Interview: Diabetes in Sierra Leone

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Since learning about the charity Help Madina, I have been keen to speak to its founder, Veronica Sawicki, to learn more about the work they do, particularly in regards to their people with diabetes in Sierra Leone. The interview below gives great insight into what people with diabetes and other health conditions in Medina face. It also goes to show what a difference small group of people can make, especially when working with the local community to increase access to health for those who need it most. It is my hope that together, with groups like Help Madina and others like it, we can share best practices and join our voices together to make a bigger impact.

Can you offer some information about your personal background and why you are interested in health and diabetes in resource-poor settings?

I qualified as a doctor in 1982 and I am a General Practitioner in Gloucestershire. Like so many others, I feel passionately about global health care inequalities and I have always wanted to do my bit to make world a fairer place. Medicine is a wonderful vocation and we are called to help those who are suffering. In 2008 I booked my flight to Sierra Leone. I was to assist in the provision of health care at the Kambia District hospital which is situated in the Northern Province of Sierra Leone not far from the Guinea border.

An enduring memory from that visit is of a handsome and athletic young man sitting upright on a hospital bed, an inpatient on the male ward. The young man’s breathing was fast and labored and he looked at me with a bewildered expression laced with fear and utter exhaustion. He had clearly been struggling in this state for hours. It was obvious that he was in diabetic ketoacidosis. He had an IV infusion in place and I approached him to look at his clinical management chart. To my horror and disbelief he was not receiving any life saving insulin. I felt there had to be some mistake and so I immediately contacted the Community Medical Officer in charge. I was told that no, there wasn’t a mistake and yes, he did need insulin. The problem was that there was no insulin in the hospital. Infact, there was no insulin to be found anywhere at all. I could not take on board what I was hearing. I felt physically sick, totally and utterly powerless.

Since I qualified over 30 years ago, the management of diabetes here in the UK has been totally transformed and those living with diabetes have a longer life expectancy and reduced risks of developing diabetes complications. How on earth is it possible that another human being living just 6 hours away by plane is allowed to die quite simply because there is no access to basic lifesaving insulin? This is the twenty first century after all and insulin will soon be 100 years old. The situation beggars belief. It is a totally and utterly inhumane state of affairs.

Would you fill us in about your charity, Help Madina, including how and why it began?

Sierra Leone is a beautiful country but the human suffering amidst the poverty is impossible to ignore. During my first visit there in 2008, as well as working at the Kambia District Hospital, I also had the opportunity to work alongside an inspirational Xaverian missionary called Brother Bruno Menici, a qualified nurse from Italy who has extensive experience in tropical medicine. I met Bruno in a small rural town called Madina which is close to Kambia. It was in Madina that Bruno set up some regular medical clinics. Patients from the surrounding villages would leave their homes early in the morning and walk, often for miles, to reach the clinics where they would be seen and treated by trained local nurses. The majority of these patients were children presenting with malaria, respiratory tract infections and gastrointestinal infections.

Bruno was desperately in need of volunteers to assist with the medical work and I jumped at the opportunity to be able to help. The seeds were sown and since that time, I have spent up to 3 months every year as a medical volunteer in Madina. Our charity which is called Help Madina was registered in 2011 and together with my husband, Dr Rohit Sethi (also a GP) and my sister, Viviane Brackenbury, a Senior Orthoptist at Kings College, London, we have established up a large number of medical and community projects to serve the local population. All of the projects are entirely community led. The details of these can be found on our website

We are extremely privileged to share a wonderful relationship with the people of Madina and the surrounding villages, one which is based on mutual trust, respect and friendship.

Please share with readers a bit about what life is like for people living with diabetes (or other health conditions) in Sierra Leone.

Sierra Leone is one of the poorest countries in the world with over 70% of the population living below the poverty line. The country possesses substantial mineral, agricultural and fishery resources but is still recovering from the civil war (1991 – 2002) which almost destroyed the country’s entire infrastructure. Sierra Leone has some of the worst health statistics in the world with maternal and infant mortality ranking in the top five countries and a life expectancy of around 47 years. Following the decimation of the health care structure during the civil war, the health service is still in the process of being organized with hospitals and primary health care services being created or rebuilt and staff being trained (Sierra Leone has only 2 doctors per 100,000 of the population).

The Ministry of Health and Sanitation is responsible for organizing health care and all medical care is generally charged for (free health care for mothers and children under the age of 5years was introduced in 2010) and is provided by a mixture of government, private and non-governmental organizations (NGOs). Up to 80% of the population however relies on traditional medicine for their primary health care needs.

