“I’m a Mununjali man,” proclaims 53-year-old Indigenous Queenslander, James Sandy. “I’m not a diabetic. I have a disease called diabetes. And I’m going to look after my body and survive to the best of my health.”
Sandy’s attitude to type 2 diabetes is not just positive; it’s marked by a dogged determination to fight and overcome the disease that he believes has already claimed the lives of nine brothers and sisters.
“There were 11 children in my family, including myself. When I was 46, three of my brothers died. Only four of us kids made it to age 50. And now it’s down to just two of us. Me and my younger sister are the only ones left.”
Sandy says that most of his siblings died of heart attacks. But now, knowing that diabetes runs in the family and that high blood glucose levels cause heart disease, he thinks the underlying cause of his siblings’ deaths was diabetes.
“I was diagnosed with type 2 diabetes in 2000. I should have taken it seriously then but I didn’t do anything about it. My last sister died in 2008 and after that, the panic dropped. It hit home to me and I just knew I had to do something to improve my health.”
"I should have taken it seriously then but I didn’t do anything about it. My last sister died in 2008 and after that, the panic dropped."
Sandy has since started walking daily, given up drinking Coca Cola, drinks at least three litres of water a day and visits his GP for regular monthly check-ups. Consequently, his health has improved rapidly since his diagnosis.
But, as Sandy contends, not everyone in the community gets the chance, time or support needed to manage their diabetes and turn their health around.
The Australian Institute of Health and Welfare has ranked diabetes as the second leading cause of death for Indigenous Australians. It also reports that almost six times as many Aboriginal and Torres Strait Islanders die from diabetes as non-Indigenous Australians.
Associate Professor Neale Cohen, endocrinologist and general manager of Diabetes Services at Baker IDI Heart and Diabetes Institute, knows the toll that diabetes is taking on Australia's Indigenous communities too well.
He's been providing diabetes support in 11 remote communities throughout central Australia for around six years and estimates that, in a township of about 300-500 people, around one in 10 are battling a severe case of type 2 diabetes.
“The range of ages we see up there is concerning,” says A/Prof Cohen. “The youngest I have on my books is age seven. I’ve never seen anything like it before. The cases we see are very severe, very early and progress very fast.
“…If this was disease was AIDS, you’d probably have the army out here helping. But because this is diabetes, they are not. People just don't understand the ramifications of it.”
According to a 2012 report, Indigenous Australians are three times more likely to have type 2 diabetes compared to non-Indigenous Australians. Indigenous Australians are also at greater risk of complications than non-Indigenous Australians, with a 10-fold higher risk of kidney failure and up to eight-fold higher risk of high blood pressure.
A/Prof Cohen strongly believes that given the young ages of the patients he sees, genetics is the major cause of type 2 diabetes in remote Indigenous Australia, although lifestyle is also a contributing factor.
“[Indigenous Australians with type 2 diabetes] need more diabetes support urgently, otherwise the health gap we talk about closing is going to widen even more, as patients who are young have the types of worst cases we’ve ever seen. They are the ones who will be dead by the age of 30 or 40. They need serious help, now.”
Mandy Williamson is a Credentialled Diabetes Educator (CDE) who works for the Melbourne-based Victorian Aboriginal Community Controlled Health Organisation.
She provides diabetes care and support to Indigenous patients aged as young as 12. “You have high instances of chronic diseases in the Aboriginal and Torres Strait community because of there is a history of oppression and dispossession, and a fair bit of poverty and unemployment underlying it,” says Williamson.
However, Williamson says she’s seen many patients improve, simply because the model of care employed at the service is culturally appropriate.
“The service here isn’t just a health service; it’s a gathering place as well as multidisciplinary community hub.”
All diabetes-related services, from optometry to podiatry, general medicine and dietetics, are under one roof. The clinic runs culturally specific support groups, a diabetes clinic and education programs. There are Indigenous paintings all over the walls and floors, and a real combustion fire in the centre where patients wait to see a doctor.
“Some people are not as comfortable going to mainstream health services or if they do go, they may feel insulted in one way or another because some [mainstream workers] are ignorant on how to respond to someone who is Aboriginal or Torres Strait Islander: there is no culturally specific response.
“So I think Indigenous Australians need a safe space and a comfortable space to visit to be treated for their diabetes. My understanding, as a white person working here, is that this is where people feel comfortable visiting, spiritually and emotionally. The community at the service is strong and it’s a safe place.”
“The Indigenous way is all about respect. You have to respect your body and mind to respect yourself, so you can respect everyone else."
Although there’s no magic bullet solution to radically reducing the prevalence of type 2 diabetes throughout Indigenous Australia, Williamson believes we should start by promoting more diabetes awareness in communities and offering more counselling and healing.
“We also need to increase the capacity of Aboriginal Controlled Health Organisations around Australia to provide multidisciplinary, community-based holistic care.”
A/Prof Cohen wants more programs based in remote Australia to promote health literacy and ensure that people who have diabetes are supported to manage their own condition. He also seeks additional government-funded schemes to challenge the poverty gap between Indigenous and non-Indigenous Australians.
As for Sandy, he thinks a focus on the individual empowerment is vital and offers first-hand diabetes advice - based on his experience- to Indigenous individuals from all mobs across Australia.
“If you are on the path to getting diabetes, do whatever you can to prevent it,” says Sandy. “There are easy ways to do it. I find my little daily walk works for me.
“The Indigenous way is all about respect. You have to respect your body and mind to respect yourself, so you can respect everyone else. If you treat your body good and it will look after you.”