June 09, 2022 Indigenous Health & Knowledge | A Conversation on Diabetes

Morning to our colleagues in the west. Uh we're we're pleased that you're joining us

for our session on Indigenous Health and Knowledge. A conversation on diabetes. Uh we

have two esteemed panel guest members that were very much looking forward to hearing from

and we will let them have the floor in just a short period of time. But first to begin with I

would like to acknowledge that I'm coming to you from Regina, Saskatchewan, which is Treaty 4

territory. The traditional lands of the Cree, Dakota, Nakota, Lakota, Soto and the

home of the Meiquis, home of the Metis Nation, homeland of the Metis Nation. On behalf of

the board of directors of Diabetes Canada, I want to mention our commitment to

working together with Indigenous Peoples and taking important steps forward on the

pathway of collaboration, reconciliation, and change. Uh

I welcome each of you on behalf of the organization to this conversation in honour of National Indigenous History

Month. Where we'll be exploring Indigenous Health History, Experience of Life with

Diabetes, Stories, and strategies for our viewers. Uh

my name is Len Daniels and I'm currently a board member with

Diabetes Canada. I'm finishing off my second term and one of the things that's been important to me not only as a

board member but a community a community member from the George Gordon First Nation is how our organization interacts

with our community and how we partner to make life better for

our our our First nation, Metis and Inuit brothers and sisters so that they have a better

life. Uh as mentioned, we're joined by two wonderful panelists who are all invited

to do an introduction of themselves right away. But a little information on each of them. Doctor Veronica McKinney

is a family physician and director of Northern medical services and an assistant

professor at the University of Saskatchewan College of Medicine. Welcome Doctor

McKinney. Thank you.

Veronica McKinney. So I am a woman from the northwestern

part of Saskatchewan. Uh both Treaty six and Treaty ten territories and I am currently coming to you from Treaty 6

territory. So thank you for having me. Thank you, Doctor

McKinney. Rebecca Commanda is a helper at the Cultural Services Department of Nogda Windeman, a

family and community services, and lives with type 2 diabetes. Uh Rebecca, welcome. Welcome.

Uh

hi, my name is Rec Commanda. I am from First Nation or the traditional name is Ganabaging

First Nation and it's in the Robison Huron Treaty in Ontario

Um it's a pleasure to be here and thank you. Thank you, Rebecca. Okay, as mentioned,

we're going to hear now from each of our esteemed panel panel members. Uh I'm going to

first invite Doctor McKinney to share a bit about why we're here. What should our viewers know or keep in mind when

discussing indigenous health, especially related to diabetes. Doctor McKinney. Hi, and again,

thank you for having me here. Um I wanted to talk a little bit just I guess because it is

Indigenous History Month. A little bit about our our history as indigenous peoples. I'm speaking with my own bias

from the Cree people. But you know I've had the opportunity to meet with various indigenous

groups throughout our province and throughout our nation. And and there are common tenants throughout all of our

communities for sure. Um so one of the things is that

pre-contact before before they were ever Europeans. There there's good evidence that we had really good diets. That we

were healthy people and that we had good ways of knowing how look after ourselves. How to

care for ourselves. Um our diets were primarily ketone diets and that's true really

across across the country but also even in the far north with the Inuit people as well. So

what they call ketone or low carb is you know higher in the fat. Uh you know meats or

proteins. And then of course vegetables and fruits. So we often had berries for fruits or

fiddle heads or spinach for for for vegetables. I, you know, I'm not that old. I'm sort of

old but not that old. But I remember even gathering spinach with my with my mum and berries

with my aunts and with my cousins and things you know that we we had even when I was

a younger person that really we're we're not seeing as much of these days for sure. Um so

you know and and what I was just describing is how we even gathered our food or how we how we did this and we did this as

a community often times. We you know went together. It was we would get exercise and going

out into either the bush or over to the lakes or or wherever we were to get our

food and gather our food. For the men often it was hunting. Uh women would do some hunting too. Sometimes with snares and

things like that. Um I still salivate thinking about good old wok of stew, rabbit stew.

Um so there's a lot of things that we did to that involved not just the physical part of

what we're eating but how we got our food. How we connected with one another. How connected

with Mother Earth and with, you know, how we had that

spirituality part of things. That there was rhythm and routine to everything we did. And it was a community

endeavour and how we how we did these things. Um and so, you

know, everything that we did had meaning and, and even the food that we eat was seen as

being part of our health, part of what we would do to look after our health. And there are different foods that we would

gather, different things that we would gather in order to make our health better, depending on what, what people

were experiencing. And so, of our traditional medicines are are things that we would gather

and still gather to this day from from wherever we are in in

on Mother Earth in on Turtle Island. Um for us it was being in the bush and it was being

along the river and being able to gather some of these medicines to treat ourselves with different things including

food stuffs in order to help ourselves. We really there was no evidence of any diabetes at

that time. When when contact occurred there was more trade that was happening and and some

of that was because of the decimation of our communities. You know many people were dying and that were sick from the

different diseases that the Europeans had brought. And so because of that our way of life had to change. And that's where

the trading came into being. And so that's where flower came from. So that's the time that Bannock was introduced into our

communities. Because that's the one thing that's really everybody thinks about as part of our traditional diets. But

in all reality that came later and it related to the flower that was traded. Um we know

that our diets were really good for a lot of different reasons. If you look at anthropological studies there is lots of

studies like I said that to show that we didn't have a lot of diabetes. We didn't have a lot of the diseases associated

with that. That people lived good, long, healthy lives. Um one of the more recent studies

are around residential schools. So when the kids were brought in to the residential schools

they had heights and weights taken. And when when those kids were to the general population.

