Non-Communicable Diseases: They Don’t Get Toe Respect

This outstanding and astonishing piece in today's Irish Independent (originally in Health and Living) outlines the disconnect between the rise of sinister, frequently silent non communicable diseases (NCDs, of which Diabetes is front and center and diabetic foot problems are legion) to communicable diseases (such as HIV-AIDS)– in a place as horribly burdened as Haiti. Few people realize that, as of 2009 (and for the first time in human history) NCD's are responsible for more deaths than communicable diseases. As Steve Jones so aptly put it, we are indeed leaving an age of disease and entering an age of decay. 

Enjoy…
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If Jean Bernadette (56) hadn't discovered she was diabetic, she would probably be dead by now. In Haiti, where the health focus remains fixated on infectious diseases like HIV, Non-Communicable Diseases (NCDs) like diabetes are often detected late, when patients need extensive and expensive hospital care.

Yet, cardiovascular diseases and diabetes rank first and fourth in Haiti respectively, while HIV-AIDS now sits well below them in 10th position.

Jean Bernadette got diabetes 15 years ago. However, like many Haitians, she hasn't had access to the right medication or treatment.

Pointing to a gap in her right foot she tells me: “Six months ago I had to go to hospital to have a surgeon cut it off.”

A study released by the General Hospital in Port-au-Prince in 2009 shows that more than 50pc of patients in the capital have diabetic foot, with ulcers and infections in the feet standing out as the major source of death in these patients.

According to 2006 figures supplied by the Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC), a private organisation affiliated to the International Diabetes Federation (IDF), one in every 16 Haitians is diabetic.

To add to the problem, FHADIMAC's Vice-President Dr Philippe Larco explains, “the concept of a chronic disease is not understood in Haiti.

“People think that it is supernatural, some kind of witchcraft, and there is nothing you can do against it. This is a big challenge for our healthcare teams in terms of the compliance of the patient with the treatment.”

In addition to such challenges lie a lack of proper funding, data collection, surveillance, available medication and treatment.

These vital pieces in the Haitian health puzzle are all scarce commodities for diabetics, as the country's health development continues to be tied almost exclusively to more visible and campaign-ready infectious diseases like HIV, malaria and tuberculosis.

Dr Larco explains that the “cost of medication is too high and patients simply cannot afford it”.

“With more than 60pc of the population living on less than €1.50 a day, it is very difficult for a family to buy insulin on a regular basis and many of them let a parent die because the economic burden is too great.”

Both of Jean Bernadette's parents were diabetics and died from cardiovascular-related complications. Her father developed chronic kidney disease and her mother died from a heart attack that she believes stemmed from years of high blood pressure.

She shows me a diabetic glucose monitor that FHADIMAC gave her last year when they began screening for diabetic patients in the post-earthquake camps.

Unfortunately she doesn't have any test strips to use with the monitor. “I can't check my sugars without strips but I can't afford them either,” she explains.

Vicious circle

Dr Larco says that a vicious circle exists where the international community doesn't fund these silent, invisible diseases and thus “NCDs don't end up on the list of priorities for the Haitian Ministry of Health which in turn blocks funding activities related to NCDs,” he says.

According to the charity UNAIDS, in 2010 up to $145m (€100m) was used to target HIV prevention, medication and management in Haiti.

As for diabetes, less than $15m (€10.5m) was used. The country has one of the lowest expenditure rates on diabetes in the Americas with only $48 spent per person.

Ironically, the earthquake at the start of last year did spark some positive change for diabetics in Haiti, with more funding becoming available for the cause.

In April this year, FHADIMAC began work on a two-year project in conjunction with the World Diabetes Foundation to open up 12 new diabetic clinics. Mobile clinics will also be set up for patients in remote rural areas. They will all carry out basic glucose testing along with eye and feet exams.

Following the earthquake, international organisations such as Medecins Sans Frontieres (MSF) have had a strong presence in the country. Dr Andre Munger, the medical chief at one of MSF's trauma hospitals in the outskirts of Port-au-Prince, says they “are now starting to take action because of the health catastrophe posed by non-communicable diseases like diabetes”.

Later this year, MSF aim to carry out a new survey on the number of people suffering from diabetic and cardiovascular complications in Haiti. “Without proper data and statistics we'll never be able to address these issues properly,” Dr Munger explains.

In order to bring this work on to the international stage and begin to tap into possible new sources of funding, FHADIMAC will present its plan at a UN summit in New York in September.

For many diabetics and other NCD patients like Jean Bernadette, such efforts could be the difference between life and death.  

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