I had a few quiet moments one day and decided to look at opportunities to contribute to the efforts of taking care of children with type 1 diabetes in Africa. A very short time later I was online making plans. Reference letters were sent, plans were made and poof…I was headed back to Africa as a volunteer – this time the east coast.
After 31 hours of airplanes and airports, I arrived in Dar es Salaam at 2300. Exhausted, but happy to be in country, I headed to my modest hotel and organized a few thoughts prior to going to sleep.
My main objectives were to help organize the type 1 registry for Tanzania and gain an understanding of how children in Africa with type 1 diabetes are provided with supplies and diabetes education. I also hoped do work with some educators there, but found them few and far between. I have long believed that the low incidence of type 1 in equatorial countries is largely due to the lack of diagnosis. Cerebral malaria and other common diseases are thought of and type 1, misdiagnosed. This appears to have been the case in Tanzania. A decade ago, the waiting room at the clinic had 3-5 children on diabetes day, now it is full. There are over 1,200 children in Tanzania that have been diagnosed with diabetes and great strides are being made in educating physicians and other health care providers to check blood glucose when a child comes in with weight loss, lethargy, frequent urination and excessive thirst. Often, however, there are no laboratory facilities or strips available for the glucometers to make the diagnosis.
Insulin is available to all children under the age of 25 at no cost thanks to the efforts of Life for a Child (Lilly sponsored insulin) and Changing Diabetes in Children (Novo Nordisk). NPH/Lente and regular insulin with syringes are the norm, with few children getting long or rapid acting insulin. Insulin doses are fixed rather than variable and few adults even adjust their own doses. Syringes are reused multiple times (20-30), and strips are allocated at 2 per day. The wonderful nurse I spent time with estimates that 50% of the children do not have refrigeration at home even in the city and the days are HOT! Insulin is stored in an earthenware jar with charcoal and water to keep it cool. Although there have been a number of excellent educational materials translated into Swahili, there are few trained nurses and dietitians that can work one on one with patients to enhance the family’s understanding of diabetes.
Many of the children have A1Cs over 14% (the highest the machine records). But a few children who have functional and devoted families resulting in attention to consistent insulin injections, exercise and overall healthy eating, are achieving A1Cs in the 7s. Amazing, isn’t it!
So as I head home, I think of lessons learned. Regardless of the way in which insulin is given, even the types of insulin that are injected, it is the carrying out of the tasks. Although the resources we are fortunate to have, the insulin pens, pumps, as many strips as we can muster, can contribute to the ease of insulin delivery; it really boils down to understanding what needs to be done, having a supportive team (families particularly), eating reasonably and in a timely fashion, exercising and most importantly, consistently injecting life giving insulin that leads to success regardless of which country the child resides.