India has more than 100 million people living with Type 2 diabetes, but in Meghalaya’s remote tribal communities, doctors are now witnessing changes they never saw before: heart attacks in 28-year-olds, strokes occurring almost daily, and lifestyle diseases that were rare just 10–15 years ago.
It is this rapidly shifting health landscape that have brought Australian and Indian researchers together for the SHILLONG Project, which is recruiting over 1,300 young people across 40 remote villages, one of the largest community-focused prevention efforts in the North-east.
The initiative is led by The Baker Heart and Diabetes Institute, Melbourne, in partnership with Christian Medical College Vellore and Dr H Gordon Roberts Hospital in Shillong — a collaboration designed to prevent an impending public health crisis in one of India’s most underserved regions.
An Australian take
When Australian researcher Kai Wallens first visited these villages, the contrast between resilience and vulnerability struck him immediately.
“My first impression was a mix of admiration and concern,” says Wallens from Prof. Brian Oldenburg’s Noncommunicable Diseases and Implementation Science Lab at the Baker Institute. “These villages are remote, isolated, and beautiful, but life there is more challenging than it may initially look. Many families seem to travel long distances for school, work, or basic services.”
Healthcare, he noticed, was hours away for many. Even basic checks required long travel. Yet what stood out most was not the lack of access, but the powerful sense of belonging.
“The Khasi people… are known for their efforts to preserve their community and cultural roots,” Wallens adds. “The challenge is that young people are now navigating their way between two worlds… That tension creates real health risks, but it also shows how much opportunity there is to support them with the right tools, processes, and ways of thinking.”
For researchers, the urgency lies in how quickly lifestyles are changing.
“Tribal and rural communities are shifting from very active, traditional lifestyles to more sedentary jobs and more processed foods – and it is happening in as little as one or two generations,” Wallens explains.
With limited access to doctors or screening, diabetes in rural Meghalaya is often detected late, once complications have already begun. He says, “It means that our project must be developed such that we strive to prevent a large-scale health crisis before it becomes unmanageable.”
The Indian perspective
For Shillong-based physician-researcher Dr Meban Kharkongor, lifestyle changes in the region are visibly recent — and visibly dangerous.
“We have been observing major shifts in lifestyle as recently as two decades ago,” he says. Roads, phones, television, the internet: modernity arrived quickly, reshaping habits in ways many villagers still perceive as superior to their old ways.
“Convincing them that this new form of lifestyle is in no way superior to their older ways is indeed something that we will have to tread on very gently,” adds Kharkongor, co-investigator of the SHILLONG project.
During field visits, the team also confronted deeply held cultural practices that shape health behaviour, especially the central role of traditional healers.
“Many families seek advice from these traditional community healers before seeing a doctor,” Wallens recounts.
But dietary habits are shifting quickly among the youth, who unlike their tribal seniors, prefer packaged snacks and sugary drinks over home-grown foods.
The project team at Shillong comprises clinicians and public and rural health experts who have been working with the people for over a decade. The team works under the umbrella of the Dr H Gordon Roberts Hospital, a 100-year-old hospital that has the goodwill of many of the local people.
And so, rather than working against the community’s cultural forces, the team members embrace them. Dr Kharkongor emphasises that building trust means recognising traditional healers as allies.
“Designing interventions that completely sideline or oppose tribal healers may draw unwarranted resistance… We have exchanged thoughts and ideas regarding diabetes, heart disease, obesity, and importantly, their prevention.”
Meghalaya’s policy of “medical pluralism” (which is the coexistence and use of multiple medical systems, such as traditional, alternative, and biomedicine, to address health and illness) supports this collaborative approach.
What the future holds
Adapting global evidence — from Finland, the U.S. and Australia — into the cultural fabric of Meghalaya required significant reinterpretation.
“Adapting global programs to tribal Meghalaya wasn’t about copying what worked in Australia, Europe or the US,” Wallens says.
Instead, the program integrates village life, schools, family structures, storytelling traditions and community role models.
“Our entire approach… involves an iterative process of listening to the needs of the communities… When people see that we respect their traditions, trust grows naturally.”
Geography remains one of the biggest obstacles.
“The terrain is remote and mountainous, coupled with bad roads… and heavy fog and rainfall,” says Dr Kharkongor. Special vehicles, generators and strategic planning will be essential — but the region’s surprisingly good internet coverage will ease monitoring and data collection.
In the short term, success is defined by awareness.
“In 18 months, if all our target population become well informed… we would consider it a success,” he says.
Long term, the goal is to reverse the rising tide of chronic disease.
“In 10 years, we would be happy if the prevalence of these diseases and their complications show a decreasing trend.”
For Dr Kharkongor, the urgency is painfully clear.
“When I started my medical career in 2012, we had 1 heart attack every 5–6 months… Last week, we saw 2 patients with heart attacks and strokes were almost a daily affair.”
“We cannot stress this enough… this collaboration is much needed, and it comes at a very crucial time for the people of Meghalaya.”
Read more: Vaccinating before India: What every family must know