Our indigenous children actually measured better than than the general population. They were at what's called the

ninety-5th percentile, which is a sign of how healthy they were. Unfortunately, after they left residential school, they

were often down to the fifth percentile or lower because of the poor things that they were

exposed to, abuse, all kinds of different things. But we also know now that there were

nutritional studies that were done on these kids Really bad things. Things like what would

happen if they only fed them oatmeal. And I have patience to this day that don't even want to see oatmeal because

it's a reminder of the residential school experience for them. Or day schools or or whatever things that they were

forced to go to. There were starvation studies that were done. And the other thing with

you know with with the residential schools and such is that there wasn't really a lot of teachings that people could

get because they were disconnected from their families and from their communities. So they didn't get to learn or be able to retain

the knowledge around how to eat, what to eat, and how to how to do a lot of these

different things. Another thing that is a good indication that we didn't have diabetes and

that we had good healthy diet is there were documentations on

the Inuit people in the far north. Um in the 1950s and sixties and one of the things that they noticed is that they

didn't have any dental cavities. Any any problems with their teeth. And that's really interesting because nowadays

the number ones surgery that young kids in our province in Saskatchewan have to come down

to larger centres is dental surgery on young kids because

of all the dental cavities that they have. And so it just shows that difference in diet that

we've had in years past and now what is happening today. Um there you know we we have much

more reliance on the food from we get from the stores or or things like that. It's hard to

even find meat nowadays that doesn't have sugar or corn syrup or cornmeal added to it.

It's not so much that people eating sugary treats all the time. Not, you know, we're,

nobody's going around eating cake all the time. Um, but it's, it's foods like the breads, the rice, the pastas,

those types of things that all change to sugar in our bodies. And, you know, when these young

kids didn't get the benefit of learning from their parents, and we've had multiple, multiple generations that have

gone through this now, with, you know, residential schools being in place for over 100 years. Um, with kids being

taken out of their homes, you know, we have young children here in Saskatchewan, greater than 86percent of our

population in government, of kids in government our indigenous kids. You don't get

the benefit of the teachings from your parents and from your grandparents and from your family around how to look after

yourself. How to eat. How to prepare the foods. How to gather the foods. And we've

lost a lot of those those pieces that really helped us to keep healthy and and stay

strong. And to not have diabetes. And so what we see is a lot of people have very poor

income. And they don't have a lot of ways to access food. Even right nowadays, with the

cost of food, a lot of people can't afford to eat. A lot of the the things that we need to

be eating to keep healthy. Um so, we see poor nutrition, poor

intake of of nutrients and a lot of people don't even have a way to go get food. You know,

here in the inner city in Saskatoon. There's not a grocery store and so for people

to be able to get food, sometimes they're relying on going to a grocery store little corner stores or things like

that. And it's a lot cheaper buy pops than it is to buy milk. Same thing on reserve or

up in the north. Um you know the cost of foods is ridiculous. We can't access

fresh foods like vegetables or fruit. And if you can it's often very expensive. Um a four

litre of milk in the north costs $13 or more. Um that

subsidized. It used to be 20 to $24 per per four litre. And so you can imagine as a mum with

very limited income, it's a lot cheaper to buy a bottle of pop at $1. 75 or $2 than it is to

buy the milk. And so we know that all of those things really tax our bodies and over time

our bodies have a limited amount of of insulin that they can produce in. All of a sudden

our body stop being able to produce it as much as what we need. So we see a lot of things

as a as a result of that and you know not only the physical part I think it's for me, my

bias, like I said, is to look at things through a pre lens, which is using the medicine wheel. But not all of our

indigenous communities use a medicine wheel. But I will use it today just because that's what I, my knowledge comes

from. Um, but we have the physical signs of diabetes. Things like when, you know, your sugars are low, we can

measure that in the blood. We can check our urines, we can do all of those things to see what that looks like physically. But

we have physical symptoms too. Those feelings of feeling shaky, sweating when your

sugars are either low or or feeling tired and having to lay down after a meal. Those are

physical symptoms that we can experience. But a lot of what is the harder parts to deal

with are are those other parts of the medicine will. So the emotional feelings that we get with with the diabetes. So tied

into those low sugars is a feeling of panic and anxiety for a lot of people when they get low sugars. I I I feel like

you have to get that sugar right away. You have to get something right away because you just feel your body. It's it's it makes you feel very

terrible. Um but it's also things like you know having a

lot of feelings of maybe guilt when you're trying so hard to keep your sugars under control.

