HEALTH AND POLITICS

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind and body, usually meaning to be free from illness, injury or pain.

The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

Health is of major concern to nations of the world. WHO and the member states strive hard to ensure this is achieved across board. A major WHO goal is to improve equity in health, reduce health risks, promote healthy lifestyles and settings, and respond to the underlying determinants of health.
This among others are the goals expected to be followed by member states and organizations.

A meeting with Prof. Cees Th. Smit Sibinga was a real eye opener as we discussed the problems faced by developing nations and africa as a continent.

Prof Sibinga is a WHO expert involved in international short term consulting missions; medium and long term projects focused on the development of Transfusion Medicine in economically restricted countries in Asia, Eastern Europe, Central Asia, Africa, Western Pacific and the Middle East.

Prof. Cees Th. Smit Sibinga and I 

A lot has been invested in terms of resource on health in the continent with little impact and Africa being a toast of many investors has to be self motivated towards adequate care especially in health for her citizens.

Our focus of discussion centered around blood transfusion practices in Africa (His area of expertise) and diabetes (my passion ),we realized that so much needs to be done to step our health practices up to conform to international standards especially in Nigeria.

Nigeria is a large country with great prospect and promising health policies but implementation has been a major hindrance to quality health care delivery.

The World Health Organization's activities deals directly with member nations and organizations hence whatever agreement signed at the World Health Assembly is binding on all member nations and as such must be implemented, likewise any feedback given by the member nations must reflect the true state of health affairs in the member country as that would be the blue print guiding WHO activity in such country.

So what happens inbetween agreements, implementation and feedback: The Politics of Health;

So many questions ranging from if the Member nations especially developing countries abide by the agreements signed at the World Health Assembly; if they give the true state of health in their respective countries as a feedback to WHO?
These questions are endless but from the few minutes interaction with Prof Sibinga i realized that the problems are not as cumbersome as thought and the solution is within reach.

Prof Sibinga said: "When you vote, you exercise your authority not just to choose your favorite candidate to govern your affairs for a particular period but also to represent your interest within that same period'

So, it is not just in us as individuals or as a nation to vote for personalities we love or adore but we also need to vote for policies and adequate representation especially in health care delivery across board.

It is imperative to note that once we are misrepresented at the international level as against the true state of health affairs or when policies end only on the papers then we need not scream isolation by the international community when in real truth the world can only help those willing to help themselves.

Interesting to note is that topmost on the agenda at this year's world health assembly is Non Communicable diseases (click here) among which is Diabetes which has affected over 347million people worldwide (about 50% of those with diabetes are yet to be diagnosed; More than 80% of diabetes deaths occur in low- and middle-income countries; WHO projects that diabetes will be the 7th leading cause of death in 2030)
With all these knowledge at our fingertips it is important for all stake holders and health advocates to rise to the challenge of ensuring that proper health care policies and delivery are achieved at all levels of governance. 

This is a clarion call to all health advocates especially at community level to also encourage the people to in addition to voting for personalities also consider policies that will make their health better and more secured.

We believe all governmental administrative structures from the community to national heads must be filled with people who stand for policies that will better the health and lives of the people
With this evolutionary mind set in view and in place we believe the African health care system will become more proactive.

DO TAKE A STEP FOR DIABETES 

HEALTHY HABITS TURNED LIFESTYLE: LESSONS TO BE LEARNT FROM GRONINGEN, THE NETHERLANDS.

 

Groningen is the main municipality as well as the capital city of the eponymous province in The Netherlands.

With a population of around 190,000, it is the largest city in the north of the Netherlands. An ancient city, Groningen was the regional power of the northern Netherlands, a semi-independent city-state and member of the German Hanseatic League. Groningen is a university city: the University of Groningen and Hanze University of Applied Sciences each have about 25,000 students.

With a background knowledge of Diabetes mellitus, or simply diabetes, being a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.

There are 3 main classifications of Diabetes Mellitus but for the purpose of this article we would major on Type 2 DM which makes up about 90% of cases of diabetes with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.

