For people living with diabetes, renewing medicine prescriptions regularly is an inescapable part of the journey to living a normal life. Luleka Mzuzu, a young mother of three who was diagnosed with Type 2 diabetes five years ago spells it out matter-of-factly: “if you default on your medication, you are going to be sick”.
Luleka lives in the Kayamandi township in South Africa and is passionate about education and self-empowerment. During the day, she is a training assistant in a private medical clinic in Stellenbosch; in between her working hours, she coordinates the Ikaya diabetes support group, a community of about 35 women aged 30-70, living with diabetes.
“We are focused on motivating each other and getting more information about diabetes” Luleka explains. “We want to know the ins and outs of living with diabetes. If we don’t know it ourselves, we outsource it and bring in third parties who can advise on how to live positively with diabetes.” Luleka is very active outside of her community: she is a member of Diabetes South Africa and a PRO member of Diabetes Africa.
The COVID-19 pandemic upended the normal activities of the group. As the number of cases and deaths rose in South Africa, social distancing measures were put in place. Regular face-to-face meetings for the group became impossible. In addition, it became difficult for group members to get their medication and move around, as restrictions applied to public transportation as well. “From March onwards, people were no longer allowed not go inside the clinics: everybody had to wait outside, which made things difficult, particularly in June-August, during our winter months” Luleka explains.
The majority of women in Luleka’s group are aged 50 and over and are therefore at a higher risk of complications from COVID-19. The pandemic presented them with a dilemma, which Luleka describes succinctly: “when you default on your diabetes medication, your situation will worsen. But if you leave your house and go and fetch your medicine yourself, you are taking the risk of going into the crowd and contracting the virus. It’s a lose-lose situation.”
Margot McCumisky, National Director of Diabetes South Africa, acquiesces and sympathises with this situation: “some people have said that they would rather go without their meds than take the risk of traveling to the clinics and sitting in the queues all day”, a tragic situation in many regards.
In a recent poll conducted by Diabetes Africa, 28% of respondents indicated that they were having issues picking up their medicines from the pharmacy during the pandemic. But the number of patients who have taken the risk of exposure to the virus to avoid missing out on their medicines is unknown. Several members of Luleka’s group did catch COVID-19 over the past few months and one of them sadly passed away.
Designing a solution for third-party medicine supply
Luleka contacted Diabetes Africa for advice. A message came from her late one evening in July: “my engine is working overtime to try and minimise the exposure for my group members when they go fetch their medication at the clinic. I want to speak to the community clinic manager and have them give me the medication so that I can deliver them to the members of my group, and not have them wait long outside of the clinic and be exposed to COVID-19. This will help the clinic with their workload and get people with diabetes to stay home and be safe.”
In low-resource environments, not all solutions are high-tech. Working with the Ikaya group and Diabetes South Africa, the Diabetes Africa team proposed a form to give authority to a family member or a trusted third party to pick up medicines on behalf of a patient.
“When I first heard about Luleka’s problem, I tried to put myself in the shoes of the healthcare professional, being a pharmacist myself” explains Bernadette Adeyileka-Tracz, founder of Diabetes Africa, and an adviser on the initiative. “In a community pharmacy setting, it is not uncommon to know the husbands and wives of patients: you get to know the regulars. But with the pandemic, we are not in a normal situation. The volume of demands for third party pick-ups increased dramatically. To cope with this, there needs to be a reliable system in place, one that makes the patient and the healthcare professional comfortable and limits the risk of abuse.”
“When Luleka came to speak with us about the challenges she was having. I wanted to do something while ensuring that the solution would be workable for others, in Africa and beyond” Bernadette Adeyileka-Tracz says. “Because the challenges that her group is facing are not unique.” Diabetes Africa worked with Luleka and Diabetes South Africa to conceive a pilot that was successfully tested by the Kayamandi group in September 2020. “I am proud that we were able to create a solution to her problem in such a short timeframe, given that diabetes patients are at a higher risk of complications from COVID-19.”
How the process works
Diabetes Africa, in partnership with Diabetes South Africa and the Ikaya diabetes support group, created a solution to allow trusted third parties to deliver medicines to diabetes patients: a single-use authorisation form authorising a family member, carer or a friend, to collect medication on behalf of the person living with diabetes.
The form ensures that all necessary information and authorisations are provided to the pharmacy and allows healthcare professionals to check the validity of the document directly with the patients. Patients need to print a copy of the form, fill it out with their details and the details of the representative. Both parties then sign the document, which is delivered by the representative to the pharmacy. A form of identification is required from the representative. The pharmacy keeps a copy of the document for reference.
Some pharmacies will have their own policies and procedures in place, and there is no guarantee that this form will be accepted. The team at Diabetes Africa is however interested to receive feedback on this form and learn to improve the process. Click here to contact Diabetes Africa via WhatsApp.