On this piece, TOPE OMOGBOLAGUN writes concerning the pains and the harrowing tales of diabetic sufferers whereas they wrestle to entry medical companies from drained and inadequate specialists
The sight of affected person information stacked on the cabinets organized at a piece of Diabetes Clinic of the Lagos State College Educating Hospital in Ikeja would startle any first timer. Some metres from the spot, sufferers filed in the direction of the dietician’s workplace, ready eagerly for his or her flip. There was a spillover of outpatients – younger and previous – in an enclosed compartment adjoining to the physician’s workplace. Whereas a few of them trying drained or half-asleep had been fortunate to get seats, others hung across the premises.
57-year-old Tunde Onasanaya was visibly pressured when our correspondent took a seat beside him. Onasanya, who needed his actual title hid to keep away from being victimised, later revealed to Saturday PUNCH that the tiring wait had turn into his lot since he was identified with diabetes 10 years in the past.
“I’ve been right here since 6am,” he mentioned, checking his wristwatch which had nearly ticked to 10am. “I left my home very early. You simply got here in; your flip remains to be far,” he added, yawning at intervals because the dialog wore on.
He said, “This has all the time been the follow each clinic day. I simply cancel each different factor I must do to be right here. That is 10am, and the physician has not attended to me. The gang is often like this each clinic day. I’ve been utilizing this clinic for over 10 years now and I’ve to cope with this.
“I began remedy at a personal facility the place I reside in Ipaja however when the problem was escalating, I used to be referred right here. In all, it’s been 15 years since I’ve been on medicine, treating diabetes.”
Mrs Antonia Babatunde had been managing diabetes since she examined constructive in 2003. She had gone to the Gbagada Normal Hospital to deal with malaria because of incessant urination however after treating malaria over and over, she was identified with diabetes.
Afterwards, Babatunde mentioned she turned an everyday customer to the clinic, ready for hours within the crowd to entry remedy.
She mentioned, “I couldn’t afford the fee in non-public hospitals, so I continued remedy with the federal government hospitals in Gbagada and since then it’s been from one appointment to a different. It’s been a troublesome journey. I depart my home in Ijeshatedo, Surulere, round 5am simply to be on the clinic early. The stress we undergo on clinic days is simply an excessive amount of. And most instances they repair a day in three months.”
Poor entry to correct healthcare
Having access to healthcare service has been a serious problem for diabetics. They spend lengthy hours in queues each clinic day which has turn into irritating for a lot of of them particularly as they’d proceed to hunt remedy for a lifetime.
In accordance with an endocrinologist on the Ladoke Akintola College of Expertise Educating Hospital, Ogbomosho, Oyo State, Dr Michael Olamoyegun, about 80 to 90 per cent of diabetic sufferers have by no means been attended to by an endocrinologist.
Olamoyekun mentioned, “All these are because of the inadequate fingers to take care of the over 90 million sufferers of diabetes within the nation. Now we have lower than 200 endocrinologists to take care of them.”
Corroborating Olamoyegun, Dr Akinyele Akinlade mentioned most diabetic sufferers are usually not properly managed and the sufferers would have developed problems earlier than they noticed a specialist.
The frustration of Mrs Sayo Adebisi, a mom of three whose 11-year-old daughter has been battling with diabetes for over two years, was palpable.
She lamented the lengthy queues she endured each time she got here to the hospital, including that they often left their Ikorodu residence earlier than 5am for LASUTH clinic solely to fulfill a variety of sufferers already ready for his or her periods.
She mentioned, “I’m actually bored with coming right here to sit down however what can I do? I don’t need something to occur to my daughter. When the nurses got here, they gave us numbers and we thought issues can be higher however no, the entire place turned crowded and when there was pandemonium, they needed to scatter the numeration.
“Solely God is aware of after we’d depart right here. Typically we keep until 4pm, and get house round 9pm. That is the ache we undergo simply to have entry to medical care.”
