Let's talk diabetes...in isiZulu

I taught my first health education class this week in a rural clinic in the township of Steadville, which is right outside of Ladysmith in the province of KwaZulu-Natal (KZN).  I set up the presentation I created (mind you, not powerpoint format but rather using cut out drawings, stick glue, markers and flipchart- hark the days of old!) in the waiting room at the clinic. There was anywhere between 35 to 50 people, including babies, the elderly, and everyone in between, in my audience. Check out the photo gallery.

The topic of the day was "Eating Well with Diabetes." I touched on the basics of what diabetes is and how nutrition affects blood glucose. We discussed glucose, insulin, and the different ways through which we can manage diabetes. As I learned from my diabetes mentor at St. Jo Hospital last year, there are essentially 4 ways to control diabetes: Meals, Movement, Monitoring, and Medications. However, I only presented three. Monitoring is not provided by the state with the resource limitation in this clinic, which is part of the public, government-run health system. A vial of test strips here cost on average R280 (~$28), not to mention yet the costs of needles, lancets, and meter, which does not seem to be as freely distributed as I remember it to be in the U.S. Considering that about half of the population in KZN lives below the poverty line, which means making do with only R500 a month, monitoring is not an out-of-pocket option for patients either. Patients at this clinic receive all of their medications free of charge from the clinic dispensary. Apparently the only medications that are used for patients with diabetes here are oral agents: metformin, glyburide, and glipizide. So I focused on "Meals" and we discussed different food groups, the "my plate" proportions, and the foods specific to the South African palate (e.g. phutu and samp- the staple starch made from milie pap). Especially since I was speaking to a general audience and not one who specifically had diabetes, I also wanted to make the information relevant to making healthy nutritional choices regardless of one's disease state.

Most of the audience speaks isiZulu, the language of the Zulu people who live in KZN, and my isiZulu vocabulary is measly at the moment. I was very grateful to have Ma Nomsa, who I'm working with at a partner NGO, translate and interpret. Despite the language barrier between us, the audience was so engaged and participated in the lively session. I had brought a sack of oranges to incentivize the crowd, and I think they really appreciated the flying fruits in exchange for answers and responses.

Much of Sub-Saharan Africa has been plagued with HIV/AIDS epidemic, especially South Africa, and most of the limited health care resources have been funneled into infectious disease campaigns. Chronic non-communicable diseases, like diabetes, have not and are not receiving awareness and management as they require. And it's not because they are not a problem here. In fact, non-communicable diseases (NCDs) constitute the greatest mortality and morbidity in the developing world today: nearly 80% of deaths in low and middle income countries are from NCDs. There's still a lot of work to be done to change this tide, but at least a waiting room full of people now know a bit more about diabetes. How do you eat an elephant? ... in small pieces.