 Obesity is thought to be the primary cause of type 2 diabetes in people who are genetically predisposed to the disease. Type 2 diabetes is initially managed by increasing exercise and dietary modification.
Rates of type 2 diabetes have increased markedly over the last 50 years in parallel with obesity: As of 2010 there are approximately 285 million people with the disease compared to around 30 million in 1985.

Long-term complications from high blood sugar can include heart disease, strokes, diabetic retinopathy where eyesight is affected, kidney failure which may require dialysis, and poor circulation of limbs leading to amputations. The acute complication of ketoacidosis, a feature of type 1 diabetes, is uncommon. However, non-ketotic hyperosmolar coma may occur

But a proper diet and exercise are the foundations of diabetic care, with a greater amount of exercise yielding better results. A diabetic diet that promotes weight loss is important. Aerobic exercise leads to a decrease in HbA_1c and improved insulin sensitivity. Resistance training is also useful and the combination of both types of exercise may be most effective.

Culturally appropriate education may help people with type 2 diabetes control their blood sugar levels, and also prevent type 2 diabetes.

 

 

Groningen has been called the "World Cycling City", since 57% of journeys within the city are made by bicycle. The city is very much adapted to the wishes of those who want to get around without a car, as it has an extensive network of segregated cycle-paths, good public transport, and a large pedestrianized zone in the city centre.

The transformation of the historic centre into a pedestrian priority zone enables and invites walking and biking by making these active modes of transport comfortable, safe and enjoyable. These attributes are accomplished by applying the principle of "filtered permeability".

It means that the network configuration favours active transportation and selectively, “filters out” the car by reducing the number of streets that run through the centre. While certain streets are discontinuous for cars, they connect to a network of pedestrian and bike paths which permeate the entire centre. In addition, these paths go through public squares and open spaces increasing the enjoyment of the trip.


The logic of filtering a mode of transport is fully expressed in a comprehensive model for laying out neighbourhoods and districts – the Fused Grid.

 In the Italian TV programme of investigative journalism "Report" appeared a short film, considering the use of bikes in Groningen a good practice to emulate in Italy.

 

Am really going to learn to ride a bicycle

 

My experience at The International Student Congress of (bio)medical sciences in Groningen is a typical example of a healthy habit turned Lifestyle, I was thrilled by the fact that a city can turn cycling a good means of daily exercise into a lifestyle and I was thrilled seeing kids cycling around.



Nigerian Medical Students at the ISCOMS (From Ukraine and Nigeria)

I believe other countries like Nigeria can emulate this great healthy habit, the hot West African weather might not allow for cycling all day long but evenings are great time to cycle.
So in the future, road constructions should have bicycle lanes; there should be subsidized rates on bicycles and importation of bicycles to Nigeria must be encouraged.

All these efforts will go a long way in creating healthy lifestyles for Nigerians thereby preventing and managing type 2 diabetes among Nigerians.

Also I will suggest the Nigerian Government should encourage student research exchanges through adequate funding and motivation as this is instrumental to economic and academic development, as this exposure is one not easily forgotten.

100 NIGERIAN FEMALE ADVOCATES IN 100 DAYS

In 2009, the International Diabetes Federation (IDF) launched the Women and Diabetes Programme, to build global support for women living with diabetes. There were an estimated 151 million women with diabetes in 2011 and this number is expected to rise to 275 million by 2030.

As a federation of over 200 MAs in over 160 countries, IDF is in a unique position to promote the women and diabetes agenda.

The Women and Diabetes Programme aims to:

Build the evidence base
Raise global awareness and commitments
Strengthen gender responsive health systems
Empower women as key agents in the fight against diabetes

The aims of the Women and Diabetes Programme are framed within the commitment IDF made to the UN Every Women Every Child initiative, which was launched by the UN Secretary General to put into action the Global Strategy for Women’s and Children’s Health:

“The International Diabetes Federation commits to increase recognition of the linkages between diabetes and related non-communicable diseases (NCDs) and women and children's health, support the integration of diabetes into existing health systems and maternal and newborn child health initiatives, and empower girls and women to prevent diabetes in current and future generations.

