Death and diabetes in Indian Country: One community’s struggle to beat the disease

Story and Photos by Karen Hollish
Odanah, Wisconsin (NFIC/New America Media) June 2010

Archie Shinaway
It was late last March, and these were just her finishing touches. Frannie had already squeezed on her jeans, tucked in a pink t-shirt and put on a gold necklace and earrings specially reserved for this event: Thursday night darts.

Helen “Frannie” Shinaway carefully spritzes hair gel into her tidy black mullet. Satisfied, she mists her ample figure with body spray. Frannie has played in the Ashland, Wis.-area bar league for more than a decade.

It’s a tradition she started with her husband Archie, who used to be one of the most formidable shooters in town. That was back when they lived about ten miles east in Odanah, the town center of the Bad River Chippewa Reservation, a sprawling wilderness along Lake Superior that's home to about 1,500 members of the Bad River Band of Lake Superior Chippewa.

But only Helen would be going out this night. After nearly 25 years of living with type 2 diabetes, Archie, 51, has entered kidney failure. Now, he’s too sick to go with his wife to darts.

In their ongoing struggles with diabetes, the Shinaways are hardly alone. Nearly 8 percent of Americans have the disease, according to the Centers for Disease control, and the country's overall prevalence keeps shooting up every year. Diabetes is traditionally thought of as an older person's disease. But the average age of diagnosis in America is trending downward, with more and more young people getting it every year.
What is diabetes? 

Diabetes is characterized by having too much glucose, or sugar, in the blood.

In the case of people diagnosed with type 2 diabetes, either their pancreas isn't making enough insulin, a hormone that breaks down carbohydrates into energy, or their body can't use the insulin it makes. Type 1 diabetes, which only accounts for between 5 to 10 percent of diabetes cases across the country, is different because the pancreas of these diabetics permanently stops making insulin. Type 1 diabetics must always rely on daily injections of synthetic insulin or an insulin pump to stay alive.

Pinpointing the exact causes of type 2 diabetes is difficult, said Dr. Stephen Rith-Najarian, a diabetes consultant who's worked with Indian Health Service since 1986. It's generally agreed that a variety of factors lead to an individual getting the disease, though he said two of these — genetics and obesity — really stand out.
While genetics certainly play a role, no one has quantified just how big their impact is, Rith-Najarian said. More and more scientists believe diabetes-causing genes must be fairly common, as the disease is increasingly prevalent among Americans from all different backgrounds.

In recent years, the public health community has focused more on obesity. While being simply overweight increases one's chances of getting type 2, having a certain kind of fat — the “intra-abdominal fat” that harbors under and around the stomach — really puts someone at risk, he said.

There are other lifestyle choices, like tobacco use and how a pregnant mother cares for her growing baby, that can contribute to someone getting diabetes. But, Rith-Najarian said, genetics and obesity are still considered the key culprits behind today's growing type 2 diabetes epidemic.

The burden is even worse across Indian Country, where American Indian and Alaska Natives lead the way in terms of prevalence. Indian Health Service reports that nearly 16.5 percent of American Indian and Alaska Natives have the disease — that’s double the diabetes rate in the general population, and higher than that seen in any other minority group. Native diabetics like Archie are also three and a half times more likely to experience diabetic-related kidney failure than the general population, and three times as likely to die from the disease.

Death from uncontrolled diabetes often comes with complications like kidney disease, cardiovascular disease, blindness, nerve disease and lower-limb amputations. It’s not a particularly pleasant way to go.

But tonight, despite all this, things go on as normally as they can in the Shinaway home. Archie, from his seat on the living room couch, calls Frannie to come downstairs. She emerges, fully spruced up for her outing. But despite her welcoming smile, her eyes are still tired, and the deep lines beneath them suggest she’s been that way for a long time.

