Advocacy for increasing access to care for people living with diabetes

Owen Nyaka, CNS Correspondent, Malawi
Monica Mkandawire is a 40-year-old mother of three who hails from Chikwa village, in Rumphi district. She has been living with diabetes for the last 21 years in Mtandire, a peri-urban area in Lilongwe city. She still vividly remembers her feelings of dizziness, irritability, fatigue, excessive thirst, poor eyesight, and insatiable hunger that she faced before being diagnosed with diabetes.

"My husband divorced me and married another woman in August 2006 after coming to know that I had diabetes," says Monica. She had never expected this action from her healthcare worker husband. He stopped supporting her and the children, adding to her financial woes. Monica cannot afford to buy 'special diabetes food- stuffs', but joining a diabetes club in her community, initiated by a retired nurse volunteer, has changed her life for better. "Medication is only one aspect of my care. Maintaining a healthy weight, increasing my physical activity, eating health foods with low fat, testing my blood sugar regularly, taking my medication as prescribed, are some of the ways that have greatly contributed to control my diabetes in the past 16-years," she says. Stigma and discrimination in patients with diabetes remains high in the community; hence the need to increase awareness and improve quality of support services by making sure that diabetes drugs are available in all hospitals, including community health centres.

"We are always advised not to eat anything before tests during hospital visits, even as we have to stand in long queues, awaiting our turn to be attended to. The number of healthcare workers in the diabetes section should be increased in order to speed up service provision," Monica stresses. Carbohydrates, when digested, change to glucose, which is then transferred to the blood and is used by the cells for energy. The hormone insulin produced by the pancreas, transfers the glucose from the blood into the cells. Diabetes develops when the pancreas fails to produce sufficient quantities of insulin- In type 1 diabetes, the body makes little or no insulin.  Type 1 diabetes usually occurs in children and young adults but can also appear in older adults. In the more common Type 2 Diabetes the body does not produce enough insulin or the insulin produced does not work as effectively as it should. This is referred to as insulin resistance. According to the latest edition of the Diabetes Atlas, 1 in 11 adults have diabetes (415 million) and every 6 seconds a person dies from diabetes (5.0 million deaths annually). Also 12% of global health expenditure is spent on diabetes ($673 billion).

In Africa, more than two thirds of people with diabetes are undiagnosed, while in Malawi 75% of those living with diabetes go undiagnosed. 38 years old Saidi Amini, who hails from Nkopi village, says that, "Diabetes is not communicable and partners should not have fear when one is found with the disease. Even though I am living with diabetes, I am sexually active and my wife is four-months pregnant now. So it is not true that people with diabetes cannot perform sexually," shares Saidi, who uses the same hospital Monica does. In Malawi, the Journalists Association against AIDS (JournAIDS) is implementing a diabetes prevention project, ‘Popularizing Advocacy to Primary Prevention’ under a project partnership agreement and funding from World Diabetes Foundation of Denmark. The organization is working to raise awareness amongst policy makers, government and people living with diabetes, like Monica and Saidi.

Lesina Grivin has also affiliated herself to the Mtandire Diabetes Club in Lilongwe. "Since joining the club my health is better now because I have been following medical expert advice," says Grivin whose health passport indicates that her last check up on 1st February, 2016 was 143 over 99 compared to her last check up on 2nd November, 2015 which was 152 over 100. 50 years old Annie Matewere, married with 7 children, is another patient who is benefiting from the JournAIDS advocacy project. However, her only concern is the shortage of syringes in public hospitals. In most cases, she does not inject herself with insulin as recommended by doctors because of scarcity of syringes. Using the powerful tool of advocacy JournAIDS hopes that in the next few decades, diabetes and other NCDs will be high on the health agenda, whereby sustainable domestic and overseas development assistance will bring change in the lives of many patients. 

Owen Nyaka, Citizen News service - CNS
May 30, 2016

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