IDF WOMEN AND DIABETES PROGRAMME ACTIVITIES

Activities of the Women and Diabetes Programme fit within four broad categories:

Global awareness & advocacy: At the national and global levels, advocate for women and diabetes as a priority global health and development issue

Building the evidence base: Epidemiological, qualitative and health systems research of the direct and indirect burden of diabetes on girls and women

Best practice projects: Combine research and in-the-field interventions to establish models of diagnosis and care for women with diabetes and to improve their health outcomes

Knowledge sharing: Organise and participate in side-events, meetings and conferences with other experts and stakeholders in the field of diabetes".






Living with Diabetes is hard on women and its burden on women is unique because the disease can affect both mothers and their unborn children.

Diabetes can cause difficulties during pregnancy and delivery such as large sized babies, miscarriage or a baby born with birth defects. Women with diabetes are also more likely to have a heart attack, and at a younger age, than women without diabetes.

For women who do not currently have diabetes, pregnancy brings the risk of gestational diabetes. Based on recently announced diagnostic criteria for gestational diabetes, it is estimated that gestational diabetes develops in 18 percent of all pregnancies but disappears when a pregnancy is over.

Women who have had gestational diabetes or have given birth to a baby weighting more than 9 pounds are at an increased risk for developing type 2 diabetes later in life


We at the Nigeria Diabetes Online Community believe in Female education and empowerment towards adequate Diabetes care and quality health delievery.
Hence, we plan to motivate 100 females who are ready to raise awareness about Diabetes in their communities.

So if you are a female or a female youth leader passionate about Diabetes Care and Prevention in Nigeria, enthusiastic about change in your community and you wish to create awareness about diabetes in Nigeria via social media thereby reducing its prevalence and the stigma associated with it.

Please feel free to contact us on thengdoc@gmail.com



References

International Diabetes Federation
American Diabetes Association

DIABETES CARE IN NIGERIA : THE WAY FORWARD

On the 28th of April The Nigeria Diabetes Online Community and Diabeticare in their usual style had a 1hour tweetchat that aimed at discussing the way forward in diabetes mellitus care in Nigeria.
There has been a progressive increase in the prevalence of diabetes mellitus in Nigeria and the burden is expected to increase even more. Considering this fact there is an urgent need to examine our healthcare systems, work on existing programmes for persons with diabetes and effectively implement a process that facilitates accessibility to such.
This discussion that pulled interested participants from Nigeria and beyond was aimed at getting opinions and suggestions that are people oriented towards forging ahead in our clamor for quality health care services and delivery in Nigeria.

Five questions were thrown in the chat.Responses are summarized

1st QUESTION: On a scale of 1-10, how would you rate DM (Diabetes Mellitus) care in Nigeria and why?
Response Given;

Diabetic care in Nigeria is very poor because it is reactive rather than proactive. Prevention should be a key strategy

2nd QUESTION: how do you think NGOs can help with DM care and T2 (type2) DM prevention in your community?

Response Given;

Access to information & education is key. People can be empowered to be advocates for change in their own #diabetes communities
Education is key; insulin without education is like a car without a steering wheel and of course access to supplies is essential: affordability & availability are major issues in many countries, especially rural areas.
NGOs have more ability to influence education in a sustainable fashion and can help through health education programmes and the organisation of peer support groups for affected individuals
Crucial programs need to consider local customs & culture - involving #youth is essential!
Founders of t1 international and 100 campaign (international NGOs dedicated to T1DM CARE and promotion of access to insulin by all by 2022) our partners find it hard to believe that insulin is still so expensive - they believe insulin should be a human right.

3rd QUESTION: How can Health care providers enhance adequate support for people with D (diabetes)?

Response Given;
There should be more awareness and education provided in the communities
Pressure needs to be put on the pharmaceutical Companies - Diabetes is not a money making scheme
Connecting them to others. Empowering people to realize they can live a normal life, without limitations
By working together we can achieve this! We can learn from other movements. Strength in numbers & empowered groups
Individualising the treatment is key. Proper education of patients with Diabetes and making them partners in their own treatment

4th QUESTION: What role can the food, drinks and beverage industry play in DM care and prevention?

