Diabetes: Combating a silent killer

•Why managing disease is becoming difficult

Diabetes remains one of the deadly diseases ravaging many homes in the country as well as in other developing countries. FUNMILAYO AREMU and ADEOLA OTEMADE look at how poor access to medical care is and growing poverty among Nigerians have made managing the disease difficult.

According to the World Health Organisation (WHO) and International Diabetes Federation (IDF), about 422 million people worldwide are diabetic and a  majority of the sufferers live in low and middle-income countries. A million and a half deaths are also directly attributed to diabetes each year, just as an estimated 24 million people are living with the disease in Africa, with an estimated 70 per cent of them not knowing they have the disease.  Existing data show that eight million Nigerians are diabetic.   , and between four and 11 per cent of the population lives with diabetes.

Diabetes, according to medical experts, happens when the body is not able to take up sugar into the cells and use it for energy. This often results in a build-up of extra sugar in the blood stream, while poorly controlled diabetes can lead to serious consequences, causing serious damage to a wide range of body organs and tissues, including the heart, kidney, eyes and nerves.

However, a major challenge with diabetes patients, according to medical experts,  is that they lack adequate access to health care, a situation which often aggravates the condition and subsequently leads to untimely death.

Pa Festus Alaka was one of such patients. It has been over 13 years since his family lost him to the silent killer. Pa Alaka, as fondly called by his family members, battled with diabetes for years and eventually lost the fight due to lack of adequate health care. According to his daughter, TemitopeAlaka, while speaking with Sunday Tribune, lack of money contributed to her father’s death.

“We didn’t get to know that he had diabetes early enough, as we might have been able to save his life. It happened that he was seeing off a friend of his on this fateful day when he stepped on a sharp object. He thought it was just a normal pain, only for us to discover an open wound that was not healing. The wound began to spread with an offensive odour. We couldn’t take him to the hospital due to absence of adequate medical care. We had to improvise by bringing in a nurse to clean the wound regularly,” she narrated.

For Elder AbiodunAkanji, despite taking care of himself and eating good food, he still got afflicted with the disease. It was a surprise to him when he discovered just last year as he turned 69 years old that he was diabetic despite his healthy lifestyle.

“I developed diabetes last year at the age of 69 and it was as a result of old age, body organs getting weaker, not because of any disease or excess sugar or excess food. It is a normal thing for any living thing to grow old and after some time, lose some functionality.I take care of myself by watching what I eat. I don’t eat unless I am hungry, and even when I do, I don’t need to eat too much. I eat just enough to take care of my empty stomach.

“I don’t have a pot belly; I drink water most of the time, avoid sugary food and I don’t take alcohol. I generally advise people to eat minimally and not develop pot bellies. You don’t need a full meal three times a day. For the past 40 years, I have been taking just a piece of meat per meal,” Elder Akanji, wondering why in spite of his disciplined lifestyle he still developed diabetes.

 

Health care accessibility and affordability

Among the many challenges that characterise the health care system in Nigeria is accessibility. Many diabetic patients often face difficulties in getting access to much needed basic health care.

According to Dr Opeyemi  Adeyemi of O and A Medical Centre, Asero, Abeokuta, Ogun State, treatment and/or management of  diabetes has to do with lifestyle and modification.

“Diabetes is a life-long disease which involves management with teams of specialists. You’re taking care of whatever the cause is; if it is type one or type two, you are looking at the lifestyle modification, like dietary modifications, exercise. If they (patients) smoke or take alcohol, one has to ensure that they have a support system for that,” DrAdeyemi explained.

“It is a multi-disciplinary approach towards care. Yes, we have the specialists who take care of that. But all these when it comes to government facilities, sometimes, they are not available. Not everyone is there.  The location of government hospital(s) is one thing and the ability of the patients to have access is another.

“Looking at other things like poverty, distance, transportation, and other factors, these are things that go into accessibility. We can do better; there is so much to do. It would be nice if we had government approved centres that take care of non-communicable diseases like diabetes so that they have specialised care and focus,” she said.

The Chief Consultant, Orthopaedic and Trauma, Federal Medical Centre, Abuja, DrGaniyuAremu, provided more insight into diabetes care in the country.

“Diabetes care is not readily accessible at the grassroots  as of today. The care for the diabetic patients is ideally given by the endocrinologists. Nigeria currently has very few of these specialists. The few who are available  are concentrated in the big teaching and specialist hospitals in the cities and urban areas. Even in those areas, their number is grossly inadequate.

“While it (care for diabetes patients) is inaccessible to most people, it is also rather expensive. The law of nature dictates that anything that is scarce will be costly. That is exactly what we see in this situation. A majority of the populace simply cannot afford the cost of being managed by these specialists,” he said.

