By Nina Skagerlind, PIH-Lesotho Summer Intern
An estimated 31,000 people suffer the daily effects of diabetes in Lesotho, a small mountainous country in southern Africa.
In the developed world, non-communicable diseases (NCDs) — including diabetes, heart disease, and lung cancer — are often associated with unhealthy and sedentary lifestyles, conditions associated with affluence and excess. This is not the case in Lesotho, or for roughly a billion of the world’s poorest people. Nearly all cases of diabetes diagnosed at PIH-Lesotho's (PIH-L) eight health facilities result from malnourishment or sudden changes in eating habits, conditions directly associated with poverty.
If left unchecked, the WHO estimates that Africa will have the highest relative increase of people living with diabetes by the year 2020.
The health impact of living in mountain communities
In Lesotho, poor nutrition is a major contributor to the development of diabetes. The rough, often snow-covered terrain makes sustainable farming nearly impossible for much of the year. Families lack the fruits and vegetables essential to a healthy diet. The primary staple diet for the majority of people living in rural Lesotho is a boiled corn meal, known as papa, heavy in carbohydrates which exacerbates diabetes.
Though the exact causes of diabetes are still unknown, we know the disease blocks sugar from leaving the bloodstream and feeding the body's cells. The best defense is achieved by maintaining consistent blood sugar levels, allowing for maximum glucose absorption. When sugar levels drop dramatically — as they do when someone suddenly stops eating, or is malnourished for a period of time — the body is even less able to feed its cells.
In a country where small villages are isolated by steep mountains, health education in most communities is scarce at best. People who know that diabetes exists often have no knowledge of its causes, symptoms — frequent urination and blurred vision — or effects, explains Sophie Motsamai, PIH-L's monitoring and evaluation manager.
If left untreated, diabetics are at risk of developing glaucoma, numbness of extremities, and heart disease, all of which can be fatal for people lacking easy and reliable access to medical facilities.
A comprehensive approach to treatment
To respond to the diabetes problem, PIH-L has created a comprehensive approach to treating diabetes in Lesotho, similar to its approach to treating infectious diseases like tuberculosis and HIV. The clinical team integrates diabetes detection and treatment into all regular checkups and outpatient visits — one of many components of a comprehensive health system. And PIH-L's network of mountain clinics brings access to these services to many remote villages and communities.
As with services at all PIH facilities, diabetes treatment is free of charge. Once detected, patients receive medicine and training about eating habits and nutrition. Physicians and nurses meet regularly with patients for health checkups and blood-sugar measurements. Because caring for diabetes requires daily vigilance, community health workers are available to meet regularly with patients experiencing difficulties between clinic visits.
Beyond offering medical services, patients living with the disease are often provided with food or given the tools to garden — a crucial step in addressing the root cause of diabetes.
A similar approach is also being used to treat diabetes at other PIH sites, including PIH-supported health facilities in Rwanda.
One burden among many
Adding to the burden of HIV/AIDS and TB — diseases infecting upwards of 25 percent of adults in Lesotho — non-communicable diseases like diabetes present an added layer of challenges to the public health system. With public hospitals overburdened by the fight against communicable diseases, poor people are too often left to fight NCDs on their own.
Fortunately, the plight of patients suffering from NCDs in developing countries is gaining global attention. In September 2011, the United Nations will hold a High-Level Meeting (HLM) on the prevention and control of NCDs.