Diabetes, which some loosely call sugar, has emerged as one of the deadliest silent killers in Malawi due to many factors, including changing life styles—evident in less physical activity and consumption of junk food—and ignorance on the causes of the disease.
In this FRIDAY SHAKER, Feston Malekezo, highlights challenges which diabetes patients face, how the country is responding to this killer and what ought to be done to limit this.
Over the years, diabetes has become one of the major diseases that claim lives of many Malawi.
Diabetes is a condition that impairs the body’s ability to process blood glucose, otherwise known as blood sugar. Though not everyone with diabetes will notice symptoms, including those with a diagnosis, some of them include excessive thirst, frequent need to urinate, increased night time urination, weakness, tiredness and blurred vision. A person may also notice that wounds and infections take longer to heal.
Though we cannot independently confirm, Diabetes Association of Malawi estimates that at least five people die of the disease in the country daily. And more people are struggling with the disease.
Victor Seyani from Bangwe Township, Blantyre, is among the many Malawians that are battling with the disease.
Sometime last year, Seyani was aware that at Queen Elizabeth Central Hospital in Blantyre, diabetic clinic sessions took place twice a week.
Seyani, who was diagnosed with the disease 10 years ago, was happy with the arrangement as having the two sessions eased congestion at the referral hospital, the sessions were clear and healthcare treatment was above par.
However, all that changed when the sessions were reduced to once a week.
“I come from Blantyre rural meaning that I need to source money for transport to attend the sessions and receive medication. There have been instances when we come to the hospital only to be told to buy drugs on our own. That aside, the issue of syringes we use for insulin are given in small rations. The requirement is that a syringe is non-reusable but we reuse them because we have no alternative,” he said.
During the sessions, the diabetic patients are screened and receive drugs according to the level of vulnerability and diabetes type.
The association said most deaths caused by the disease are due to, among other reasons, ignorance, negligence to get screening and treatment and lack of proper healthcare.
The association’s National Coordinator, Joseph Phiri, agreed with Seyani on the short supply of syringes used in injecting insulin for type two diabetes clients in some public hospitals of the country.
He emphasized that the least one can get is 10 syringes out the recommended 60.
Clients, who use insulin, inject themselves twice a day and require at least 60 syringes in a month.
Insulin is a hormone that is responsible for allowing glucose in the blood to enter cells, providing them with the energy to function.
According to the association, about five percent of the country’s population is diabetic.
“The least one can get is 10 syringes to be used for the whole month. This is common mostly in central hospitals and a few district hospitals. It is a sad development because a patient living with diabetes can easily be infected. If you talk about sterilization, that is a non-starter because, come to think of a local Malawian in the village, will that person be able to manage?” Phiri said.
He said most people die of diabetes due to ignorance of the chronic disease.
Phiri’s assertion is backed by Willis Kalitera, Managing Director of Diabetes Awareness Association.
Kalitera said rural Malawi, which makes up over 80 percent of the population, has the highest diabetes incidences in Africa.
He said many are ignorant of the symptoms or attribute them to witchcraft.
“For example, someone can have a swollen leg and they will believe they should step on a ‘magic pin’. Many turn to traditional healers. Sadly, most cases go to the hospitals at a late stage and some don’t even make it that far,” Kalitera said.
“Diabetes, like many chronic conditions, is overshadowed by HIV/Aids in most if not all developing countries. Today 1,800,000 Malawians are HIV positive and 1 percent of these patients are diabetic. Cases of type 1 diabetes and HIV are only found in urban populations and very few in the rural areas.”
He said the disease has become more dangerous as it is strongly linked to hypertension, or high blood pressure, which many people are not aware of; hence, the need for massive awareness.
This is one of the reasons Mzuzu Lions Club is conducting fundraising activities such as big walks to enhance awareness of the disease.
Mzuzu Lions Club Secretary, Symon Gondwe, said they are raising awareness about type 1 and 2 diabetes through the Blue Fundraiser to finance similar initiatives in other districts such as Chitipa and Karonga.
“We wish we could do more but we are constrained by lack of financial resources,” Gondwe said.
Though there has been limited research on non-communicable diseases (NCDs) in general and diabetes in particular in Malawi, International Diabetes Federation studies indicate that quality of care for diabetic patients in the country leaves a lot to be desired.
A 2015 report published in Malawi medical journal indicates that the prevalence of diabetes in Malawi is at 5.6 percent among adults aged between 25 and 64 years.
The report says another factor contributing to the prevalence of diabetes in Malawi is its relationship with HIV and Aids which increases the risk of diabetes.
But commenting on the issues raised, specifically on the short supply of syringes, Minister of Health spokesperson, Joshua Malango, said they strive to maintain standard levels of drug and equipment supply to all its hospitals.
Malango said in 2019 the ministry did extremely well by reaching an average level of over 70 percent from around 40 in drug supply.
His sentiments come when in September last year, Malawi received the United Nations Interagency Award for the prevention and control of NCDs.
On the numbers of people dying because of the disease daily in Malawi, Malango doubted the authenticity of the diabetes’ association’s figures.
Meanwhile, his counterpart at Central Medical Stores Trust, Herbert Chandilanga, has said consignment of the syringes has arrived in the country and by today central hospitals should be able to receive them.
“Yes, we did not have the medical supplies but coincidentally, the syringes are here. We will be making deliveries and by tomorrow [today] all central hospitals should have the consignment,” he said.
In the 2019/2020 financial budget, the Ministry of Health received K101 billion with K25.9 billion meant for the procurement of drugs, of which K10.6 billion is for central hospitals, K15.3 billion for district hospitals and K5.8 billion for ambulance procurement.
Commenting on the matter, health rights activist Maziko Matemba said although efforts are there more needs to be done.
“Challenges are there mostly because of resources. If you noted, most partners fund other programmes such HIV/Aids, TB [Tuberculosis], malaria, vaccines such pneumonia and maternal health, but not diabetes. To make matters worse, diabetes is also affecting people in rural areas unlike in the past when it used to attack urban dwellers,” he said.
World Health Organisation (WHO) says diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
In 2016, an estimated 1.6 million deaths were directly caused by diabetes in the world.
Among other ways, WHO says healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways of preventing or delaying the onset of diabetes.