And yet they're not responding the way that you would like. You know I often say my

patients come in and they bring me their log books and they say oh I'm I was bad there. I had a piece of cake. I went to my

cousin's birthday. It's okay to have a piece of cake. We just need to figure out how to be able to build that in and how

to do it in a way that's safe for us. Um and I often say those logbooks are more for

people to know what how their sugars are being affected. But unfortunately many doctors

kind of use them like almost like a report card. And it makes us feel really guilty when we find that our shares

are too high. And we're not being able to manage them properly. And not because of what we're doing like without

we want to not do anything good. But because sometimes there's other things that are making it difficult. Um the

other thing that can be hard is fear. And my family most of my family members have diabetes

for sure in their 20s. Um and many I have got many that as a result of the diabetes have

lost body parts like pieces of limbs or their entire limb. Um

people on dialysis. You know people that are really struggling. And and I see how

it affects them. And how it affects their their emotions. But also how it affects them

spiritually. You know I I look at my uncle. One of my uncles just recently lost his leg after having you know and this

is the thing. It's not a it's a not a one time thing. It's usually you'll go in and you

might lose a a toe here or there and then maybe another toe. Maybe part of your foot. So it's like a slow process

lots of times. To get to that loss of of your leg. But my my

uncle was a proud hunter. He was somebody who would you know be a guide at times for others. But often would would bring

back food for the community and would often share with people. And it was a source of food for

many of our elders in particular. And for him to have lost his leg to not be able to go and hunt in the way that he

had before. Um to not feel confident that he will have a sugar level that will allow him

to go walk in the bush in case somebody's not there with him that he he won't die or pass out. You know it just really

eats away at who you are as a person and spiritually. How you feel about yourself. That sense

of hopelessness. That sense of of connection with other people. You feel like you're alone and isolated. Like you

can't do those things that you want. Um even the the foods that we we have to be careful and people often think about

well you know what can I eat if I go here what am I going to be able to eat? What am I going to be able to do? So you know it

really impacts a lot of things. How our sugars are kind of impact even our own participation in ceremonies. Um

people I know of many of my relatives but also patients who

are concerned about attending ceremonies because they're not sure how their sugars are going to react and how they will be able to manage those

things. Um but it also the mental part of things. You know all the learnings that we need

to do in order to be able to look after ourselves. And it's again learnings over many years

I would say. Because it's not only learning things like how to check your sugars and how to

take the medication or how the medication works. But as time goes by our bodies change as well. And so things are

changing and we need to learn as as we're going. And it's complex things that are difficult to to really get good

answers on I think for a lot of people. And nowadays with the way the medical system is, everybody's in a hurry, there's

too many people, not enough people to provide the services. And I find that many of our indigenous populations just

really don't have access to, to the healthcare that they need. If you're living on reserve, it often means you have to go off

reserve. You're usually in the federal system, so that means you have to get an, you know,

apply for a travel, to be able to leave the community requires, you know, several

days notice before you can actually leave community to go to an appointment. They have to approve it. It can be a very

long drawn out process to to go and be seen. And even if you have a nursing station you know

some of our reserves are quite large and people don't always have a way to get there other than walking. So, trying to,

you know, get to even the nursing station sometimes can be hard. What medicines you have access to are limited

depending on whether you're in the federal system or provincial, around social assistance or not. It makes it

difficult to manage manage your diabetes when you only have certain things to do. And I also think the other problem

that we're seeing is that many times the way that the students are taught is you know they

talk about diet and they talk about exercise. But they're kind of thinking about it from what I call a western way of

looking at things. A very privileged way of looking at things. As if you can go to the grocery store and just buy whatever they they say you know

eat salads and you know lean meats and and you know eat three times a day and do all

these things. If you the money to do that. You just can't do that. And many times people

don't want to say that to their providers. They realize that it's they feel almost ashamed.

So they they don't want to talk about what their reality is. And yet what the doctor is prescribing or what the nurse

or the nutritionist is prescribing is not something that they can have access to. Um I often talk about exercise

because people often think well you just have to get off your duff and get moving or go for a

walk or go to a gym. But we don't have such things always on reserve even in the inner

city, people living in the inner city don't always have access either. Um and I tell the story of one time I was

working up in a far northern community. And I wanted to go for a walk and so the nurse

handed me a crutch and I thought oh well what's this card? Are you thinking I'm going to fall? And and she said

no no that's for the polar bears. And so it's not always safe to go out and go for a walk. On many of our reserves

in the north and even down south here. There are many dogs that will attack you because they groom around and and so

you have to be careful when you go for a walk. Um in the inner city, sometimes there's gangs,

sometimes there's crime that you don't feel safe that you can go for a walk. So, even though it sounds like it would be an easy enough thing,

sometimes it's not something we always have access to. And I think for many of our Indigenous population, you

know, these things are are prescribed and then you're looked at as not being dedicated to making things

better because you're not able to do those things. but you know, that's always the case either. That's often times just

because we don't have access to these things. Um so there's been many things that have led us to have these very bad cases

of diabetes. And it is getting worse and worse. We're starting to see young children with type

2 diabetes. I've seen children as young as seven or eight years old. Um whereas we never used to see that ever before.

