Pecos Road runs due west along the southern boundary of Phoenix. On the city side of the road, new subdivisions of retirement homes are pushing up their tile roofs like mushrooms that sprout with no rain. On the other side of the road lies the flat scrub of the Gila River Indian Community, some 600 square miles, most of it empty. The reservation shimmers out of the reach of the builders like a desert mirage.
This land was no good to anyone in 1859, when it was allocated to the Pima Indians. Today it has 13,000 Native American residents, living in squat cinder-block houses in scattered, dusty hamlets; three casinos that have boosted the tribal income to $100 million annually from $4 million; irrigated cotton, alfalfa, and citrus, for Pimas were always farmers; and a hospital and two kidney-dialysis clinics, with another medical clinic in the planning stage. Kidney failure is a deadly complication of diabetes, and Pimas, so far as scientists can tell, have the world’s highest rate of type 2 diabetes. The Pimas have grown to hate this superlative perhaps more than the disease itself.
Mary Thomas, the 60-year-old ex-governor of the tribe and presently its lieutenant governor, drove me around the community. A few miles south of Pecos Road, we came to the St. Johns Mission, a quiet, whitewashed church. There was once a Catholic boarding school for Indian children on the grounds. Thomas said that when she was 17 and in school here, she went for an eye test and was told she had diabetes.
“So you have type 1 diabetes?” I asked. In type 1 diabetes, the pancreas stops making insulin, the hormone that facilitates absorption of glucose from the blood into cells. Without sufficient insulin, glucose levels in the blood skyrocket, damaging organs, vessels, and nerves. Children with type 1 disease require insulin therapy for the rest of their lives.
“No,” Thomas said flatly. “I have type 2.” Forty years ago it was almost unheard of for teenagers to have this version of diabetes, in which high blood sugar occurs even when the person makes insulin. Doctors described that rather unusual condition as “mild” diabetes or “mature onset” diabetes. Today it is called type 2, or non-insulin-dependent, diabetes.