The Ministry has no specific policy, programme or action plan that is currently operational for the prevention and control of diabetes. There is a complete lack of diabetes sensitization and education in Sierra Leone and as far as I am aware there are few if any health care facilities specifically for the management of diabetes. So for someone living with diabetes in Sierra Leone, access to care is extremely difficult indeed. Furthermore, continuous availability of affordable and life saving diabetes medication is a major problem. Diabetes places an enormous financial burden on people with diabetes and their families often leading to severe hardship. Not surprisingly, the average life expectancy for a child with T1DM is less than a year.

Frank is 10 years old. He was recently diagnosed with diabetes. When we first saw Frank in the diabetes clinic, his mother brought with her his insulin which had been prescribed by another hospital facility. The insulin was out of date (and infact no longer manufactured). His family were paying one million leones ( approx £140.00) a month for the treatment which meant that they could no longer afford to build their home. At our clinic, Frank was shown how to inject himself with the insulin we had brought and his mother cried with happiness at knowing that her son would receive continuing supplies brought over from the UK.

Peter is 16 years old. He was diagnosed with diabetes about 12 months ago and lives at home with his family and attends school when he is well enough. He would like to be an accountant.

During the last 12 months, Peter has had insulin intermittently when it is available. Unfortunately, most of the time, there is none so he has been very ill. His mother has brought Peter to the HSH repeatedly for admission, carrying him on her back when he has been semi-comatosed. The extended family felt his mother should abandon hope of treatment and let him go. She refused to give up. Both she and Peter are now so incredibly relieved to have sufficient supplies of insulin provided by our charity.

Mohammed is 12 years old. He lives in Makeni with his extended family and has diabetes for which he receives treatment in the form of glibenclamide. He has infrequent episodes of ketosis and requires insulin intermittently. His grandfather would always take Mohammed to see a traditional healer in his native village when he was unwell.

The 3 boys and their respective families now meet up and exchange experiences of living with diabetes. In this manner, they learn from each other and the grandfather of Mohammed now brings Mohammed straight to the HSH whenever he is sick.

Help Madina has recently started a diabetes center and is trying to build a registry of people living with diabetes so that they can be connected to one another. Can you tell us a bit about that and what you hope to achieve?

Initially, there were a number of patients attending the clinics with diabetes who did not know much about their condition and there was a lack of educational material to provide information and assistance. I suggested to Dr Patrick Turay, medical director of the clinic, that I create some patient leaflets on healthy foods and diabetes. Having done these, the idea of developing a diabetes service from the Holy Spirit Hospital began to emerge and in 2013 a diabetes speciality service was launched by Patrick with the assistance of Help Madina.

The clinic opening followed a period of intense nurse training based upon the formulation of a diabetes clinic protocol. We now have a diabetes team, a diabetes register for patients and individual diabetes medical records. Patient information support has been developed and translated into the local language, including written information on diet, foot care and healthy lifestyle. Patients are provided with the opportunity to learn about diabetes, they are given health care information and any questions or fears they may have about their condition are discussed.

In addition, we are raising awareness about diabetes in the community by speaking on the radio. We have had live question and answer phone-ins. There is clearly huge ignorance about diabetes with one person asking us if diabetes was caused by witchcraft and another asking if it was a sexually transmitted condition. It would also be wonderful to start a patient group for diabetes. This is a project that we are very keen to encourage and hope to be able to launch later in the year. The long term plan is to set up a diabetes service of excellence at the HSH with a roll out of services into the community.

Access to insulin remains a problem and Help Madina is assisting in the provision of insulin for the patients with type 1 diabetes. Basically, I bring out 12 months supply of insulin with me each time I visit Sierra Leone. This clearly is not a long term solution but is the only option at present.

From your experience working with those living with diabetes in resource-poor settings, what are the most important issues faced by people living with diabetes in Sierra Leone that you would like to see changed? How can we work together to make that change?

Many problems need to be addressed. There needs to be organisation of the health system, public education and information about prevention of diabetes, accurate data collection, drug procurement and supply, affordability of medicines and care, training and availability of health care workers, patient education and empowerment, community involvement and diabetes associations and above all: strong political will. The need for change is urgent.

Before I visited Sierra Leone in 2008, I was not aware of the difficulties faced by those with diabetes in developing countries – this is despite me having spent many years here in the UK working as a doctor with a specialism in diabetes. I have spoken to friends and colleagues regarding these issues and they too were ignorant about such matters. Organisations that have social media networks such as T1International and the 100 Campaign certainly have the potential to raise global awareness and initiate change by placing diabetes higher on the global agenda. I believe this can and will be done.

Thank you so much, Veronica, for everything you do through Help Madina and for helping us to understand a bit about diabetes in Sierra Leone.

Related Post: Living in Sierra Leone with Type 1 Diabetes