ENDOCRINOLOGIST-ANTHROPOLOGIST TO INDIGENOUS PEOPLE, IN THIS CASE THE AMERICAN INDIANS. LOS INDIOS

 I am happy to have come to the USA for my post graduate studies in Endocrinology (excellent clinical education at Jackson Memorial Hospital of the University of Miami) but even a greater gift has been working with the Native, Indigenous people of the country, commonly called Indians. Just after my first acquaintance with them, I realized that to look after a culturally distinct group (my first encounter was with a tribe which had managed to maintain their language and religion), you need much more than what they teach you at the Medical School. So I went to London to study Medical Anthropology which has become immensely useful in my professional and social life ever since.

Today I was happy to read that a distinct group of doctors from multiple specialties under the auspices of American Heart Association had come out with recommendation for Diabetes Care for all sectors of the American society which possibly is the most culturally diverse upon this earth. 

I was interested in the comment of the lead author, emphasizing what we in our work environment had known for a while:

Dr. Joseph and colleagues point out, clinical care and treatment account for just 10%-20% of modifiable contributors to health outcomes. The other 80%-90% relate to social determinants of health, including health-related behaviors, socioeconomic factors, environmental factors, and racism.

I would be more generous. Only 25% of the Diabetes care is MEDICAL, the rest is SOCIAL in origin and treatment. In the context of Indian tribes, that would include the clan, the family, the loyalty to the tribe and its traditions including the language.

I have hundreds of examples but let me give you one from today. In countries where there are obstacles of many sorts, I highly recommend the peer to peer project mopotsyo.org in Cambodia

A patient of mine sends me Blood sugar readings and also photos of food and his life. So he and I know which food makes his blood sugar goes up. With regards to Nutrition, let me say nothing more than: American food and American Indians cant mix very well with each other. ( in fact I don't think American food is good for any one, including Americans)

this reading is slightly higher than normal for him a couple of hours after eating, he and I know the culprit but we do not talk about it. I might may a comment like: you normally do not have blood sugars that high to which he might answer, you know I can bring it down. Respectful and not hierarchical or condescending. 

he sent a note: I am going for a walk. usually the walk is about 1.5 miles.

He sends beautiful pictures from his walk. in his camp, there is a lovely Cuban Royal Palm and I ask his permission to take a photo of me hugging the palm tree. Being a traditional native person, he does not feel superior that his doctor is hugging a palm tree but understands fully when I explain that in the Cuban pantheon of Spirits, the palm tree represents Chango, the supreme spirit, represented also by the thunder. 

When I go visit him in his family's compound, i walk with him along this path and he is always eager to tell me something about the jungle or the animals that live there. 

At the end of the walk, after a rest of 15 minutes he sends me his BS. He has a continuous glucose monitor Libre so that is easier for him to send me the readings. 

He does not laugh that his doctor has named the alligators nearby, Monsieur Francois for instance. 

In the months we have been communicating with each other. He has seen no other doctor but his Hemoglobin A1c (a measure of his blood sugar) had come down from 11.5 to 7.6, a reduction of almost 100 mg/dl points of blood sugar! I am very interested in the kidney metabolism among the Native people and his kidney function also has improved. I have added no new medication but have stopped several of his other medications that his Family Doctor  had him on. Remember Diabetes Care is not ONLY about medications.

Here Lifestyle does not mean giving him recipes or caloric restriction charts but being there for him when he needs (he never bothers me with telephone calls). Showing respect for the patient, putting his concerns first and assisting him with the 20 %  of how best to get benefits from his biomedical encounter ( protection of kidneys, eyes and feet and the heart, laboratory tests)

I can only say, proudly, that i am an Endocrinologist to the American Indians (as well as some other Indians  in other countries of this continent)

and I am grateful for the wonderful people that I have worked with in the Meskwakia HoCank UmonHon Lakota Kickapoo tribes..