PREVENTION OF TYPE 2 DIABETES BY LIFESTYLE

PREVENTION OF TYPE 2 DIABETES BY LIFESTYLE

NOTHING BEATS LIFESTYLE CHANGES TO PREVENT AND TREAT TYPE 2 DIABETES IN USA/EUROPE/AUSTRALIA/NEW ZEALAND…etc.

I have just attended a fabulous professional meeting of the (American) Endocrine Society in Houston, Texas. Believe it or not, there were 8000 participants, divided among Clinicians and Researchers.

All the Endocrine systems were covered in detail.

Race and Culture do matter in metabolic diseases where there is a huge lifestyle component. While admitting that Type 2 Diabetes is the worst treated disease in the USA, Professor Davidson, was able to show multiple differences in obesity rate, treatment adherence rate, outcome rate among various groups of Spanish speaking immigrants and their children, the so called, “Hispanics”.

Surprisingly, Asian Indians living in America (belonging to Pakistan, India, Nepal and Bangladesh) had the highest rate of Type 2 DM of all the residents of the USA! Obesity rate among Asian Indians born in America is at the same level as the American born Mexicans!  I have a cultural explanation on why “Indians” die fifteen years earlier when they migrate to the west.  Acculturation leads to unhealthy behaviour.

A plethora of new drugs to combat Type 2 DM were paraded by professorial peons from the academia. None of the newer drugs can quantitatively improve Type 2 DM control at a level comparable to Lifestyle modifications: whether it is prevention or treatment. The apologists for the newer drugs that improve Diabetes control by a mere 0.7 % begin their drama: When the Lifestyle is no longer feasible…as if Lifestyle is just another pill which has lost its efficacy.

Why are Metabolic Diseases such Obesity and Type 2 DM are (a) so poorly treated and (b) so poorly controlled?

(a)        Responsibility of the doctor

(b)        Responsibility of the patient

There seems to be a discordance between (a) and (b)

It seems that what the doctors are capable of doing does not chime very well with what the patients of capable of…A Medical Anthropologist would call it, a Conflict of Explanatory Models.

The fact that there exists programmes (such as MoPoTsyo.org in Cambodia) peer educators who themselves were patients once upon a time, advise and educate the patients in a non-clinical setting. And the fact that the control of Diabetes at MoPotsyo.org is higher than what one can find at the offices of a Family Practitioner or Endocrinologist in the USA or in the Diabetes Clinics at Universities in the USA.

With MINIMAL medications (Metformin, Insulin and Sulfonylureas) and MAXIMAL counselling and comforting, better control has been achieved in one of the poorest countries on earth (Cambodia) than the richest country in the world. It is accomplished at a cost that is only a minute fraction spent on this disease in the western countries. When the sugar does not come down, the first consideration is counselling about Lifestyle since it is what contributes most to the control in this programme, among other social forces.

The cost of Health care is driven up by the Disease Care providers (the doctors) than by the DISEASE.

I will give you an example.

My sister who has survived one breast and two lung cancers went to see a Dermatologist about a small patch of alopecia areata (bald spot in the hair), came back with orders for the following blood tests, which included:

FH.LSH, PROLACTIN, DHEA, ESTRADIOL, TESTOSTERONE, T4, T3, TSH, UPTAKE along with normal tests (CBC, Metabolic Panel etc.)

My sister and I along with her Family Practitioner is concerned that the Dermatologist may have received a hefty proportion of these tests thus ordered, the total costs may be between 1000-2000 dollars! Irrelevant tests to the problem of Alopecia Areata! Who is driving up the costs of care for Alopecia Areata? The disease or the dermatologist?

Let us talk about the patient. Why are they reluctant to listen to the patient? Various studies in many countries have revealed a similar pattern.

-Perceived prejudice of the doctor against your culture (no wonder Vietnamese patients choose to go to Vietnamese doctors)

-Lack of trust in the knowledge of the doctor. Medical advertisements and the media play up drugs and weight loss programme and increase the expectations of the patients. The approval of a new anti obesity drug, Lorcarserin, was covered by all major news channels as well as all the on line news agencies! Lorcarserin can make you loose 3% of your body weight, so if you weight 180 pounds, you can expect to loose at the end of one year of swallowing the pill at a very high cost, about 5 pounds. Lifestyle changes are much cheaper and healthier to boot. Internet, Media has increased the chasm of lack of trust in the provider.

