In my last year of pharmacy school at Purdue University, I was fortunate enough to travel to Kenya for a 2-month rotation where I worked in the country’s referral hospital. I was ecstatic to learn and grow as a clinician with this experience; however, I was a bit worried about managing diabetes in an underdeveloped country. As I was preparing to depart for Moi Teaching and Referral Hospital (MTRH), I began to stockpile as many supplies as I could fit in my suitcase. I had 6 vials of Humalog, 1 vial of Lantus (for emergencies), a back-up travel pump, 2 glucagon injections, 8 sensor sites, a large pack of AAA batteries, and sites and reservoirs to last me probably a year. Not to mention a carry-on suitcase filled entirely with fruit snacks, which resulted in me receiving many peculiar looks from TSA personnel. It wasn’t until I had the opportunity to work in the diabetes clinic at MTRH that I realized how truly blessed I am to have been diagnosed with type 1 diabetes in the United States.
While shadowing in the diabetes clinic at MTRH, I was able to learn a great deal about diabetes in Kenya. Due to the lack of resources, only a select number of patients are accepted into the MTRH clinic. Patients pay for the insulin at a wholesaler’s price if he or she is able to, but if not, they receive the insulin for free. Patients also receive needles and blood glucose testing materials; however, they are required to reuse needles and ration test strips in order to make the supply last longer. The most innovative concept I saw there was the “homemade insulin cooler”. Pictured below, the insulin cooler is a clay pot that is filled with coals. The patient puts his or her insulin in a glass jar in the middle of the pot, puts water on the coals, and then sets it in the shade. And wa-la! An insulin cooler for patients that do not have electricity or a refrigerator.
One thing I learned about the Kenyan culture is it is not rude to ask questions or point out differences. When the wards got too hot from the afternoon heat, I would often take off my white coat while working. Little did I know that the Dexcom sensor on my arm made me just short of a celebrity. Every day I would be stopped and asked, “What is on your arm?” One gentleman did not believe the sensor could do what I advertised, so I proved it to him with a simple glucose check on my meter. When the readings were virtually the same, he was amazed.
Inside the hospital, it was easy to describe what the device on my arm was; however, educating a tribesman that spoke little English in the middle of the Serengeti Plains proved challenging. Since diabetes, type 1 or 2, isn’t largely prevalent in this part of the world, he had no clue what I meant. The word I landed on to describe the sensor was disease, which he then proceeded to tell all the other tribesmen when asked. I think they took pity on me after that because I got some great deals on souvenirs!
Lastly, I want to share with you my experience with Sammy. Sammy is a Kenyan male who was diagnosed with type 1 diabetes at the age of 14. From age 14-18, Sammy was constantly in and out of the hospital with DKA. It wasn’t because he didn’t have access to insulin or didn’t know how to take care of himself. It was because his family simply believed in traditional curative medicine. Instead of taking insulin daily, Sammy would drink herbal supplements, he would go to a tribesman that promised to cure him, and he would pray constantly for a cure. It wasn’t until Sammy was 18 years old that he finally realized the only thing that made him feel better was insulin. Can you imagine having to beg your mother to take a life-saving medication? Sammy can because taking insulin went against his whole familial belief system. Not only that, but insulin was also expensive for his family to afford on a yearly salary of $15,000 USD. Sammy was fortunate enough to have been accepted into the diabetes clinic at MTRH. Here, he was able to receive free insulin and testing supplies, and his HbA1c went from above 15 to below 10 for the first time in his life. Sammy, now 28 years old, works in the diabetes clinic and helps patients that were just like him.
My learning and growth in Kenya was exponential. I knew that diabetes came in many shapes and sizes, but the greatest thing I learned was that diabetes comes in many cultures as well.
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