The Staff of Aesculapius and the Medicine Wheel: Managing Diabetes on a Pima Reservation

“There’s a lot more to diabetes than simply blood sugar,” says Don Warne, MD, MPH. “You need to look at the spiritual, mental, emotional and community aspects of this disease.”

Dr. Warne, an Oglala Lakota from the Black Hills of South Dakota, ought to know. Over the last 150 years, diabetes has had an utterly devastating effect in Native American communities. The problem is deep and it cannot be reversed simply by prescribing insulin.

“Medicine in the traditional view is life-force stimulation. A physician may deal with the physical world, but a healer deals with physical ailments via spiritual and emotional channels,” he said at a conference on indigenous healing traditions of the Americas, sponsored by ProCultura, a non-profit organization dedicated to cross cultural exchange between healers from diverse traditions.

Trained in family medicine and medical acupuncture, Dr. Warne practices at the Gila River reservation in Arizona. He is attempting to bring together the technical power of allopathic medicine with the spiritual, environmental and social power of traditional healing. “Modern medicine values confidentiality. But on the reservation, we value social connection, family support and participation. Not talking about things is a very bad way to promote health. You get better when you know your whole community wants you to get better.”

The onslaught of diabetes among Native Americans reflects the massive social changes that occurred when Native people were forced off their land and into reservations. Diabetes has been particularly deadly among the Pima with whom Dr. Warne works. Approximately 50% of all Pima Indians are diabetic.

“The Pima were very healthy on their traditional diet of squash, corn, beans, Chollo buds, cactus berries, and wild fish and game. When the Coolidge Dam was built in the 1930s, they were forced onto reservations and forced to become dependent on commodity foods—sugar, white flour, cheese, peanut butter, milk, canned meat, and salt.”

Gerard Kisto, a Pima who works as a healer and facilitator with Dr. Warne added that traditionally, the Pima were on their feet all the time. “Pima people didn’t have horses until the Spaniards came. It was a foot running culture. We had runners who went from village to village. Since the damming of the river, our whole lifestyle changed.”

The Pima lost many other things besides their traditional diet and vigorous physical life. The Danes Act of 1887 officially outlawed Native American religion. “Remember that healing was tied to religion,” explained Dr. Warne, adding that this law was in effect until 1978 when President Jimmy Carter signed the Native American Religious Freedom Act. “The effects of all of this on Native Americans is still being felt. What happens when a people is told that all of their values are wrong, that their ancestors are burning in Hell, and they will be beaten for speaking their language or practicing their religion?”

Telling a Pima his or her blood sugar is too high does not address these other dimensions of experience. And if you don’t address the broader context, patients won’t get better, no matter how much insulin and Glucophage you prescribe. “People don’t listen to their doctors because their doctors don’t listen to them,” said Dr. Warne.

People only get well if they are motivated to do so, said Mr. Kisto. This holds true for all people, not just Native Americans. But loss of motivation can be particularly acute in Native populations. “We seem to have lost our connection to what is larger than us. A lot of what we try to do is get people to look at themselves and find motivation again. With diabetes, we’re killing ourselves. We need to get self-education going so we can make better choices in our lives.”

Dr. Warne and Mr. Kisto use a combination of conventional allopathic therapies and dietary interventions with their diabetic patients. They also include a number of herbal medicines like prickly pear cactus and chaparral, as well as traditional practices like sweat lodges and talking circles. But much of their healing work involves counseling.

“I sit with the patients, without any barriers. No desk, no instruments between us. I need to feel what the individual is going through,” explained Mr. Kisto. “I talk to people at the level they understand. I try to facilitate dialog between our elderly and the doctors. They may not understand each other even when they are both speaking English. People need to understand what they are doing. So I try to explain what the medications do and how they need to take them.”

While he is fully able to bring the Staff & Serpent of allopathic medicine to his patients, Dr. Warne has also reintroduced the Medicine Wheel, an ancient symbol that integrates the four principal dimensions of human life: the mental (realm of attitudes and decisions), the physical (realm of activities and actions), the emotional (realm of feelings and reactions) and the spiritual (realm of beliefs, values, intuitions and visions). These are further superimposed on the four cardinal points, which represent four distinct approaches to healing: the North (meditation), the West (herbs, diet, exercise), the South (counseling, social support), and the East (prayer).

“The doctor-patient relationship in allopathic medicine involves the doctor using his mind to assess the patient’s body. There’s very little true interaction. In the traditional view, there’s a superimposition of the four dimensions of being, with all four points overlapping. We are all constantly cycling around the Medicine Wheel.”

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