The agitated mom mentioned she needed to abandon her enterprise, the identical method her daughter skipped college on each clinic day.
Adebisi added, “It’s traumatising to need to cope with this. This identical factor occurs each time. It‘s the identical irritating expertise each time.”
Adebisi mentioned probably the most painful factor was that the medical staff weren’t often thoughtful in the event that they missed their clinic days and wouldn’t do something to salvage the scenario.
She mentioned, “The nurses would flip us again and inform us to return again the next week. If not that it was a baby concerned, I’d have stopped coming to the clinic due to the ache.”
Mrs Gladys Oghenekevwe additionally lamented that she was exhausted from the clinic stress. She mentioned she got here from Mowe in Ogun State to obtain remedy at LASUTH. Like others, she wakened early to return round to obtain remedy.
She mentioned, “I’m used to coming right here and queuing. That is how we’ll keep within the clinic ready for remedy until the day ends. I’ve locked my store; I do know that I could by no means do something productive right now once more.
“Everybody remains to be right here; nobody has seen the physician until now. That is midday already and now we have all been right here since early hours of the day. At instances, when it’s one’s flip, the medical doctors will get drained already.”
Narrating how his diabetic journey began, Mr Segun Philips, mentioned he had a household historical past of illness and he was careless along with his way of life.
He mentioned, “By the point, I realised that I used to be taking an excessive amount of alcohol, it was late. I had come down with the illness. I realised my legs had been unusually swollen. I started to really feel weak unnecessarily. At some point, I started to really feel a type of uneasiness and heaviness whereas on the workplace, I then began to really feel like I used to be simply going to burst open, so I took permission to go away the workplace and went to the hospital.”
Philips mentioned that he went to the hospital a few instances however nothing improved. It took a number of hospital visits earlier than he was identified rightly.
He mentioned, “I went to the hospital, they handled malaria and typhoid, then they moved to treating me for ulcer. They stored administering all kinds of remedy on me earlier than I needed to go to a basic hospital the place I used to be identified with excessive sugar degree and referred to LASUTH.”
Different challenges
The challenges of residing with diabetes particularly in Nigeria are huge – from lack of entry to insulin to the price of having wholesome diets. For example, the WHO mentioned a century after its discovery, insulin and different elements of diabetes care stay past the attain of many sufferers.
Many individuals residing with diabetes lack common and reasonably priced entry to elementary elements of diabetes care, which embrace insulin and oral medicines, gear and provides, a nutritious diet, a protected place to train, psychological help and endure stigmatisation.
The President, Endocrine and Metabolism Society of Nigeria, Prof. Olufemi Fasanmade, mentioned the burden of diabetes mellitus in Nigeria was growing steadily, noting that victims spent between N20,000 and N150, 000 month-to-month to remain wholesome.
Fasanmade mentioned, “Diabetes is a really expensive situation. In Nigeria, a typical affected person will spend N20,000 to N30,000 to correctly management it. That is the minimal and it covers drugs, blood exams, and clinic attendance. When problems like kidney illness come into the image, some sufferers have a month-to-month expenditure of N100,000 to N150, 000.
Babatunde didn’t have a private testing package and needed to wait until the clinic day to get examined.
She mentioned, “I can’t afford that sugar testing package for the reason that diabetes began. It has affected my eyes, so I needed to cease work because of the stress. It’s God that has been caring for me. I used to have one testing package however because it received spoiled, I haven’t been in a position to purchase one other one.
“I spend so much on medicine. Getting insulin is a matter by itself. One of many medicine I exploit is N1,000 per sachet and if I used it as prescribed, I received’t be capable of get cash to feed. I solely take the appropriate dosage when the signs are excessive.”
For Philips, the price of feeding has been a problem because of what he described because the financial scenario of the nation.