We've also seen we know that women who are pregnant can have

gestational diabetes they call that. When they get the diabetes during pregnancy. And we know that those women more

more often than not will go on to have diabetes later on. And the young kids that they've had

will also be more prone to diabetes. So we have to be really careful and protect our

our women who are pregnant. Um or who may be getting pregnant. To to have healthy diets and

support them in good nutritional food. Because that's going to have an impact on our babies going forward.

And we know as I mentioned the cost of foods. and our access

to supportable income is really not very sustainable right now either. So there's more and

more challenges being put in our way to be able to to look after ourselves in the ways

that our ancestors taught us. Um it's difficult for people even living in community to be

able to hunt and fish and to be able to gather enough food and sustenance to be able to to

live on that. And many of our young people are getting away from those foods. If they up in the north. They don't want

those foods. They want what they see on TV. They want McDonald's. They want you know all those advertised foods that

seem to be so good for us but they're really not. Um so there's a lot of reasons why we're seeing a lot more

diabetes than ever before. And you know unfortunately the the diabetes that we see it also

leads to higher rates of of problems afterwards as well. So things like having kidney

failures. So needing dialysis. Things like I said like getting the infection and getting our limbs cut off. Um heart

disease, you know, again, I got so many family I could tell you about but I've had, you know,

an uncle who at 28 had a heart attack secondary to his diabetes from all the damage

done from that. I've had another cousin who was in her 40s and I kept thinking she had

acid reflux but it was actually her heart and it was because she was diabetic. And so, all

of these diabetes are leading to all kinds of problems and we're even now finding out that COVID a year after you have it,

some people are developing diabetes with that. So, we're seeing in the past, we had

really good healthy diets and we know that if we could stick to a diet that was more in keeping with our traditional

ways, the better it would be. Um but we also know that we've had a lot of things that have

impacted our diet all along the way and they're not making it better. In fact, it seems to be

getting worse. Um having said that, we do have a lot of people now that have lived with

diabetes and know how to be able to manage. So, some of the things I've seen is maybe over

on the West Coast where the nutritionist started learning how to do some traditional of

of food and that they were taught with the elders and they worked with the elders and then are starting to teach that

along with the elders to some of the patients and it's making a big difference. Um it's even

learning what foods that aren't so good for us. So I often talk about pasta or macaroni or

spaghetti. But if you have a half a cup of that it changes to 15 teaspoons of of sugar in your body. So instead of having

that great big plate of pasta maybe try and have just a little bit and filling your plate with other things

instead. Or How do you manage with the medications that you're taking and such? So I I

don't want to talk too much about that but that just gives you a little bit of a history and where we've landed today

with diabetes and and why it's such a big issue in our communities. So I'll leave it at that and and maybe turn it

back to you Lynn. Thank you, Doctor McKinney. Excellent

information and excellent commentary which is so crucial and beneficial to our

communities. I was interacting with one of my cousins a number of weeks back and she's from

the north and still has a number of family members in the north and when I say it north,

our families from Wallace and Lake. And so she was talking to me about how difficult it is to

get information from the healthcare system to our communities and so having each

of you participate in this session today and having it, you know, through Facebook.

Again, allows another opportunity for this information to get back to our community. So, thank you very much for your, your, your words

of expertise. I think we'll move over to talking in a round

table format and give Rebecca an opportunity to share some perspectives and insight. Um

which will help us in terms of our knowledge and understanding on health health system and what's important for us as

individuals to keep in mind. so, in your experience, what

distinguishes indigenous approaches and knowledges of health and what have been barriers to honoring this in a

western context and how can we and that's both indigenous and non-indigenous contribute to

this improvement. So, Rebecca.

I I want to say Doctor McKinney, you you talked about

Medicine Wheel Approach and I really do look at my health in in that way as well and that

really takes it from an indigenous perspective of looking at your health in that way and I look at like my my

physical health and how how how does that my diabetes impact from that like and that also

like when you're mentally not in a good spot, your your sugars go up higher and if you're so I I kind of try and

do that that balance and I talk to my knowledge keepers. I I talk to even traditional

healers in in my community and that and I also talk to in my

community we have a diabetic team that actually runs like a

diabetic clinic so it's a diabetic nurse. It's a like we have a somebody that works in

our community gym that also and then we have like a foot specialist and like it it's

amazing that we have this opportunity in our my own community with having that

specialist because you I hear from other communities. They don't always have that opportunity to have a team that

actually sits there and listens to what you need and it they really cater to like the

individual and like you said like diet your diabetes is going to change throughout your

life. It's it's never going to stay stagnant. It's it's depending on how how you are

doing with your stress levels. What are you eating and it's trying to find that balance and

you even like what I ate before may have changed what it like

what I'm eating now so then I have to adjust and adapt to that and I I really I've been

doing really well with that lately. I've I've got what's it

called? Uh a sensor that checkes my blood sugar so I have it on my arm right now. So

that actually helps me quite a bit. And Because it tells me what my levels are even when

when I think oh, it's a little bit high but like, I don't know if it's like really high. So, then, I have that the, the

sensor, so I check it, and I'm like, okay, it is a little bit higher. So, then, I know, oh, I I could either drink some water

or I can go for a walk because we know water is life and our

body is made up with 80% of water. So, it's important that we we take in as much water as

possible and but there's also that reality that a lot of first nation communities don't have access us to safe water.

