The Herald (Harare)

10 September 2002

Zimbabwe: Plight of Diabetes Patients

Harare — Enock Mutizwa Mvenge is an energetic boy doing Upper Sixth at Mount Pleasant High School in Harare.

This teenager spends his spare time playing the guitar and composing gospel songs. He recently won a television contest for young talented musicians and earned himself $15 000.

Enock is also one of the Sunday schoolchildren that accompanied the Upper Room church choir in the city centre and recorded a CD called Komborera, together with Prudence Katomeni and Prince Mafukidze, in Canada about three years ago.

His friends call him "Mtukudzi junior" because he plays Oliver Mtukudzi's songs with so much passion and he wishes to pursue a career in art and music.

"I have applied to study music at Thames Valley and Ealing Universities and that is all I wish to do because music inspires me so much," said Enock.

The young man is lively, ambitious and optimistic about life. But behind this bright and outgoing figure is a story of a person struggling and dicing with death every moment of his life.

He has diabetes type 1.

This condition requires injection of insulin into his body everyday because the pancreas that releases this insulin does not function.

"I am just as good as having no pancreas at all and imagine living a life knowing you can die any time if I fail to get the drug which is in short supply at the moment and unaffordable," said Enock, who turned 18 this year.

His initial reaction to the disease following a blackout in Glen Norah about four years ago was that of shock and denial.

"I just could not believe it. Couldn't imagine a life without chocolate. I wish someone could bring me a sugar-free chocolate," said the young man.

The normal sugar levels in a human are between 5,5 mmol/l-5,7 mmol/l on a glucometer.

"My sugar levels had reached 38,8 mmol/l and that was catastrophic. But I can actually live a close to normal life only if the drugs were readily available," he said.

Late last year, a monthly prescription for his drugs Isophen and Actrapid cost an average $1 500 but the figure has since risen to over $21 000.

A city pharmacist described the price of diabetes drugs as shocking and gave an example of Actrapid that was being dispensed at $25 507 for five pens, which can only last for a month.

"Most diabetes drugs now range between $9 000 and $30 000 depending on the combinations because they are imported," said a pharmacist along Nelson Mandela Avenue in Harare.

Enock complained bitterly about the lack of awareness on diabetes and other diseases that have been overshadowed by the HIV/Aids pandemic.

No single week passes without reading or hearing a story on both electronic and print media of how the Aids pandemic was wreaking havoc in the country.

One would think it was the only terminal illness that was afflicting the nation.

"My dad died when I was in Grade One and my mother is an unemployed widow. I am surviving at the mercy of my three sisters and their husbands . . . but for how long?"

Some consequences of diabetes include leg amputations caused by gangrene, loss of sensation, loss of eyesight, liver degeneration, and inner bleeding to death because of varicosis of the esophagus and renal atrophy.

An example of a person who lost his sight due to this condition is Sekuru David Tapera Hunda (68) of Ridgeview in Harare.

He solely blamed doctors for his demise, saying, although he had complained to them about the constant thirst and frequency in urinating, which are some of the symptoms of diabetes, they never bothered to test for the condition.

"It all started in 1992 and even had spectacles prescribed twice by two different doctors.

"But my eyesight worsened in 1996 and none even mentioned about having a diabetes check. Now all I see are shadows," said Sekuru Hunda, who suffers from Type 2 diabetes, a condition where the body still makes some insulin, but cannot use it properly.

In March this year, a Form Two student died after falling in a diabetes coma for three months.

Speaking to The Herald this week, a brother of the deceased, who is a public relations officer with a leading parastatal, expressed hurt and disappointment about the erratic availability of diabetes drugs.

"I don't want to talk much about it because I still feel very bad about my sister's death. We did everything to try and save her life by acquiring our own glucometer.

"We used this gadget to check her fluctuating sugar levels because there seems to be no special attention for diabetes patients in this country," he said

The teenager died at a leading private clinic that had only one glucometer, an issue that angered the family considering the amount of money they had pumped out during her three-month admission.

