Image may be NSFW.
Clik here to view.
It’s not often a doctor has the opportunity to help mold the health care system of an entire country, but since 2007 Antoinette Moran, M.D., a professor and pediatric endocrinologist at the University of Minnesota, has supported a dramatic shift in how Uganda, Tanzania and Kenya approach the fight against pediatric diabetes.
Moran made her first trip to African in 2007, visiting Mulago Hospital in Kampala, Uganda, where the University has a resident exchange program. After seeing a call for faculty volunteers interested in providing teaching assistance Moran signed up. However, due to the sophistication of diabetes care in the U.S., she was worried about the level to which she’d be able to contribute.
“When I arrived and observed the state of pediatric diabetes in Uganda, to say things were bleak would be an understatement,” recalled Moran. “Children with diabetes were seen in the same clinic as very ill adults. They did not have medical records so we didn’t know their histories, there was no equipment to weigh them and there were no trained staff to provide diabetes education or educational materials.”
Moran recalls that the children had all the physical signs of poorly controlled diabetes combined with issues accessing treatment.
In the clinic, Moran found children had problems getting enough insulin and none of them had the ability to test their blood sugar levels at home. Worse, without access to treatment most children died shortly after diagnosis. At the time, there were less than 100 active cases of diabetes in the country. Burdened by the cost of treating diabetes, many families simply could not afford the necessary supplies. In one particular heart-breaking patient case, a 10-year-old diabetes patient named Michael was abandoned by his mother shortly after his diagnosis because she had no way to pay for his care.
Paving a path forward
In 2007, Moran recalls there wasn’t a single pediatric endocrinologist in sub-Saharan Africa outside of South Africa.
Grace Buwule, M.D., a pediatrician at Mulago Hospital, was assigned to care for children with diabetes. She’d learned about the condition via textbook and tried to obtain any available information about the disease. She asked Moran for help in developing a pediatric diabetes program and together they developed a plan.
Buwule identified two nurses, a junior physician and a pharmacist to form the Mulago Pediatric Diabetes team. Moran helped train this team while she was at Mulago Hospital in 2007 and 2008, and even brought the team to Minnesota for further training. Together they developed protocols and came up with a plan to help children receive insulin.
Since then, things have improved considerably for children with diabetes in Uganda. The Chairman of Pediatrics identified a new, child-friendly space for the clinic with private exam rooms. A charting system is in place and all children are weighed and measured. Diabetes education materials are available with protocols in place. Through the Changing Diabetes in Children (CDiC) program, Novo Nordisk Pharmaceuticals, working with the Ugandan Ministry of Health, is providing free insulin and test strips to children with diabetes. Importantly, there are now trained pediatric endocrinologists in Uganda.
In another positive step, in 2009, the European Society for Pediatric Endocrinology (ESPE), together with the International Society for Pediatric and Adolescent Diabetes (ISPAD), established a pediatric endocrinology fellowship program in Nairobi, Kenya. Since then, more than 30 pediatric endocrinologists and their medical team members have been trained.
Moran has participated in these training programs in Kenya, Tanzania, and South Africa, and three physicians from Uganda are now trained pediatric endocrinologists.
Recently Moran returned to Uganda to put on a conference to help implement the CDiC insulin program. Now more than 400 children are known to have diabetes in Uganda, showing that treatment is extending their lives. However, the majority of these are adolescents, and many young children with diabetes are still dying without ever being diagnosed.
Acknowledging that there is still much more work to be done, Moran did say that she’s noticed things have improved dramatically over the last few years. She’s even seen a few familiar faces in the clinic.
“In 2007, I diagnosed diabetes in a 2.5-year-old boy named Shafik. Because of his young age he was not expected to live. I just saw him again last month and he is a healthy, thriving 9-year-old,” said Moran. “That was a really great moment for me and for everyone involved. I also saw Michael, the now 16-year-old boy whose mother abandoned him at age 10. While Michael and his father struggle financially, he is overall doing well and plans to become a doctor.”
Through all her travels to Africa Moran has gained valuable perspectives on diabetes care and treatments. Where she once had concerns about her ability to translate care into such a different health care environment, now she sees ways to take action and solve problems on a global level.
“We had to start at a very basic level of care and understanding of what diabetes is and how we can treat it,” Moran said. “From how to work in multidisciplinary teams to how to use test strips and insulin, it was a learning experience for everyone. Patients and care providers in Africa are eager for information, and once they have it they embrace it and use it well. It reminded me of how lucky Americans are to have what we have.”
The post U of M doctor helps change diabetes care in Africa, gains valuable perspective appeared first on Health Talk.