So the boiled water advisories that are happening in many communities. Uh my community itself was under a boil water

advisory before. And a lot of people think it's just a way up north thing and I'm in Ontario

and it happened here. And we were under a boil water advisory. And so that also changed our relationship with

our our food and our community and our our what we ate and how we had to change and adapt

that. And so I really discovering a much as I'm going

in my life and really fighting the balance and it's just it's

really important for that. And then I'm also me and my partner are planning to have a baby

soon. So I'm also trying to make sure that my sugars are in a a really good levels and

stuff. So I I have to go see a specialist that's not in our in our community. I have to go outside of my community. Uh in

Sudbury. So that's an hour and a half out of my community to go see a specialist. that's a

doctor that's specialized in pregnancy in that. So, I have an appointment with her soon.

So, then, we will talk about more strategies for me and, I,

I really do understand, even the stresses of, when your, when your sugars are really low

and you feel frustrated about that, you, you get in those reps at times, it's, it's

called like a, a diabetes burnout, that's what it's called. So, it's, where you think everything right and then

something your sugars are just not showing it and then you get like so frustrated because you're like I'm doing

everything that I could but something's not going right and so, in those moments, I'll

either go up to my my knowledge keeper and ask them like I'll

I'll pass them the semi. I'll be like, okay. I I have a question for you. I either need something to help me with my

mental health or I need something to help me with my

spirituality or or something. I I I look for that and if it's not that, then he's the balance. I I'll go. Okay. So

now I gotta go to my medical professionals and see if the medication is needs to be

higher or lower and so it's like really trying to find that that healthy balance between

everything and My my family has been whenever

we do our ceremonies we we we eat our traditional foods. Uh so we'll have the the wild rice

the hominy corn or corn if we can't get hominy corn because hominy corn is getting rare to

find around Ontario right now. So so if anyone has any please send it my way.

Uh we moose meat or fish. Uh we we interchange that and then our our berries and we know the

importance of berries and how how good it it is for our bodies in order to have the all

those those berries. Um

I just, it also just brings into my thought of in the way which means all my relations.

If you think of our our creation story it wasn't just

and like in our immediate families, it was the the the minerals came first and then it

was the plants and then, it was the animals and then, we came last and we were so vulnerable

that we needed all those other families to take care of us and

so, that really shows that importance that we need all

those good stuff in our in our life, in our diets because that's what they were there

for. They were, they gave up their lives in order for us to

live on and and what I was also taught that we never take more

than what you need. So, whenever we we harvest stuff, I don't always harvest just for

myself but I harvest for my grandmother, elders in the community or you know, just

loved ones that are like that are injured or something and they they can't go out physically. You, I end up

thinking of them whenever I do any of the work that I I I do in my community and that's why

I'm known as a with a helper, a female helper in in my work but it also just in my whole life,

I'm a I'm a helper. I'm I'm always willing to help those in need and if yeah. I think

that's where my thought is right now for I kind of jumped like all over the place and

That's okay Rebecca. Uh thank you for your your insight and, and knowledge, and, and

sharing. Uh, I know our listeners and our audience who have found that, you know, very

informative. But it, it resonated with me because

again, because a number of my family members and my my mom and dad as well. Uh, have been

impacted by diabetes. Uh, one of my cousins has some

remarkable changes not only I guess in his his personal life,

but, you know, to his, I guess, physical, well-being. And has

done that through, you know, just looking at the disease a little bit differently. And

recognizing, you know, it's, it's possible to, you know, have a better life. Uh, you

know, while still having a life. You know, everybody thinks that that you can't

manage because it's going to have so much disruption and impact on what you can and

can't do. And that's actually not correct. That's not accurate. It it's about, you

know, controlling what you're doing, you know, in terms of physical, but also looking at

what you're putting into your body, and recognizing, I, I mean, I, I heard Doctor

McKinney talk about, you know, logging, recognizing some of that food is doing to you and

how your body reacts. And and and you know again maybe making slight changes. You know not

refraining from it totally but making slight changes. Because I know my cousin is very active

on Facebook. But talks about you know how yes he's made

changes. But it hasn't meant a complete void. In in in staying

away from certain things that give a direct reaction to how you know his body responds to

whatever he's putting in his body. So, I guess my message is this, you can make changes.

They will have some impact in terms of, you know, I guess, you know, how much you consume

for example, but you know, slight changes add up to significant changes in terms of

your well-being. And so, again, if there's any message that we can take away from both Doctor

McKinney, as well as Rebecca is the importance of just everything in moderation. You know, it it's it's A lot of it

is just being aware and and educating yourself and learning from you know our esteemed

panel in terms of their expertise and their sharings and how that can help you make

some some changes. Uh in in managing your your situation.