-Inability to pay for the unnecessary or irrelevant drugs even when you have insurance

Lantus is the trademark of Glargine Insulin, long acting insulin; it can be bought in the form of a pen with prefilled syringes that may last a patient 10 to 15 days. Cost is over 600 dollars and even if you are billed 20 per cent by the insurance companies, you may have to pay nearly 100 dollars. For people with limited incomes, 200 or so dollars per month for medications is certainly burdensome… here in the richest country on earth!

Instead of reaching out for the prescription pad (supplied to you by the drug companies in many cases) Doctors could spend (and learn to) on advice to change the lifestyle of the patients. (An overweight or obese doctor is very seldom effective; it goes without saying, in persuading the patient to change his or her lifestyle)

It is cheaper for the doctor to reach out for the prescription pad and write the newer medication, justifying that lifestyle and other medications have all failed. But the failure may not be due to medications. However effective a medication may be, as one Surgeon General had reminded us, it is only good if it is taken!

(Capitalism American Style, an ad in Financial Times for Investment company)

Responsibility for health is a shared concern. Patients occupy a different space-financially, culturally –than the providers. Patients need a little help with COACHING to improve their HEALTH, they need an advocate. They turn to their doctors looking in them for a Coach and Advocate but they are deeply disappointed.

As my colleague among the Indians has repeatedly said: It is with the heart that one looks after a patient with Diabetes and not with the mind.

HAVE A LITTLE HEART..

WHY I LIKE TRAVELLING TO/FROM/IN THE USA

Going Home, A good day to Fly..
Websites, newspapers and radio are full of horror stories of air travel within the USA, but they are just talking about the structural changes that has happened in American Aviation Industry. Indeed, in  a country where the Aviation Industry is taxed to the hilt(17 different taxes making up to 20 % of the fare), competing against the likes of Emirates(Dubai), Etihad(Abu Dhabi) or Qatar Airways(Qatar) is out of question.
But when it comes to a more HUMAN way of travel, involving the interesting lives of ordinary people, very few countries can match the US of A!
I am flying to my European home today, and the SuperShuttle arrived promptly at 0600AM as promised.
A bushy haired, muscular man with chinese features is the driver. I say, Buenas Dias since most non-african drivers tend to be from Latin America, here in Miami. Good Morning, he says, eagerly helping me with my luggage.
I was the only passenger and we made good time to MIA.
What a lovely conversation!
You will learn if you keep your ears open, say the American Indians and I did learn a lot in a the very short time from this driver, Vito, from the Philippines.
Have you heard about my country?, he enquired.
Not only have I heard about it about your country, I have visited your country also.
Manila, Baguio..a brief visit flying Royal Brunei airlines from BSB.
When you talk about Philippines with any one, some of the themes that come up that touch the lives of all Filipinos are:
-Nursing in USA/UK/Europe esp Germany
-Hotel/Service Industry  mainly in the Middle East, occasionally in Malaysia, Singpour and Brunei
-the corrupt government of Estrada and Marcos
-Americanization of the Philippines, something they are very proud of 
-Cultural diversity of Filipinas including Indigenous(First) peoples of Asia, such as Ilongot/Bugkalot people of southern Luzon
-Hawaii/Guam and Filipino migration
-Spanish Colonization/Catholicism
Believe it or not, we touched on all those subjects! in the short journey from my sister's home to MIA.
Vito, married to a Nurse, father of a Nurse has been in the USA for 36 years. I am an American citizen, I am so grateful that this country has given me a life that I couldnt have dreamt about, but in my flesh and blood, I am a Filipino, said He.
How refreshing is it for me to hear that,especially after the few days in Houston just this weekend, full of people who are ashamed of who they are: the Mexican Immigrants and their children.
He continued:
From when we were children we were taught to be nice to others, we are taught to help others that is why you would find many of us in the service industry, nursing and transportation and hospitality management. We were the only country to be colonized by the Spanish and their culture after 300 years has had its effect.
He had served seven years in the US Army, to show gratitude for the country that helped him achieve his dreams, his mother/father, his older brother/family they are all here in Miami. In Miami, asians are as rare as vegetarian food in La Habana, Cuba! there are only about 5000 filipinos in this area, compare that to the thousands of Colombians, Venezuelans, Peruvians and Brazilians and not to mention the 2 million cubans who make South Florida their home.
I told him: it is so good for me to talk to someone who is proud of his country of origin. If you had said to me, I am an American(despite your US citizenship) I dont think we would have had such a nice conversation..
thank you, have a safe flight, said Vito, the muscular long haired Filipino.

