Lucy Dollokieh, a mother of four from Liberia’s Nimba County, developed severe pains when urinating and thought she had been cursed by a witch, but when a volunteer came to her village describing diabetes symptoms she recognized them, went to a nearby hospital and was diagnosed with diabetes. She now injects herself daily with insulin.
With low awareness of the disease’s symptoms and only one hospital in the country that can diagnose it – Ganta Methodist Hospital in Nimba County – the vast majority of the estimated 50,000 cases in Liberia go undiagnosed, according to the World Diabetes Foundation (WDF). Many sufferers who seek treatment do so when the disease is well developed and they are already losing their eyesight or limbs, staff at Ganta Methodist Hospital, where Lucy was diagnosed, told IRIN.
John Dowee, a diabetes victim, 45, told IRIN he had no idea he was suffering from diabetes until he was told by a doctor at the hospital. “I suffered a lot. Whenever I urinate I go through severe pain. It hurt me a lot, but I never knew I was infected.”
Many diabetes sufferers think they have been cursed by a witch, said Viktor Tayror, an administrator at the hospital. They visit witch doctors, offering them kola nuts to decipher the curse, he said. Many are instructed to sacrifice animals to get better. One patient recently treated at Ganta hospital went into a diabetes coma that she thought had been inflicted by witches.
Misdiagnosis in clinics compounded these beliefs, said Tayror. “If they come to a clinic they may get treatment for different things – for a UTI [urinary tract infection] or something else. So people don’t get better and they consider it to be a witch,” he told IRIN. “They don’t know what to do.”
Diabetes, which the UN World Health Organization says causes about 6 percent of deaths worldwide every year, is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. (See WDF’s diabetes facts).
While infectious diseases are the biggest killers in the developing world, non-communicable diseases, including diabetes, will become the biggest killers in the next 25 years, according to the World Health Organization.
To raise awareness of diabetes, WDF-trained practitioners run regular radio shows on local radio stations on what they call the “sugar sickness”, said Nora Keah, a nurse and diabetes supervisor at the hospital.
Health staff keep the message simple: “We tell them,` this is what happens, and we can help you’,” added Tayror.
WDF also trains nurses and midwives at Ganta Hospital in proper diabetes care, including running regular screenings at the hospital and around the county to teach them how to manage the disease, including injecting themselves with insulin, and taking their own blood tests. Taking a train-the-trainers approach, practitioners teach community volunteers to encourage people to get tested.
All testing is free, but patients must pay for treatment: US$3 for a vial of insulin, to be injected daily, versus the $20 market rate. Most patients use one vial a day.
Some 200 people have been diagnosed and treated in the two months since the programme began, far higher than previous numbers, said nurse Keah.
While WDF covers training it does not finance staff salaries or drug supply, to try to encourage the project to be sustainable, according to Hanne Strandgaard, programme coordinator at WDF. The Ganta Hospital runs a revolving fund for drug purchase – “people have to get used to buying,” said Tayror – “but $3 per day is still a lot for many Liberians.” Some 83 percent of Liberians earn less than $1.25 a day according to the World Bank’s most recent statistics.
To move forward, the government needs to subsidize diabetes treatment – it currently gives the disease no support because it is low on the health agenda, said Strandgaard. All diabetes care is currently funded by two donors: the WDF and Insulin for Life though Ganta Hospital staff are trying to encourage the US Agency for International Development to come on board.
It is now up to the hospital to persuade the government to adopt the project’s model and to show that it is working, to try to elicit some longer-term funding, Strandgaard told IRIN.
Tayror said hospital staff plan to extend the project further into communities, even into schools, if they can secure more funding, which officially runs out at the end of the year.
While many patients were grateful to finally receive relief from their suffering, some are not optimistic they will be able to keep up treatment. “My condition is very critical,” said patient Zokeh Suah. “I would prefer to die and stop suffering from this disease. I sometimes wonder how my life will turn out.”
[Courtesy IRIN News]