He mentioned, “I don‘t strictly abide by the dietician suggestions; I additionally use my mind. What I eat in abundance now are the unripe plantain and greens, as a result of we’re of their season and they’re comparatively reasonably priced. If I’m to keep up the prescribed weight loss program strictly, how do I care for my household? I nonetheless have to purchase medicine and different prescriptions. There are occasions, I’d come again to the clinic and they’d change my medicine fully. Most instances, the present medicine are costlier than the earlier ones.”
Adebisi mentioned she had gone to mattress many instances in tears seeing the emotional ache her daughter went by way of as she couldn’t eat common meals taken by her siblings.
She mentioned, “I really feel unhealthy for my daughter. Her meals are completely different and youngsters love candy issues. The price of medicine is one other headache. She will end N9,000 price of medicine in per week or two. At instances, it’s troublesome for us to feed after shopping for her rugs. I used to be suggested to purchase her a machine for testing however I don’t have the means now.”
COVID-19 issue
Past meals stuff and different consumables, one of many different issues affected by COVID-19-induced inflation is the costs of medicine.
WHO studies that 18.3 per cent of COVID-19 deaths within the African area are amongst individuals with diabetes, one of many circumstances that international research have discovered to extend the chance of extreme sickness and dying amongst sufferers contaminated with the virus.
The WHO evaluation of 14 African nations, which supplied info on COVID-19 and comorbidities, confirmed that the chance of problems or dying from COVID-19 amongst individuals with diabetes elevated with age, with individuals aged 60 years and above dealing with higher dangers.
One of many threat elements for diabetic sufferers since COVID-19 is lack of entry to medicine.
Babatunde whereas lamenting mentioned medicine she purchased pre-COVID-19 period had been now costly.
She mentioned, “Medication at the moment are very costly, I’ve even stopped shopping for some. It’s simply those I noticed are all the time a part of my prescriptions that I now purchase. I purchase the most cost effective type of insulin. It was once N2,000 to N2,500; now it’s N7,000. I’ve to ration the utilization of the insulin.”
Oghenekevwe additionally lamented that past the fee it was so troublesome to even get most of the medicine in addition to insulin in the course of the COVID-19 lockdown whereas entry to healthcare companies was harder on the interval.
She mentioned, “The pandemic lockdown actually affected my well being. My late husband additionally died throughout that interval. We took him to the hospital however they didn’t attend to him. He died the next day. My elder sister affected by diabetes additionally developed some problems throughout that point. We couldn’t get her medicine and even insulin turned ‘gold.’
“We rushed her to the hospital however she additionally wasn’t attended to. We tried our greatest however she died inside two weeks.”
Like others, Philips was not spared. He mentioned all through the lockdown which lasted about two months, he stopped shopping for medicine as they had been too costly.
He mentioned, “I went to the pharmacy in my space to get my medicine however I couldn’t discover any of them. I despatched somebody who was a frontline employee to assist me test for it on the island. When he instructed me the costs, I didn’t hassle to purchase once more. The medicine I used to purchase for N4,000 to N5,000 had elevated to N15,000 to N20,000.
“All by way of the lockdown, I didn’t use any medicine, I used to be simply monitoring and taking a bitter leaf and it labored successfully for me. It was a troublesome time for lots of people residing with diabetes.”
Worrying statistics
The rising statistics of diabetic sufferers the world over is sort of worrisome and alarming. WHO celebrates World Diabetes Day each November 14 globally to focus consideration on the ailment due to its dire penalties on human well being. The theme for this yr until 2023 is: “Entry to Diabetes Care – If Not Now, When?”
In accordance with WHO, about 422 million individuals worldwide have diabetes, the bulk residing in low-and middle-income nations like Nigeria, with 1.5 million deaths immediately attributed to diabetes yearly. Each the variety of circumstances and the prevalence of diabetes have been steadily growing over the previous few a long time.
Additionally, the Worldwide Diabetes Basis revealed that one in 10 adults worldwide lived with diabetes in 2021. These statistics amounted to over 567 million adults residing with the illness. The quantity was predicted to rise to 643 million by 2030 and 783 million by 2045.