She’s got plenty of reasons to feel worn down. There’s the ever-present shortage of money, stress of raising a new foster daughter and lack of a reliable family vehicle, just to name a few. But by far the biggest challenge facing her is Archie’s health.

For the last three years, Archie’s been on a draining, three-times-a-week dialysis regimen that began when the nearest clinic was still more than an hour’s drive away in Duluth, Minn. Now a local clinic has opened up, so Archie has to travel just ten minutes to get to a machine that can do the work his kidneys no longer can.

Still, the family is always waiting for “the call” announcing an appropriate kidney donor has at last arrived. Once it comes, they’ll have to hurry down to the University of Minnesota’s Fairview Hospital in Minneapolis. It’s almost a four-hour drive to the city, and Helen already has a place lined up to stay. She’s also planned out who will look after their 18-year-old son, Cody, their foster daughter, Madison, and their chihuahua, beagle and cat. She's done everything she can to get ready for the operation, and now she just waits for the call to come.

There are pockets of Indian Country where the diabetes epidemic is more pronounced, and Bad River is one of them.

Mike Murphy, a nurse practitioner who’s worked extensively with the area’s diabetic population, estimates that one in three tribal members living in the area have the disease. Dr. Stephen Rith-Najarian, a diabetes consultant with Indian Health Service, said that means Bad River falls in line with other tribes in the upper Midwest, who as a whole are in the top third of all American Indian communities in terms of diabetes prevalence.

Also troubling is another large segment of the population that’s teetering toward a diagnosis, the people with “metabolic syndrome,” a condition also called pre-diabetes. They’re showing some of the warning signs of diabetes — like having elevated blood sugar levels, high blood pressure, or a budding bit of pudge around their middle — but they haven’t yet hit a full-blown diabetic state.

When they're combined with Bad River’s already-diagnosed diabetics, more than half of the population is directly affected.

So it ends up, as Murphy puts it, that “everybody out here knows somebody with diabetes.”

Resigned to the disease

On a recent afternoon, the Bad River Elderly Center buzzed with the sound of several dozen elders chatting and eating lunches of roast beef, buttered carrots and mashed potatoes with gravy. Dessert was pineapple chunks, and there was plenty of regular but watery coffee on hand, with the optional additions of Splenda and dry creamer.

Amoose, resigned to the disease
Every weekday, the center offers a free meal to tribal members who are 55 or older, the benchmark for being an elder here. Knowing that elders have an increased risk of developing diabetes and that staying slim is a key prevention measure, the management here has a nutritionist come in to critique their meal program and suggest sound menu options.

The sunlit, spacious building is a frequent destination for elders like Amoose, 70, who come to eat, sip coffee and socialize. Amoose worked for years as a photojournalist in the community, back when it still had a tribal newspaper. As usual, Amoose still had plenty to say about tribal politics.

He was less talkative, though, when it came to a question about the state of his diabetes, which he’s had for 15 years.

“I don't know,” he said, pausing between bites of gravy and potatoes. “I haven’t tested.”

And why not?

“Bad news,” he quipped. “It never goes away.”

His is a common refrain. With Bad River’s widespread prevalence of diabetes comes a collective resignation to the disease that makes many health workers cringe.

In late March, at the annual powwow held in the gymnasium of Northland College in Ashland, a small group of teenagers ditched out on the formal festivities to head down to a hidden ravine. Stopped along the way, one girl took the lead in answering for the group. Had they ever read News from Indian Country? Um, No. Had they ever seen its news show online? A flat and disinterested No.

Did they know anyone with diabetes?

At this, the whole group let out a dismissive “Duh.”

“Uh, yeah,” the girl said, sneering at the suggestion she wouldn't.

Their interest piqued, her male peers started rattling off the diabetics they knew.

“My uncle, my auntie...” one boy started.

“My grandpa, my dad, my aunt...” another added.

“My cousin, my grandma...” a third piped in, almost as if in competition. Eventually, they were all talking over one another as they listed family members affected by the disease.

