I found this interesting because I normally come down in favor of western medicines and treatments:
In the case of the diabetes epidemic, I really paid attention to the narrative of the disease as dictated by Western biomedicine and, in contrast, indigenous peoples of Western North America. And I learned that they are operating on very different narratives. Western biomedicine says diabetes is caused by Indian genes, poor diet & lifestyle, etc. To many tribal people, this is a very doom and gloom story–if diabetes is caused by bad genes, what can you do about it? It’s disempowering. It also shames and blames Indian identity. Not surprisingly, many medical interventions, like getting diagnosed and treated, are traumatic in their own way. Getting one’s blood drawn and scrutinized for glucose levels, for example, reminds many of having their blood scrutinized for tribal enrollment. It can be felt as another face of social control.
Many tribal people, in contrast, understand the diabetes epidemic as an expression of the generational trauma they’ve experienced. Things like European epidemics, Indian boarding schools, nutritional trauma, environmental degradation, and reservation life were really hard hits to Salish life and culture. And these wounds span generations. And this is cited as the cause of the diabetes epidemic in tribal communities. So in this sense, there is definite spiritual and cultural dimension in diabetes etiology with Salish people.
So you have these 2 ways of looking at diabetes: one focuses on genes & diet, the other addressing cultural wounds. So when you build a diabetes program based in a biomedical understanding and try to implement it in a community that sees generational trauma as the primary cause, the program will fail. However, if you create a tribal diabetes program based in their cultural understandings, then you can get somewhere. So that was the big lesson: know the mental models of who you’re working with, and meet the people where they are. Not where you are.
The whole thing is worth a read.