Seya mau menum ice tea, tedak gulah (no sugar)

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Chanti Chanti Chanti

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DASH in Bali

18 hours, something like 600,000 gallons of Jet Fuel, 120 grams of carbohydrates in the honey roasted peanut variety, 30 units total for insulin and yes I still have diabetes in Bali Indonesia. Like many nations across the globe, the rate of diabetes has imploded due to a variety of reasons in Indonesia and especially Bali. In this blog story we seek to uncover 3 stories of diabetes in Bali.

On a dirt road, followed by barking dogs and squawking chickens, we ride on the back of motor cycles through the small rural urban town of Klung Klung Bali. Guru Indra, and I are set to meet with the local Doctor of the police station in town to talk about diabetes at a local level. As a white foreigner I would never be able to just call up the local doctor and ask for a meeting to talk about diabetes.  With Indra, the Doctor invited us in with open arms. We spoke about the increase and rise of obesity and type 2 diabetes, in addition, the Doctor was impassioned by his concern that other doctors like him are not doing enough to educate and prevent diabetes locally and island wide. To my surprise the Doctor also mentioned that half of his patients are type 1 and require insulin but only half of them take insulin. Diabetes is tough, but in circumstances where resources are limited and life is fragile, I couldn’t imagine what diabetes would be like, until I met a Balinese women living with it.

Ibu Oka, is the granddaughter of Bali’s last King and the mother of Guru Indra. My godmother Ibu Gadong lived with Ibu Oka as a kid. Walking from the Ashram to Ibu’s house, we pass hundreds of Bananas, Papaya and Mango plants, fields of rubbish and 3 temples characteristic of Tomb Raider with Laura Croft. Bali is a paradise, but for Ibu she could not experience it. Due to long standing high blood sugars, high processed foods and a lack of exercise, Ibu was in a dark place with her diabetes. To add to her burden, Ibu has a very involved, supportive family. Yes although her family is very attentive to Ibu’s health, especially to her “bad” blood sugars this love was keeping her down instead of empowering her to get back on tract. Ibu’s health team gave her a plethora of potentially helpful medications that even google would have a hard time in sorting through, but Ibu was having trouble taking all of them and then not seeing any positive results. In our first meeting, Ibu’s diabetes identity was in the dumps. In carefully choosing none judgmental words hopefully translated in a non-judgmental way by her son Indra, my goal was to leave Ibu with three ideas. 1 That a BG is data, 2. Insulin is a hormone that people need to live, 3 that’s it’s okay to be a diabetic. In having Ibu check my BG, give me a shot and then see the DASH lessons with the kids in the Ashram, she was able to plant the seed of acceptance. There is still a long way to go, but now Ibu has reduced her HbA1c, is checking her BG’s regularly and substitutes avocado juice for pineapple, mango, and dragon fruit juice. Unfortunately Ibu’s story was one of many and the catalyst to my interest in discovering the core of the diabetes problem in Bali.

IMG_0238

From Bali, to Java and across Kalimatan, I met people and Type 3’s (loved ones of people living with diabetes) struggling to live with diabetes. My western Identity in terms of openness and extrovert nature ran perpendicular to that of the Balinese identity. The conversation about diabetes initially started with a whisper with just a couple of older Ashram members and then developed into all the kids at the Ashram doing BG checks, especially before we played Babi (Pig) with the newly arrived basketball net. The kids loved the checks, they viewed it as a science project that they could alter with putting soda, honey or fruit juice on their fingers. My Bhasa language skills are not up to date, but my body language skills and teaching by showing, gave the kids space for self-discovery to make the connection for themselves about sugar and the effects on blood. This is a power tool, and for one kid it was a life saver. His BG’s were elevated in back to back checks, so we knew something was off. Nunga is a Balinese Messi, short with a healthy BMI and athletic build, yet his BG’s were in the 250’s. Fortunately his BG’s went back down due to cleaning his hands from the Watermelon juice that compromised his BG’s. We will keep an eye on Nunga’s levels and in all my experiences with diabetes in Bali I found it tougher than normal, life threating and extremely isolating. One day we will bring DASH to Bali and try to reverse this negative picture of diabetes.

Statistical information about the prevalence of diabetes in Indonesia is often conflicting and incomplete, but there is little doubt that the number of people suffering from both Type 1 and Type 2 diabetes is growing at a fairly dramatic rate.

The International Diabetes Foundation (IDF) reported there were 7.6 million people in Indonesia diagnosed with diabetes.  More than 154,000 people died from diabetes-related complications in 2012 according to the IDF.  Another study found that the incidence of diabetes doubled between 1995 and 2000, and is expected to increase to over 21 million by 2035.  The vast majority of these cases will be Type Two diabetes.

Bali Indonesia is a part of me, it’s my second home. My first home is in the SF Bay Area helping youth, parents and adults find the courage to go the extra yard to do the diabetes care that will keep them healthy for the same amount of time as any other person. Diabetes life in Bali adds another step to the process of managing diabetes, it’s not impossible, but just takes a little more courage and support then diabetes life does in the US.

Last Day in Bali

Stay tuned for the following blogs on hanging out with Kendall Simmons NFL OL Pittsburg Steelers and New England Patriots in addition to the reaction and response to World Diabetes Day in Berkeley. On December 14th we’re doing a training on Sports and Diabetes for teachers, coaches and personal trainers with Children’s Hospital Endocrinology Department and Health Medicine Department. For more info see the  flyer here

Our next camp is on March 22nd in Oakland, more details on our webpage (dashcamp.org).

Thanks,

Wayan Lucas

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