Heart Watch: On the front lines

Back at the reservation’s health department, nurse practitioner Mike Murphy is working to change all this.

 Mike Murphy
He’s the case manager for Bad River Heart Watch, a program that provides intensive case management to people with diabetes and pre-diabetes. It started six years ago, as one of 30 Healthy Heart pilot projects funded across the country by Indian Health Service's Special Diabetes Program for Indians (SDPI). These projects, as well as a host of other diabetes treatment and prevention efforts funded through SDPI, will end after 2011 unless Congress reauthorizes the program.

Like the other Healthy Heart programs, Bad River Heart Watch is trying to decrease its participants’ risk of cardiovascular disease. Cardiovascular disease is not only a major diabetes complication, it’s also the biggest cause of death among American Indians and Alaska Natives.

Unlike the new elderly center, which was a big-ticket structure built in recent years, the building that houses Heart Watch is more like the rest of the buildings here: it’s a modest, small, prefabricated structure with an old coat of peeling light blue paint. Just through the front door is a beat-up looking reception area.
Traditional Foods projects
and the Eagle Books

Seventeen Indian communities across the country are fighting diabetes with traditional foods, exercise and stories as part of a Centers for Disease Control and Prevention five-year grant program.

Dawn Satterfield of the CDC's Native Diabetes Wellness Program said each of the communities are receiving $100,000 a year for their Traditional Foods projects. Much of this money, she said, came from the Special Diabetes Program for Indians, which will end in 2011 unless it is reauthorized by Congress.

Satterfield's office received 70 project proposals during the grant's last application period. But, she said, they only had enough money to fund 17. These include, among others, projects for the Standing Rock Sioux Tribe of North and South Dakota, the Nooksack Indian Tribe of Washington and the Red Lake Band of Chippewa Indians in Minnesota.

But even Native communities that aren't benefiting from the grant program, such as the Bad River Band of Lake Superior Chippewa in Wisconsin, still have access to another powerful CDC resource: The Eagle Books.

Several years ago, the CDC asked tribal leaders from all over the country what they thought was needed to beat diabetes. The leaders unanimously agreed that their children needed stories, which to that point had been absent, about how to live a healthy life in the face of convenience foods and widespread sedentary habits. The Eagle Books, a four-part children's series in which an eagle teaches a young boy and his friends how to be healthy, came out of these conversations.
In Bad River more than 200 copies of the books have already hit the community, Melissa Geach of Bad River Heart Watch said.
To learn more about the CDC's Eagle Books and Traditional Foods projects, visit

Around the corner is a hallway, with Heart Watch’s main office and Murphy’s consultation room at one end. On the other end of the hallway is a conference/break room, where a coffee maker produces a near-constant stream of a “coffee-like substance,” as Murphy calls it, that pervades almost all government offices on the reservation. Murphy relies heavily on it to keep barreling through his days, which he splits between working for Heart Watch and the emergency room of Ashland’s hospital.
Heart Watch’s four-person team has been together since the program started, and they’re proud of their successes. They’ve enrolled close to 100 participants. They’ve kept at least eight people off dialysis, and  they've helped many others lose weight and have better glucose control. Their quarterly community event, Journey toward Wellness, is immensely popular, and hundreds of people come out for the free health screenings, feast and information. They also built a small fitness center in an unused office of the community center, and already more than 100 community members have asked for facility keys.

Part of Heart Watch’s success is due to how well its staff works together. Murphy's right-hand woman is project coordinator Melissa Geach, and these two, who are neither tribal members nor diabetic, are zealously devoted to getting people to take better care of their bodies.  Their energetic personalties — Geach loves to share self-care handouts — are countered by the more laid-back styles of Rae Principato, the project’s data coordinator, and its director, Mary Lou Salawater. As tribal members, these women bring an intimate knowledge of the community to their jobs, and as diabetics, they know how difficult living with the disease can be.