Response Given;
The food, drink and beverage industries need to be properly regulated!
Remember type1 is about a lack of insulin nothing to do with food types - watching food groups helps maintain better blood glucose control
Although food, drink & beverage industries do play a role in the lifestyles of people (& co morbidities), more sugar free alternatives of common beverages should be made available

5th QUESTION: In what ways can 'WE' increase community awareness on a large scale?

Response Given;
TV campaigns or radio jingles on Diabetes happen to be important means of mass education and this can be linked to a local community (health/ fitness) prevention event.
Empowering local role models with diabetes.
recognizing the basic symptoms and encouraging a healthy lifestyle for all
All forms of media (TV, Radio, Print, and Social) will help with the awareness. Currently very little is being done through them.

In lieu of this we at the Nigeria Diabetes Online Community hope to partner with individuals and organizations who see a need to propose and effect change in the Nigeria Healthcare system towards adequate Diabetes Care.
Thanks to all our Nigerian participants and our international friends who graced the meeting and also participated through great ideas and suggestions.

THE DYNAMICS OF DIABETES CARE IN A DEVELOPING WORLD

INTRODUCTION

    According to the international Diabetes Federation diabetic Atlas; Diabetes Mellitus is one of the most common non-communicable diseases (N.C.D) globally.
D.M, is the fourth leading cause of death in most high-income countries and now there is substantial evidence showing that it is epidemic in many economically developing and newly industrialized countries.

     Africa, a multicultural, religious and ethnically diverse continent had traditionally been dominated by infectious diseases but with rapid urbanization, NCD’s are quickly becoming a priority for health in this continent; with an estimate of about 14.7 million Adults being diabetic in 2011 and a projection of 28.0 million by year 2030.
     According to I.D.F, financial estimate of Africa indicate that at least USD2.8billion was spent on health care due to diabetes alone in 2011 and this is expected to rise by 61% in 2030. It is however imperative, based on the facts above as health care givers and stakeholders to firstly understudy Africa with its peculiarities and strategize a befitting and appropriate health care system that put into consideration and accommodates the African mindset.
This health care system must understand Afric’s multicultural settings,religious inclinations and embrace its ethnic diversity.

FACTORS AFFECTING DIABETIC CARE AND POSSIBLE SOLUTIONS

Africa, a developing continent is characterized by multiple factors that has plunged the continent into an era of economic and social setbacks and this has slowed down the rate of health care delivery in the continent.
Factors influencing African health care delivery noteworthy include:

1)  RELIGION
         Vast majority of Africans anchor their belief to A Supreme Being who is held in the highest esteem with instructions and guidance being handed over through HIS representatives to the followers. These representatives are called clergy. African religious setting is multifaceted and has been a great influence on lifestyle and philosophy. Some believe diseases and ailments serve as a punishment for wrongdoing or an attack.
   The role of religion in diabetic care cannot and must not be underestimated as it plays a major role in the attitude of individuals and the community to diabetic care. In view of this, community diabetology should be encouraged with individual communities coming up with programs that put into consideration religious beliefs perculiar to such community.
Diabetic education and enlightenment should also be integrated into all religious institutions.
                     

Community Diabetes Awareness

2)   EDUCATION
According to UNESCO Africa fact sheet:
176 million Adults are unable to read to write.
47million youth (age 15-24) are illiterates.
21millions adolescents are out of school and 32 million primary aged children are not in school.

The fact above reflects a continent with poor educational foundation for both the adults and the youths (future leaders). Education is paramount to information dissemination and economic Growth
International design of diabetic care and education should be revisited with the inclusion of more flexible and grass root friendly Programs. To an average uneducated African, “the absence of disease is Health” as against the W.H.O Definition of Health and this mentality coupled with cultural and religious belief system on disease affect preventive medicine in Africa.
      To a large extent, people don’t tend to complain until they start noticing complications; this added to the silent nature of D.M results in the highly complicated D.M found at hospitals.

