Sia Figiel’s Super Effort
A Samoan novelist tackles her type 2 diabetes and becomes a role model
The first time I saw Sia Figiel, I thought, “Who is this woman in the Superman shirt and cape?!” You couldn’t miss her: On a patient and health care provider panel at the American Diabetes Association’s Disparities Partnership Forum, she stood out among the suits, insignia blazing over her shorts and tattoos. Figiel, a 45-year-old writer and mom who lives in Tampa, Fla., was giving the perspective of a Samoan type 2 patient on treating diabetes in high-risk populations.
Later I wondered, “Why haven’t I heard of her before?” This after Figiel gave an impassioned speech about diabetes in her native American Samoa, where more than 21 percent of the population has type 2 and more than 80 percent of adults are classified as overweight or obese. She eloquently described a perfect storm there of westernization, imported food being considered a status symbol, and a culture of shame about diabetes, all leading to untreated complications and premature deaths in her community. When she told the story of her 10-year-old son giving her insulin injections, there wasn’t a dry eye in the house—including her own.
And finally: “I’ve gotta meet this woman!” This as I was watching what Figiel calls her first act of diabetes activism: a graphic YouTube video called “Sia at the Dentist,” in which she is shown having all of her teeth pulled, one by one. A crushing combination of high blood glucose levels, susceptibility to oral-health problems because of diabetes, and a resistance to seeking out treatment brought her to that point. The video, produced by Poly One Media, was gut-churning. I counted at least six people who left before it ended. I stayed, eager to hear more.
Figiel took time to sit down and chat about her diabetes journey. One of the most beloved Samoan writers of her generation (and often called American Samoa’s first female novelist), she is a storyteller by nature: Her turn of phrase is beautiful. But instead of writing fiction, she’s focused now on sharing her own story and bringing diabetes in Pacific Islanders to light. She wears the Superman shirt and cape to be memorable, she says, but also to make a statement. “Any diabetic who takes charge is a superhero in my book,” she says. “If you’re actively taking care of yourself, you’ve got superpowers right there and then.”
Her advocacy started with the “Sia at the Dentist” video, but her diabetes story begins well before that. Type 2 diabetes runs in Figiel’s family. Her dad died of complications more than a decade ago. Her late mother had amputations and was on dialysis due to complications. “With those kinds of genes, I said, I bet you it’s in my blood as well,” Figiel remembers, and went to get herself checked. She was diagnosed with type 2 diabetes in 2003 and began taking metformin. Despite seeing all around her the potential diabetes had to ravage the body, “I didn’t take it seriously,” she says, and slipped right back into eating the food her family was cooking. And that’s where more serious problems started.
In Samoan culture, as in so many others, food is a language, Figiel explains to me. “When you’re giving food, for example, to Lindsey, you’re here, but we’re not just giving to Lindsey,” she says. “We’re giving it to your mother, your father, acknowledging the genealogy.” That was fine when Samoans were subsistence farmers, growing the food they ate. However, since the islands of American Samoa became a territory of the United States in 1900, traditional ways of farming and cooking have given way to urban living and imported foods, such as turkey tail—canned fatty scraps left over from turkey processing. Western ways of eating, even if unhealthy, are seen as a mark of prosperity. That’s created a class distinction based on food, Figiel says.
Couple that with a sense of shame about having diabetes, and Figiel was living with her diabetes in secret. Her doctor told her, “These are the facts, but it’s basically a losing battle,” she says, and it became a self-fulfilling prophecy: Figiel managed neither her diabetes nor her weight, topping out at around 400 pounds. When she moved to the continental United States in late 2012, she decided to face up to her medical problems. She was diagnosed with periodontitis, the most severe form of gum disease. By then, she says, she had lived with mouth pain for “a good three years,” but she hadn’t been confident enough to go to the dentist in Samoa. “Living on a small island, I didn’t want to go to the dentist … because nothing is confidential. I didn’t want to come out about that.”
Realizing that she was facing the loss of all her teeth compelled Figiel to act. Removing the stigma surrounding diabetes among Samoans, she says, could help people live healthier lives. “Even the woman that filmed [the video] said, ‘Are you sure about this? People are going to know about this.’ I told her that’s the whole point!” Figiel says. With that video, her activism began.
Taking control of her health was the next step. Figiel has lost more than 100 pounds, in part by walking and swimming at local family recreation centers. She’s also focused on eating in a healthy way, with sensible portions, plenty of vegetables, and a meal plan that includes her whole family. “Don’t think you can eat a leaf of lettuce today and lose 200 pounds,” she says. “You must eat, but don’t starve yourself. Eat the right foods.” She manages her diabetes with diet, exercise, metformin, and insulin, and says her insulin needs have dramatically decreased in the past year or so as she’s lost weight.
Figiel has taken her show (and cape) on the road. She’s shown “Sia at the Dentist” at conferences on Pacific Islander health and on several university campuses. Just as at the ADA disparities conference, she has seen people walk out—and, in a way, she’s thrilled with that response. She recalls one young white man who slammed the door as he walked out of a classroom. “I said to myself, ‘I hope that slam means that he is telling himself that he will never get diabetes,’ ” she recalls. “That was a very powerful reaction. Once two women walked out and they were saying, ‘It’s gruesome.’ I said to them, ‘That’s the reality.’ ”
Her openness has earned her attention from other diabetes advocates and the Samoan community. Her raw emotions in sharing her story also are gripping, and she hopes they’ll strike a chord with those who need them the most. “In my community, we don’t cry!” she says with a laugh. “It kills me that I’m crying, and in front of a whole bunch of people.”
Figiel knows that, beyond Samoans, she represents Pacific Islanders who are scattered among thousands of island homes in a vast ocean as well as in communities around the world: “I just wanted to be assertive and strong, but then it just hit me: I’m here, representing the largest body of water on the planet, and that water spoke to me and wanted to be released. That ocean of salt said, ‘You’re not alone; we’re coming.’ ”
More opportunities keep coming for Figiel, too. She continues to tell her diabetes story. She’ll be competing in the 2014 Nautica Malibu Triathlon—another example she wants to set for her community. “That woman,” Figiel says of the old Sia, “was afraid that she might not fit into a coffin, and look at her now: She’s a triathlete two years later. It’s exciting to be fit; it’s exciting to be strong. The power is all in your hands. You’re not always going to get it right, but … there’s always tomorrow. Each day is a blank day. It’s like writing: There’s always a blank page.”
Sia Figiel’s diabetes advocacy started with a video that graphically displays tooth removal. You can see “Sia at the Dentist” at bit.ly/siadentist.
The American Diabetes Association has information specifically for Asian American, Native Hawaiian, and Pacific Islander communities. Visit diabetes.org/aanhpi to learn more.