So I think I'd like to look at open the floor to see if we

have any questions from any of our audience in terms of those

that have tuned into here from our esteemed panel. So and do we have anything that Doctor

McKin or Rebecca can respond to? We do. Thanks very much,

Lynn. I'll just take a quick second to introduce myself. My name is Anne Besner. I'm with

Diabetes Canada, Senior Manager of Patient Knowledge and Connection and I just want to take a second to let you know

that I'm joining you from Ottawa. and

Ottawa is originating on the unseated Algonquin Anishinabe

territory from coast to coast to coast. I acknowledge the ancestral and unseated territory of all the Inuit

Metis and First Nations people who call this land towns.

we have a comment from one of the viewers who just wanted to thank all of the panelists for

sharing your knowledge and perspectives. Um and thanked

Doctor McKinney for an excellent overview. And so this question goes to her. Um the

listener is wondering if Doctor McKinney is able to share some

examples of more appropriate recommendations. Um when working with indigenous people

that are more realistic and appropriate for diabetes management. Okay, so yeah, I,

you know, well, first off, I, I think it's important to figure out like where you're coming from, like, what, what you do

have access to, or right, where you don't. So, generally, one of the things that I try to

recommend to people is protein, a little bit of protein at every meal if possible. And I talk about what does that look

like, you know, can you have Greek yogurt instead of, you know, regular yogurt? Do you

have access to that? Trying to get plain yogurt and then sweetening with stevia instead of something else. how do you

can you get some loose meat? Can you get some fish? Um you know or are you having to buy at the grocery store? Those

types of things. Um and figuring out like you know what vegetables you do have access to. I always let people know

too that peas and corn are actually technically not vegetables. They're starches. So they will also raise our

shares a little bit higher. So you can still have it. It's just smaller amounts kind of thing. And what do you have

access to? And sometimes you know there's things like for instance in where where we are here and even in some of our

northern communities. We have something called the good food box. So there you pay $20 and

you get a box full of local kind of food. Sometimes it seems a little weird because you get things like squash and

stuff like that. You're kind of like what do I do with that? So even that just trying to help people walk through what does what can you do with that and

how can you make it so that you know because lots of this people don't have any experience with any of those things. But the other thing and

the other overwhelming thing that I really heard from Rebecca as well is in a way diabetes is kind of exploring

about yourself. Finding out new about yourself. And if you think about it in that way. And

I also think it's a way to kind of look at how do I connect a little bit more with the people

around me, my community, or what's available. How do we reach out and do those things? And it's often hard for people

to reach out. But if you can do that there's a lot out there. Both in ways of getting food.

Both in ways of learning. Maybe going for a walk. Like whatever it is that you need to do. We

also know that the stronger you can be in your own culture. Whatever that looks like. Um

the stronger your health will be. So we know those things as well. So it's trying to figure those pieces out and and you

know that's what I clearly heard Rebecca talking about is everyday it's learning more and more about yourself and things

are changing but you're still learning and and trying different things. And you know I was really lucky. My mom was

raised by her Kokom and her Kokom was a traditional woman who was a traditional midwife and and healer. And my mom

didn't get taken way to residential school. She got a a birth certificate and a death

certificate on the same day because she was really premature. They didn't expect her to live. So that was lucky for us because she had a lot of

knowledge that she shared with us. But we took that for granted because we didn't know. Not everybody gets to know

these things. So sharing what you learn is so important. That peer support. And finding out

from others that have diabetes. Or even that don't. Like what what are you doing that's working? I'm lucky because I

was I've been able to do what I've been taught and that's helped me. I know I'm on the verge of diabetes but I if I

stick to what I was taught which isn't always easy. Then I do okay. But I've had a low

sugar. I know what that feels like. It's horrible. And you know so I'm I learn. I learn what works and what doesn't

work for me. Um but that might not be the same as the next person. So but talking about it

it's okay to talk about it. It's okay to find out what what do you have in your communities? And what can you

do to make things work? Things like community gardens and things Sometimes can be a good thing and that's, you know,

we've done that. When I was young, that's what we did. It's a lot of gardening and gathering of food and stuff like that. And and we had a

freezer. Isn't that crazy I thought? But we had a freezer and we could freeze things. That made a huge difference for

us for sure. So, just trying to figure out like, what, what works for you? What do you have access to? What can you do? Um,

and checking in Diabetes Canada always has great ideas. But there's also different programs, usually wherever you

are through the healthcare systems around learning about Diabetes. So, if you can connect, sometimes they can

help out or they can find some of the programs and if you don't have it in where you are, they can maybe suggest ways of

maybe getting that. Like that good food box I was talking about. So, anyways, there's

lots of different things you could do but but talk about it and talk with each other about it because you'll find out

there's lots of ideas out there. I just want to add, that's very important that you

actually do talk about it. It's it's nerve-wracking. It really is at is to open up to talk

about your own health net but at the moment that you're do it it actually lifts off so much

stress off of you and you feel like people are actually listening to you and you open

up and tell them about the different health issues that you're currently experiencing.