3)   CULTURE
       African culture is varied and diverse. With the introduction of westernization, Africa’s age long culture and traditions are being substituted for western styles. This with urbanization has to a greater extent made Diabetic Care progressive in Africa i.e. through the media, internet, community research and community screening.
      In light of these remarkable progress; styles, trends and culture that promotes preventive care in diabetic health care should be considered in Africa
 

Free Community Diabetic Screening Conducted by Students Of Olabisi Onabanjo University Teaching Hospital,Sagamu,Ogun State,Nigeria

4)   POVERTY
        According to a UN report-

Half of the population of Africa lives below a dollar a day.
32 of the world’s 38 heavily indebted poor countries are in Africa (World Bank).
Slums are homes to about 72% of urban citizens.

These alarming facts reflects a continent where half of its population can’t boast of good feeding habits, good social status and most importantly access to quality health.
Procurement of drugs and the ability to afford healthy diets are difficult by people who live below a dollar a day. Hence, diabetic care should involve Philanthropists, Non-Governmental organizations, Societies, Governments and pharmaceutical companies who through serious effort and commitment would empower the continent economically.
    Also, I.D.F through its national bodies in Africa and affiliates should engage government into subsidizing drugs to make them affordable, available and extremely cheap such that majority of the African populace can have access to it and afford it. This will make life easier for those suffering extreme hardship in Africa


    Finally, it is imperative I point our attention to a silent but serious issue in Africa: Medical ethics and trado medical ethics.
    Africa, unlike many developed continents where rules and regulations guide healthcare delivery system is faced with a challenge. The trado medicals (groups of people that use herbs in treating medical conditions) are generally not well structured and not aligned with the medical professionals. This has for a long time been a major issue of contention with people being deceived in the ability of a single drug to cure all ailments in existence. ‘Gbogbonise’ – A drug for all ailments as it is called, has been largely marketed and sold amongst the uneducated in the community,with even a small fragment of the educated patronising them giving false hopes of a permanent cure to D.M and this has accounted for high percentage of late presentation at the hospitals.
      To forestall these activities, it is important to involve, train, and educate the tradomedicals on diabetic care and this I strongly believe, will go a long way in stopping the menace constituted by late presentations at clinics.
 In addition, a structure can be put in place by the African government and leaders for the tradomedicals which will spell out the ethics of their profession and limit the unprofessionalism demonstrated in the community.



Various Tradomedical Schemes At Marketing Drugs in Nigeria

In conclusion, the peculiarity of the African continent requires calls for a more radical and strategic approach in diabetic care with health care givers, researchers, government, and NGO’s understanding the challenges posed by the factors and putting these into consideration in developing a plan in diabetic health care delivery for the continent.


REFERENCES
 IDF Diabetic Atlas (5th Edition)
uis.unesco.org
achieveinafricawordpress.com
articlebase.com
africanlibraryproject.org


Adejumo Hakeem
hakeem_adejumo@yahoo.com

From the IDF africa Newsletter 2nd edition

Our Emotional Meeting with Omolade a Nigerian T1DM Child



From Left to Right (Dr Adekoya, Omolade, Her Mom)


Omolade is a 13 year old Nigerian Type 1 DM.
For her having Diabetes Mellitus wasn't something she bargained for.

Dr. Mrs Fetuga (Consultant Peadiatric Endocrinlogist at OOUTH with Omolade during one of her sessions )

Meeting with her was facilatated through our collaborative partnership with the Paediatric endocrinology department of the Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H), Sagamu, Ogun State, Nigeria. Dr Mrs. Fetuga (Consultant, peadiatric endocrinologist at O.O.U.T.H) and Dr. Adekoya (Senior Registrar, peadiatrics department OOUTH)

Diabetes mellitus type 1 (also known as type 1 diabetes, or T1DM; formerly insulin dependent diabetes or juvenile diabetes) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose.
The classical symptoms are frequent urination, increased thirst, increased hunger, and weight loss. (source wikipedia)

Tears of Joy fills Omolayo's Eyes as she sees herself in the Big Family united by D.

Tears of joy flowed through her eyes as she went through our album of PWDs all over the world who identifies with her, understands how she feels and sees her as family.


Omolade is a girl filled with bitterness wondering why God had given her a disease she has to live with forever despite adequate explanation and suport from her HCP.


Her hope was re-kindled knowing and practically seeing that she is not alone and she has thousands of children like her all over the world with T1DM, including adults.
This gives us an idea of a need for peer support for T1 PWDs in Nigeria where everyone can relate, interact and socialize.

