Albert Chopito's grandmother died with gangrene, her feet blackened with infection, a gruesome consequence of her long fight with diabetes. Just a little over a year after starting junior college on a scholarship, Albert was forced to quit and return home to care for his parents. His father died in 1995, wheelchair-bound and on dialysis, more than a decade into his own fight with diabetes. The following year, his mother died of complications from diabetes while barely into her fifties. "Diabetes has played a big part in my family," Albert says unnecessarily.
So Albert ran. He started in the fourth grade, on his elementary-school cross-country team. Two years later, he completed his first half-marathon. As a sophomore, he was already training with the high school juniors and seniors as a sixth runner on the storied Zuni High School team. Unsatisfied with his progress, he buckled down and ran more, and faster. By the start of his junior year, he was the team's number-one runner, a position he didn't relinquish until graduation. That year, both the boys' and girls' high school cross-country teams won state championships. Albert finished first.
Now 33 years old, Albert cannot stop. He feels the family's disease walking behind him, waiting for him to slow down. "It's the reason I keep running," he says.
In the weeks since the September 11 terrorist attacks, those who follow sports -- not to mention many athletes themselves -- have struggled to find relevance in games and sweat. But on the Zuni Tribe's ancestral land, a 500,000-acre dreamscape of soaring red buttes, sudden rock outcroppings and sandy desert hills, you don't have to look far. Here, sport is literally a matter of life and death: You play or, too often, you die.
Type II, or Adult Onset diabetes, a disease characterized by too much sugar in a person's bloodstream, typically evolves in people as the result of poor lifestyle choices: too much bad food, too little exercise. Slowly, it squeezes off the circulation. As the disease progresses, its victims' extremities die from malnutrition. Later, if the heart doesn't stop first, the kidneys fail. Not surprisingly, in a country that spends hours on couches and billions on potato chips, where stadium seats now have to be super-sized to accommodate ever-larger fans, the incidence of diabetes is on the rise.
But no matter how bad diabetes has become among whites, it can't touch the damage it is doing to the country's Native Americans. In tribal populations from Maine to New Mexico, the disease has made inroads that would be considered catastrophic among the general populace. Recent studies show that American Indians are about three times more likely to get diabetes as non-Indians. Most researchers agree that that number is grossly underestimated.
And it's spreading downward. Adult Onset diabetes used to be rare among children, who needed years and years of a bad diet and inactivity to permit the disease to take hold. Today it is alarmingly common among Native American children, some as young as ten years old. One recent study, of Arizona's Pima tribe, showed that thirty years ago, less than three-quarters of a percent of girls between the age of ten and fourteen developed Type II diabetes. Today that number is about 3 percent and growing.
The Zuni are no different; if anything, they're a little worse. Family practitioner Scott Doughty arrived at Zuni Pueblo from medical training in Wisconsin four years ago. A year after he began working at the local health clinic, the job of directing the tribe's diabetes program opened up. No one else wanted it, so he signed on.
A young-looking, angular man with a blond ponytail and small wire-rimmed glasses, Doughty says that nearly one-third of all Zunis over the age of 35 already have diabetes. By the time they reach fifty, about half will have the disease. About 3 percent of non-Indian women develop a particular form of diabetes while pregnant. In Zuni, that number is closer to 15 percent. It is telling that Zuni Pueblo, with a population of just over 10,000, has its own dialysis unit.
There is good reason to believe that genetics plays a role. Although no such gene has been pinpointed, medical researchers have long suspected the presence of a "lean gene" in Native Americans. The theory goes that indigenous people adapted to feast-and-famine cycles by developing the ability to store fat efficiently during times of plenty to carry them through times of scarcity. The problem comes, of course, when famine disappears and is replaced by cheese fries, soda pop and tortillas made with lard.
Another cause of the high rate of diabetes among Zunis is a peculiar confluence of ancient and modern that is common on reservations. Cheryl Ritenbaugh is an anthropologist who studied diabetes among Zuni teenagers in the mid-1990s. Now a researcher in Portland, Oregon, for the Kaiser Permanente Center for Health Research, Ritenbaugh says that for many years, tribal elders spread the word that the local water was responsible for diabetes. And in a way, she says, they were right. About a half-century ago, the tribe's aquifer dried up and a new well was dug. Though safe, the new water was bitter and orange and smelled of sulfur. Many of the residents turned to soda as an alternative -- which has exacerbated the diabetes problem.