(Friends in Miami)

Ashamed of Who you are.. A Texas Tragedy

ASHAMED OF WHO YOU ARE.A Texas Tragedy

Maria, a waitress at an elegant function for Doctors at the Hilton Hotel in Houston said: I don't like speaking Spanish. Her English was not all that good either!

I replied: Sorry, I only speak Spanish and I would like you to speak in Spanish to me and added the question, where are you from, Maria?  Saltillo in Mexico but I never go back there.

(things are big in Texas, look at the size of the shrimps)
What a shame! These immigrants who are not well educated (the well-educated Mexicans, most of whom are of Spanish ancestry tend not to migrate. It is the ones who have Indian ancestry and who are poor and destitute, who migrate to the USA, now or before. Then again, much of southern USA was Mexico once upon a time), why are they so eager to negate their history, when it is so obvious that they are Mexican?

It is not the case with Cuban migrants to this country and their children born here in the USA. They would be only too glad to speak Spanish to you. They do not change their names from Flores to Flowers! I consider the Cuban migration to the USA since 1962 to be one of the more successful migrations to the USA since the Jewish migration of the early 1900s/late 1800s. Also most of the Cuban migrants are literate, are professionals to a large degree and quickly become established in USA. Whether Health or Wealth, Cuban migrants to the USA are much better off than the Mexican migrants (high school graduation, teenage pregnancy, obesity, diabetes, percentage under poverty line etc.)

Next day at lunch at Viet resto within walking distance of Hilton Hotel, the waitress was a rather chubby Vietnamese young woman. She may have looked good once upon a time. Her name was Nga.

A beautiful name (a personal connection for another Nga in Vietnam).

It means Ivory in Vietnamese, I informed the waitress.

(chemically grown chicken on this dish, so large and tasteless: bun ga nuong)

I didn't know that, she said. I was absolutely dumbstruck! Here is a Viet Khieu who does not know the meaning of her name? Or does not wish to admit that she knows? She could have easily changed it to Alicia or Daisy. Or something less exotic if she wanted to.

When they are mired in shame, it affects them including their “success” in this society that gives them the freedom to forget who they are.

Jews are proud of who they are and try to pass it on to the next generation. At the meeting I was attending, there were a fair number of Iranians, and I am certain they wouldn't deny their origins (despite the autocratic, narrow minded rulers of their country). I met a Farnoosh, and she proudly told me, it means Splendid…

Splendid Indeed, and I see a good future for the Iranians in the USA: like the Jews, Armenians, and Cubans!

And I shall sing this lament for Mexicans, which the dictator Porfirio Diaz once said:

Oh Poor Mexico, so far away from God and so close to the United States!

(if you eat like Americans, you begin to look like Americans: in the rates of Overweight and Obesity, Australians are not far behind!)

A REMARKABLE AUSTRALIAN .. DR ASHIM SINHA

I am at the Annual Meeting of the Endocrine Society which is like a pilgrimage to practising Endocrinologists around the world..
As I entered the hotel where the meeting was to be held, a familiar voice greeted me and that belonged to Dr Ashim Sinha, a remarkable Australian..
I have nothing but respect for him for the wonderful life he has led and continues to do so, always in the service of other people and at the same time helping others to reach the level he has reached, never forgetting where he came from...
He reminded me of what my father said of his hero, Zhou En Lai... let us all get ahead together.. He is the australian that i have met without prejudice and an universal view of the human spirit and at the same time anchored well in the culture that gave birth to him.. with which endocrinologist from Adelaide to Zimbabwe, can I talk about 

Bankim Chandra Chattopadhyay?