The IDF additionally estimated that about 24 million persons are at the moment residing with diabetes in Africa. The continent is predicted to expertise the best enhance in diabetes globally, with the variety of Africans affected by the illness predicted to rise to 55 million by 2045, a rise of 134 per cent, in contrast with 2021.
In accordance with the report, 81 per cent of the affected adults (about 4 in 5) lived in low and middle-income nations whereas diabetes led to six.7 million deaths in 2021 – that means that diabetes-related dying occurred each 5 seconds, the report famous.
In 2019, an estimated 1.5 million deaths had been immediately brought on by diabetes, WHO mentioned in an April 2021 report, including that diabetes was a serious reason behind blindness, kidney failure, coronary heart assaults, stroke and decrease limb amputation.
Sufferers search options amid lengthy queues, delayed appointments
Babatunde said that the COVID-19 pandemic had thought her easy methods to handle diabetes and she or he had developed a routine of augmenting her restricted medicine and insulin with prayers quite than spending hours in queues on the hospital.
She mentioned, “I now deal with myself at house because of the price of medicine and even the stress of queuing on the clinic. Because the pandemic, issues went actually costly together with the medicine. I simply couldn’t even get a variety of my medicine. So I resorted to treating myself at house. I already know the medicine so I simply go to the pharmacy to purchase them in addition to the insulin. The stress on the hospitals and the insults from these nurses is way.”
Philips additionally lamented that the stress he handed by way of earlier than he might see medical doctors had turn into so insufferable that he not stored appointment dates.
He mentioned, “I haven’t been going to the hospital as regularly as I ought to anymore as a result of the stress is an excessive amount of. We’d have to attend for over seven hours earlier than we might see the physician and we don’t even spend near 10 minutes with the physician. I now go to every so often. I’ve been utilizing bitter leaves and a few pure herbs and they’re efficient. I simply monitor my sugar degree and BP at house.”
Nonetheless, Olamoyegun, the endocrinologist, warned it was flawed for sufferers to ignore their medical appointments.
“The physician wants to look at them infrequently. There are occasions they would want to discontinue some medicine after noticing enchancment amongst many different causes. Most of diabetic problems are sometimes because of discontinued drugs. Folks shouldn’t discontinue from remedy, it doesn’t matter what,” he suggested.
Vitamin in diabetes administration
A dietitian, Mrs Titilayo Onadipe, mentioned wholesome diets performed key roles in managing diabetes and different illnesses.
She mentioned, “Everyone ought to inculcate the behavior of maintaining a healthy diet diets. That is vital to regulate the sugar degree and it’ll additionally assist individuals to keep up an excellent Hb1c.
“If individuals keep a nutritious diet, the fasting blood sugar within the morning will all the time be regular. Wholesome diets additionally assist individuals to stop the problems of diabetes.
Mind drain amidst worrying statistics
It’s no information that the medical occupation in Nigeria has been confronted with migration of medical doctors and different well being professionals to different elements of the world for greener pastures.
Olamoyegun bemoaned a scarcity of specialists to take care of diabetic sufferers throughout the nation.
He mentioned, “I’m first a basic doctor earlier than an endocrinologist and it’s not solely in endocrinology that we don’t have sufficient specialists, it’s throughout the board. Nonetheless, the rationale why diabetes is exclusive is the truth that the quantity is on the rise. I attend to different sufferers with hypertension, kidney stones, coronary heart failure, stroke and the remaining. As a physician, my companies aren’t restricted to individuals with diabetes or different endocrine ailments.”
In accordance with him, the distribution of specialists to diabetics is 600,00 sufferers to a specialist.
He defined, “I specialize in endocrine points and the most important endocrine downside the world over and in Nigeria is diabetes. Now we have lower than 200 endocrinologists in Nigeria serving 90 million adults (diabetics and people with excessive threat) and the vast majority of them are concentrated within the South-West, particularly in Lagos.
