Good morning. Patrick White here, a feature writer at The Globe. Today I’ll take you behind the scenes of my reporting on diabetes in First Nations communities. We have that below, along with the latest on Hurricane Helene and a plan to revitalize wild rice. But first:
Today’s headlines
- Israel vows to continue ceasefire talks as Netanyahu attends the UN General Assembly in New York
- Senior federal Procurement Department officials reject allegations that an employee linked to ArriveCan was told to lie to investigators
- China is now more ‘audacious and sophisticated’ in foreign-interference operations, the Hogue inquiry is told
James Gott, 75, lost his left leg 18 years ago owing to complications from diabetes and his right leg was amputated three years later.Fred Lum/The Globe and Mail
Indigenous health
Fighting the phantom
Deputy Chief Marcel Moody looked at me like I’d just asked the dumbest question he’d ever heard.
We were sitting in his office at the heart of Nisichawayasihk Cree Nation, an eight-hour drive north of Winnipeg, talking about the distressed state of northern health care. The community had declared a state of emergency a few weeks earlier because the short-staffed local nursing station was overwhelmed.
“Is diabetes much of a concern here?” I asked.
Moody stared at me with eyebrows raised, mouth agape. Over the previous 40 years, diabetes had gone from non-existent to full-on epidemic in many First Nations across the country. In some northern communities, the rates had surpassed one in four – compared to about one in 10 for Canada as a whole – leading to a surge in amputations. I knew the Canadian Institute for Health Information (CIHI) was about to release a statistical snapshot of these amputation rates across the country, so photographer Fred Lum and I were in northern Manitoba for an on-the-ground perspective.
The deputy chief must’ve wondered what rock we’d been living under. He could’ve been cruel but chose generosity. “Of course it’s a concern,” he said. “Would you like to meet some diabetics?”
We stepped out of the band office and he started pointing people out. “He’s got diabetes. ... She’s got it. ... Her uncle goes to dialysis.” The prevalence was shocking. It seemed he pointed to every second person we encountered. On his phone, Moody showed me pictures of friends and family who’d suffered amputations. “With the lack of care here, a simple cut might mean amputation,” he said. “It’s an epidemic in First Nations communities.”
Statistical agencies are only beginning to catch up to what Moody and countless others have observed for years. The CIHI figures released this week show that diabetic amputation rates vary drastically depending on where people live. Manitoba has the highest rate of diabetic leg amputations – twice the national mark and four times higher than Quebec, which held the lowest rate. People in remote communities such as Nisichawayasihk suffer diabetic leg amputations at rates seven times higher than those in more urban areas. That urban-rural health care divide is more stark in select provinces. In Ontario, for example, the age-standardized diabetic leg amputation rate is about 22 times higher in remote communities compared to larger population centres.
The solution is more foot screening and more aggressive treatment of diabetic foot wounds before they reach limb-threatening condition. That’s easier said than done. Many remote health care facilities are so short-staffed that they only deal with emergencies. Foot screening and blood-glucose monitoring are an afterthought.
Some Canadian cities are experimenting with limb preservation clinics to treat these stubborn wounds. These specialized clinics draw on a wide range of specialists (podiatrists, vascular surgeons, orthopedic surgeons, infectious disease experts, endocrinologists and others) with a singular goal of saving limbs. The results have been impressive, but until they reach people as far away as Nisichawayasihk, these clinics won’t address the stark inequities.
- Read more on the devastating, often-preventable toll of diabetes on First Nation communities
The Shot
‘Is this a crazy idea or is it plausible?’
Scientist Pankaj Bhowmik examines a sample of wild rice.Heywood Yu /The Globe and Mail
The wild rice industry in Canada is facing unprecedented challenges. It is the only cereal native to North America and has been a staple for First Nations over thousands of years – but the work force is aging and yields are declining. Now a team of researchers is taking a multipronged approach to revitalizing the crop. Read more here.
The Wrap
What else we’re following
At home: Live Nation bets big on a new 50,000-person concert venue in northern Toronto.
Abroad: Hurricane Helene made landfall in northwestern Florida as a Category 4 storm Thursday, killing at least three people before weakening and moving across Georgia Friday. See the latest photos from the ground.
Bright lights: Francis Ford Coppola’s Megalopolis is “audacious, rule-breaking filmmaking,” Barry Hertz says.
Big city: The mayor of New York Eric Adams has been charged with accepting illegal campaign contributions, in a scheme that stretches back a decade. He vows to fight the charges.
Editor’s note: A previous version of this newsletter incorrectly stated the new concert venue will be built north of Toronto. It will be built in the northern part of the city.