“We have run the tests. I’m sorry to tell you that you have
diabetes.”
To an American, these words hurt. They straight up suck. If
I were to hear them, I would cry. I mean, I have to prick my finger a few times
a day and sometimes give myself injections of insulin. If not properly handled,
I’ll have to wear unfashionable orthopedic shoes to deal with foot issues. I’ll
have to be aware of my diet in whole new ways.
The worst part? Inconvenience. The best part? Living.
To a Swazi, this is a death sentence. There aren’t blood
pressure monitors here that I have seen; if there are, then they are not priced
where people could buy them easily. There are no injections of insulin. Swazis
take a daily pill to treat some of the symptoms, but there is no available
treatment for diabetes in this part of the developing world.
The worst part? Death. There is no best part.
I frequently find myself faced with health conditions here
that I hadn’t even heard of 7 months ago. I never knew that an infant could die
of a heart attack (kwashiorkor). I never imagined a condition (diabetes) that
my grandmother lived with for so many years can be fatal in just a few. I never
thought I would see polio. If someone I knew had fever, chills, and body aches,
I would think that toughing it out for a few days wouldn’t be fatal, but the
type of malaria here (Plasmodium
falciparum) can kill just 48 hours after symptoms appear.
There is no pill to fix hypertension. There is no time for
exercise when you have fields to tend, children to raise, and chores to do.
There is no chemotherapy for cancer. There are no inhalers for asthma, which is
a very common disease due to severe air pollution.
“I would rather have HIV than be diabetic in Swaziland.”
This was said by a health professional here in Swaziland. One in three people
in the entire population have HIV, and among women of childbearing age that
number is one in two. HIV is easy. You get ART (antiretroviral therapy) free
from the government, use a condom from now on, and live out your life (granted,
life expectancy here is 32). When you have a population that was and is hit
this hard with HIV, you master the treatment. My village has a tiny little
clinic that doesn’t even hold antivenin for seriously fatal snakebite, but they
manage ART for this community and some Mozambicans that hop the border. They
may not have malaria treatment, but they have an expert client on staff to talk
to people about what it’s like to be HIV positive. Pills for diabetes aren’t
available, but I can get a free rapid HIV test any time I want (I can’t even do
that in the US – for information, read my research team’s papers).
Healthcare in Swaziland has been shaped based on an epidemic
of proportions modern America can’t even imagine. HIV here wiped out an entire generation,
which I am painfully familiar with as I work with their orphans. Now that the
epidemic has been addressed, the other diseases now have time to be addressed.
Time, however, isn’t the issue; as with all things here, it’s money. America
can manage diabetes, but those solutions can’t be applied here unless drug
companies are willing to make drugs cheap and someone is willing to give the
patent to a company that will manufacture blood sugar monitors at low cost
here. Donations would also help, but who would donate monitors to a dying
family in rural Swaziland in a village where you can’t pronounce the name or
even drive on the roads? My village isn’t even on Google Earth. Seriously, you
can’t zoom in and it’s in black and white. Thanks, Google.
My American friends and family, appreciate the privilege we
all have with our healthcare. Yes, it’s expensive. Yes, the insurance company
is a scheme where a few people get rich and we all still pay out the ears for
basic care. Yes, an ER visit can seriously screw your finances. However, if you
go to an ER, they’ll have treatment in stock. Doctors, though expensive, have
the treatments available to take care of you.
Diabetes isn’t a death sentence for us. I vow, as a future
public health professional, that I will not rest until it stops being a death
sentence for the people that I have come to love. The highest attainable
standard of health is a basic human right*, so who exactly is human enough to deserve that right **?
I think we all are.
*Harvard School of Public Health
**Dr. Paul Farmer, Partners in Health
