Diabetes in Native Communities May Lead to Disabilities but Need Not Result in Financial Despair

by Susan Ricci-Fox


Mike B., an art teacher in his mid fifties, is living on the Fort Belknap Indian Reservation in north central Montana.  Six months ago, his left leg was amputated as a result of his Type 2 diabetes.  The surgery, in a way, was only the beginning; it was followed by months of rehabilitation and difficult aftercare, including learning how to get around in a wheelchair.  During this time of recovery, Mike remained away from his job and, in turn, the income it provided.  He is able to “survive” on the reservation with help from friends and family, but his financial prospects are dubious at best.  Mike currently has no financial resources upon which to rely, and likely would not qualify for any traditional loans to tie him over until he could return to work.

Even six months after the surgery, it is still unclear weather Mike will be able to return to his career as a teacher.  One obstacle is just getting to work.  Mike has great difficulty transferring himself from his wheelchair to a vehicle, and currently lacks the strength to perform this task and stow his chair independently.  This is a challenge Mike didn’t have to face in the past, but he will have to make the accommodation if he hopes to return to his teaching position.  Without this job, Mike’s economic opportunities on the reservation would be severely limited.

Stories like Mike’s are heard in Native communities across the country.  Diabetes is a particularly devastating and pervasive disease, especially for the Native American population, young and old. Based on the most recent estimates from the Center for Disease Control, Native Americans are diagnosed with diabetes 2.2 times more often than Caucasians; and among other racial and ethnic groups, Native Americans have the highest incidence of diabetes in the country.

With diabetes, one must constantly monitor symptoms, blood sugar levels, and dietary intake. The physical effects of unmanaged blood sugar levels can be devastating to the body as it begins to break down—including nerves, kidneys, the heart, eyes, and feet. Benita Plain Feather, Fort Belknap’s Tribal Diabetes Director, explains that, “most of our clients with diabetes-related complications…have difficulty maintaining employment due to the loss of vision and mobility.”
 
In addition, patients who need dialysis as a result of such complications are often lost from the work force because of the treatment regime.  Dialysis is often three times per week and three hours per day, with a two hour commute each way.  The treatment itself results in about an eight hour day, further making it difficult to hold a job with regular hours.  Without employment, many people on reservations with disabilities find it difficult to simply maintain enough resources for food and rent.

Aside from the physical ramifications of the disease, the emotional stress can be just as debilitating. Not only does one face possible job insecurity, but also must be able to continue providing food and shelter for their family on top of adjusting to a new way of life with a disability. Some express that the rural life in reservation communities can also add to feelings of isolation, which can escalate into depression.  Particularly for people with mobility or sight impairments, transportation difficulties can re-enforce feelings of hopelessness and anxiety.

For those in wheelchairs, accessibility is yet another issue. According to the National Council on Disability, tribal and federal office buildings on reservations are not always accessible for people with disabilities as some tribes lack the resources to retrofit their buildings to accommodate people with disabilities. Additionally, many reservations lack the paved roads and sidewalks that would allow a wheelchair user to travel to work easily.  All of these factors can compound to limit the economic opportunities for a person with a disability living in a reservation community.

To make matters worse, there is no long term financial aid on the Fort Belknap reservation to assist in times of need like these. The diabetes program is able to distribute buffalo meat, but they do not have the resources to provide funding—neither does the tribe. There is a short-term loan program that provides a limited amount of funding for tribal members, but it is often a small amount and is used mostly for basic necessities like family emergencies, school clothing, travel expenses to visit a sick relative, or a car repair. Vocational rehabilitation programs on the reservation are also rather limited.  They can assist people with disabilities in finding temporary work and job re-training, but little financial education or asset building information is available.

According to statistics published in 2002 from the Indian Health Service (IHS), the annual indirect cost of diabetes as it relates to lost workdays, restricted activity days, permanent disability and early death was $40 billion. All of this not only contributes to the increasing cost of treatment, but it also impacts reservation economies. Tribes lose members of its work force, and people out of work cannot put money back into the local businesses and must receive general assistance.  In Fort Belknap, diabetics make up close to ten percent of the entire population; however, that figure is based only on those people that are currently enrolled in the tribe’s diabetes program. IHS estimates there are many more people on reservations across the country that remain untreated or undiagnosed.

Diabetes and its complications are not restricted to just adults.  Diabetes is being diagnosed in young people in greater numbers than ever before. According to the Center for Disease Control, American Indian youths have the highest prevalence of Type 2 diabetes in the United States. In the 2004 IHS Diabetes Program Statistics report, during a recent fourteen-year span there was a 77 percent increase of diabetes in American Indians and Alaskan Natives less than 15 years of age. For Native children ages 15 to 19 years old, the increase was a staggering 128 percent. American Indian and Alaskan Native children are increasingly diagnosed each year with Type 2 diabetes, some as young as 4-5 years of age. If these children do not take care of themselves properly, the result will be a decrease in the future work force in Native communities as they struggle with an increase in health problems and disabilities.

Of course there is not a single solution that will alleviate these issues for diabetics in Native communities. Where much of the population is poor with inadequate health care, a number of strategies must be put in place to assist with achieving self-sufficiency. This includes increasing job opportunities that provide reasonable accommodations, creating a reliable transportation system for those unable to drive themselves, and developing more programs that assist with financial education and asset building.  

The Oweesta Corporation assists Native communities with the latter by helping create Native community development financial institutions (CDFI), which include financial education and asset building programs as part of their services to their communities.  These institutions offer a number of different asset building strategies to help community members build wealth and become financially self-sufficient.  Some of their programs include: 

• Individual Development Accounts (IDA) which are matched savings accounts designed to help people save for things like cars, houses and education

• Earned Income Tax Credit (EITC) programs which promote claiming the EITC from the federal government, which often goes unclaimed in Native communities resulting in millions of lost dollars each year in places that need it the most

• Volunteer Income Tax Assistance (VITA) programs which offer free tax preparation services to help alleviate the amount of tax refund dollars lost each year to high cost predatory tax preparers

• basic financial education programs which provide people with the crucial information to make informed financial decisions about issues such as accessing credit or even opening and managing a checking or savings account.

These programs can provide disabled Native people with the knowledge to take control of their lives and enhance their financial futures and are one of the most promising solutions to combating poverty in Native communities.