For the participants who are willing to put in the work, Murphy meets with them once a month for a year and then once a season after that. They discuss things like weight, blood pressure, diet, exercise, cholesterol and smoking. They talk about foot, eye and dental care, as these parts of the body tend to be damaged by diabetes.

These aren’t the hurried, impersonal visits patients often experience in other medical settings. Murphy listens, for as long as needed, to what’s going on in their lives. By doing so, he learns about what underlying issues are causing them to overeat, abandon their exercise program or start smoking once again.

Some patients don’t want to share personal details, so Murphy sticks to a review of their numbers. But when they do want to emotionally unload, it can sometimes be harrowing. This was the case during a recent appointment with Mary, an elder who’s had diabetes for nearly 15 years.

She’s lost weight, exercises and is in generally good control of her condition — and the proof of her efforts showed on her chart.

“Your sugars are great!” Murphy said.          

“Your labs are awesome, and you’re like a superstar with your good cholesterol!”

But she’d recently had a stroke, which are often brought on by stress. So what, Murphy wondered, had been causing her stress?

Mary described how she’d been trying to get one of her young relatives out of a toxic home situation. Born addicted to drugs, the child was now being molested by one of the adults who lived with her. Mary hadn’t had any success getting area authorities to intervene, and knowing this was going on — but not being able do anything about it — was tearing her up inside.

It was no wonder, Murphy said, that her body was showing signs of cardiovascular stress.

By providing a safe space in which to talk and healthy ways to deal with stress, Heart Watch is trying to counteract the         some of the widespread social problems here — like poverty, joblessness and alcohol and other drug addiction — that feed  into the diabetes epidemic.

It’s a tall order. After Mary had left, Murphy said her story, while disconcerting, wasn't that unique.

Compared to most of what comes through his office, he said, “that was light.”

Putting future plans on hold

 Archie Shinaway is on
dialysisthree times a week

Back in Ashland, the home life of Frannie and Archie Shinaway is looking comparatively serene.

Moo Moo the chihuahua, originally intended to be Frannie’s little lap dog, curls up in his favorite place, which is anywhere that touches Archie. Fat Boy the beagle snores softly on the floor, and the TV quietly hums. Cell phone in hand, Cody heads out to meet up with friends. Frannie waits for her ride to darts, straightening her shirt and poufing up her hair.

For this family, Heart Watch has provided the guidance and encouragement Archie needed to stay alive. Murphy helped Archie lose weight, get his blood sugars under control and discovered his kidney failure.

But despite Heart Watch and Archie's hard work, the family has been through several big scares over the last few years. What started as a small foot infection quickly turned Archie’s toes black, making their skin peel off and creating a horrid stench. He lost two toes from one infection, but the damage could’ve been worse. He had another infection that, had it made its way up to his heart, would’ve killed him, Frannie said.

So now anytime Archie has a cut or scrape, Frannie is right there to clean and disinfect it. She makes it her job to know every injury afflicting his legs and feet.

Archie steps into another room, to check in on one of the animals.

Left alone, Frannie talks about how all this — Archie’s infections, his amputated toes, his increasingly dire need for a new kidney — has changed how she thinks about them as a couple.                    
Whereas before, she never hesitated to imagine their future in a long-term context, she now stops herself when her fantasies head out too many years ahead. Her eyes misting over with tears, she says she just doesn’t know if he’ll be around.

Having a successful kidney transplant would make it much more likely that Archie will be able to continue on, at a higher quality of life, for years to come. So every Shinaway family member always has their cell phone, or sometimes two, on them, so they can mobilize the moment the hospital call comes.

Archie comes back in, and for now, Frannie drops the topic. She looks out the window. Her ride is here.

Archie, once one of the meanest dart-slingers in town, will stay home to rest.

Frannie heads out alone for darts, hoping, as she always does, that soon the call will come. 

