Paul Rooks (L), 49, his wife Ester (C) and son Damon chat in their home...

Paul Rooks (L), 49, his wife Ester (C) and son Damon chat in their home while waiting to depart for the clinic on the Pine Ridge Indian Reservation in South Dakota. It's a monotonous routine that Mr. Rooks endures three times a week, and one that is becoming necessary for an increasing number of Native Americans across the rural United States. A ongoing report by the Strong Heart Study, funded by the U.S. National Institutes of Health, says that more than 50 percent of Native Americans over the age of 45 are diabetic. A member of the Oglala Lakota tribe, Mr. Rooks has kidney failure brought on by diabetes. According to the American Diabetes Association, Native American diabetics are six times more likely to suffer renal failure than others who have the disease. Photo taken June 25, 2001.