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A Staggering 50% of Native Americans Have Diabetes Under Onslaught of Sedentary Reservation Lives

Damon Rooks hoisted his disabled father into a pickup truck and together they drove across the dusty roads of the Pine Ridge Indian Reservation to a clinic 50 miles away in Porcupine, South Dakota. After four hours of dialysis, 49-year-old Paul Rooks struggled back into the truck, and he and Damon headed home across the Great Plains in temperatures of more than 100 degrees.

It is a monotonous routine that Rooks endures three times a week, and one that is becoming necessary for an increasing number of American Indians across the rural United States. A member of the Oglala Sioux Tribe in South Dakota, Rooks has kidney failure brought on by diabetes.

A staggering 50 percent of American Indians over the age of 45 are diabetic, an ongoing Strong Heart study funded by the U.S. National Institutes of Health estimates. The National Association for American Indian Children and Elders says the diabetes rate is eight times higher at Pine Ridge than among the general population.

A year ago, Rooks began noticing small black ulcers on his toes, the early signs of the uglier side of diabetes - poor circulation leading to amputation. His big toe was the first to go, and in less than a year he lost both legs just below the knee and eight fingers. Once a day his wife, Esther, washes the fossilized stubs on his hands with sage.

"I know (my neighbors) were shocked to see this guy walking around, and the next thing they know he doesn't have any legs to walk on, no fingers to use," he said without bitterness.

Along with colorful Indian art, a photograph hangs on the wall from his son's high school graduation last summer. Paul stands proudly with an arm around Damon, who is wearing a shiny royal blue cap and gown. Both beaming Rooks had legs then. "It is tough, but you put a smile on your face," said the elder Rooks, who is also hooked up to oxygen most of the day.

It is not uncommon to see others on Pine Ridge with missing limbs, mainly because diabetes among American Indians often goes undiagnosed or untreated until it is too late. The American Diabetes Association says diabetic Indians are four times more likely than other diabetics to suffer amputation and six times more likely to suffer from kidney disease.

Rooks' hometown of Wanblee, population 1,570, is wracked with the disease. He said at least seven people have suffered kidney failure like him and have to make the trek to Porcupine and other faraway towns for dialysis.

A Vietnam War veteran, Rooks served as the reservation's chief of police for 12 years and witnessed many social problems during that time. Diabetes is just as damaging as the social ills, he said, but has not received the attention it deserves.

Indeed, the American Indians' difficulty with diabetes is not widely known among outsiders. Some on the reservation are distrustful and feel shame over their plight, said several sources. When seeking information about the epidemic, a Reuters correspondent initially met with reluctance by social agencies to discuss the problem, before people like Rooks expressed willingness to share their stories. "There are other problems, like alcohol and drugs, but that's nothing compared to diabetes," Rooks said.

Shannon County, which spans Pine Ridge, is the poorest in the United States. Only Haiti has a lower life expectancy in the Western Hemisphere. By some estimates, the unemployment rate reaches 90 percent. But poverty is just one of the factors contributing to the burgeoning diabetes rate.

"There is a very big genetic component, and it was an advantage many, many years ago," said Strong Heart researcher Barbara Howard, who works with American Indians in Arizona. In the days of feast or famine, Indians could consume large quantities of food in one sitting and their efficient bodies stored it for the lean times, she explained. But now, the sedentary reservation lifestyle combined with a consistent supply of food that is high in sugar has turned what was once a positive into a deadly negative. Alarmingly, diabetes rates are also climbing among American Indians under age 18, who account for half of the reservation population.

"A lot of our children and teen-agers are not very physically active," said Mark Butterbrodt, a white pediatrician in Pine Ridge. Many parents sequester their children indoors fearing gangs, stray dogs and the broken glass that litters Pine Ridge, he said.

A group of men in the town of Oglala were inspired to start a walking club thanks to "The Diabetes Prevention Hour," a weekly radio show co-hosted by Richard Iron Cloud, director of the Porcupine Diabetes Prevention program. "One of the things we realize is that 75 percent of the process has to be our own selves taking care of ourselves and changing our lifestyle," Iron Cloud said in a recent radio show. He practices what he preaches and has helped his family make significant improvements in diet and activity level.

He and others in his town even convinced the local trading post, the only grocery store within miles, to carry fresh fruits and vegetables, a rarity on the reservation - the "rez," as locals call it.

Suzanna Kills Back, a diabetic herself, watched her 44-year-old mother die of diabetes complications. But it was not until two of her own children were deemed at risk for the disease that she began to take action. "If I don't help them take care of themselves, they're going to end up like me," said Kills Back, now an outreach worker with Iron Cloud's organization who educates parents on how to protect their kids from the disease. Harvesting wild turnips with her children is just one of the ways she has improved their diet and encouraged them to get more exercise.

Paul Rooks has inspired his son to take diabetes seriously, but he fears for the future of the Oglala Sioux Tribe if the epidemic is not halted. "I thought I still had some time left to help people," he said, looking down at his wooden feet tucked inside black leather sneakers. "But it is fast diminishing."

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