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Chronic suffering

Poor diabetics

by Eleonore von Bothmer

In depth

Beat needs two insulin injections every day

Beat needs two insulin injections every day

Diabetes is typically considered a disease that afflicts the prosperous, but the illness is spreading fast in developing countries. The World Health Organisation expects more than 75 % of all diabetics to live in such countries by 2030. Even in Malawi, one of the poorest countries in the world, some five percent of the population suffer from diabetes. A little girl and a retired teacher who have to cope with the illness are examples of the people affected. By Eleonore von Bothmer

Since Beat was diagnosed with diabetes, her life has changed quite a bit. Ever since, she has had to eat five meals a day instead of the customary two. The nine-year-old starts and ends each day with a visit to the neighbours. Because they have electricity, they also have the only refrigerator in the village – a giant, ancient machine.

Beat gets an ampoule of insulin from this rusty fridge twice a day. Her pancreas no longer produces this hormone, and the medication has to be kept cool so it can be injected safely. When her monthly ration is exhausted, Beat and her aunt, who is taking care of her, have to travel 20 kilometres to the Queen Elizabeth Central Hospital (QECH) in Blantyre (note interview with Theresa Allain, a QECH doctor, in D+C/E+Z 2011/12, p. 474  f.). If they are lucky, the country’s largest and oldest clinic will have enough insulin on hand, and they won’t have to waist hours waiting in vain. Up to now, Beat has been lucky.

The government pays for the medicine as long as the clinic’s pharmacy has it on stock. The trip to Blantyre costs 300 kwachas (about € 1.50) however. That is a lot of money for the family that basically relies on subsistence farming. In Malawi, most people have to make do with less than the equivalent of one dollar a day.

Beat’s aunt earns some extra money by selling peanuts at 10 kwachas a bag. She has to sell 30 bags to afford the monthly bus ride from the village to the city. And she looses a day of work too. Diabetes is a financial burden that worsens poverty (note David Whiting, “Diabetes as a development issue”, in D+C/E+Z 2009/02, p. 66 ff.).

By the time Beat’s disease was de­tected, she was almost dead. She was often dizzy and always thirsty, she felt like she had to urinate all the time and was losing weight. These are all typical symptoms of diabetes, but in Africa, everyone thought it was malaria. After all, millions of people contract – and die of – this tro­pical disease every year. Even when the symptoms are obvious, hardly anyone thinks of diabetes – and that is even true of health centre staff. Typically, they are not doctors, but trained assistants at best. They are simply not aware of diabetes. ­Malawi lacks doctors because those with medical degrees find better paying jobs in rich nations. Today, more physicians from Malawi work in Britain than in their home country.

Although no malaria was found in her blood, Beat was given malaria medication at a health centre nearby. The pills did not help of course, so the girl came back and was given medicine to cure worms. By the time the QECH doctors diagnosed diabetes, Beat was close to a coma. The girl could only return home after ten days of intensive care and six weeks of hospita­lisation.

Beat suffers from type I diabetes, which primarily affects children. In all likelihood, the disease is not the result of malnutrition or a lack of exercise, but rather caused by a virus that attacks the pancreas. If one does not act fast, it can quickly become fatal. Children in southern Africa are especially vulnerable. On average, they only survive a few months. The statistical maximum is seven years after being diagnosed. Beat’s grand­mother does not read statistics, but she understands just how serious the situ­ation is. “Pray for Beat,” she says.

Improving the pension

Ten years ago, Lynn Kapira, who was then a 47-year-old teacher, was diagnosed with diabetes. The disease has already severely damaged her body. Like many diabetics, she suffers from high blood pressure, and she has been paralysed on one side since she had a stroke five years ago. Soon after, her left leg had to be amputated. Today, she is confined to her wheelchair. “I completely depend on my relatives now,” Lynn acknowledges, “and they are tired of having to take care of me all the time. They do not say so, but I sense it.”

She knows of four other diabetics in her neighbourhood near the capital city of Lilongwe. They know each other, but do not discuss their medical condition. Lynn says that it is a pity because they really could support one another: “Again and again, it is hard to get insulin.” To keep it cool, she stores it in a clay pot filled with water under her bed. “When the clinic runs out of supplies, I go from health centre to health centre to get insulin.” In those cases, she has to pay for the medicine herself.

Lynn wonders how she can generate more income. Her pension is small. She would like to buy a cow and produce milk. She reckons that 20 litres could daily be sold to a cooperative and that each litre would earn her six kwachas. That money would cover her expenses, including the costs of her illness, and she would not depend on her family’s money. But first, she must buy the cow, and she cannot afford to do so on her own. She says the government should – but does not – give her money: “They think it’s a bad investment because they expect diabetics to die soon.”

Lynn is disappointed in the state. “They should do more for us,” she demands. “They should help us help ourselves. Instead, they are killing us softly.” She insists that she doesn’t want something for nothing. “I just need some help to pay for a cow.”

Even without government support, Lynn refuses to give up. “I can’t just sit around all day doing nothing,” she says. Recently, she bought a chick for 100 kwacha, raised it, and sold it for 1,000 kwacha. She invested this money in more chicks. But a cow costs around 54,000 kwachas, so Lynn will have to raise quite a few generations of chickens.