by Sr. Marguérite De Clerck, SNDdeN
In Congo-Kinshasa, the management of diabetes in primary care is celebrating its 40th anniversary, without festivities as the local situation is still not very favorable.
Evolution of the program
The first consultation in primary care took place in the general hospital, called Hospital Mama Yemo, by Dr. De Clerck (Sr. Marguérite De Clerck, SNDdeN), assisted by 2 nurses. They are still active in the program today. A team working towards the same goal, puts their best effort today into this care, under difficult circumstances and under the direction of Dr. Kensese. In the early years, Kinshasa was growing fast and distances became increasingly difficult to cover with poor transportation facilities. We soon felt the need to decentralize: Some health centers started accepting patients from surrounding villages. This was the beginning of an integrated network of primary health care. Our doctors visited the health centers regularly and our team provided training to experienced nurses. This network of structured care became available to patients enrolled in each center. All of this is in line with the government strategies for implementing the concept of primary health care.
With two new locations per year, the city is gradually covered with health centers providing consultation for diabetes at affordable prices and at a reasonable distance from home. We are working with 80 health centers and hospitals who agreed to receive such patients using the same strategies that were developed in accordance with the recommendations of the International Diabetes Federation. The various health providers, such as medical care of the Kinshasa Diocese, the medical service of the Salvation Army, some private associations or government clinics remain responsible for the management and care in their clinics. They use simple but effective strategies that provide quality health care at an affordable price. Many doctors and health workers collaborate each day and receive a modest salary or none at all.
Patients and Program
Most of the patients are adults with type 2 diabetes. More than 10 000 attend the different clinics regularly and, on average, each year 1500 are newly registered. The clinic’s management has received various limited support over the years. This support helped overcome some crises, nevertheless it is not enough . The program is now largely self-supporting: the patient pays a flat fee for routine treatment and he or she pays for the different medications. We try to provide everything at a reasonable price and, subsidize treatment if possible. However, the real tragedy takes place when hospitalization is required. The hospital stay can be long, especially if it’s a foot problem or gangrene. Consequently, the hospital fees rise and become too high for a family of modest means. We do our utmost best to prevent complications by all possible means, and by educating patients and families through preventive care, provided during a consultation or in our education center.
Education: Top Priority
Training is a priority in numerous workshops and professional training sessions in a program for nurses and physicians. Each year, usually 100 -150 participants receive a certificate. Interest remains strong and we have to limit the number of candidates. Other education programs for patients, families, nurses, doctors are sometimes made possible through occasional support from various organizations. The challenge is enormous in a city with more than 10 million inhabitants. A recent study revealed that the prevalence of type 2 diabetes is at least 5 % of the adult population. Assuming that half of the population of Kinshasa is older than16, this means that 250,000 people need guidance, advice, monitoring and treatment.
To better organize education, a house in Limete has been rented. Here beats the heart of the educational activity: We give courses, workshops, seminars. Each young person learns how to control diabetes in the Wednesday session each week. We sell booklets that help patients and family caregivers in dealing with diabetes. Courageous volunteers are helping with the management of the center. Nevertheless, fixed expenses are not to be neglected and we need help to carry on this important activity.
Need for funding
In 2000, Sister Marguérite De Clerck set up a specialized consultation for young children and teenagers. They felt lost between the adults who sometimes had to deal with many complications. Since 2003, “Life for a child,” a department of the International Diabetes Federation, has been giving us excellent support. In 2010 the pharmaceutical company Novo joined to assist young people in four clinics that were specifically organized for them. Here, everything is free; insulin, syringes, equipment to measure blood sugar. All of these young people have type 1 diabetes which is usually difficult to treat. As they become adults, such persons are in need of lifelong treatment which is relatively expensive. We have not yet found a solution to help these young adults correctly. A team of caregivers who supervise these patients must be trained , but there must also be a way to deliver insulin and monitoring equipment at a subsidized price.
More and more young doctors or nurses are interested in the treatment of diabetes integrated in other health care issues. Funding remains difficult. The most important support usually goes to programs such as AIDS Tuberculosis, malaria, trypanosomiasis, vaccinations. There is a significant imbalance. There are ten times as many people worldwide who suffer from diabetes than from AIDS.
Our vision for the future
This year, we put most of our effort into training. We need to educate more people to allow better care and avoid costly complications of the disease, including foot problems, gangrene or kidney failure. Doctors and nurses need regular training. Occasionally our teams are even invited to other African countries especially to share their knowledge and difficulties. We try to encourage initiatives in the different provinces who are taking interest in diabetes even though they are often living in difficult conditions. The cries for help are frequent and moving. This is a task for the future, which is in the hands of our young and enthusiastic team of caregivers, hand in hand with patients and their families.