By Dr. CHRISTOPHER J. MORGAN
World Diabetes Day was marked around the world last Monday, November 14, by diabetes associations, public health units and community groups through community forums, risk assessment screening and general information sessions on diabetes.
Local community diabetes champion, Kathy Nelson, spent the morning at a diabetes forum sponsored by the Canadian Diabetes Association (CDA) and Novo Nordisk and the afternoon doing what she does best, speaking to a large group of community members about diabetes at TAIBU Community Health Centre.
Kathy Nelson is a community diabetes champion. Her deep commitment, passion and tireless energy in helping people prevent or live better with diabetes is second to none. She is an experienced (several decades) registered nurse, decorated with awards from the community and from her current employer of over 25 years, Mount Sinai Hospital, and is a Certified Diabetes Educator (CDE).
I first meet Kathy in 2002 when we worked with dieticians Vida Stevens and Ava Morgan and physician, Dr. Miriam Rossi, in developing the African Canadian Diabetes Prevention Program. Kathy had recently founded (in 1999) the Caribbean Chapter of the Canadian Diabetes Association which today has become one of the most active CDA chapters. Through the chapter’s monthly meetings with invited specialists (dieticians, optometrists, endocrinologists, chiropodists, exercise physiologists, cardiologists, etc), Kathy has been able to provide one of the most comprehensive community-based diabetes education programs anywhere.
Beyond the activities of the chapter, Kathy has conducted numerous diabetes mall screenings throughout the GTA, screening several hundred people on a weekend.
My wife and I have personally helped her at a number of these screening and I have witnessed many community members who did not know they had diabetes become aware and receive careful guidance.
Community- and church-based health fairs, diabetes assessment screening at Afrofest, as part of the Black Health Challenge or as the key developer of the Annual Black Diabetes Expo, Kathy has almost never turned down an opportunity to educate the community about diabetes.
During Diabetes Awareness Month I thought it was most appropriate to have a conversation with her about the source of her motivation and what she feels needs to be done to eliminate diabetes from the Black community.
Why are you so passionate and committed to educating the community about diabetes?
In 1985, I had to go to Jamaica because my 70-year-old father had developed a severe ulcer on his right leg that would not heal. Initially, they thought the ulcer was cancer-related but blood tests revealed he had undiagnosed Type 2 diabetes and the best course of action was amputation.
The following 10 years he lived quite normally with his prosthesis (artificial leg) until he developed a urinary tract infection which was treated with antibiotics. His blood sugar was not tested at the time but the infection was sending his blood sugar levels into the ceiling, which led him into a diabetic coma and he died.
Kathy says she firmly believes that, had her father’s blood sugar been tested at the time, he could have been administered insulin and he would have been alive today. She says she also believes she could have done more to educate her father and mother on managing diabetes but that she did not know enough about diabetes at the time.
On the return flight to Toronto, filled with anger, guilt and pain, Kathy decided to find a way to educate people about diabetes. Step one was “self-education”, so she joined the CDA, attended diabetes workshops, conferences in the U.S. and the Caribbean, and earned her Certified Diabetes Educator designation. In the process, she formed the Caribbean Chapter of the Canadian Diabetes Association and began sharing her knowledge with thousands of people from the community through mall screens, her monthly church-based chapter meetings, community-based research projects and health fairs.
You have been very successful in building the Caribbean Chapter of the Canadian Diabetes Association over the years. What have you found to be the most effective approach in bringing an important health message to our community?
You need to meet the people where they are; meaning you go to the churches, community centres and the neighbourhood shopping malls.
Diabetes is a global epidemic; you have attended international diabetes conferences in the U.S., the Caribbean and Canada, what have you seen or heard at these conferences that you think would be useful in Canada?
In Jamaica, for instance, the Jamaican Diabetes Association received funding from Japan to implement a “train the trainer” pilot program in five parishes. The goal is to have “lay” people in the community, called “community health workers”, who provide diabetes education and support to community members. This works very well in a place like Jamaica where people don’t always have the money to see a doctor.
The pilot was evaluated and it is now being expanded to the other parishes. Jamaica also has a similarly successful program in relation to foot care under the supervision of a podiatrist, and the U.S. has community health workers working alongside CDEs to provide education in diabetes self management.
Education is the key; educating the community in self-management improves quality of life and prevention.
There are elements of this in Toronto through diabetes education centres within community health centres and CDA also provides educational presentations in the community in response to community requests.
What recommendations would you make in terms of public health policy or improvements to the Ontario and Canadian health care system in order to significantly reduce the incidence and impact of diabetes in the Black community?
Develop awareness programs for diabetes prevention and management, healthy lifestyle programs that address healthy eating and physical activity, which are language- and culture-specific as they relate to food, health, beliefs and practices, physical activity and religion – especially in order to reduce the impact in known high-risk populations such as South Asians, Blacks and Aboriginals.
We need to expand our church-based programs, get into schools focusing on healthy eating and increased physical activity. We also have to educate restaurant owners to lower the level of trans and saturated fats and sodium in their menus.
We need to disseminate a culturally specific diabetes education program through a multimedia social marketing campaign utilizing radio, television, ethnic newspapers and the Internet explaining the risk-factors, communicating key messages – “know your risk factors: high blood pressure, high cholesterol, too much fat around the waist, smoking, family history” and “get tested, by asking your doctor every year, and know your numbers”.
I suggested that a health promotion and social marketing strategy would be critical to facilitate the dissemination of the health messages she spoke of and that community efforts would be strengthened when supportive legislation is in place that, for example, ensures food manufacturers and restaurant owners only make and sell “healthy foods and healthy meals”.
What activities are you and the chapter planning in the coming months and New Year?
The next Caribbean Chapter Meeting will be on December 5 at the Anglican Church of the Nativity in Malvern. In the New Year people should plan to attend the Third Annual Black Diabetes Expo on April 28 at the Jamaican Canadian Association’s centre. The Expo is being held in partnership with CDA with sponsorship from TAIBU Community Health Centre.
For more information about the Caribbean Chapter of CDA or the Black Diabetes Expo call Kathy Nelson at 416-987-0339.
Next week, a diabetes testimonial.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or firstname.lastname@example.org