So if you're you're experiencing highs or constant lows tell your medical professional or your

traditional healer who whoever you you see on a regular basis and ask like tell them going on

and that way they they know what what steps you could possibly take and yeah, there,

I'm really lucky that I have a really good team where I am, that they, they're really

opened for when I, I tell them, like, okay, this isn't working and they, we, we strategize together. It's not just them

telling me that things need to change. I was like, no, I, things need to change, and we need to, you need to help me

strategize a bit better. Thanks, Rebecca. I have another

question for you actually. So, coming back, to you, if you don't mind, fielding this

question, it's with regard to, what we've been hearing in the media, there, there are lots of

troubling stories, that, that have come out, recently, and certainly not a new phenomenon,

but related to people of indigenous descent, experiencing a lot of

discrimination and racism in the healthcare system. So, I'm wondering you feel comfortable speaking a bit to that, whether

it's from your own experience, or just your, your thoughts about that, and, and perhaps, where you see the need for the

greatest amount of improvement, with respect to that? I I do

see there there's some challenges for me to open up about like the traditional healing that I I receive at

times to tell them that like you know my my my knowledge keeper or my traditional healer

told me that to use this and then for me to bring it up to like a a non-indigenous person

at times they like the teachings behind it they they weren't there when the I received all the teachings so

there's that that miscommunication that they they miss at times if they they

haven't received all like all the same teachings as as I did at that moment when I'm asking

for that traditional healer for that help and support and it is that that little bit of fear of

opening up to them because I'm like well you might judge me on on that because I I'm I know

I'm seeking help but do I need to disclose that part when I know that that's still helping

me so like I really try and do a mixed of traditional healing

with the Knowledge Keepers and with the like the non-indigenous health and I try

and do a mixed method but I don't always disclose all all of the stuff that a traditional

healer has given me. Because there's there's so many teachings that are is involved

and that ceremony and if you can't always disclose some of the ceremonies that end up happening because that ceremony

was only meant for you at that moment. And So, like, at the,

that moment, I, I don't know, like, there's, there's limitations that I want to disclose at the, at that, at

that moment when it comes to my, from that. could I

contribute to? Yeah, I I was going to say like, there's different types of racism too. I think often times when you

hear the word, you think of what you think of right away as somebody calling somebody else down because you're brown or whatever and there is thought.

I mean, that's not that's true. There's the internalized racism

too. So, that's where you see the lateral violence in communities and people, you know, put you down, oh, she

thinks she's all that. She doesn't know anything. You know, that that's tough to deal with too. But it's the systemic

racism that I think we really need to start addressing. So if you're living on reserve,

you're getting in a different system. You don't have access to the provincial system all the time. You don't have the same access. That's a

challenge. That's a big challenge. What what medications you have access to? What food do you have access

to? That's all a system that is not allowing you the same access as what somebody else

has who's not living on reserve. Um you know, it's how many of our people are living

in poverty and on poor low income. That we are

disproportionately represented. We are disproportionately represented within the healthcare system. It's not because we're all, you know not

capable. It's because the system is not allowing us to live our best lives. The same

way that you would be able to if you were a non-indigenous person living in community. So you know we have to start

looking at those what are the parts of the system that are doing that? How do we start to change that? And demanding

those changes. Because the end of the day, one of the things I go back to is some of our

petrogloph teachings which showed that, you know, the only way that we will all survive is

if we all come together, all nations, all people and put our knowledge together and and use

it and it's interesting because I really feel that like, you know, when I when I talk about

these things, they are things that would be helpful for for anybody. You don't have to be indigenous to know that these

things are helpful and we have good and in fact some people have said that part of what

COVID has shown us is that our traditional ways are very meaningful and very helpful. And that we have something to

share with the rest of the world. So let's start sharing. And let's start doing that a

little bit more. Where we can really learn from one another. But let's look at those systems because what are those systems

built on? Our healthcare system is built on a colonial system based on the old European ways. So of course they don't work

for us. Makes sense. So we have to start looking. What are those ways that we can look at those systems and change them

so they're open for everybody. Not just one sort of group of people. Wonderful. Thank you. I

I agree with both Rebecca and Doctor McKinney's commentary. Uh the system isn't perfect.

But if you don't force change, change will never happen. And

you know one thing I've learned in dealing with my own personal health challenges is you have to utilize the system. Meaning

each area of the system has its area of expertise. So it's not only taking information from my

doctor. But also his nurses and the people that he associates with are just as knowledgeable.

So talking to them as well. And then the pharmacist the pharmacist is very helpful as

well in helping you understand some of your health challenges. And then if you are experiencing problems, there

are advocates in the healthcare system that you can reach out to. Oh and before I forget, I

have gone to see a dietitian to help me understanding food and reading of labels and I would

encourage people if they have access to that to, you know, utilize the resource because

they are very knowledgeable and help you understand the impact of the foods that you're

consuming. So, excellent resources. That's great. Thank you so much, Len. I think the

next question can go to, to each of you, the three of you and and maybe you could take a

turn responding to this. Um so, as health is positively correlated with a sense of

security in cultural identity. Um accessing cultural knowledge and traditions means that

culture is protective for many indigenous peoples. Can you speak

to the hold notion of culture as therapy. Maybe we can start with Rebecca.