Mixing modern and traditional medicines

The room hums with the sound of mechanical kidneys beeping, whirring and buzzing, their expensive and intricate components flushing out the toxins in patients’ blood.

It’s nearing noon on a Wednesday in late March, and Archie is hooked up to one of the dozen dialysis stations at FMC Dialysis Clinic in Ashland. An imposing machine, covered with dials and screens that are monitored frequently by nurses, hulks beside him. Two thick, clear tubes come out of it and into his right arm.

They enter through his fistula, a man-made lump where an artery and vein have been fused together for this purpose. One of the tubes takes Archie’s blood out of his body and into the machine; the other delivers the now-cleaned blood back in.

The room is impeccably clean. Archie sits back in a vibrating, heated easy hair. A swiveling TV monitor, with 66 cable channels and headphones, is positioned just within his reach.


Gitaganing Garden, a
community's attempt to get
back to traditional foods

High-tech dialysis facilities like this one exist so diabetics like Archie, who reach renal failure, can stay alive. But across Indian Country, where the diabetes problem has been building for decades, there is also a growing movement to proactively beat the disease through diet, exercise and nutrition.  These efforts, such as the Tohono O’odham Nation’s Food, Fitness and Wellness Initiative in Arizona, focus on returning to traditional foods.

Traditional foods are key to saving the Bad River Band from diabetes, elder and Northland College Native American Studies professor Joe Rose said at the college's spring powwow. Rose was raised in a traditionalist family where he ate foods like wild rice, venison and garden tomatoes. Not only are these healthier than most processed foods, the process of gathering, hunting and growing them takes exercise.

“All the young kids, they sit in front of the TV,” he said. “We’re going to have to get back to some good food, and more wild game that’s not all shot up with antibiotics and growth hormones.

“Were going to have to get back to local foods,” he added, “and grow some of our own vegetables.”

Early signs of progress

Back in the dialysis clinic, patients bring one another up to speed on their bodies’ latest ailments. For one regular, a younger but extremely pale man with a new bandage on his arm, it’s a troublesome hangnail infection; for Archie, it’s an arm still recovering from his recent carpal tunnel surgery.

Archie’s wife Frannie made him a soft blue afghan to help him stay warm during his appointments, and today he pulls it up around him for comfort. His tall walking stick, made by a family friend, rests in the corner. Archie uses it when he exercises in his neighborhood, and he also props himself up with it when he’s leaving the dialysis clinic, much weaker than when he came in.

Archie goes to his four-hour dialysis appointments every Monday, Wednesday and Friday. In October, he will have been doing this for three years.

 Archie with his family
The only way Archie will ever go off of dialysis is if he undergoes a successful kidney transplant. Among members of the Shinaway family, the matter of a Archie getting his new kidney is referred to not as an “if” but a “when.”

Working against Archie is the fact that American Indians have the lowest rates of kidney transplants and donations of all ethnic groups, said Dave Baldridge, director of the National Indian Project Center in Albuquerque, New Mexico. This is the case, Baldridge said, because so many potential donors and recipients are just too overweight to go under the knife.

But with Bad River Heart Watch’s help, Archie has lost 86 pounds, and he’s been given the go-ahead from his doctor for the operation. Archie isn’t alone in being helped by a project funded through the federal Special Diabetes Program for Indians. There are lots of anecdotal stories, like those of the Shinaway family, that show some of SDPI’s positive effects in communities like Bad River.

But longer-term statistics are harder to come by, Dr. Rith-Najarian of Indian Health Service said. After World War II, which brought Americans increased mechanization and access to convenience foods, obesity rates started to creep up across the country, and especially so in Indian communities. But it wasn’t until the 1980s that diabetes among American Indians started to be studied as a public health problem, and SDPI didn’t start until in 1997 — decades after the problem was already well entrenched.

