About thrice during our conversation, Dr. Dipesalema Joel refers to diabetes as a “silent killer”.
Then he presents the statistics ÔÇô and the picture gets grim. You’d understand why he makes the bold statement that diabetes is becoming a serious problem in this country, as well as worldwide.
These are the numbers from the International Diabetes Federation, which does samplings in different countries around the world to determine the disease’s prevalence. In 2010, there were 284million people worldwide who lived with diabetes. In 2011, the number shot to 366million. It is suggested that global trends indicate that at this rate, by 2030 there would be 552million people living with diabetes.
Now let’s bring it home. In 2010, 4.1% of Botswana’s adult population lived with diabetes. In 2011, the national prevalence doubled to 8.2% of the adult population. As it is, Joel states, Botswana has the third highest diabetes prevalence in Africa after Mauritius and Seychelles. He points out that 94 000 people in Botswana within the 20 ÔÇô 79 age bracket have diabetes. The global trend indicates that the most affected people are in the 40 ÔÇô 59 age group.
Before explaining how Botswana ended up with such a high prevalence rate, Joel asks me what I find common about Botswana, Seychelles and Mauritius. Then he answers the question himself.
“These are all middle income countries,” he states, “which has translated in higher incomes for the general population. As a result of the relative wealth, lifestyles have changed.”
Then he spells out the rest. Urbanization. Sedentary lifestyles. Less physical exercise. Mushrooming of fast food outlets.
“That is the source of our obesity. When obesity goes up, Type 2 Diabetes also goes up,” he says.
Joel’s analysis confirms the figure from the International Diabetes Federation that says 80% of diabetes patients are in high and middle income countries.
“The number of people with Type 2 Diabetes is increasing,” he says. “We face a major challenge because Type 2 Diabetes is insidious. It’s a silent killer. You may live with it, but not know that you have it.”
Joel says of the 183million cases of Type 2 Diabetes worldwide, 50% don’t know that they have the condition.
What he finds scary is the lack of knowledge among the public about the cause of diabetes and how to prevent it. He says people should get into the habit of regularly checking their weight and blood sugar levels.
“Most people only present themselves to the doctor when they already have a serious problem, which would then call for expensive interventions that cost a lot of money cost to the healthcare system,” he says.
It is estimated that US$465billion in healthcare expenditure in 2011 was due to diabetes interventions, which represented 11% of the global healthcare expenditure.
So what is being done to stem the tide?
At the forefront of the war on diabetes is the Diabetes Association of Botswana, which Joel chairs.
The group has a number of initiatives such as public awareness campaigns, as well as hosting regular meetings for its support group. The meetings are open to members of the public. Joel explains that since diabetes is a multi-system disorder that affects eyes, the brain, the heart, and kidneys, the Association strives to bring different specialists to educate diabetes patients and their friends about care and prevention. Then there is the outreach programme, through which members of the public are screened for diabetes, obesity, and high blood pressure. The last such public screening exercise was on World Diabetes Day (November 14), which was held at Game City.
Joel says out of the 400 people screened, 12 learnt for the first time that they had diabetes. Then there were others who didn’t know that they had high blood pressure or obesity.
Interestingly, Joel explains that diabetes equally affects men and women, and that there is no predisposition for any group. The disease is even being seen in children. Currently, there are 120 diabetic children registered with the Diabetes Association of Botswana. He states that 78 000 children develop Type 1 Diabetes every year.
As well as the low level of public understanding about diabetes, Joel suggests that even the national healthcare system is geared towards infectious diseases such as HIV, malaria, and Tuberculosis, with little emphasis on non-communicable diseases. That is the same paradigm adopted by the donor community, which regularly donates funding to fight TB, HIV, and Malaria.
“You rarely come across money donated to fight non-communicable diseases,” Joel says.
One of the interventions that Joel thinks can make a difference is basic education to the public on things like lifestyle change to keep leaner bodies, and the right diet. He says people should be weaned from the diet that is high in fat and sugar.
He says people should be encouraged to cycle to work, rather than sit in cars for extended periods.
He holds Norway as an example of a country that actively encouraged its population to cycle and made it safe to do so by building tracks for cycling. In other European countries, there are changing rooms at work such that when one gets to work, they can take a quick shower and change from their cycling attire.
“In Botswana, I know that some people have said they cannot cycle to work because it is too hot.
The problem is that there are no facilities. There is also danger on the roads where cyclists have to share roads with cars. If councils invest in cycling tracks and companies provide changing rooms, I think more people would cycle to work,” Joel says.
How do you convince people to keep lean where there is a tradition that says obesity is a sign of wealth, status, and good living?
Joel concedes that this long-held belief could have predisposed Batswana to promote obesity.
“We need to revise this mindset,” he says. “In terms of longevity, someone with a BMI (Body Mass Index) of 18 ÔÇô 25 likely to live healthier than someone whose BMI is above 25.”
Joel notes that whilst most diabetes patients are in urban centres, even the so-called villages are fast catching up. He says this is because a lot of Botswana’s villages have become urbanized, and are no longer traditional villages where people consume low calorie food that is not too refined.
The rural-urban divide narrows even in terms of access to the news media, and its heavy commercials that glorify a culture of fast food.
“No day passes without a TV commercial that advertises a fast food outlet. As a nation and an Association we are faced with a challenge of changing perceptions that to be seen to be civilized you should be seen to be eating a certain type of food,” he says. “We need to nip the problem before it gets out hand. Diabetes is an emerging epidemic. If we don’t act now, soon diabetes will present the same situation that we are facing with HIV.”
