Medical team trips to third world countries provide an intriguing arena for the diabetes educator. Medications are often hard to obtain, and when they are available, they may be 1-2 years out of date. Glucometer strips and home blood glucose monitoring are rare, and medical personnel to maintain prescriptions and follow up are few and far between. However, diabetes still occurs, and as it happens, frequently in the country of Jamaica.
I am on my return flight from my second trip to help provide diabetes counseling and care as part of a medical team to a mountainous, rural area of Jamaica. The mission clinic where we provide care has transformed over the past two years from a railroad car and platform, to a lovely, but simple, medical facility. People came from miles around to receive medical care and refill their medications. The clinic started at 8:30 a.m.; people walked, taxis brought others, and those fortunate enough to have access to a car arrived early each day. Many people waited for 8 to 9 hours to see us, with babies on their hips. Our medical team this trip consisted of 3 physicians, 2 dentists, a retired nurse and me (the RD, diabetes educator). In addition, we had 7 “helpers” that were an absolute god-send!
Medicine is SO DIFFERENT in a 3rd world country! I checked blood sugars on over 600 patients in 6 clinic days, and I sadly report 26% had fasting BG values over 126 mg/dl, many in the 200-300 mg/dl range. Several had BG values over 400 mg/dl and our highest was a beautiful 36 year old woman with a BG of 517 mg/dl.
Unfortunately, she will haunt me for a long time. After a lengthy discussion with me, and later in the day with the physician, she remained adamant that she would not take insulin. That by being a “better diabetic” she would conquer her disease without shots. I provided her with an injection of insulin prior to her leaving to demonstrate how effective it would be with lowering her BG values; I then recommended she return in two days with BG results. We would then revisit her diabetes and strategies to control BG, emphasizing that her body was probably no longer producing insulin, and it would be life saving. She did not return.
I can only hope that she returns next week to the Mission, where the nurse may be able to provide more support and secure her agreement to give daily shots. In contrast, I was fortunate on a home visit to encourage a woman with a left arm amputation, how to draw up and inject insulin. She was delighted that she could do it on her own, and was willing to continue on two shots of 70/30 insulin per day. The stories go on and on, both positive and sad. A take home message for me was how fortunate we are to have such a variety of medications available to our population, and have access to supplies through some type of support program in almost every circumstance.
The experience enriched my life. A reminder of the importance of listening, touch and caring no matter what culture we serve. The wonderful toothless, smiling faces and grateful people will be embedded on my mind forever. Although occasional medical team visits is not the best delivered health care…if each of us gives just a bit of our time, and shares a bit of our expertise with others, we can make a difference in those we serve, and they in us.