November 29, 2006 - At the end of a long, dusty road, past a traditional Tohono O'odham ramada and a sign that read "watch for tortoises," a motley crew of young men walked slowly along a row of wild beans.
In their hands, they held old hoes - one mended with heavy duct tape. They flipped the bean plants to the center of the row as a combine rumbled behind to pick up them up.
November meant harvest time at Tohono O'odham Community Action's farm - a laboratory for traditional ways of farming that until recently were all but lost in the shuffle of modern life.
Except for the modest machinery, the harvest routine looked much like it did a half-century ago, back when it appeared to be a dying art. This time, though, the crops stood to relieve a modern problem: diabetes.
The "bad sugar" disease, as it is known to the Tohono O'odham, affects not only people on the reservation but also people across the globe.
According to the Diabetes Research Foundation International, about 7 percent of Americans have the disease. About 194 million have it worldwide - six times as many as 20 years ago - and, according to the World Health Organization, this number is expected to more than double by 2030.
Diabetes has been called "one of the greatest public health challenges of the 21st century."
In Arizona, about 375,000 suffered from the disease in 2005. About 65,000 of them lived in Pima County.
This month, residents of Southern Arizona observed Diabetes Month by attending health fairs and workshops on the topic. They sought ways to improve their health and fight the illness.
The Tohono O'odham Nation, a reservation larger than Connecticut that stands just west of Tucson, has one of the highest concentrations of diabetes in the world. More than 50 percent of adults on the reservation have the disease, according to Indian Health Services.
Those involved with the old-time farm have an elegantly simple approach to the disease: To find a solution, look backward to before the problem existed.
Before diabetes entered the public consciousness, the Tohono O'odham watched it tear apart their families.
In the 1950s, type-two diabetes, the kind usually associated with obesity, was practically unheard of on the reservation. But in the second half of the century, that changed.
During World War II, Tohono O'odham men joined the military and left the native foods the tribe had eaten for ages to wither. When the men returned from the war, they took jobs in commercial cotton fields near the reservation instead of going back to their farms. At mealtime, they began eating pinto beans that the government disseminated as part of a welfare program.
In the 1930s, the nation produced about 1.8 million pounds of traditional tepary beans annually. By 2001, it produced fewer than 100 pounds.
The new diet wreaked havoc on the Tohono O'odham. Studies suggest that their bodies evolved to weather the feast-and-famine cycles their ancestors faced in the desert and are highly efficient at turning calories into fat.
Traditional foods, such as tepary beans and cholla buds, worked well for the Tohono O'odham. Soluble fiber in the beans reduced blood sugar, slowed its rate of absorption and improved insulin production.
In the second half of the 20th century, Native Americans started coming down with bad sugar. It made them sleepy, caused sluggish blood circulation and often led to amputation, a common result of the disease.
Terrol Johnson, founder of Tohono O'odham Community Action, or TOCA, heard stories about the effects of bad sugar as a child.
"My parents would say, 'This person got a leg chopped off,'" he said. "We were like, 'What?' 'That person got a leg chopped off.'"
Eventually, the stories hit closer to home. Doctors amputated Johnson's step-grandma's leg. Johnson's parents told him that if he continued to eat junk food and candy he'd get the bad sugar, too. In 1996, a doctor diagnosed him with diabetes.
Four years later, his grandfather died from complications of the disease. By that time, Johnson's sister and both his parents had it. Next, two of his aunts died from it.
Johnson sometimes thinks back on his grandfather's unwitting contribution to diabetes on the reservation: During World War II, he learned as a Navy cook how to make doughnuts.
"He got home and would make doughnuts and sell them in the village," Johnson said. "He didn't know. No one knew."
When diabetes began surfacing, local and national entities stepped in to work on the problem. Indian Health Services, in collaboration with the Tohono O'odham Health Department, put diabetes prevention projects in place in the community and in schools. The Tucson Indian Center began offering nutrition education, as well. A variety of integrated medical programs started offering treatment.
A small group of Tohono O'odham decided to address diabetes from a different angle: Since nobody had heard of bad sugar 50 years ago when everybody ate like the ancestors did, they began to study the way the ancestors ate.
