As I mentioned in the last post, diabetes is becoming a major health issue for low-income areas of India. It is estimated that there will be a 42% increase from 51 million to 72 million in the developed world and 170% increase from 84 to 228 million in developing countries by 2025. Studies conducted in India in the last decade have highlighted that not only is the prevalence of type 2 diabetes high, but also that it is increasing rapidly in the urban population (Ramachandran, Snehalatha and Viswanathan, 2002) Similar to the West, there are correlations to obesity and a growing trend for people to eat cheap, processed foods that are high in fat and low in nutrition. It is also believed that high rates of diabetes in gas and contaminated water-affected areas may be due to endocrine problems caused by toxin poisoning.
It’s an ongoing global challenge to address the problem of diabetes. As with smoking, alcohol consumption and sexual health, it’s easy to give people statistics and facts, and tell them what they should be doing, but far more difficult to encourage actual change in behaviours. Type 2 diabetes occurs when the body is unable to produce enough insulin to sufficiently break down sugar, usually in older, overweight adults, but increasingly in younger people too, leading to high levels of sugar in the blood which eventually affects almost every physiological system. It’s an insidious disease and many people do not recognise the importance of carefully controlling blood sugar to prevent long-term chronic health problems such as heart disease, peripheral neuropathy leading to amputation, retinopathy which causes blindness and kidney failure
(Just have to share: 50 Indian judicial magistrates have just invaded the library and a significant proportion of them are now crowded round this desk with cameras asking me what is my salary (I don’t have one), how can I adjust to the mealtimes in India (what???), if I think the atmosphere is polluted in Bhopal (duh) and if I am some kind of philanthropist to be staying here (no). And of course the four most important questions one can be asked in India. “Are you married?”, “Why not?” with a disappointed head shake, “Can I have one snap? “May I know your emailed?” Oh India I love you!)
The community healthworkers and volunteers often do diabetes health education in the bastis, and Shahanaz – the librarian here at Sambhavna – conducts a weekly health promotion session in the clinic, while people wait for treatment. We have developed a set of cloth posters (left) which are simple and clear to understand with minimal writing and bright drawings to educate people about the symptoms, effects and control of diabetes, including the use of yoga and herbal medicine to reduce blood sugar. These can be easily transported to the community or used in the clinic and can be hung on a wall or used on the floor depending on the setting. People are shown hibiscus flowers and other plants that help to reduce blood sugar and are encouraged to gather them from the garden, and yoga positions are demonstrated. Often there are one or two people listening but gradually a crowd gathers, and even people who are pretending not to pay attention give Shahanaz sideways glances and sometimes interject with the odd comment. Several people said that their blood sugar levels are much better controlled since attending the sessions.
One Bhopali woman, Saira Bano, who has had poorly controlled diabetes for some time and has resulting chronic leg ulcers (left) which cause great pain and are notoriously difficult to heal, has dropped her blood sugar from 300+ to 150, a remarkable achievement and one she accredits to Shahanaz.
Shahanaz taught me about using natural remedies for diabetes. I have been drinking bitter gourd juice and have changed my diet and now my sugar levels are better, my legs are healing much faster. It is important for people to know the natural things they can do for themselves.
We are hoping to start a peer support group, where people like Saira Bano (left: Shahanaz and Saira Bano) get involved with educating people about the realities of living with diabetes in a Bhopali basti, something that Shahanaz or me, or any doctor or nurse can never know. The obvious role will be to impart advice, answer questions and discuss what they have found to be useful in learning to control diabetes, my hope is that on a more subtle level people will feel supported and encouraged by meeting others who have learned to manage this debilitating condition, and that confidence and education within the community will grow around the issues relating to diabetes.
It is really positive to hear people talking about their successes in improving health, particularly in a way that is non-reliant on pharmaceuticals which often simply mask symptoms, instead of addressing the real underlying issues. Hopefully, increasing numbers of people will get involved, information about controlling diabetes will continue to spread and slowly people will take steps to reduce their blood sugar and make the changes in lifestyle that are necessary to prevent the illness in the first place, helping to bring about improvement in health for the people who live here.