Growing up in Trinidad, I frequently heard about people who had "sugar." These references were generally muttered with a sad shake of the head and a sympathetic softening of the voice. I found it hard to imagine why the possession of such a splendid commodity should occasion such grief. In those days, like any other child, I loved sugar and, given the opportunity and lack of parental supervision, would indulge myself hugely, particularly if some soda crackers and butter happened to be handy.
What confused me even further was that one of our neighbors, a buxom lady named Esther, was reputed to have a "sweet man" who would visit her whenever her husband was at work. Recalling from Hansel and Gretel that exquisite edifices could be erected entirely of confectionery, and also having read about other culinary curiosities such as gingerbread men, I easily assumed that Esther's surreptitious suitor was composed entirely of sugar. Every time I met her in the neighborhood shop, buying crackers and butter, I recognized a kindred spirit and knew exactly what she was doing.
Later I learned that having "sugar" meant having diabetes. After the deaths of many of my own relatives, I came to appreciate why it is an occasion for grief. Knowing I am a potential victim concerns me, particularly when I remember my grandmother's leg amputation and her subsequent death. Yet I can't say knowledge has really changed my behavior.
This is entirely consistent with human nature. Smokers know smoking is harmful to their health and they continue to smoke. It is the same with drug, alcohol, and all other forms of addiction. A "fix" never fixes anything.
Why are we like this? People are more willing to change governments than lifestyle, in the same way they prefer to change therapists and physicians rather than behavior--especially how they eat and drink--when they have diabetes. I remember my father's family--all of whom were notorious for their alcohol consumption, with a particular predilection for over-proof white rum--telling him they'd learned they could still drink, but should stick to brandy, as that helped to cure diabetes.
There are stories galore of people who go for diabetes treatment and, when given a diet sheet with what seems to them very paltry provisions, ask, "This medicine, doc, you want me to take it before or after meals?" Sufferers from diabetes are always on the lookout for a miracle remedy. Like jungle predators they move from bush to bush, from recommended herb to guaranteed grass; boiling, mashing, mixing, looking for the cure. Witch doctors and charlatans, like the colonial planters of old, thrive on King Sugar and laugh all the way to the bank with money squeezed from an increasingly desperate breed.
Health professionals have to take a lot of the blame. For the most part, they have a vested interest in illness rather than wellness. They dispense potions, prescriptions, pills, and diet plans without providing the patient with a context for understanding diabetes.
There are three "E's" in public health--enforcement, engineering, and education. When engineering in the form of the magic bullet does not exist, and enforcement is impossible, education has to be the remedy and it has to be timed to reach people when they need it most.
The Caribbean countries have the highest rates of diabetes in the Americas. In clinics everywhere, the benches are filled with people who, as their names are called, shuffle or hobble painfully forward to receive their pills or insulin injections. Most are losing or have lost their sight. Most of the men are impotent. Most of them, had they known how much they had to lose, and had they been part of a caring, supportive environment, would have done things differently. Fortunately, organizations like the Caribbean Diabetes Association are being formed to provide this environment, to shift the emphasis from illness to wellness, and to stress prevention.
One last thing: there should be no more "diabetics." There should be only "people with diabetes." This would keep the focus on people and their needs rather than the disease. This will promote good health rather than pander to morbidity and mortality.
(Tony Deyal was last seen advising Esther and her "sweet man" that if they know what is good for them they will go easy on the crackers and butter but will continue to exercise regularly.)
Tony Deyal is media communications advisor at PAHO's Caribbean Program Coordination (CPC) office in Bridgetown, Barbados, and a regular columnist for several Caribbean newspapers.