In 1996, Johnson helped to found TOCA with the goal of addressing community problems through culturally based responses. In 2000, soon after Johnson's grandfather's died, TOCA and a local community college designed a survey to find out whether tribe members would eat traditional foods often if they had the option.
Of the 128 who responded, about 60 percent said they would, but availability and preparation time stood in the way.
That's all the encouragement TOCA needed to start growing tepary beans on a grand scale and teaching people how to prepare them quickly - with a crock pot and freezer.
The old-time garden grew from a quarter acre at a church to one acre at a hospital. It moved to Johnson's grandfather's land, where it continued to grow.
About three years ago, the Tohono O'odham Nation handed TOCA 100 acres for farming, and the farm soon will expand again.
This month, the Community Food Bank bought 3,500 pounds of tepary beans from the TOCA farm. The food bank will pack the beans into diabetic food boxes - half for the reservation and half for dissemination by Catholic Social Services.
"They're such a good source of protein and such a good way to control that blood sugar level," said Melena MacLeod, the food bank's Value Food Store manager.
Chef Janos Wilder, of Janos restaurant at The Westin La Paloma Resort and Spa, has caught the spirit of native foods, as well. Not only does he serve them, he's contributing recipes for an upcoming TOCA cookbook that shows people how to make meals of desert crops.
"We're going to show how these foods can be incorporated into a diet faster and easier," said cookbook writer Mary Paganelli.
TOCA's work has garnered national attention. The Ford Foundation and Kellogg have stepped forward with grants, and CBS featured the organization on "60 Minutes."
Despite widespread support for the Tohono O'odham community's return to traditional eating habits, there's no denying that the reservation is surrounded by compelling messages from fast-food America. Even Johnson has a hard time steering clear of them.
Johnson said he eats tepary beans once or twice a week and has stopped drinking soda, save the diet variety. But despite his role in native crop education, he has difficulty stay ing on the straight-and-narrow path.
"I'm single and live alone," he said. "There's McDonalds on one corner of the street and Taco Bell and Jack in the Box. It's so easy to go get these foods."
So far, he's managed to keep his diabetes in check with pills, but at age 33, that's about to change, his doctor recently said.
"Because of how badly I control my sugar, I have to take insulin," Johnson said.
And although bodies of European origin may be better adapted than Johnson's to handle the starches and fats found in modern convenience foods, more and more people in Tucson are facing a similar fate.
Growing waistlines are evident in modern furnishing trends. Designers are redefining size standards, offering plus-size chairs, roomier coffins and extra-wide toilet seats.
Even the Coast Guard is rethinking its standards, according to the Associated Press. In 2004, a Baltimore water taxi capsized due to too much weight. The passenger limit of 25 people had been set in 1942 when the average American weighed 140 pounds. Now Americans weigh an average of 168.
The extra poundage is not limited to just adults. A Harvard study this summer concluded that children under 6 are much more likely to be overweight than 20 years ago. In 1981, 6.3 percent carried extra pounds, and in 2001, 10 percent did. About a fifth of the children in the study were under six months old.
The Marana Health Center sees so much diabetes that it created a program to screen for pre-diabetes symptoms including elevated blood glucose levels, high blood pressure and obesity. The disease looms on the horizon of a high percentage of clients who visit the clinics not even thinking of diabetes.
"I would say probably at a minimum one in five patients have pre-diabetes and don't know it," said Deborah Hanks, head of the screening program.
While health screening is an essential part of fighting diabetes, some people believe the solution to the epidemic will come not by way of the medical profession but through culturally based innovations like those at the TOCA farm.
Anthropologist Carolyn Smith-Morris, who studied diabetes among the Gila River Indians, said non-native communities could take a lesson from Native Americans who have started to address the disease from new angles and find culturally based solutions.
"To put the burden of diabetes on the back of our doctors and research scientists is wrong," she said. "That's not the right place for it."
Instead, she said the burden should fall on local policy makers, ministers, school board leaders and business bureaus leaders - all who are in a position to influence the structure of people's day-to-day lives.
"People have to work to make a living," she said. "Leaders must insist they do it while having time for their families, walking at work and accessing healthy foods at work. These are the things that make a future without diabetes conceivable."