In 2013 Dr Veronica Sawicki, an alumnus of the 2010 Diploma in Tropical Medicine & Hygiene, helped set up a diabetes clinic in Sierra Leone, a country where access to diabetes care is severely limited. Here Veronica describes the challenges of setting up the clinic, the progress made and plans for the future. Veronica is also the co-founder of charity Help Madina – you can read her April 2015 Alumni Blog about the charity here.
As Sierra Leone recovers from the devastation caused by Ebola, the country is facing another epidemic: that of non-communicable diseases, including Type 2 diabetes. Though the diabetes epidemic is global, Sub-Saharan Africa (SSA) is set to experience the biggest projected increase in the prevalence of diabetes worldwide. Moreover, SSA is the hardest-hit region in terms of greatest loss of life from premature death among persons with diabetes due to cardiovascular disease, kidney failure, blindness and amputation. Limited economic resources, poor health care systems and a lack of diabetes education means that most diabetic patients are diagnosed in the advanced stages of their condition when complications are almost inevitable.
With regards to Type 1 diabetes, the prognosis of young people with the disease is scarcely better than it was before the discovery of insulin – the average life expectancy for a young person diagnosed with Type 1 diabetes can be as little as six months (average life expectancy in the UK is 68 years). Premature death due to coma constitutes a day-to-day threat for the majority who depend upon insulin to survive. Essential insulin and other medications remain widely out of reach, due either to their excessive cost or the unreliable and insecure supply chains that make these life-saving supplies unobtainable.
The Ministry of Health in Sierra Leone has no specific policy, programme or action plan that is currently operational for the prevention and control of diabetes. For someone living with diabetes in Sierra Leone, access to care is extremely difficult.
An opportunity to make a difference
I qualified as a doctor in 1982 and I am now a General Practitioner in Gloucestershire. I did my Diploma in Tropical Medicine & Hygiene at the School in 2010. Like so many others, I feel passionately about global health care inequalities and I have always wanted to do my bit to make the world a fairer place. I have been working as a medical volunteer in Sierra Leone since 2008 and I am co-founder of a charity, Help Madina.
An enduring memory from my first visit to Sierra Leone is of a young man at Kambia District Hospital. He was in diabetic ketoacidosis and had an IV infusion in place. To my horror and disbelief he was not receiving any life-saving insulin. I was sure there had been some mistake and I immediately contacted the Community Medical Officer. He told me that no, there hadn’t been a mistake – and yes, the patient did need insulin. The problem was that there was no insulin in the hospital. In fact, there was no insulin to be found anywhere at all.
Five years ago, I had the privilege of attending medical clinics in Sierra Leone with Dr Patrick Turay, Medical Director of the Holy Spirit Hospital (HSH) in Makeni, Sierra Leone, and a fellow alumnus of the School.
The vast majority of patients attending the clinics presented with infectious diseases, but a significant number were being followed up for chronic conditions such as hypertension and diabetes. Most of the patients with diabetes knew very little about their condition and there was no educational material available to provide information and assistance. I suggested to Dr Turay that I create patient leaflets providing information on healthy foods for those with diabetes. This then led to the idea of developing a diabetes service at the Holy Spirit Hospital.
The Diabetes Clinic
Firstly, a diabetes clinic protocol centered around structured care was created. A vital part of this protocol was the setting up of a diabetes register. This was then followed by a period of intense nurse training and the formation of a dedicated diabetes team. Individual diabetes medical records and patient information leaflets were developed – these included written information on diet, foot care and healthy lifestyle. Finally, a suitable consulting room was equipped with the basic equipment required for a diabetes facility. The financial input was minimal.
The diabetes clinic was launched in 2013 by Dr Patrick Turay with the assistance of Help Madina. There was little publicity initially, but patients gradually heard about the clinic through word of mouth.
The diabetes clinic is rapidly expanding, with 225 patients registered to date. The vast majority of patients have Type 2 diabetes but we do have a group of young patients with Type 1 diabetes, for whom insulin is essential. There are also a significant number of patients who have a type of diabetes which I have not encountered in the UK – these are generally adult men in their twenties who appear to require insulin from time to time only.
Nursing staff Matron Ann Marie Koroma and staff nurse Michael run weekly clinics which are held every Wednesday. They work extremely hard, with approximately 30 patients attending the clinic each week. The number of patients being admitted to the wards with diabetes complications is increasing.
Diabetes awareness in the community
Posters and billboards depicting diabetes symptoms have been displayed in Makeni in order to increase public awareness of the condition. There have been live radio broadcasts on diabetes, with questions posed by the audience. A diabetes association – The Holy Spirit Diabetes Association Sierra Leone – has been launched. The executive committee meet regularly and clearly aim to be a powerful lobby group campaigning for improved diabetes services throughout the country.
Access to insulin remains a major problem and Help Madina is assisting in the provision of insulin for patients with Type 1 diabetes. We provide insulin free of charge and I bring a 12 months’ supply of insulin with me each time I visit Sierra Leone. This is clearly not a long term solution but it is the only option at present.
The challenges for access to diabetes care in Sierra Leone
There are many problems needing to be addressed with accessing diabetes care in Sierra Leone.
There needs to be organisation of the health system; public education on and information about prevention of diabetes; accurate data collection; drug procurement and supply; affordability of medicines and care; training and availability of health care workers; patient education and empowerment with community involvement; and above all: strong political will. Until there is a national diabetes programme in place for Sierra Leone, the HSH Diabetes Facility is working hard to provide affordable and best possible medical care and support for those with diabetes.
We are planning a two-day workshop on diabetes at the HSH in 2016. All interested healthcare professionals are invited and it is hoped that a representative from the Ministry of Health will attend.
Read more about Help Madina here.