Elder Akanji confirmed that much having  been managing his own condition for a while. “Managing diabetes can be very  expensive, as everything is expensive in the country these days,” he said.

Indeed, as  Dr Adeyemi explained, “Non-communicable diseases like diabetes are lifelong diseases and very expensive over time. Even people who make so much money, when you look at how much they spend over time, you will see that it is quite expensive to manage. It is not just about the drugs, you are looking at the lifestyle as well.

“You’re telling someone you have to eat right and the cost of eating right is there; exercise, medications, spikes in prices. Changes in exchange rates would influence the prices of these commodities and affect the purchasing power of the patient and it might become quite expensive for them to cope with.”

 

Effects of untreated diabetes

A lot of time, patients often ignore tell-tale signs when they have one disease or the other. According to DrAdeyemi, untreated diabetes could affect all the organs of the body, as it has to do with the sugar level in the blood stream.

In her words, “If diabetes is left untreated, it could affect all the organs of the body. It would lead to death. We have people who do not even know they are diabetic, and all of a sudden, they go unconscious. When they do their blood sugar test, they find out that its way above scale and that is when they realise that they have diabetes.

“So, it is advised that one should have a proper check every year. It is important to do a full body check at least once a year, where every vital organ will be checked.  With this, one would be able to know if there are issues with controlling blood sugar level and it would be addressed quickly before it becomes worse. It can lead to kidney failure,  can lead to diabetes foot, which has to do with all sorts of wounds in the foot,  loss of sensation in body parts, issues with the eyes and all the organs you can think of.

“Looking at it holistically, having to deal with the fact that one has a life-long condition, it would take a toll mentally; it could affect how people see themselves and how they relate. Having to take medications everyday can also be depressing. In case of sexual health, some of these can lead to unfulfilled sexual and reproductive experiences. It could affect organs and lead to more costs to deal with this diseases condition.”

Dr Aremu also corroborated DrAdeyemi’s opinion stating that leaving diabetes untreated leads to serious life-threatening complications. Some of these complications include but are not limited to blindness, chronic kidney failure, peripheral vessel diseases that may lead to limb gangrene (rotting of flesh caused by lack of blood supply) and eventual loss of the limb.

He advised people living with diabetes to stay clear of carbohydrates and eat more healthy food. “Taking less of carbohydrates like yam, cassava and maize; living on veggies and fruits, weight control by exercise and eating moderately, special care during pedicure, comfortable footwear that will not have pressure points, regular blood sugar checks,” he advised.

 

How diabetic health care be improved upon

With limited access to health care, lack of fund, ignorance and many more, experts agreed that  government has a role to play in providing a sound accessible health care for the people.

According to Dr Adeyemi, government should build special centres for specialised diseases, putting more resources into care, and making  such special centres accessible to all.

“We could have special centres for specialised diseases; we could put it under non-communicable diseases. Hospitals that have specialists in them which are  usually a teaching hospital or government hospital should be closer to local communities so that the masses could have easy access to them.

“Government should put more resources into care generally, not into diabetes alone,and promote research into creating better afro-centric care for Africans. All the important disciplinesthat will be needed for care should also be available at the tertiary level,” she proposed.

Noting that the disease wreaks more havoc in elderly people, Elder Akanji implored the government to provide some welfare facilities for old people as well as recreation centres, just as he called for more awareness to educate people on how to live healthily after active service.

“There are so many things government should have been doing that they are not doing. I am now in retirement and a pensioner. We need to appeal to the government to provide some welfare facilities, especially a hospital for the elderly, including recreation centres for them.

“My house is not far from a general hospital, thus it is easy for me to access the hospital whenever the need arises. What about those whose houses are far from general hospitals? The government needs to create more grassroots health centres, and employ more hands in our hospitals,” he advised.

Dr Aremu, in his own view, suggested that the government should employ doctors to man rural and urban hospitals, undertake  awareness campaigns to enlighten the masses more on the dangers of diabetes when not adequately taken care of.

“To make diabetes care more accessible to patients, government needs to do a lot in the areas of employing doctors to man rural and urban hospitals, equip the hospitals with the basic laboratory tools that will help in the diagnosis of diabetes in good time to avoid long-standing undiagnosed diabetes that always presents later with complications.

“Awareness campaign needs to be undertaken on a regular basis to enlighten the masses on the ways to be aware of this disease, recognise it when it occurs and take the right steps when it is detected by going to appropriate health centres,” he explained.

Given the deadly nature of diabetes and the fact that it is not captured under primary health care in the country, it is not unlikely that the number of patients and indeed victims would continue to rise, considering the cost of managing it and the growing poverty among the populace.

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