Drug shortages frustrate diabetes fight

What is Malawi doing to lessen the pains of seeking drugs that are not available for diabetics? As Malawi commemorates World Diabetes Day tomorrow, which is commemorated on November 14 internationally, EPHRAIM NYONDO highlights continued challenge of diabetic drug shortage in the country.

Sometime in October 1986, Timothy Ntambalika, after a long illness, left his home in Traditional Authority Nchilamwera, Thyolo, for Queen Elizabeth Central Hospital (QECH) in Blantyre to seek treatment.
He had endured a bad headache and fever, and he thought it was malaria.
Expecting to be told of plasmodium in his blood after a test, the doctor stunned him with news that they had found a ‘highest sugar (glucose) level of 460 mg/dl’.
Normally, medical experts say, glucose level in a human being before and after eating is supposed to be between 70mg/dl and 180mg/dl.
At 460mg/dl, Ntambalika had abnormal levels of glucose and, in medical terms, that amounts to diabetes, a non-communicable disease (NCD).
“It never occurred to me that I could have diabetes. Diabetes is a disease that I did not pay much attention to. I thought of it more as something for other people, not me,” he says.
He adds that for all the time he had been sick, he just could not think about having a strange disease because he never experienced specific symptoms.
In fact, it is this nature of not having specific symptoms, according to Moffat Nyirenda, a professor at the College of Medicine, that makes diabetes dangerous.
“Signs and symptoms that diabetic patients experience are usually those associated with other common health disorders such as blurred vision, fatigue, increased hunger, weight loss, increased thirst and frequent urinating,” he says.
Even when they have it, reasons Lutengano Kadammanja of Diabetes Association of Malawi (DAM), people do not realise it.
“They only present themselves to the hospital with diabetic complications. Therefore, this day [Diabetes Day] reminds us of how devastating diabetes can be and how best we can control it,” she says.
Even worse, the tragedy, according to Nyirenda is that people rarely go to the hospital quickly because they do not take the symptoms seriously.
“Early diagnosis can help solve the problem and that by observing hospital prescription and advice, one can be rescued from being diabetic,” he says.
Of course, thanks to his discipline in taking medication since 1986, Ntambalika is still strong today. However, a World Health Organisation (WHO) research done in 2009 shows that diabetes, once considered a rare disease in sub-Saharan Africa, is now becoming common.
The WHO reveals that 5.6 percent of Malawians are diabetic. But statistics compiled by DAM indicate that about 10 000 people in the country are living with diabetes.
In fact, according to Kadammanja, the trend of newly-diagnosed diabetics in the hospitals shows that the prevalence of diabetes is growing every year.
With these increasing figures, diabetes presents yet another scar on the country’s health care. Its worst venom on humanity, argues Kadammanja, is that it is always misunderstood, giving birth to untold myths.
“They say diabetics should use honey, should use brown sugar, or some say they should use peanut butter. All these are misconceptions,” she says.
But diabetes, she underlines, is a disease which is controllable using specific medication, such as Protaphane/lint or insulin.
However, it is challenges in accessing these drugs—most of which are expensive for an average Malawian—which diabetics in the country face.
Last year, during commemoration of World Diabetes Day, Ntambalika, a diabetes survivor who formed DAM, urged the Ministry of Health to act urgently on the shortages of various drugs for the diabetic such as Metformin, which cannot be easily accessed from pharmacies at government’s major hospitals across the country.
“Our major concern, as people living with diabetes, is that there is an acute shortage of drugs in the country, some people have to buy drugs from pharmacies which are very expensive, while such people even have no money,” he lamented.
He added that the problem is further complicated by human resource constraints.
“For instance, Tuesday, which is a diabetes clinic day, most patients are frustrated to discover that health workers specialised in diabetic care have been shifted to other departments and often get attention from medical students who might not have expertise in diabetes management,” he says.
Josephine Koloviko, a Blantyre-based member of DAM, concurs with Ntambalika that the country has a serious shortage of diabetic drugs and also appeals to government to help reduce this problem.
“The medicines are scarce and patients are going to die if no action is taken urgently,” she warns.
She suggests that government should court donors and other development partners to help solve the problem urgently.
Dr Beatrice Mwagomba, director of NCD and Mental Health Unit in the Ministry of Health, says the essential health package conditions of the current heath sector plan for 2011 to 2016 includes NCDs such as diabetes.
And Ministry of Health spokesperson Henry Chimbali says such drug challenges raised by patients and the association will soon be eased.
“We know their problems, and we are trying to ensure that insulin should be available at all times,” he says.
As Malawi and the rest of the world commemorate the day this year, it should not just be a moment of talk. It should be a call on how the country can move on in creating a better world for diabetics.  n