Educator takes misery out of diabetes

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When Sandra Shade first went to work for the Chinook Health Region's Diabetes and Lipids Education Centre, her job was to focus on the urban Aboriginal community. Within a short time, however, she was getting so many referrals from the nearby Blood and Peigan reserves that they were included in her Aboriginal diabetes prevention and maintenance program.

"Diabetes has reached epidemic proportions among Native people," Shade said. "Lots of people have the disease and don't know it. And Aboriginals also get far more complications from the disease than non-Natives."

One out of every four Canadian Aboriginal adults has Type 2 diabetes, Shade said, and trends indicate the number of Native people with the disease will triple in the next 15 years.

"Statistics on the incidence of the disease in this area aren't available, but the number of cases I've personally seen have more than doubled in the year-and-a-half I've been with the program," Shade said.

"We try to make the Native community aware of the incidence and nature of the disease, and how to prevent it. And for those who already have diabetes, we teach them how to manage the disease to prevent complications," Shade said.

She also tries to give non-Native health care professionals an understanding of Aboriginal culture, so they can better help their patients.

"Native people usually go into a cycle of depression and denial when they learn they have the disease. It's hard to make them realize it's not going to go away. We also have to teach both our clients and their physicians that there's no such thing as a borderline case," she said.

Being a member of the Blood tribe helps in her work, Shade believes. Her clients are more comfortable talking to her, and feel more at home at the health unit facilities because she's there.

"I think we establish a rapport a lot faster."

Shade and her co-workers have recently organized an Aboriginal diabetes network for the area with the Alberta Diabetes Association, the Blood Hospital, the Blood and Peigan health services and the centre.

The group will also be sponsoring a First Nations Diabetes Conference, scheduled for May 12 to 14 at the Lethbridge Lodge, with Shade as the chairperson.

"We have some excellent speakers for the conference from both the U.S. and Canada. They'll be talking about the pathology, prevention and management of the disease, and will also offer more intimate workshops. We're hoping for participation from both health care professionals and the community," she said.

The conference will also feature a powwow and cultural activities.

Though Shade feels the Aboriginal diabetes program is a positive force, she recognizes there are many obstacles to complete success.

"I have some clients who have managed to turn their lives around completely," she said, "but there are still a lot of challenges."

Transportation to the centre and other care facilities remains a problem for many on reserves, even though they've set up a satellite program in the Alberta community of Fort Macleod, and hope to establish two more in Pincher Creek and Cardston, also in southern Alberta. Money is also a problem for many of Shade's clients.

"We recognize that it costs money to eat healthy, so we've come up with low-cost ways to prepare healthy meals. We also try to get the women of the household to come in with their family members, since they're the ones who prepare the meals and need to know what to do. In fact, we always try to have our clients come in with someone else from the family. We give out so much information, we think two sets of ears are better than one," Shade said.

"When clients are first referred to the centre, they are sent for a battery of tests. Each patient is then given a one-hour session with someone who explains the disease. If the client truly understands the pathology of diabetes, they'll have a better chance of being able to understand why they have to watch their diets, eating schedules and medication."

Clientsalso meet with a dietician, who works with them on an individual basis to fit at least part of their current eating patterns into a healthier diet and lifestyle. Each client is then given a follow-up education session and is reassessed on the basis of their progress. After that, they are scheduled for follow-up work, including a hemoglobin test, every three months. Patients are also scheduled to get a lipids profile from their doctors, as heart problems and diabetes often go hand in hand.

Though Shade still works occasionally as a floor nurse - she's a registered nurse and has recently completed a Bachelor's degree in nursing at the University of Lethbridge - she is particularly interested in health education.

"My position with the Aboriginal diabetes program has been growing as I grow," she said. "I enjoy the personal contact with patients you get working in a hospital, but I think you can make a lot of difference in health education."