diabetes care in rwanda: AGAINST ALL ODDS - International Diabetes

diabetes care in rwanda: AGAINST ALL ODDS - International Diabetes

the global campaign Diabetes care in Rwanda: against all odds Crispin Gishoma Rwanda is a small developing country of 26,338 square kilometres, land...

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the global campaign

Diabetes care in Rwanda: against all odds Crispin Gishoma

Rwanda is a small developing country of 26,338 square kilometres, landlocked in central Africa, with an approximate population of 12 million inhabitants. The majority of people are subsistence farmers. Rwanda is home to one of the most appalling crimes of the 20th century, and it will take generations of Rwandese to heal from the devastation and loss. In the ‘1994 Tutsi Genocide’, more than a

million people were innocently killed, thousands exiled, or jailed and many widows and orphans left behind once the killing stopped. Public services for the population were crushed and the healthcare system was paralysed with very few professionally trained doctors remaining in the country. Healthcare facilities and centres were destroyed and access to medicine was nearly non-existent.

While Rwandan institutions were overwhelmed by multiple emergencies, the health sector spent most of its remaining resources on infectious diseases, including HIV. Diabetes care in Rwanda suffered during the conflict and people with diabetes struggled to survive. Diabetes was overlooked, and people were in danger. Diabetes care policies did not exist, and seriousness of the condition was played down by doctors and ignored by the general public.

Diabetes was overlooked, and people were in danger.

Rwanda Diabetes Association (RDA) headquarters

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To tackle these challenges, Rwanda Diabetes Association (RDA) was created in 1997 with the aim of improving the well being of all people with diabetes in Rwanda, and to join the global effort to advocate better diabetes care and prevention. For 16 years, RDA has been given support by the Rwanda Ministry

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of Health, the International Diabetes Federation (IDF), Insulin for Life, Life for a Child Programme, World Diabetes Foundation, Insulin Zum Leben, Team Type 1, Marjorie’s Fund and the University of Pittsburgh, USA. It is only through the support of these organisations and programmes that people with diabetes in Rwanda have access within its clinics and government hospitals to information by trained healthcare professionals on diabetes self-management. Advocacy for diabetes in Rwanda has also progressed for better diabetes treatment, improved communication with diabetes care stakeholders, and access for indigenous people. Diabetes care and training In a country where diabetes awareness is low or perceived as ‘a rich man’s disease’, RDA prioritised national media communications to increase awareness, early diagnosis and prevention. One of the objectives was to train and even correct journalists and healthcare authorities about diabetes information. Now after three years, journalists have been awarded for their work in helping to inform the population about diabetes. In addition, RDA has a magazine which is also used as another platform to disseminate diabetes awareness messages. However, diabetes awareness is meaningless without available care and treatment. RDA has opened clinics in Kigali and Gisenyi (northwest Rwanda) with an average of 20,000 patient visits per year. Main activities within these clinics are consultation, treatment, education, training, counselling, and providing diabetes medical supplies. Since 2005, RDA’s efforts have facilitated training on diabetes management for more than 800 healthcare professionals. One indicator of the results of this training is a marked difference in the number of people who

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Laureates at the end of the diabetes training

have been diagnosed since that time. In addition to the permanent diabetes care and training in Kigali and Gisenyi, RDA works closely with 32 hospitals throughout the country where a team of nurses and diabetes educators conducts quarterly visits. These visits include diabetes training and awareness sessions with people who have either type 1 or type 2 diabetes.

we know that youth with diabetes were usually dying either before diagnosis or as a result of poor diabetes management. Since 2003, the ‘Care for Youth with Diabetes Programme’ of RDA in partnerships with the IDF Life for a Child Programme, Pittsburgh University, and Team Type 1 provides care, education,

Youth with diabetes were usually dying either before diagnosis or as a result of poor diabetes management. Care for Youth with Diabetes Programme One of the great achievements of RDA is caring for youth with type 1 diabetes. In a small country like Rwanda where diabetes was nearly unknown, it was unthinkable to the general public that diabetes could be a danger for youth. The survival of children diagnosed with type 1 diabetes depends on access to insulin. Based on nine years of experience,

