In this interview Yemurai highlights some pretty tough situations, noting that diabetes supplies are incredibly expensive for some people and ‘’Because of these high prices some people go for weeks without insulin because they simply can’t afford it or because they do not have any medical insurance to cover some of their medical costs.’’ However, she wants to work on ways to prevent these problems to make life better for people living with diabetes in Zimbabwe, and Africa as a whole, and she feels that more awareness and better education for nurses is part of the solution.
Can you tell me a little about you and your background in regards to diabetes?
My name is Yemurai Machirori. I am a 20 year old lady from Zimbabwe. I was diagnosed with type 1 diabetes in September 2004, a month before my 12th birthday. “I want to help children like me”, were the words I said to my mum when she took me to hospital on the night that I was diagnosed with diabetes and I am glad that I am finally working on that. I am greatly involved with the Zimbabwe Diabetes Association, helping them with screenings and diabetes education.
Accepting that I was diabetic came almost naturally because I had grown up seeing my mother taking shots so it really was nothing new to me. Even though I had come to accept it in my years in junior school, things came to change when I went to senior school as I was now in a new environment, with new people that did not understand me. My experiences made my passion towards helping children with diabetes grow even stronger.
You are an International Diabetes Federation Young Leader in Diabetes (YLD) - how did you find out about the programme and what does it mean to be part of the Young Leaders group?
I found out about the YLD programme through Zimbabwe’s first young leader, Stewart Tembo. Stewart had served as my diabetes counsellor and mentor. I had often complained to him about how there were no activities which involved young people with diabetes in Zimbabwe. It was after my constant nagging about wanting to be a peer educator and children’s counsellor that he introduced me to the YLD programme. It was probably my perseverance and passion that let him to consider my abilities.
Being part of the young leaders group is an unexplainable feeling for me. It has brought so many opportunities for me and above all, it is helping me in my campaign to help children who are living with diabetes in Zimbabwe. My campaign involves the project that I will be discussing in Melbourne.
What are the general economic conditions in Zimbabwe and how they might affect people with diabetes?
Zimbabwe is a beautiful country that is bordered by South Africa, Botswana, Zambia and Mozambique. Zimbabwe’s economy is stagnant and is still recovering from the 2008 hyper-inflation period. The country has low economic growth of about 2% and high interest rates which makes it costly to borrow money and not worthwhile to save. Disposable income is automatically low for employees because of salaries that are not adjusted for inflation.
Because of the high prices in the country, diabetes supplies become automatically expensive, and out of the reach of the ordinary person. Because of these high prices some people go for weeks without insulin because they simply can’t afford it or because they do not have any medical insurance to cover some of their medical costs.
For some of us it is probably unimaginable to think that people are forced to go for weeks without insulin. Could you explain a bit more about the healthcare system and medical facilities throughout the country, with a focus on diabetes care?
The healthcare system in Zimbabwe is divided into two – the public system and the private system. The public hospitals try to sustain those people that cannot afford medication, giving insulin and diabetes related medication and products to people who cannot afford to go to private doctors and specialists.
At these public hospitals children under the age of 18, as well as those people above the age of 65, get free insulin and free check- ups from the doctors there. However, it is not always possible for everyone in line to get medication because of the high demand. Some people will be forced to stop taking insulin because they cannot afford it. Because of the big numbers of people that the doctors have to attend to, they may not have enough time to do full body checks as these may take time. As a result, some diabetics do not go for basic eye tests, foot care, as well as dental checks because of the exorbitant prices charged for the services. They may therefore go only when they get sick.
In the private hospitals, however, one would find that more care is given to people with diabetes, with constant checks from the nurses and doctors. Queues are shorter at private specialist’s surgeries and service is a lot more efficient. However, they are more expensive and are beyond the reach of most people.
It is important to note that if one does not have medical insurance (medical aid) they will most probably not be able to get medication.
Insulin may cost up to USD $9 per vial for someone who does not have medical insurance and only USD $3 for a person with insurance.
What might you say is the most important issue or problem for people living with diabetes in Zimbabwe that you would like to see changed?
The price of insulin and other diabetes supplies is definitely a problem that needs to be adjusted in Zimbabwe. It doesn’t make much sense to me that a person does not inject themselves for more than two days all because they cannot afford to buy insulin. I think insulin prices must be made affordable to the general public and given for free to those that cannot afford it. In this day and age, I believe that no one must die because they cannot afford insulin, it has become such a necessity to most people and people must start taking it seriously.
Is care and access to medicine different depending on where you live throughout the country?
Access to medicine is definitely different across the country. One will find that insulin is cheaper in the big cities and more expensive in small towns. A vial could be $6.00 in a big city and $12.00 in a small town, something that doesn`t make sense at all. Care is also different across the country. The nurses in small towns sometimes have no education at all about diabetes or if they do, they take it for granted. Some clinics in the small towns even lack diabetes care instruments such as glucometers and insulin, and people with diabetes have to travel to the big cities for these regular check-ups. Sometimes these small clinics cannot even afford to screen diabetes.
What happens to people who cannot afford to visit the physician or who cannot access their insulin supply? Is there anywhere else for them to turn?
People who cannot afford to visit the physician usually go to their nearest Zimbabwe Diabetes Association (ZDA) office for assistance. The association always tries to help those people who cannot afford to get insulin. It also gives diabetes education to people who cannot afford to visit physicians. The association also refers patients to hospitals and physicians. However, in some parts of the country some people will opt to go to traditional healers or herbalists for “alternatives”, which is very dangerous.
It is so great that the ZDA exists to help those that it can, but horrible to hear that people are still without insulin! Can you discuss any other factors that may help lead to more adequate care for people living with diabetes?
I think acceptance by society would definitely help lead to more adequate care for people living with diabetes. If people start appreciating that diabetes is just as important and serious as HIV, then diabetic care would also be a set priority. Offering diabetes education to the nurses, especially those in the remote areas of the country, would also help lead to more adequate care for people living with diabetes because once they have been educated, they will stop taking diabetes lightly and instead start fighting towards its prevention.
If you could share one main message in regards to diabetes in Zimbabwe with your government or anyone reading this, what would you say?
Diabetes is on the rise, especially among the young generation and it is up to us to try and prevent the spread of diabetes through education and acceptance of the ailment. It is time for us to start making noise about diabetes. Every diabetic voice has to be heard and no one must die of diabetes. Gone are those days!!
Thanks so much, Yemurai. It is wonderful to feel your passion and enthusiasm though your words. I know there are many of us who agree with you that gone should be the days when people are dying due to their inability to access or afford insulin and supplies. I look forward to working with you and others to put an end to that for good.