"I was in danger but now I am all right"
On the screen, a man in a yellow polo-shirt is wearing a mask. He speaks in Lingala, one of the five official languages in DR Congo. “When I first received the diagnosis, I was surprised because my blood sugar was high. The result was 300mg/dL”, he explains. Although he is speaking fast, the emotion in his voice is perceptible: “I was astonished. I was also troubled.”
According to the national directives for the management of diabetes, a fasted blood sugar level equal to or higher than 126 mg/dL is a diabetes diagnosis. The man on the screen, Kabo, is among those who regularly visits the ‘Diabetes and Health’ Education Centre, one of the pioneering institutions for the treatment of diabetes in the country, and a hub for patients and professionals. “I come for the treatment [here] because I have seen where I came from and where I am now. I was in danger but now I am all right: I went from 300mg/dL to 120mg/dL.” The message is followed the names of the hospitals and health centres where people can be screened for diabetes in Kinshasa. A female voice-over concludes: “live longer, live better, get tested and treated for diabetes.”
Disseminating the message
Kabo’s testimony was shared via social media to encourage people to receive a free screening for diabetes and hypertension in Kinshasa. Kabo describes himself as a “first-hand witness” for the importance of early diagnosis. Initially a patient, he became an advocate. When he heard about the free screening campaign organised in Kinshasa, Kabo reached out to colleagues on the roadworks to get tested: “I have already brought four people here. They have already started their treatment.”
Over 10,000 people screened
The screening campaign was initiated by WHO and UNICEF, with the local support of the National Programme for the Fight against Diabetes (PNLD in French) and the National Programme for the Fight against Hypertension, both under the Ministry of Public Health. To date, over 10,900 volunteers have undergone screening. 5,595 people have been diagnosed with either diabetes, hypertension or both. For roughly half of them, this was a new diagnosis. Many people who had previously been diagnosed came back to know their status, as they could not afford to test their blood sugar levels regularly.
Dr Marie Claire Kolie, who coordinates screening activities across the 10 sites selected for screening explains the reasons behind the campaign: “When the pandemic was declared, we observed that most patients who died had comorbidities, and particularly hypertension and diabetes.” As in other countries across the continent however, many people living with diabetes in DRC remain undiagnosed and are left out of reach of the care system. “At the moment, we don’t have statistical data that could give us a picture of the real situation”, observes Jean-Claude Dimbelolo, Head of Management at the National Programme for the Fight Against Diabetes. On the basis of the available studies, “the prevalence in the Democratic Republic of Congo is estimated to be 7-15% in large cities and at least 4% in urbano-rural areas”, he observes. A lower estimate would be that 1.5 million people live with diabetes in DRC. “At least 50% of these people do not know they have diabetes.” adds Dr Dimbelolo.
Screening is only the first step
Screening is only the first step towards reducing COVID-19 mortality. Once a patient is diagnosed with diabetes, or hypertension, they begin their treatment with one of the medical teams in the hospital and care centres. For Dr Michael Mpinga, who supervises patient management at the ‘Diabetes and Health’ Education Centre, primary prevention among the general population is essential, but secondary prevention, which aims to avoid future complications, is a key element of care for patients with diabetes. “One does not cure from diabetes”, he reminds us, “but one can live long with the condition”. During the pandemic, care for patients with diabetes is more important than ever: “If their condition is controlled, they are less likely to become gravely ill”, Dr Kolie notes, speaking of the people who have been diagnosed with a comorbidity. “We explain to them how to behave and we raise their awareness on how to avoid catching COVID. We also distribute free masks and hand sanitizers.”
Long term perspective
Healthcare professionals are aware of the limits of diabetes screening and care at the moment. For Dr Dimbelolo, in addition to the cultural and psychosocial factors that may influence a patient’s ability to control their diabetes, socio-economic obstacles remain the main obstacle: “the management of people with diabetes at the level of the country is still problematic.” he says. “The daily treatment is costly, and the financial means come out of the pocket of patients.” “We don’t yet have an insurance system that can cover them adequately”.
The diagnosis campaign continues in Kinshasa. Partners in the initiative are currently investigating ways to expand the geographical scope and duration of the programme in a sustainable way.
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