The official magazine of RDA

March 2014 • Volume 59 • Issue 1

the global campaign

Diabetes screening on World Diabetes Day 2013, Kigali, Rwanda

Fight Against Obesity initiative and World Diabetes Day, Kigali, Rwanda

insulin and other supplies for children and young adults up to 25 years who live with type 1 diabetes. Education for Diabetes Conversation MapTM The Education for Diabetes Conversation MapTM tools have been a success for diabetes education in Rwanda. Based on IDF recommendations, the Conversation MapTM is effective for diabetes education and RDA has used these tools to improve self-management skills and to protect people from complications related to diabetes. One of our clinic patients told us, ‘I would have been dead without RDA’s help and my knowledge about diabetes saved me. Before I was desperate and

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had accidents but since I was educated with the Map tools, I manage my diabetes better and I feel confident, healthier and I am able to work’.

RDA emphasizes the importance of exercise and a healthy diet to prevent type 2 diabetes and cardiovascular diseases. Fight Against Obesity initiative and World Diabetes Day Diabetes advocacy is an important priority for RDA. Using event opportunities, together with over-weight people living in Kigali who are often afraid to show up in public, RDA launched the ‘Fight Against Obesity’ initiative by encouraging over-weight people to

exercise in order to prevent diabetes. This also provides a platform to advocate against discrimination of people living with diabetes or the obese. RDA emphasizes the importance of exercise and a healthy diet to prevent type 2 diabetes and cardiovascular diseases. Since it was created, RDA has had an average of two public events quarterly (sports, screenings, diabetes education, media events, and more) but World Diabetes Day (WDD) celebrated every 14th November is the most popular event. In Rwanda, the WDD campaign is the most important event to advocate for diabetes and involves many different, concerned people. Local associations, health oriented NGOs, the government, WHO and many other organisations join together with the RDA to raise up the voices of people living with diabetes. Diabetes Camp The very first diabetes camp for youth in Rwanda was held in the Mwulire

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Diabetes Education Centre. The objective of this camp was to resolve problems that many young people living with diabetes face after diagnosis. Most problems are characterized by a lack of knowledge about self-management vis-à-vis diabetes, loneliness, and lack of confidence in their future because many drop out of school early due to diabetes stigmatization. The slogan of our first camp in Rwanda was ‘Live better with diabetes’. Diabetes Education Centre The Diabetes Education Centre in Mwulire, set up in 2010, is the only education centre in Rwanda. It was created in order to assist youth with diabetes and help them overcome challenges. RDA realized that most youth with type 1 diabetes had no future when they passed the age of 25 and lost access to the programme that covers 100% of the necessary treatments, medicine and regular education. Their knowledge about diabetes self-management was low and they lacked vocational training or stopped their studies because of diabetes complications or poor family means. Many of the children with type 1 diabetes are very poor and cannot even afford the recommended diet.

Many of the children with type 1 diabetes are very poor and cannot even afford the recommended diet. The RDA education centre provides diabetes education, including life style behaviour education as well as vocational training to enable youth with diabetes (15-25 years) to be successfully independent after the programme. Training sessions include diabetes care, beauty salon workshops, tailoring, baking and agriculture. There are 15-20

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Campers learning about growing vegetables

Diabetes Educations Centre in Mwulire, Rwanda

youth trained at a time, for a period of six months. The programme is free of charge for all children. There have been 97 young people trained so far. Despite the efforts of Rwanda Diabetes Association, there is much more to do against an increase in the number of people who are diagnosed and an increase in people at risk for diabetes. Factors that adversely affect the lives of people with diabetes in Rwanda include poverty, discrimination, food insecurity, lack of

diabetes education and lack of organized and consistent care. Everyone has a right to efficient medical care regardless of social economic background.

Crispin Gishoma Crispin Gishoma is Director of Rwanda Diabetes Association.

March 2014 • Volume 59 • Issue 1