"Palliative care does not exist anymore and the reality is there are no drugs and diabetics will die painfully from a condition that can be controlled.

"Just imagine, how are the poor people with this condition managing? This is devastating because I lost a sister, who was so full of life," he lamented.

Zimbabwe's health system is presently under a crisis as all health support staff have been on strike for nearly a month now.

A report in The Herald mentioned diabetic patients as having waited in agony to have their sugar levels checked.

The 14 dieticians at Harare Hospital, for example, who offer these patients special diets are on strike, leaving them exposed to food that is detrimental to their health.

Head dietician at the hospital Mr Roy Chiyanga said he was catering for the critical patients at the intensive care unit, which meant that all other patients with life- threatening illnesses like hypertension, asthma and cancer were likely to face serious problems.

A local physician said he was increasingly attending to diabetes, asthmatic, high-blood pressure and hypertension patients who were faced with sudden death if these conditions were not properly monitored by drugs.

"The major problem facing these patients is affordability of these drugs which are vital to their survival.

"Strokes are also on the rise and it is necessary to have drugs that control these conditions before they are fatal and it is every doctor's duty to check patients' blood pressure levels," said the physician.

However, a mock survey has revealed that a simple procedure of that nature is not done during any visit to a doctor.

A few years ago, nurses did random tests for blood pressure along First Street and they noted lots of people whose blood and sugar levels had shot to dangerous levels.

Most of them were not even aware they suffered these conditions and one woman was actually ferried to hospital because a stroke was imminent.

There is an estimated 100 000 people known to be suffering from diabetes in Zimbabwe but the figure could be higher as most people come to hospitals when damage has been done.

Mrs Juliet Musengi, an official with the Ministry of Health and Child Welfare, said there had been over 100 percent increase in new cases between 1996 and 2000.

She admitted that it was becoming difficult to control the disease as drugs had become too expensive for the ordinary person.

"We had successfully lobbied for subsidies for these drugs but the lack of foreign exchange has resulted in the drugs not being purchased through the normal channels," she said.

Although causes of this condition are not known, it is a genetic and highly inherited disease. It is also known as a diet and lifestyle illness that has gained so much momentum in the last few decades due to changed eating habits.

"If nothing is done now to control this condition, we will pay the price in a very big way," said Dr Stanley Midzi, deputy director, disease prevention and control, in the Ministry of Health and Child Welfare.

Zimbabwe has paid the price of not having brought the HIV/Aids pandemic to the fore when the disease was discovered in the early eighties.

Over 2000 HIV/Aids-related deaths are recorded every single day and a cure is still a pipe dream.

What is diabetes?

Diabetes is a metabolic disease. It arises when there is a lack of a certain hormone, insulin, which must be present to enable cells to take up glucose from the blood.

This has two consequences - the cells starve in spite of the abundance of glucose in the blood, which cannot be used.

This starvation in the long run has negative effects on the whole functioning of the organism - the level of the blood sugar is increased and damages the walls of the blood vessels.

The effect is diminished blood supply to all organs, with all sorts of results like blindness.

There are two kinds of diabetes.

Type 1 diabetes is usually found in children. It arises when the body stops making insulin completely.

In type 2 diabetes, also called adult onset diabetes, the body still makes some insulin, but cannot use it properly.

Most adults with diabetes have type 2 and this condition accounts for 90 percent of all diabetes cases.

When food is digested in the stomach and intestines, carbohydrates are broken down into sugar molecules or glucose.

Glucose is then absorbed into the bloodstream, and blood glucose levels rise. This rise in blood sugar normally signals special cells in the pancreas, called beta cells, to release the right amount of insulin.

Insulin allows glucose and other nutrients such as amino acids from proteins to enter muscle cells. There they can be stored for later use or burned for energy.

When the body has a problem making insulin or the cells do not respond to insulin in the right way, diabetes results.

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