Friday, October 31, 2014
Diabetes in the Dominican Republic
382 million people in the world suffer from diabetes. In the Dominican Republic, over 10% of the population has what they call azucar, ‘sugar’ or diabetes and some people say it will rise to 20%. To be honest diabetes has never been particularly high on my radar and I don't know that much about it. I had a great uncle who had it, a second cousin and a daughter of a friend, but I have never thought of it as particularly dangerous.
That is, until I moved into the campo. Here, everyone seems to have it. In fact we are the only house in our area where no one has diabetes.
The statistics show that Dominican Republic is the 21st most affected nation with diabetes in the world. The United States is in 29th place, Canada in 51st and the United Kingdom 199th place. The full list is here.
The reasons given for the Dominican Republic being so high up the list are firstly genetic. It is thought that Hispanics, American Indians, and black people are more likely to get diabetes than white people, and it is thought to be passed down through families as well. It can also be attributed to a sedentary lifestyle which is definitely a Dominican trait. In addition it can also be due to being overweight, and nearly 70% of the Dominican population is overweight, plus a poor diet also does not help. The diet issue is true throughout the country with a heavy reliance on white rice and root vegetables, starches which turn to sugar, and a lack of protein and vitamins. Oil and salt are also both used to excess.
To gather more information I went to talk to two of my neighbours, Leida and Jose Manuel, the latter is usually known as Sukin. He runs the local colmado and they live in one of the 8 homes which make up our campo.
Sukin and Leida are both 62 years old and have been married for 38 years. They have a son and a daughter, both of whom live in New York. Well it could be anywhere in the United States as they call the whole country New York. They both suffer from diabetes. Sukin has had it for around 18 years and Leida 14 years. They both found out when going to the doctor for other problems and the infamous Dominican medical analysis discovered they were diabetic. Sukin’s father died of diabetes related issues aged 80 and Leida’s mother as well when she was 64. No one suggested they should be regularly checked even with a family history and nor are their children being checked.
They go to the diabetes institute in Santiago every 3 months to be checked, and there they are given diet sheets. Now Leida and Sukin eat what they grow and what he has in the colmado. They eat white rice, chicken and beans, and yuca and corn which they grow. Sometimes spaghetti and avocados in season. And he has white bread delivered daily which they eat.
They told me that if they follow the diet they would starve, as it says no or little rice and no root vegetables. No potatoes nor pasta and nothing with flour in it. They are allowed one serving of rice a week and one portion of yuca a fortnight. But all they eat is rice and yuca, so the diet sheet goes out of the window. They are allowed brown rice and whole wheat pasta, neither of which are sold within 70 miles of here and even if they were, they have higher taxes so are very very expensive. They can't eat cornflakes but can eat bran flakes which I have never seen in the country. Corn, which they grow, is a no no, but they should eat broccoli, which is expensive and hardly ever available and spinach which I have never seen here.
They try their best. They do not eat sugar, so no sweet coffee, no natural juices loaded with sugar. Instead they drink packet juice or cartons and don’t bother to read the sugar content on the side.
They are both insulin dependent. Sukin buys the bottles of insulin for 100 pesos – just over US$2 – at the Botica Popular which is the government pharmacy and they last around 2 weeks for them both. They both inject twice a day. If the Botica does not have insulin, then he has to buy it from the regular pharmacy and it costs ten times that amount. Leida has a machine with strips to check her sugar levels which her son brought from the United States but she never uses it as she isn't sure how to. Sukin has never used a machine. He has had two low sugar episodes where he has fallen unconscious and had to be taken to hospital where luckily, he recovered. His sight is now failing.
Leida had her right leg amputated 2 years ago due to poor circulation and gangrene, and her sister had her leg amputated just afterwards. She is the lady we bought our house from. Leida’s other sister died 18 years ago from complications related to diabetes, including gangrene. Leida’s other leg is now being affected and she anticipates another amputation in the not too distant future. She is upset as her wheelchair has a problem with the wheels and she can't go outside the house as it will only go sideways.
There are just under 1,000 amputations a year due to diabetes in the country and 75% of those that have one limb amputated will have to have the other one too.
It seems to me that so much could be done which isn't happening. Firstly, education and those whose parents are both diabetic should be checked regularly and early in the their lives.
Secondly, the food which diabetics should eat should be available and everywhere, not just in the international supermarkets in the large cities and tourist areas. Why are brown bread and brown rice not available everywhere? And why tax whole wheat pasta and brown rice higher than white rice and pasta? There is no point in giving people a diet sheet for things they cannot buy as they are not available or if they are they are twice the price.
I am sure people somewhere are working to solve this problem but it affects so many people's lives here and so many are dying unnecessarily that there must be a solution. I just don't know what it is yet!