Speaking with her mom about the financial implication on the family, she explains she spends N1,400 ($9) per vial and omolade uses 6 vials in a month making a total of ($54); this excludes the cost of glucometer and consumables.
This cost for a low income family in a developing country is burdensome and we aim through our partners to make this available thereby putting a smile on Omolara's face and that of the family.

We have been in constant touch since our meeting on the 4th of April and we have seen the joy associated with having a family united by D.

We wish to use this medium to appreciate the Peadiatric Endocrinology unit of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria for their support.
For every Nigerian T1DM Child we are committed to giving them the support they deserve.

Here's a call to HCPs, Health Care Givers, Diabetes Advocates and PWDs to identify with T1 children towards giving them the emotional support needed to encourage and motivate them towards a proper self management of D.
Do you know any Type 1 Nigerian Child please feel free to inform us.

Follow us on @theNGdoc or email us thengdoc@gmail.com

The challenges, hopes and aspirations of Living with Diabetes......Our interview with a Nigerian PWD

Nigeria typifies the classical example of living with Diabetes in a developing country where Diabetes is considered a social stigma and people are not eager to be termed or associated with it.

Developing countries like Nigeria have their peculiar challenges especially when such countries are still battling with communicable diseases and with increase industrialization opening doors to spread of T2DM.

We decided to take an innovative step by interviewing Mr Bolaji Lawal @BabanMoh , An investment banker with specialty in fixed income securities,capital market investment and corporate finance. He is a Type 2 Diabetic and resides in Port Harcourt (South South, Nigeria).




@theNGdoc: Brief Introduction of you sir and a summary of your journey so far as a PWD

Ans: I realized I was diabetic in December, 2010 after receiving malaria treatment and realized I was losing weight,My HCP quickly conducted a series of tests and informed me I was diabetic, he placed me on drugs

@theNGdoc: How has Living with diabetes affected your day to day activities?

Ans: Initially it was difficult but as I understood and got used to living with D,it became easier. Am hardly affected now.

@theNGdoc: How has the Nigeria health sector being able to improve your living with D?

Ans: I am eternally grateful to the University of Port Harcourt teaching hospital for saving my life.

@theNGdoc: Does the Health Care play any role in managing and preventing Type 2 Diabetes in your area?

Ans: Doctors in private practice need more training on management of DM,they can identify it easily but management needs improvement


@theNGdoc: What are the challenges faced by PWDs in Port Harcourt, Nigeria?

Ans: Quite a number but so many people are dying in Port Harcourt because of lack of proper management

@theNGdoc: Does the Health Care policy of Nigeria recognize the International Diabetes Charter of Rights and Responsibility of people living with PWD?

Ans: Please what is the Int'l Diabetes Charter of Rights and Responsibility about?


@theNGdoc: What ways can the Nigeria Diabetes online community, International Communities and Federal Government of Nigeria affect and help improve lives of PWDs in Nigeria in addition to activities already on ground.

Ans: Encourage a national weight loss program 2.Compel manufacturers to write the health risk on soft drinks, @DiabetiCare: @BabanMohD food and drinks industries in Nigeria should alert the masses on the health hazards linked to fizzy drinks jst like d tobacco ad does #ngdoc



@theNGdoc: We hope this interview serves as an eye opener and encourages other PWDs to speak out.Thank You all for your time Mr Bolaji Lawal

Thanks, pleasure is mine. Also like to extend my appreciation to Dr. Korubo and his team in Uniport Teaching Hosiptal


The purpose of this interview to encourage as many PWDs to identify with the Global diabetes online communities for care and support and to also help as many national and international organizations interested in Diabetes prevention (T2DM) and care (T1DM and T2DM) in developing countries get access to information directly from PWDs.

Full transcripts of the #tweetinterview can be gotten here

We are currently working on promoting the International Diabetes Federation Charter of Rights and Responsibilities of PWD in Nigeria

A big thank you to those that joined the #tweetinterview on the 1st of April 2013 @theNGdoc


We also wish to appreciate Mr Bolaji Lawal for being a part of this event.