By 2012 or 2013, Indian Health Service will better know how its prevention projects are working. But already, Rith-Najarian said, some of the preliminary data is encouraging. Between 1999 and 2004, American Indian and Alaska Natives experienced an 18.5 percent reduction in new kidney failure cases — making them the only ethnic group to see a significant decrease in this serious condition.

While American Indian and Alaska Natives are the only ones to have achieved this benchmark, they are hardly the only population facing a staggering diabetes problem. Across the country, as Americans' bodies continue to swell with corpulence, the prevalence of type 2 diabetes is growing across the board. It’s so serious that if current trends continue, one out of every three Americans will develop the disease, Rith-Najarian said. 

“While diabetes has hit American Indians harder and before the general population,” he said, “the silver lining is we have have a head start on how to get out of this mess.”

One elder finds food from the land...

It’s a late March afternoon and the Bad River, just recently having shed its ice, is swelling with spring melt. The birds joyfully announce that the seemingly never-ending winter is over at last. The dirt roads are rutted with mud, and the black bears are finally getting out and about. Soon they’ll be crossing people’s lawns, getting into their garbage and bothering with bird feeders. That’s when the residents will call for Bob Wilmer, the band’s game warden. Bob comes catch them in drum traps, put them in the back of his truck and release them on the far ends of the rez.

While a good many elders on the reservation have diabetes, Wilmer is not one of them.
Joe Maday and Bob Wilmer
Collecting sap

“My bad cholesterol is low, my good cholesterol is high. My doctor keeps asking me about my diet, so he can recommend it,” he said. “I keep telling him, ‘I eat everything that’s supposed to be bad for you.’”

“I eat fat – I eat butter, eggs, whatever – and I’ve never had a problem,” he elaborates. “Just call me lucky.”

Luck may play a role in the case of Bob, and certainly so does genetics. But he also lives a rather active lifestyle, which is supposed to be key factor for preventing the disease. For his work, Bob has to hike through the forest, chase down poachers and wrangle up stray dogs. He spends days on Lake Superior with other natural resources experts, checking in on rare bird populations, and he snowmobiles down deep-woods paths to ferret out riders without the proper permits. Having daily adventures like these certainly plays a role in keeping him trimmer than people whose job tethers them to a desk.

On this afternoon, even though he is taking a vacation day, Bob is tromping through the woods on the northeast side of the reservation, collecting maple sap with his friend and fellow elder Joe Maday. The pair have been harvesting sap from this tribally sanctioned sugar bush for the the last five years. They lug big buckets of the clear liquid through the woods and heave them into the back of Joe’s truck.

Then they drive back to Bob’s house, where he’s constructed a sap-boiling system from re-purposed materials. He and Joe take turns feeding logs into the fire and skimming bits of organic matter off the sap's surface. They boil it for hours until it's finally syrup.

 A Fresh Perch
Bob buys a lot of his food from the Wal-Mart in Ashland, but he also eats many things that he or his friends harvested from the land, such as maple syrup, venison, perch and wild rice. In the woods, he can find wild turkey, partridge, bear and rabbit. In the waters of the Kakagon River, Bad River and Lake Superior he can catch plenty of walleye, pan fish, trout, salmon and other fish. Bob and other gatherers can find wintergreen, leeks, apples, juneberries and other plants to harvest across the reservation.

Asked once if he spoke much Ojibwe, Wilmer laughed.

“I’m a modern Indian,” he said.

Despite taking on this label, a lot of the food Bob eats – and the active role he plays in getting it – draw on deep Native traditions of self-sufficiency.

…and another grows food for the next generation

It’s a sunny weekday in mid-April, and syruping season has passed. Becky LeMieux is standing on the dark stage in the gym of the Bad River Community Center. The windowless room's only light source besides a single incandescent bulb is a series of grow lights that shine down on tiny seedlings. They are baby squash, tomatoes, peppers, broccoli, cabbage and sage. All are destined to be part of community garden projects across the reservation. Once they're big enough, they’ll go into raised beds planned at the elderly center, a plot at the community garden, or a family’s home garden.