“The distribution contains: Lagos, 15; Oyo: 9; Osun, six; Ondo, three; Ekiti, three; Ogun, 5; Kwara, two; Kogi, two; Edo, 4. There are some states within the jap a part of the nation that don’t even have any endocrinologist. We don’t even have sufficient medical doctors not to mention specialists. So, by the point you slender it right down to diabetes, you’d discover out that about 80 to 90 per cent of diabetic sufferers have by no means been attended to by an endocrinologist.
“You’d hardly discover any of those specialists in rural areas and now we have fairly a variety of sufferers in rural and sub-urban centres.”
Akinlade, who has been practising as an endocrine specialist for over 11 years, mentioned the scarcity of medical doctors “signifies that there can be extra work for these of us who’re on the bottom.”
He added, “On the a part of the sufferers, it signifies that there can be extra sufferers who are usually not properly managed and lots of of them would have developed problems earlier than they get to see a specialist.
“On a clinic day, in my unit, I see nothing lower than 60 to 70 sufferers. These ones are completely different from these I see as a basic doctor. Earlier than you’re a specialist, you’re first a basic doctor. And as endocrinologist, it’s not solely diabetic sufferers that you just attend to; you attend to different endocrine points notably thyroid dysfunction. Since it’s extra work, it interprets to emphasize and I’ve learnt to develop coping mechanisms in such a method that it doesn’t get to me.”
The President of the Nigerian Medical Affiliation, Prof Harmless Uja, likened the speed at which medical practitioners depart Nigeria to practise overseas to sitting on a time bomb.
He mentioned, “This situation have to be correctly mentioned on the appropriate desk between the Federal Authorities and stakeholders, as a result of the way in which issues are going, we’re exporting our greatest and producing for different nations. Our medical doctors are well-trained and wherever they go, they are going to be employed. The very best factor is to know the elements accountable for mind drain within the well being sector and cease them earlier than they turn into monsters.”
Just lately, the NMA president mentioned most of the the explanation why medical doctors are migrating from the nation are because of poor work atmosphere, insecurity, poor remuneration and poor gear to work with.
He mentioned, “Remuneration and atmosphere in different nations like Europe, America and Saudi Arabia are much better than Nigeria. No physician would need his youngsters to be out of faculty, we need to have one of the best for our youngsters.
“We imagine that the suitable factor to do is to have a conducive atmosphere to work. Now we have misplaced over 20 of our medical doctors to COVID-19. A lot of our medical doctors are adopted and kidnapped; as soon as there may be insecurity within the land as it’s, it turns into very troublesome for individuals to remain.”
The best way ahead
Olamoyegun mentioned, “For us to have sufficient specialists to cater for the well being of the individuals, it might take one other 100 years. To start out with, what number of medical doctors can we produce in a yr? Then what’s the variety of specialists that we produce in a yr? Amongst the specialists, what number of of them are endocrinologists?
“One of many methods we are able to bridge the hole between the variety of diabetic sufferers and the medical consultants is by adapting what we name telemedicine.”
In accordance with WHO, telemedicine is the usage of info communication expertise to ship well being care companies comparable to prognosis, remedy and prevention of ailments.
Olamoyegun mentioned adopting which means sufferers might entry medical companies from any location within the nation so long as they’ve entry to cellphones.
He added, “Using telemedicine will make it even simpler for these in rural areas to entry sufficient medical companies as all they want are cellphones. You hardly see consultants in rural areas. This technique will make it simpler for individuals in rural areas to get related to an skilled.
“They might get identified and handled through numerous digital means. For individuals who don’t have cellphones, a big display can be utilized at their group well being facilities to have periods with the consultants.”
Akinlade on his half mentioned extra well being staff must be educated whereas additionally addressing the excessive migration of medical staff in a foreign country.
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