Erudite but humble, human and helpful, I am so glad I am your friend, Ashim. I will make every effort to be in Cairns to witness your good work and go with you to Thursday Island and Bamaga to see your humanitarian work with the Thursday Islanders and the Aboriginal Australians. You deserve your medal from the Royal Australasian College of Physicians..

You are truly a Good Australian!

Ashim took me to an Indian restaurant, called Korma Sutra with its fine North Indian food and we shared a drop of New Zealand Sauvignon Blanc.. I have gotten to know him better this time.. met him a few years ago at another Endocrine Meeting in San Antonio..

I truly admire your attachments to what you consider to be important in your life ....

Apart from our chosen carreers we have Australia and our love of the Indigenous people in common.. and the literature and culture of Bengal..

The Friendliest HILTON hotel so far...

LOYALTY OF A TRAVELLER
When I began traveling to the USA, I noticed that Loyalty to a brand: airline company, Hotel Chain, Book Store, Coffee Store, Restaurant was to be recommended and adds to the quality of your visit to this country.
Of course I am very loyal to the Native People.. which is accompanied by great joy..
The Hotel Group I like to stay is Hilton Hotels. This year I have been lucky to stay at Hilton Hotels in some unique places:  Salalah in Oman overlooking the shore where Zheng He stopped nearly 600 years ago! Kuching in Sarawak with a wondeful view over the river...
Here is the view of the sunset from my room at Hilton Americas Hotel right in the heart of Houston. I am here to attend an International Conference in Endocrinology so I will have no chance to enjoy Houston but I will have plenty of time to enjoy this hotel.

I am grateful to the personal attention given to me by the General Manger of the hotel (Mr. J deR); the Front Desk Manager(Ms.V.Y). I am always pleasantly surprised how erudite are the Concierge at Executive Lounges are: with the one in Salalah I could discuss the Persian language; the one in Kuching gave me detailed account of the history of a chinese fishing village and Mr J G here in Houston, reminded me of the historic significance of the Statue of Washington in Wall St in New York and the Church where Sr Washington had prayed after taking the oath as the First President! Ms J was very helpful at the Lounge.
The day was made sweeter by a meeting at the Poster Session, the meeting was held at the Convention Centre connected to the hotel: a doctor from Teheran, who will be appointed an Asst Professor of Endocrinology at Emory University, she had left Iran just six years ago and I appreciate her achievement... it was so good to talk about Shamlou, Shanameh and Hafez....

THE AMULET EFFECT: SOCIAL ASPECTS OF DIABETES CARE

WHAT IS AMULET EFFECT IN THE CONTEXT OF MEDICAL/HEALTHCARE  (dedicated to Dr SB at Pine Ridge Indian Health Services)

Health is not an absence of Disease

Medical Care or Disease Care is not synonymous with Health Care.

Disease care providers, mostly MDs, and more and more Nurses and other mid level providers  (in the USA there are Physician Assistants, Nurse Practitioners) and other technical staff including Pharmacists are in the picture when there are manifestations of DISEASE are present in the individual BODY of a patient (A person is converted into a Patient when such manifestations are present). There is any consideration for CULTURE, Society, and Explanatory Models of Sickness of the individual patient.

Health care on the other hand, goes beyond the individual, in our case, involves the entire tribe and the extended family in the kinship system. A person has ILLNESS and he resents the attempts by the Disease Care Provider to objectify it into a DISEASE without proper explanation. (This contributes to the non-adherence to medications and other prescriptions_

In our context, the Disease Care Provider has to take into account that our patients do not exist in a vacuum and there are extended effects of the words of the Provider and their actions and their medications.

On a recent visit to the Pine Ridge Indian Reservation, we were involved in a long discussion about Culture, Disease and Illness in the context of Diabetes Epidemic among the Indians.

I happened to mention that regardless of the state or status of the provider in various parts of the world, the measures of Diabetes Control varies only by a little

Control of Blood Sugar is defined, generally, as HgBA1C below 7% and it is around 30 % all around the world:

Whether it is a Primary Care Provider in Miami or

An Endocrinologist in Private Practice in Los Angeles

Indian Health Service Clinics and Hospitals in any part of the USA or

VA Hospitals and Clinics in the USA

What was surprising to me was that it was very similar in many other situations, some very dire, around the world!