Up until just recently, Becky worked as the tribe’s nutrition educator. For 13 years she taught cooking classes, led dehydration workshops and took kids into the woods to harvest wintergreen leaves for tea. She worked with families, children and elders, encouraging all of them to honor their bodies and the earth by eating local and organic foods. She helped them learn how to save money by harvesting food, and she taught them how to turn commodity foods into healthy meals.

Becky can remember a time when the Bad River food landscape was different. When she was a kid, at least half her diet consisted of what her dad could harvest. After he brought home a box of fish, her mom filleted and processed it. Becky learned how spear fish, process deer and harvest wild rice. Today, she estimates that about a quarter of her diet comes from locally hunted and gathered food. She wishes it were more.

Recognizing the diabetes epidemic and operating from the premise that “food is medicine,” Becky helped found the Gitiganing Garden Restoration Project nearly a decade ago. Soon after, she and Luis Salas, another community organizer, secured several years’ worth of federal funding for a rotating crew of AmeriCorps volunteers.

These 20-somethings first started coming to the reservation around 2003, and most of them stayed for a year. Helped by the volunteers, Becky and a small group of other community leaders built a community garden plot in Old Odanah. By starting seeds and publicizing an annual plant giveaway, the group encouraged people to garden both at the community site and at their homes.

Gone is much of the original infrastructure, manpower and funding that was around when Gitiganing started. But Becky is still here, and her devotion to keeping these seedlings alive is the main glue holding this grassroots gardening movement together.

The involvement of community elders like Becky may be essential in the fight against diabetes in Indian Country, Dawn Satterfield, of the Centers for Disease Control and Prevention’s Native Diabetes Wellness Program, said.

 Becky LeMieux
watering plants

More recently, Melissa Geach and her Bad River Heart Watch co-workers have been taking an active role in promoting gardening here. This spring they put on a series of four gardening classes about soil selection, vegetable production, composting and planting fruit trees. More than a dozen enthusiastic community gardeners turned out for each class, she said.

It’s good that Heart Watch and other community members are stepping forward to help with the gardening project, because Becky — the movement's most devoted advocate to this point — is growing a bit tired of the pace. Her new job as a community health advocate isn't as connected to nutrition education, and she doesn’t know if she will be allowed to incorporate the community garden work into her new role. She is getting tired of defending the importance of putting resources toward people eating better food.

Becky’s developing her own health problems, too: she keeps gaining and losing the same 10 to 15 pounds, and she knows it’s putting her at risk for developing diabetes. It seems that every time her weight is where she wants it, a relative she loves very much will relapse into drinking. The stress sends her dietary restraint out the window, and her weight shoots up once again.

She gives of herself freely, both to her blood relatives and to the many others she invites into her extended family. But lately, Becky said, she envisions backing off a bit from the work world, and from all the people who depend on her so much.

“For me,” she said, “I just want to slip back into the wilderness.”

She said she wants to cultivate a serious home garden, and do more hunting and gathering.

“Even if,” she laughed, “it's just going outside and popping a few partridge that have been sitting there.”

Looking back

It’s a low-key Wednesday afternoon at the Shinaway house. Archie went to dialysis this morning, and now he’s resting on the living room couch. Moo Moo the chihuahua sleeps contentedly on his lap. Frannie tends to Madison, who just came home from Head Start.

On a cluttered shelf below the television sits an 18-year-old VHS tape of Frannie and Archie's wedding day. They pull it out, blow off the dust and ease it into the VCR. For the next hour, they’re transfixed by the younger versions of themselves, their family and friends. Archie wore a tuxedo, teal bow tie and aviator sunglasses; Frannie wore a handkerchief-bottom dress and a look of absolute joy. They were married in the lush backyard of their home on the reservation. As the wedding party walked in, a stereo played “When a Man Loves a Woman.” Some of the bridesmaids, and even Frannie, wept. Their son Cody, who will graduate from high school this month, was just a baby who hung on Archie’s arm during the cake cutting.

