Larry Krotz - Diagnosing the Legacy: The Discovery, Research, and Treatment of Type 2 Diabetes in Indigenous Youth

When my work as a community health nurse began in earnest in the mid-1990s, the picture of diabetes was only the beginning of what was to come. It was then that I became aware of the DER-CA (Diabetes Education and Resources for Children and Adolescents) program at the Health Sciences Centre in Winnipeg, and this is also about the time that I met Dr. Heather Dean. The emerging diagnosis in children, especially in First Nation communities, was about to explode. I knew of only a handful of children with type 2 diabetes and just one in the community where I was working. At the community level, we began to hold diabetes classes on a regular basis to try to address the challenges of living with diabetes, to share information about the disease, and to provide prevention and management strategies. Since then, working with diabetes has been a large component of my nursing work: participating in workshops, conferences, training sessions, DREAM (Diabetes Research Envisioned and Accomplished in Manitoba) and DEVOTION (Developmental Origins of Chronic Diseases in Children Network) committees, and working with Diabetes Canada. Being diagnosed with type 2 diabetes myself in 2003 has driven me to learn and sharetalking to others about the despair of having an illness that needs to be dealt with on a daily basis is ongoing.

In 1999, the federal government funded the Aboriginal Diabetes Initiative ( ADI ) in response to the calls from First Nations to address the growing epidemic. The ADI allowed us to put lay workers in communities to initiate diabetes prevention and awareness at the community level. The funding has been stable but has not allowed for increased screening and treatment. The mobile screening project meant to assess and prevent complications has not moved beyond the initial twenty First Nation communities. Yet, with strong support from colleagues such as Dr. Dean, Dr. Dart, Dr. Wicklow, Dr. McGavock, and Dr. Sellers, we move forward armed with the data and knowledge that arises out of their work. Thanks to their perseverance, nurses now benefit from up-to-date information about the number of children diagnosed and about the ongoing research and its findings. This information allows us to plan, strategize, and have a voice in addressing diabetes in Indigenous communities. How fortunate it is for us that Heather Dean and her associates persisted in gaining support for this research. The relationships that their team developed with people in the community, like Bertha Flett and Mary Jane Wood, were built on respect. Their successes clearly speak to the benefits of a collaborative approach and are a credit to their hard work and involvement over the years.

Indigenous health care personnel have long known and understood the value of relationship building, and we know that stories must come from people at the grassroots level. I believe Larry Krotz understands this, too, and with this book he has given us the story of the people. Through Larrys storytelling, I could feel the ups and downs, the struggles and breakthroughs, as the narrative unfolded. Although the story is tragic and frustrating at times, this is the reality of living with diabetes. Readers will better understand the challenges of Indigenous patients living with diabetes through the individual stories from the people, and appreciate the tenacity of the doctors in trying to get the diabetes research world to take notice of their findings in Manitoba. Indigenous nurses will identify with Anita Crates feelings about having family and friends who struggle with diabetes. As nurses, we share her doubts about whether we are making a differenceit can be overwhelming at times, but it helps to know you are not alone. Most of all, this book helps those in the community because it indicates their voices are being heard.

Diagnosing the Legacy tells how the diabetes picture evolved in Manitoba and shows that it took a fight and commitment to get the research world to take a look and see that, yes, type 2 diabetes in children was in fact occurring. It also confirms that our partners, including the DER - CA , DREAM , and DEVOTION , are including Indigenous people and knowledge in medical treatment and research, and that elders are invited to all our meetings and gatherings to guide and help us to work collaboratively in a good way.

Frances Desjarlais, RN , BN

Winnipeg, January 2018