Still, a huge culprit remains lifestyle. Simply, among Zunis, "there is a higher rate of obesity, a more sedentary lifestyle and a diet higher in fat and calories," says Doughty. Some of that, he adds, is reinforced by the culture. Religious festivals, which occur every few weeks, often are centered around feasts and eating.
But this is also exactly where the best hope to fight the disease can be found. Exercise -- athletics -- can make a huge difference. It is old news that activity wards off many ills. But with diabetes, sports can actually cure you, too.
It was with that in mind that the Zuni Wellness Center was founded. Opened in 1983 in a former high school, the center has grown steadily in popularity. Today it offers several aerobics classes a day, as well as spinning and weight- and cardio-training -- all free of charge for residents. Seven years ago, in an effort to knock down the problem of obesity and inactivity before it began among teenagers, the high school band room was converted into another athletic center. It is tightly stocked with weights, cardio machines, a climbing wall -- and video games. "We call them bait," says Ritenbaugh, who helped set up and run the center between 1993 and 1997.
Building facilities is one thing; getting people to work out is another, and promoting the healing power of sweat is an endless battle. Every Thursday morning, a Wellness Center staff member drives over to the hospital's weekly diabetes clinic and attempts to recruit new athletes.
"We tell them, 'You gotta help yourself. If you're embarrassed, don't worry, we'll help you,'" says Lydia Simplicio, a health-promotions specialist who has made the trip many times. If a person agrees to give exercise a try, the Wellness Center doesn't take any chances: It sends a van to the person's house to make sure he gets there. Still, Simplicio adds, "Some people are in denial. Some just refuse to talk to you; they don't want to face their diabetes."
But every so often, someone does. Delsalena Bobelu was diagnosed with Type II diabetes while still in her thirties. When she showed up at the Wellness Center, she weighed more than 180 pounds and could barely walk in. Today she's down to 135 and has thrown away her diabetes medication. She attends an aerobics class three times a week; once in a while she'll even run a ten-kilometer race.
Indeed, running may save more Zunis than anything. Running as a necessity and as a sport has a long history in the tribe, and many residents have taken to it easily. Nearing its twentieth year, the Zuni Fitness Series "Outrun Diabetes" races are more popular than ever. Held once a month between May and September, the races attract as many as 500 people; diabetics can enter for half-price. Smaller running clubs have also sprung up in recent years, and in the early morning hours, many people -- particularly women -- can be seen jogging through the pueblo or on the many trails surrounding the town that wind up to the mesas. Each year, a small contingent of Zunis travels east to run the Boston Marathon. Even the pastor of St. Anthony's Mission, in the center of the pueblo, raises money by running marathons.
There have been numerous other attempts to get the Zuni blood pumping. Recently, a grant was used to buy more than a dozen mountain bikes for kids to ride. "I thought we'd get only a few kids," says Heather Pratz, who organized the first ride last week. "But we had to turn kids away."
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Last week also saw Walk to Work Day. Nearly everyone was allowed to show up an hour late for work so that they could have time to hoof it instead of driving to the office. The tribal governor strolled alongside everyone else, and the streets were empty of cars.
Bright spots are not always plain to see. Doughty says evidence from the most recent comprehensive study of the disease in Zuni shows that despite all the effort and all the sweat, the diabetes rate among the tribe has stayed more or less the same as it was twenty years ago. But, he points out, in a country where the illness is surging, maybe simply holding the line is okay. More encouraging, the study also demonstrated that exercise (even extremely moderate exercise, such as slow walking) and other lifestyle changes, including a leaner diet, had by far the greatest effect on curbing diabetes -- greater, even, than drugs.
And every once in a while, someone breaks out into the open. Recently, Albert Chopito entered the Duke City Marathon, in Albuquerque. He came in third. Not as good as he'd hoped -- he thought he might even have a chance to win the race -- but not so bad, either. And his times keep getting better. More important, his wife and daughter have both taken up the habit.
Albert says he tries to keep in touch with his former high school track teammates. Some have already died in alcohol-related car wrecks. Others have stopped exercising -- always intending to start again, he says, but sapped of momentum by their jobs, their households and a too-familiar inertia. Yet some, like Albert, are still running.