Diploma in Tropical Medicine and Hygiene (DTMH) alumna (2010), Veronica Sawicki is a GP for the NHS in Gloucestershire and the co-founder of the charity Help Madina. Prior to forming Help Madina, Veronica was a GP partner for the NHS for 20 years; she resigned from the post 2 years ago to concentrate on the charity, and now does locum work. Veronica spends three months a year in Sierra Leone working on various projects. In response to a clear and desperate need in the country, Help Madina assisted in the development of diabetes services at the Holy Spirit Hospital (HSH), Makeni, where fellow alumnus Dr Patrick Turay is the Medical Director. In this report, Veronica tells us about the challenges of setting up a diabetes facility in Sierra Leone.
There is clear evidence of a diabetes epidemic in Sub Saharan Africa and yet there is no national programme for diabetes in Sierra Leone. In 2013, the Holy Spirit Hospital (HSH) in Makeni, one of the largest cities in the country, launched a diabetes unit. This unit is the only facility in Sierra Leone that provides structured diabetes care for both outpatients and inpatients. At the diabetes unit at HSH we screen for gestational diabetes and we are hoping to start screening for impaired glucose tolerance in the future.
In preparation for the opening of the diabetes facility, there was a period of intense nurse training and the development of both outpatient and inpatient protocols, and a diabetes register was established. We have over 300 patients registered with the clinic; patients from all over Sierra Leone come to the unit. Patient information leaflets, including culturally appropriate diet sheets and advice on foot care are available. We are now receiving patients referred from government hospitals particularly the more difficult cases. Most patients have Type 2 diabetes but we look after 11 patients with Type 1 diabetes. The ages of our patients with Type 1 patients range from eight to twenty-five years old. Some patients demonstrate symptoms of atypical ketosis prone diabetes mellitus, but it is difficult to confirm these cases. Recently, we lost a teenage girl from septicaemia due to a dental abscess, which unfortunately was an avoidable death. Based on the work I have been involved in at the unit, I suspect that the life expectancy for a young person diagnosed with Type 1 diabetes in Sierra Leone is very short; however, there is no data to confirm this. Those with Type 2 diabetes pay for their medication but all patients with Type 1 diabetes have glucose meters, strips and insulin free of charge; the insulin is subsidised by Help Madina and Insulin for Life. Insulin is not readily available in Sierra Leone and when it is, the cost is so high that the majority simply cannot afford it.
The story of Issa
To exemplify the challenges faced, here is a summary of the experiences of one of our young patients called Issa.
Issa is a 24 year old Sierra Leonean from Freetown, the capital of Sierra Leone. Seven months ago, Issa was diagnosed with Type 1 diabetes. He was found in a coma and was admitted to hospital in Freetown for diabetes ketoacidosis (DKA). He was discharged on oral hypoglycaemic agents, but could not afford to pay for his medication, as a result, a few months later, Issa had another episode of DKA. On this occasion, Issa was admitted to the HSH and recovered with appropriate treatment; he was subsequently discharged on insulin.
Issa and his wife, Hawa are now staying in Makeni as Issa has to go to HSH every day for a fasting blood glucose test followed by an appropriate dose of insulin. The journey to the HSH is not an easy one, Issa walks several miles to the hospital, often he has not eaten as food is expensive. Sometimes he is hypoglycaemic on arrival at the HSH. Individual members of staff buy Issa food bought from street vendors. Issa had a small business selling coal but the coal was stolen during one of his admissions to hospital. He is looking for work but it is not easy. The management of patients with Type 1 diabetes here in Sierra Leone is fraught with difficulties and the situation is pitiful. If Issa has his insulin but does not eat, he becomes hypoglycaemic. If Issa does not have his insulin he goes into ketoacidosis.
A recent development from the launching of the diabetes unit has been the official registration of a patient led diabetes association. This association was established to promote diabetes awareness, to provide support for those with known diabetes, and to campaign for a national diabetes programme. To raise awareness about diabetes, the association marked World Diabetes Day on 14 November 2016 with a peaceful march through the centre of Makeni.
The staff at HSH work extremely hard to provide the best possible care for those with diabetes in Sierra Leone, and the diabetes association is campaigning for a national programme of diabetes care. A petition has been organised, which will be presented to the government.
For further information about Help Madina you can visit their website here.