dimanche 4 octobre 2015

PLANET OF PRE DIABETES: THE CASE OF COLOMBIAN AMAZON

PLANET OF PRE-DIABETES
OR
HOW I GOT A DISCOUNT AT A PHOTOSHOP IN COLOMBIAN AMAZON
One visionary leader in the year 2000 went against the then enthusiastic endorsement of globalization by eager politicians from the Left and the Right, from the East and the West. He predicted that Globalization will increase the gap between the rich and the poor will create a greater proportion of marginalization among the Youth of the World.
What he did not mention that Globalization would also bring PRE-DIABETES, a condition created and hijacked by the Drug Companies (Pharma) and the Doctors in their employ.
The current mentality prevalent in the medical circles and exported to the developing countries, is that, if a collection of laboratory tests could be given a name (Whatever happened to Metabolic Syndrome?, the current catch words are Pre-Diabetes and Cardiac Risk in Diabetes), then it can be treated with medications, letting the doctors and other care providers off the hook from searching for the reasons and treating the social conditions that gave rise to “Pre-Diabetes”
(Acanthosis Nigricans a skin marker easily seen on the back of the neck has a good correlation with impending glucose dysfunction)
The Prevention programmes of the Omaha and Winnebago Tribes (in an isolated part of Nebraska, thus of USA and the world) were the first ones to point out that the condition that gives rise to Diabetes, can be detected in children and it was purely cultural and social in nature, Wisely they did not assign a name to it, wisely avoiding medicalization of a social condition, which might punish the sufferer with castigation and accusation. The medicalization might lead to drug treatment of a social condition which needs social interventions.
Leticia is a small town at the Amazon region where the borders of Colombia, Peru and Brazil converge. It had changed colonial hands more than once, mind you, the local native population were never consulted and now is the capital of Amazonas province of Colombia. Indians who were Peruvians all of a sudden became Colombian and of course they had relatives in Brazil. I had written about how this fragmentation destroyed their identity and led them to a cultural barrenness. Afraid that the town might maintain its Peruvian identity, much like the Amazonian towns on the Peruvian side, the government of Colombia encouraged people from Antioquia, Bogota and Tolima among others to come and settle or at least influence the character of Leticia. Many came, and most stayed and it is their descendants who own most of the businesses, whether selling handicrafts or imported from Bogota goods or Auto Rickshaws from India or Motorcycles from China. The Indian once again is pushed into the background and the tremendous mixing gave rise to an Indian look without an Indian culture to the town.




I am a Letician, became the cry of Identity, along with Globalization of plastic produces, it also became an identity to be a Pre-Diabetic, as the population quickly put on weight, gathering a taste for the plastic food imported while living in the Amazon basin!
One such entrepreneur is CR, a descendant from the time of mixing in Leticia, which gave him a dark hue skin colour and pretty white wife. He owns LetiColor Leticia where all your photographic needs are attended to. His operation is rather busy, with pregnant women coming to be photographed with their bare bulging bellies while the husband or partner tenderly holds her, clad in nothing but underpants! Intimacy revealed at this special time of their lives, occasionally an older child or children are included in the photo, usually fancily dressed in laces and ribbons and cheap Chinese shoes.

I wanted to get a message printed on a Tee Shirt and another one on a drinking mug.  I asked him the price and he stated them, shouted some orders and I tried fitting the tee shirt on his wife who obliged thus making it possible to choose a size and a style.
While chatting, laughing and watching his coworkers busying themselves with the mixture of clientele that is very representative of Leticia, I noticed a small pill card containing a few Metformin 850 mg tablets. I looked at it and asked him, are you not too young to be taking these?
CR who is not yet 30 began his story. His business is flourishing that means that he is always sitting at his computer and works long hours. There has not been any exercise for the past many years and the food portions had increased as had his body size. His wife chimed in, he does not like to walk, has his little car parked in front of the store. A random blood sugar had been done and a doctor had interpreted the results to be Pre Diabetic in range and ordered these medications, he takes one a day regularly, a habit which is new to him.
Oh Globalization, Pre Diabetes is thy name, I thought to myself. I was genuinely concerned that the attraction of wealth and irregular hours would make this young man with a pretty wife, succumb to the kinds of consequences of high blood sugar that we see in North America. I started talking to him right then and there, about nutrition, what to avoid in this Amazonian backyard and what to increase , told him the difference from Fruit juice freshly made and easily available rather than the ones in the can or a box. Two things you must avoid, if you are not to get Diabetes, one is the excessive desire of the Colombian palate for Bread (many a Colombian might have bread and milk for dinner!) and avoid any drink that comes in a can, and can I avoid Diabetes if I take these medications? He asked eagerly. This is a social disease and the results would come from your changing your lifestyle, he screwed his nose and forehead, but his pretty wife looked at him pleadingly, poor favor, listen to the doctor.

Two days later I came back to the store, I was given the merchandise I had ordered but CR was not in the shop. I told them that I am going around to the Café Barbacoa for a Pintado (small café much similar to Cortadito of Cuba). An Amazonian downpour delayed my return, but there he was. I had the Accu Check device to check the blood sugar. He had eaten two hours before, his breakfast, without bread. He said to me, doctor, I am happy you are interested in me; I will follow your advice as I don’t want to get Diabetes. The machine showed his random blood sugar reading to be 119 mg/dl which is a fairly good value two hours after breakfast. I congratulated him and he looked so pleased. When I come back next time, I want you to be leaner, in all fairness had lost about 7 kg, his pretty wife looking on encouragingly. He sounded genuine, when he thanked me.

I told him, I had received my merchandise, and that I would like him to email me the designs and I wanted to pay.
No, Doctor, you have been kind to me, I cannot accept any payment from you.
The amount involved was not large but I was really touched by this gesture. I handed him my card and said to him, you can write to me with any medical questions you may had.

Gracias y Hasta Luego
As I am returning to the Indians of Nebraska, I cannot begin to reread that great Medical Anthropological text:
Shamanism, Colonialism and the Wild Man
A study in Terrror and Healing
By Michael Taussig, an Australian Jewish Psychiatrist with a PhD degree in Medical Anthropology who teaches at New York.

It would be a good background reading about the Globalization and the disease among a population subdued and terrorized in the Amazonas in the 19th and early 20th Century, when the Peruvian City of San Antonio became the Colombian City of Leticia