyone around the table and give them the evidence in a way that it’s not dumping data all over them but showing them what is really going on in terms of diabetes and what is going happening. This is in terms of the underlying factors in the diabetes epidemic, the real cost of the epidemic, both social and economic costs to the community,” said Morrow.
Though she said the specific figures were not available as of yet, the diabetes epidemic in Eeyou Istchee does not just put a tremendous amount of pressure on the local health infrastructure but that the cost in human suffering is just as dramatic. With the expected spike in diabetes cases over the next 25 years according to their data, it can only be anticipated that without change, both the suffering and the price tag for diabetes care will soar.
Morrow believes that each community’s stakeholders will be inclined to participate because the goal is to shift community priorities to create healthier, happier and cleaner communities. And, what is good for the people is also good for businesses.
“Because it is such a huge and complex issue what we need is a new creative energy to make it fun and to bring young people into this process. We are envisaging something like a one-or-two-day community meeting but not just sitting around watching PowerPoints and talking about problems. It would be really small groups that are interactive, fun, involve a lot of creativity and really getting out in the community,” said Morrow.
So far Morrow said the Public Health Department is exploring different methodologies that could be examined at these local summits. One idea is to get participants to walk around their communities and create a sort of local “report card” about their walking experience to see what could be improved upon. People would be able to grade their surroundings positively for aspects of the community that make their experience more pleasurable and also make note of what detracts from the experience.
She gave examples of having broken glass around the community or a lack of sidewalks as negative aspects that could be addressed. In the long run, the grading experience would be to get participants to create a vision of what they would like to see within their communities so that a local action plan could be developed for positive change.
And, positivity is also a major aspect of this campaign. Just recently the Public Health Department had several Crees talk about the healthy lifestyle changes they have made over the regional radio network. Many spoke about the changes that they have done so that they do not develop diabetes. Mabel Wapachee of Mistissini gave the example of how she trains to run half marathons just to keep in shape. Also, some of the communities have participated in pedometer challenges to see which of them had made more steps and how that positively impacted their health.
For Morrow and her colleagues, the challenge of dealing with the diabetes issue over the last 15 years has been taxing, particularly on the local Community Health Representatives and so taking a fresh approach to dealing with the epidemic has actually been fun because the past has been so demoralizing. She described how for some representatives to set up community walks and programs only to see the problem increase has been difficult but that spreading the burden of dealing with the issue to the entire community can only be positive for everyone.
Public Health has already gotten one community on board to have the Maamuu Nakahehtaau team come in and begin the process. As Morrow explained, Eastmain Chief Rusty Cheezo is a diabetes sufferer himself and he was only too glad to welcome the team in to use his community as a “guinea pig” for the revolutionary program to begin.
While the CBHSSJB is looking at this new philosophy to battle the diabetes issue with excitement, Morrow said there was another important message here that cannot be ignored. While the epidemic is a huge problem in Eeyou Istchee, Aboriginal people are like the canaries in the coal mine, the whole world is heading in this direction as obesity is on the rise. At the same time, she thinks the problem can be solved locally.
“The solution to the Cree diabetes epidemic can be found within the roots of Cree culture and so it is just a matter of digging in to find those solutions here and not outside somewhere else,” said Morrow.