"So that the people may live--hecel lena oyate kin nipi kte"

Abstract

Type 2 diabetes is spiraling upward around the world, ensnaring adults and youth from societies in the throes of industrialization. Over time, uncontrolled diabetes leaves in its wake people facing renal failure, blindness, or heart disease, and communities with little hope for preventing this "new," chaotic phenomena. Westernized lifestyles (e.g., physical inactivity, processed foods), in concert with human genomes yet being mapped, are recognized explanations for the escalating prevalence. The web of causation, however, is woven by complex interactions with environmental, sociological, and historical roots. Reservoirs of adaptive capability reside in the knowledge systems of indigenous elders who have, in their lifetimes, known the rarity of diabetes and the epidemic’s impact on their people. The purpose of this ethnographic study was to document, understand, and support Lakota and Dakota elder women’s beliefs and knowledge about health protection and diabetes prevention. In-depth interviews among 9 elders served as the primary method to answer these research questions: 1) To what connected factors do Lakota and Dakota elders attribute diabetes? 2) What narratives do they offer that reveal health protection and diabetes prevention as culturally constituted practices, both in the past and the present? and 3) How do these elders express their concern and share their wisdom? Secondary methods included exploratory fieldwork, observation, and documentary photography. This study revealed diabetes as an “outside,” or externalizing, disorder for which attributions were both externalizing (e.g., environmental damage, sadness, boarding school eating habits) and internalizing, involving personal imbalance (e.g., inactivity, indiscriminate eating). Chaos narratives were balanced with narratives of restitution, testimony, quests for cures and meaning, and health wisdom. Emergent themes included: the “place” of place, local knowledge, storytelling, and memory in emotional, mental, spiritual, and physical health; the goodness of the land; water as a gift of life; respect for all things, including food; gratitude to God; generosity and sharing. Health messages need to be rooted in understanding and cultural values, including hope.