Um well for for me using the four sacred medicines really

does help ground me in in my life. Uh like so the sema, the

tobacco, I I I hold it. I'd say my morning prayers. Um I I lay it down like every every

morning you know to say put my good intentions out. I I don't ask for strength because

usually when you ask for strength that actually has another challenge on you to show you how strong you are. So

I just asked for let's have a good day. Ah so I start off with that and

then I ah you know, I have the sweet grass in my house. I I

give I give that out to and then I have cedar and then I

also have sage and I just I try and have a like a really well

balanced in in my own healing and I smudge as as much as I can. But then I also take into

consideration full moon time protocols. Which is whenever you're on your moon time I don't touch any of my sacred

items or medicines at that moment. It's it's my like because you're already going

through a cleanse and a healing process on that time and you're it's a moment where you're

allowed to reflect and do that internal work on your own and

you have in order to know that you need like I only learned that through all the different teachings that I've received

from different elders that you know moon time is also menstrual cycle. If for those

who might ask what what is a moon time I just I figured that question end up coming up. but

yeah, like, for, there's, also, like, even the foods that we eat, food is medicine. The

water that we drink, that is medicine. So, like I'm trying to consume a lot more water.

Uh, I know the odd time, I, I will pick up, like a, a pop, but then, you know, I talk to

my dietitian, I asked them, well, what kind of pop, if I do drink a pop, what kind of pop can I drink? And then, they

said, the, the zero sugar pop, that

just I've I've just discovered like a balance of throughout my life. Thank you. Doctor McKinney,

what what are your thoughts about culture as therapy? I I think it is. You know, I I

think there's been many traumas to, you know, to indigenous peoples throughout throughout

many years throughout, you know, 1 00 years or more here in in Canada. And so one of the

things, one of the teachings that I was given is that we carry a lot of those. And so if we don't work on that healing

part of things, we will manifest these hurts in many ways. And so I think it is

something that we work on every single day and we learn things. But sometimes I think our

culture is not only just ceremony. It's how we are with each other. And so I haven't

subjected you guys to my stupid bad humour. But but I joke around a lot. And I know my

colleagues comment about that a lot. That they hear laughter. They or in my patients say this to me. I know where you are

because I can hear you laughing. In every room there and and that's the thing. I think humour is big. It's huge.

That's part of our culture. My culture anyways. But you know we we talk and we joke around

but we we you know we make light of some of these things. And I think that's important too. In letting it go. Picking

out the positives and letting go of the stuff that's crappy. It's not working for you. Yeah.

Put it away. But laughing and not being afraid to laugh at ourselves. And I just was thinking about Rebecca saying

don't ask for strength. I know what I've been doing wrong now.

No more challenges. So, you know, like, just, just having that, that fun and being who

you are, because we each have gifts within ourselves. So, letting ourselves discover those gifts. And, and, you

know, they're all changing, and even as we grow, we still are learning different pieces. So, it's good, like I said, to

learn about yourself and one of the beauties I think that we have is our culture is, we don't have that ageism, where

you're supposed to be limited because you're older, that's kind of **** In our culture, anyway So let's just let it fly

and let ourselves learn what we can do because you will fly when you do that. So anyways those are my thoughts. What a

wonderful lesson. Thank you. And and Len. Yeah the only PFL

ad. Peace that I'll add on is absolutely correct is laughter. Laughter is a big you know big

component in terms of well being. Need to keep it loose. Uh the only other thing I'll mention is you know in the

western world we have different ways of of looking after ourselves. If you have access to resources in terms of your

emotional, mental, you know, spiritual aspect of your well-being. Uh a lot of our

employers nowadays offer a component where you can reach out to your own resources. So,

your elders, you know, you can reach out to indigenous, you know, counsellors and you know,

therapists and you know, psychologists, what have you. So, keep in mind, again, you have resources. Utilize them to

whatever facet you need to help you with your overall well-being. Thank you, Lynn.

So, we're just about at time. We'll wrap up here but I just wanted to take a minute. Um on behalf of Diabetes Canada to

thank Doctor Veronica McKinney, Len Daniels, and Rebecca Commanda for joining us today.

We're we're so grateful that you could sit with us today that you could share lessons

from your heart. Um and that you could tell us a little bit about your insights and

perspectives on diabetes and and healthcare. Um and maybe I'll just pass it back to Len for for a final word to close

us out. So again Rebecca, Doctor McKinney, On behalf of

the board of directors but also our organization Diabetes Canada we want to thank you for

sharing your expertise, your insight, your wisdom, sharing a few laughs with us because we

all know how important this is to our community in helping them you know navigate the

challenges that they have with this disease. But also the other challenges that they have you know to overcome. So this

goes a long ways to just one small thing that will go along ways to helping them in their

day-to-day lives. So, thank you on like I said, on behalf of the organization. It was great to to see you again and again,

I look forward to our Pastor Carlson in the future.