Even longer than he’s been married to Frannie, Archie’s been diabetic. The toll the disease has taken on his body worries Frannie, who fears that their future together may be cut short by an uncontrollable infection, heart attack or other diabetic complication.

But Archie doesn’t write himself out of their coming milestones. He’s already thinking at least two years into the future, when his 48-year-old wife will be able to go with him to the Bad River Casino’s Wednesday “Nifty Fifty” night. The promotion is restricted to gamblers aged 50 and up.

“She's got two more years,” Archie says, “before I have to plan an over-the-hill party for her.”

Planning for the future

It’s a glorious spring afternoon in Bad River: the sun is out, the formerly snow-covered grass is growing greener and it is Earth Day. Community organizers have planned a clean-up of the reservation’s back roads, ravines and powwow grounds. Volunteers pull old tires, broken strollers and rusted cans out of the brush. They take away the garbage in plastic bags, leaving the places in better shape than they'd found them that morning.

For their efforts, they attend a luncheon feast in the community center that was lovingly prepared by women elders. If they work for the tribe — and most of the volunteers here today do — they get to go home after lunch. The afternoon off is the tribe’s way of thanking them for the work they did to better their community.

Famished from the morning’s exercise, most volunteers load up their plates with wild rice soup, veggies and bread. To drink, many choose a cup of local wintergreen tea made by Becky LeMieux. As it goes down, the warm minty tea soothes and hydrates.

 Wiggins working out
at Heart Watch

Just feet away, in the center’s small fitness room that was built by Heart Watch, two of the morning’s volunteers keep moving. They are Robyn Garcia, 33, and Daniel Wiggins, 27. The couple have five young children together.

At this moment, they’re the only ones using the fitness center's elliptical machines, treadmills and weights. In the next room, the sound of the Bad River Singers builds. The young men are contributing their talents to the Earth Day feast, and their athletic drumming and singing is starting to seep through the concrete walls and into where Garcia moves up and down on an elliptical machine.

Garcia, a member of the Lac du Flambeau Band of Lake Superior Chippewa, moved to Bad River because Wiggins and his family are from here. Like Wiggins, the trim and toned Garcia takes her exercise habit seriously. She wanted to get back into shape after she was in a car accident, and to avoid having health problems down the road. A lot of people don’t realize that you can control and even prevent diabetes, she said.

But her boyfriend does. His mom, who has since passed away, had type 2 diabetes and lung cancer. He comes in from the weight room and joins Garcia on the aerobic machines. He hops on the treadmill closest to her and starts running at a fast clip.

Wiggins has lost more than 50 pounds, going from 230 to 178. With this weight loss, he has significantly cut down his risk of getting type 2.

“That’s the reason I’m trying to stay in shape,” Wiggins said. “To avoid diabetes.”

 Garcia Working out

The pair come to work out for almost an hour every weekday. On the weekends, they get their exercise by running around with their kids. They stay active to make sure they’ll be around when their children graduate from college, start their first jobs and have their first babies of their own. They also want to set a good example of how to lead a healthy life, so that their children will know how to avoid diabetes, too.

As the Garcia and Wiggins talk through exercise-shortened breaths, the Bad River Drum grows louder. Their booming drums and singing thunder through the fitness center walls. Wiggins starts to sprint on his machine, and Garcia pushes her arms out harder on hers.

The sounds of the young men participating in an ancient tradition mixes seamlessly with a more modern noise, one that may too prove essential to sustaining future generations in the fight against diabetes.  Beneath the swelling music can be heard the quiet but powerful whir of exercise machines.

This article was concieved and produced as a project for New America Media's Ethinic Elders News Fellowship, supported by The Atlantic Philianthropies and News From Indian County.