The rule-crazy, diligent Singapore; war torn Basra in Iraq, where trying to get medical care might get you killed or Qatar where they are eating themselves to death!

Then the erudite doctor, S.B, listening to my talks asked,

Could it be an Amulet Effect? That a patient, or at least some of them feel well with the encounter with the Doctor, Nurse, Nurse Practitioner or Physician’s Assistant or Pharmacist or Technicians?

Being a cultural anthropologist, I had to say YES!

The uniformity of the results shows the effect what we can call the Amulet Effect- as a result of that encounter some persons have made changes in their quality of life to achieve the result, and in others the Amulet Effect did not work for more than just symbolic reasons.

American Indians have always told me that of all the ingredients in their health care, what is the most important is the Relationship they establish with the provider regardless of the status of the provider.

Most of the patients with Diabetes in this world, do not have access to the newer Insulin or the newer injectable or oral medications such as the Incretins but all of them can have access to Metformin (shown to be the most effective drug in the treatment of Type 2 Diabetes, especially in the first few years of diagnosis, one months supply can be had for about one dollar in many poor countries)

The Amulet Effect encourages Lifestyle changes, improves the quality of life, thus the uniformity of the results

To get better results than this, we do not need the newer medications that bring down the A1C a fraction of a percentage at an extreme cost but we need changes in the society that increases the quality of life for the society as a whole

Whether it is in the war zone in Iraq or

In an Indian reservation where they have no access to good food

Or the United States of America where an average person ingests close to 100 pounds of chemicals per year

If Diabetes Type 2 or Cardiovascular Diseases are labelled and touted as Lifestyle Diseases, then the answer is Lifestyle modification made easy by creating appropriate societal conditions.

Social Illnesses are not healed by newer Incretin medications. The answer for these diseases is not in the Doctor’s Offices, Clinics or Pharmacies.

Dr Emerson, CMAJ, 1986, talking about Disease and Illness:

For terms whose meanings

are not clear and whose uses are partly judgemental, a proper definition should be required.

Prof Marshall Marinker, Medical Humanities, 2000

Disease then, is the pathological process, deviation from a biological norm. Illness is the patient's experience of ill health, sometimes when no disease can be found. Sickness is the role negotiated with society. 

 BBC showed part 1 of 3 The Men who made us FAT. I will upload the link later.

Normally I do not participate in internet Forums or discussions unless something is that close to my heart. When someone had posted in a scientific forum that Sugar is the cause of Obesity, I couldnt post the following as a rebuttal: Hope you agree with me.

In the USA, I work exclusively with Native Americans. A group of people who were all lean, in 1908, (their last year of freedom among the Lakota was 1862) are now 95% overweight or obese. So just to say it is calories and lack of exercise would omit many other factors.
I can send you a graph of whether "sugar" consumption has increased or decreased in the USA. It has decreased since 1970 but what has increased is the intake of artifical sweeteners such as High Fructose Corn Syrup and also Maltodextrin, Glucose, Aspartame etc. 

It has been shown that one can a day of Diet Coca Cola over the years can lead to Metabolic Syndrome which is a precursor for Diabetes Type 2.

  30 per cent of americans are overweight, 30 per cent are obese, the most overweight countries in the world (except some polynesian islands) are : UK Australia New Zeland and Canada.  The middle eastern countries such a Kuwait and Qatar (which may have gained no 1 spot if you count only Qataris who make up less than 25 per cent of the population of Qatar, the rest of them being indentured workers from the west and the east and africa and other arabic speaking countries).  I am aware of the situation of Diabetes and Heart Disease in many asian countries: India is the capital of Type 2 DM and the highest rate of heart attacks for men under the age 40 in the world, China is not far behind, the other member of BRIC countries  Brasil also has high rate, the reasons in these three countries may be the same. I have seen at least 40 normo glycemic, normocholesterolemic, normo BMI (less than 23 kg.m2)  and very active (by podometer readings at least walking 5 miles per day) with  four vessel bypass surgery in Bangalore India. The rate of Diabetes in thinner Malaysians of Indian origin is greater than the overweight Chinese in both Malaysia and Singapour. Cambodia which has a very high rate of Diabetes type 2 has no problem with obesity. One has to consider the genocide they suffered under Khmer Rouge and the stress that was put on that society since most of the new type 2 DM are under the age of 40, who were either born during khmer rouge or soon after that.

