Our colleague, Aracely Basurto, from FUVIDA diabetes center in Guayaquil, Ecuador, was contacted via Facebook by a young girl called Darlenis, seeking advice. Darlenis is the only young person with T1D on San Cristobal Island, in the Galapagos Archipelago, so has very little support regarding her diabetes management.
There are no specialist doctors which means that Darlenis must travel to Guayaquil in Ecuador for annual appointments. This is very expensive for the family.
Aracely says “Darlenis does not have test strips for glucose control, so every morning, noon and night she has to walk four blocks to the health center to check her blood glucose, returns home, and injects her insulin, prescribed by the doctor.”
These doses of insulin are fixed, and can only be changed by the doctor, so she must take the same dose which allows no flexibility for what she eats and the exercise she does.
On one occasion, Darlenis woke up feeling ill. Her father took her to the Health Centre, however, they had no test strips. Darlenis went home and drank some juice but felt no better so they had to travel to another island, Santa Cruz, two hours away.
There was some delay at the health center because a doctor had to order the blood glucose to be checked. By this time Darlenis’s father was frantic. Eventually she was allowed to check her blood glucose. A severe hypo was thankfully avoided.
This illustrates how the complex Darlenis’s situation is and the difficulties she and her family face.
The staff at FUVIDA have provided testing equipment from Life for a Child, and have taught Darlenis and her family food label reading so that she can adjust her insulin according to what she eats and her exercise. Acracely: “She learned that by making a proper count she can eat the food she wants and so far had been told
that it was forbidden.”
Aracely adds: ‘There are many cases like Darlenis. Children are exposed to a health system that does not accept them responsibly, and unfortunately, with this poor control, life is shortened and the chances of survival are reduced by half.’
The diagnosis of a child with diabetes can be scary and overwhelming for families anywhere in the world. Imagine having three children in one family, all diagnosed at a young age. This is what happened to a family in Indore, India.
Shivani, a diabetes educator and dietitian tells us, ‘’Divit being the eldest takes care of his both brother and sister. Not only does he puts his insulin and check sugar by himself, he does the same for both his brother and sister. We have given separate glucometers, strips and lancets to all the 3, and he takes well care to keep each one’s kit separately’’
They are a farming family on a very low income, so having three children places a considerable burden both financially and emotionally. This is where Life for a Child and The Radiance Clinic come in. We send diabetes supplies to the clinic where Dr. Sandeep and his team keep a close eye on the family.
Aditi is 10 years old, Divit is 13 and Faiyaz 7, the photo above shows the family at the clinic receiving supplies in January 2016 and the photos below show them a year later, at the beginning of February. They are persevering with the constancy of diabetes and doing well.
You can help to support families like this one by participating in the Spare a Rose, Save a Child campaign.
Conducting a camp or activity day can be very daunting for diabetes centers in less-resourced countries so we encourage all the centers we support to start small, think about doing a 2 hour support group and build from there. We give comprehensive guidance and support for the first activity, and offer a manual and ad-hoc advice for subsequent activities.
Just as in more economically resourced countries; the impact camp has on young people, cannot be underestimated:
“Then I went to camp – it was stunning. Everyone had to test their glucose and take insulin. For the whole day everyone is the same. Each summer I became closer with other campers who are now some of my best friends. I wasn’t alone, the feeling was beautiful”. Nweke, Nigeria
Nweke was 14 years old when he was first seen in the children’s emergency room in DKA 8 years ago. He was subsequently diagnosed with diabetes and supplied with insulin and strips by Life for a Child. He is now doing well and was one of the finalists in our Art competition held in 2015.
When Kate Souris, a masters of public health visited Bolivia and Life for a Child’s partner centre, El Centro Con Vivir, she reported that the education and resources provided at the diabetes centers and summer camps, ”are a relief to children and parents alike. As children learn to take more responsibility for their management and share with each other, seeing that they are not alone, parents may be able to let go of some of the fears that come from being a primary caretaker. Peers can educate and inspire among themselves, helping each other to take the condition more seriously, while providing the relief that can only come from being understood on a core level. I asked Camilla, a young girl supported by Life for a Child: “How is it to have friends at camp who have type 1 diabetes?”, she said; ”It’s a relief”’.
Make a donation and help us send more kids to camp.
Imagine not having a refrigerator to store insulin! In some countries, evaporative cooling using clay pots are an alternative to a refrigerator. No one really knew how efficient these alternatives were so Life for a Child conducted a study to find out.
Thirteen devices were used in seven countries (10 clay pots, a goat skin, a vegetable gourd and a bucket filled with wet sand), and two identical commercially manufactured cooling wallets were compared. Read the abstract below:
BACKGROUND: Insulin loses potency when stored at high temperatures. Various clay pots part-filled with water, and other evaporative cooling devices, are used in less-resourced countries when home refrigeration is unavailable. The aim of the study was to examine the cooling efficacy of such devices.
METHOD: Thirteen devices used in Sudan, Ethiopia, Tanzania, Mali, India, Pakistan and Haiti (10 clay pots, a goat skin, a vegetable gourd and a bucket filled with wet sand), and two identical commercially manufactured cooling wallets were compared. Devices were maintained according to local instructions. Internal and ambient temperature and ambient humidity were measured by electronic loggers every 5 min in Khartoum (88 h), and, for the two Malian pots, in Bamako (84 h). Cooling efficacy was assessed by average absolute temperature difference (internal vs. ambient), and % maximal possible evaporative cooling (allowing for humidity).
RESULTS: During the study period, mean ambient temperature and humidity were 31.0°C and 32.0% in Khartoum and 32.9°C and 39.8% in Bamako. All devices reduced the temperature (P < 0.001) with a mean (sd) reduction from 2.7 ± 0.5°C to 8.3 ± 1.0°C, depending on the device. When expressed as % maximal cooling, device efficacy ranged from 20.5% to 71.3%. On cluster analysis, the most efficacious devices were the goat skin, two clay pots (from Ethiopia and Sudan) and the suspended cooling wallet.
CONCLUSION: Low-cost devices used in less-resourced countries reduce storage temperatures. With more efficacious devices, average temperatures at or close to standard room temperature (20-25°C) can be achieved, even in hot climates. All devices are more efficacious at lower humidity. Further studies are needed on insulin stability to determine when these devices are necessary. Copies of the full paper are available on request. Pictures show the clay pots and devices studied, and a young boy from Sudan with the clay pot he uses to store his insulin
This has been published in full in Diabetic Med. 2016 Jul 26 DOI: 10.1111/dme.13194. Ogle GD(1,)(2), Abdullah M(3), Mason D(1,)(4), Januszewski AS(5), Besançon S(6).