So it would be difficult for me to accept that there is just one reason which is non biochemical to explain the obesity, diabetes etc in various population. The oppression , colonization, joblessness and hopelessness among the American Indians have a lot to do with their obesity, insulin resistance (like many indigenous peoples their insulin levels are high to begin with starting at age 7) and Diabetes. 
I also have a graph showing sugar consumption and rate of diabetes in 25 different countries and there is no correlation. Once again what do we call "Sugar"?
Regarding nutrition and fat, i would consider every day american food to be one of the worst in the world. If we are just going by fat and cholesterol of the food content, the French who eat five couse lunches and dinners have half the rate of americans when it comes to diabetes and heart disease compared to USA, which is popularly referred to as the French Paradox. 

Americans consume about 100 pounds of chemicals per year in various forms and i am sure that BPA which is stil  in use and the multides of Endocrine Disrupting Chemicals in that country may explain some of the differences in their high rates of Thyroid Dysfunction, Lowering levels of Testosterone, High levels of Precocious puberty among others. 
Greetings to all of you, my colleagues from La Habana, Cuba where we could prove that Anxiety about Food alone was responsible for the rise in obesity when suddenly the food supply diminished after the fall of Soviet Union. and Cubans are not sedentary people. We dance almost every day. Bienvenidos.. 

Queridos Hermanos de Puerto Rico .. en Pine Ridge..Dakota del Sur

Borinquen de mi amor!

Yo soy hijo de Borinquen
Y eso nadie va a cambiar
Y el día que yo me muera
En ti quiero descansar
Yo te adoro Puerto Rico!
Y eso nadie me lo va a quitar

A great pleasure of visiting Pine Ridge Reservation of the Oglala was the fact that there are a few Puerto Rican professionals working at the Clinic and the Hospital. 

I had just left Cuba only about a week earlier and to speak in Spanish to citizens of our sister island was an unexpected pleasure indeed...

The similarities between these two islands are numerous, both were colonized by the Spanish and ruled by them for nearly 400 years. The geography is very similar, mountainous surrounded by tempestuous seas. The way the spanish language is spoken is also similar. There has been an enormous cultural exchange between the two islands, for example in the Music of either island..

Even the flags are similar, with a slight change in the colour of the triangle in the flag..

So the Indians, Lakota, had brought together, a Jewish Endocrinologist from Australia who calls La Habana and Paris, his home ... speaking in Spanish to a group of doctors and nurses descended from the soil of Puerto Rico, our sister Island in the Caribbean in the language common to both of us..

The presentation was about the history of Diabetes among the Lakota and at the end of the presentation I projected a video of the song, Lamento Borincano..

This is one of the best known songs in the Americas, and I cant imagine any cuban in the island not knowing this song.

As various scenes depicting history and every day life in Puerto Rico known before the conquest as Borinquen, all of us began humming and one of the doctors was singing the lyrics..

I said to myself: there is no need to talk about Cultural Sensitivity to these people, they come equipped with it, so it is a good fit for the Indian people who find it hard to work with culturally insensitive European-origin people who may be living in the same geographic zone.. Coming from a Colony of the United States, being sensitive to the thoughts of colonized people of which Indians are one, is a good cultural congruity which will benefit the Indians.

While working with the Indians in remote parts of this country, I have met very interesting people. On this visit alone, I met a doctor who is certified to run a Bariatric chamber who is also a motorcycle enthusiast. A calm Jesuit from whom I could learn meditation! An Indian who grew up in Denver who manages a Coffee shop .. and the coffee is so good that I found drinking coffee in Sioux Falls after that a chore! a Dentist from Hawaii! and many more..

You always expect to run into unusual Indians, one such was the Grandson of Chief Red Cloud.. 

Namibia was introduced by a social work student whom I met in another reservation!

After meeting my colleagues from Borinquen I am fired to visit the island, which I have visited only twice.

HAPPY BIRTHDAY, MARK MERRICK, AN OMAHA INDIAN

Last year, W S, an UmonHon, had announced publicly that from now on I was her brother. According to the Omaha Kinship system (the first kinship studied thoroughly so all kinship systems are referred to as Omaha Kinship), I inherited a large family of brothers, sisters, neices, nephews, grandchildren!
Already I was acquainted with the Merrick family and now it is their turn to take me in, thus people I have known and had been friends for a long time, began calling me and greeting me: Hello, Brother. After the initial adjustment, I began to realize the heavy responsibility of being adopted into a family. The true meaning of relationship became clearer to me. whatever affected the family members now was a part of your story as well. 
Mark who would have been sort of the eldest member of this clan and a Roadman, was celebrating his birthday and I showed up and was able to see the extended family to which I now belonged.
It was indeed an occasion to remember...I caught myself a couple of times, referring to the Rez, as "home" since that is what is for the family. When I invited a member of the M family to come to Miami, he said, it was enough once going away from the Rez, I am not leaving another time!
I am grateful for being accepted into the family and I will try to be a good relative..

HIGHER GROUND, COFFEE SHOP IN PINE RIDGE: THE BEST COFFEE FOR MILES AROUND

A friend of mine had informed that there is a Coffee Shop in Pine Ridge Indian Reservation.. I wanted to check it out soon as I reached the Reservation.
As I entered the Cafe, a jolly faced Indian demanded: show me your tribal ID and then laughed and cautioned me about traveling to Calcutta since he has had some bad experience there..
I thought to myself, here I am in the middle of South Dakota in a fairly isolated part of the world, and this Indian is talking to me about travel to Calcutta..
I ordered a Cafe Americano with hot milk and his wife at the helm of the coffee machine and it was just excellent.
Repeated visits endeared me to this place, a warm and welcoming place and its owners: Leon/Belle/Tami. The coffee was consistently good and the Lunch offering if you could get them since they ran out, as they had a loyal following. It was not unusual to see various characters: some permanent and some fleeting, psychiatrists, geologists, doctors and nurses, young people on internet and others whiling their time away..
Leon is the great grandson of Blunt Horn and extremely interested in the history and culture of his people. He is friendly and gregarious and a pleasure to talk to.
It would be a pity if you miss The Higher Ground and Senor Leon if you are passing through Pine Ridge.

GIFTS OF THE INDIANS

Whenever  I leave a Reservation of the Indians, I think of the graciousness of them, their eagerness to be friendly and their desire to give you gifts: not only material gifts including handicrafts but also human gifts: kindness, friendliness, eagerness to share the knowledge they have..

I have just spent a lovely week at the Pine Ridge Oglala Lakota Indian reservation.

VISIBLE TOUCH WITH LAKOTA HISTORY

How often can you meet a memorable man who is a grandson of a famous Lakota who was born in 1822?

1908 Average Height 5 foot 7 inches, Average Weight 142 lbs
1862 THE LAST YEAR OF FREEDOM
The Terms of Fort Laramie concluded in 1868 granted the Lakota a single large reservation that covered parts of North Dakota, South Dakota and four other states.
Chief Red Cloud insists that he will not sign until all the army forts in the territory are removed.
Assassination of Sitting Bull and Break p of the Great Lakota Nation

Paying respects to Chief Red Cloud at his tomb at the Jesuit Cemetery near Pine Ridge, South Dakota

and today I had the privilege of meeting Chief Red Cloud's grandson, also called Chief Red Cloud

 Strong in his words, dedicated to the welfare of his people, I was impressed with this gentleman who is still active, at age 92, fighting for justice for his people. He is very active in the treaty rights of his people. He would like the Black HIlls and the State and National parks to be returned to the Lakota and the private landowners who rushed into the ladn after the gold was discovered to pay their taxes to the Lakota. 

I AM CERTAIN HIS STRUGGLE AND DREAM WILL COME TRUE.

The American Hegemony is declining a.nd thus they are becoming humble and they would recognize what is that they have done to the Indians and make reparations

WASH-TE