Al-Ahram Weekly Online
14 - 20 February 2002
Issue No.573
Published in Cairo by AL-AHRAM established in 1875 Current issue | Previous issue | Site map

Diabetics in danger

The sharp decline in the Egyptian pound's exchange rate against the dollar is wreaking havoc in unlikely places. Reham El-Adawi investigates the plight of the country's diabetes sufferers

"I inject myself with insulin twice a day before breakfast and supper. Each shot is LE6 (thats LE360 per month) but my salary is about LE600," explained Mustafa Gamal a diabetic of 20 years. "Like most diabetics, I started my treatment with tablets but these lose their effect with time. An insulin injection then became crucial," Gamal said. The injection is both painful and expensive.

"Thankfully my family helped me to bear the expense but as the disease advances complications develop. After 20 years, the disease now affects my liver and my eye-sight."

A shortage of affordable insulin now adds to Gamal's difficulties. "A month ago, I fell into a coma and nearly died because, for three days, I couldn't find the insulin I needed," he told Al-Ahram Weekly.

For a diabetic, insulin is as necessary as air for survival; and yet for the last five months there has been a severe shortage of certain types of insulin and some have totally disappeared form the market.

Wafiq Madbouli, another diabetic, says he stockpiled a huge amount of Mixtard 30/70, one of the most effective types of insulin -- not to mention one of the cheapest costing a relatively low LE6.60 -- as soon as he realised the shortage. "I know that my behaviour is wrong and worsens the problem but what can I do? My condition is very advanced and I can't live without insulin for a single day."

The insulin drought was confirmed by Michael Victor, a pharmacist in Al-Manial district. "Everyday, I apologise to dozens of patients who are desperate for insulin. Many complain that they weren't injected for two days. I receive only ten boxes per day of the cheap types of insulin. These invariably are sold out in half an hour and all that is left is brands costing LE40 to LE90: a price most can't afford."

In an attempt to solve the problem, the Minister of Health Ismail Salam, announced this week that the price of Mixtard 100 would be decreased from LE40 to LE31. However, according to many regular users of insulin interviewed by the Weekly, this is not much a solution since this type of Mixtard is not used widely.

And while the shortage of insulin has been a front page news story for months, the existence of an insulin crisis is strongly denied by Galal Ghourab, chairman of the Egyptian Holding Company for Medicine. He argues there is only a shortage in the Mixtard 30/70. He claims that since the beginning of the shortage, imports of Mixtard 30/70 have increased from 300,000 to 600,000 boxes a months. Ghourab explained that currently, the Health Ministry pays LE40 million a year in insulin subsidies, but that this figure needs to increase to compensate for the growth in consumption and the rise in the exchange value of the dollar against the Egyptian pound. He told the Weekly that the company is involved in international negotiations to manufacture the drug locally.

But Mustafa El-Hadari, head of the medicine policies department at the Ministry of Health, accuses the Egyptian company -- a Health Ministry affiliate -- of reducing insulin imports and distribution following the devaluation of the pound in July 2001.

Diabetics must test their blood twice daily. Technology has reduced the time needed to take the measurements and the size of the devices, but the price remains prohibitively high. The machines, not subsidised by the Health Ministry, cost between LE370 to 500. Each measurement then requires a test strip costing LE3, i.e. LE180 per month.

And the number of diabetics is increasing. While there is no comprehensive figure for sufferers, Sameh Abdel-Shakour, dean of the National Institute of Diabetes and Endocrinology (NIDE) warns that "The number of visitors to NIDE is on the rise, currently our turnover of patients is between 13,000 and 15,000 per month."

Dr Salah El-Ghazali Harb, head of the diabetes unit at Nasser Institute Hospital said that first a reliable survey of diabetics must be conducted before any attempt can be made to curb this disease which dates back to the Ancient Egyptians. Citing a WHO report, he declared that by the year 2014, the number of diabetics will exceed 350 million worldwide.

And it is not just the physical pain of the disease that patients must suffer. Employers often discriminate against diabetics, Ali Leila, a sociologist told the Weekly. Private companies will only hire diabetics if they forgo company health insurance. Treating diabetics as outcasts often causes them to deteriorate physically as well as psychologically, Leila added.

On this point, Dr Harb stressed the need for public awareness of the disease. Though there are several associations in Egypt trying to raise awareness, there is no coordination. Dr Harb urged that one organisation should be established to deal with all diabetics' affairs, including the early diagnosis and control of the disease-related illnesses.

Dr Harb relates the expansion of diabetes to the shortage of general health education and diabetic education in particular. He suggests that educational television programmes is the best way to teach the public. These broadcasts should be monitored by specialists to prevent misinformation.

Sufferers also need adequate diabetes education. "The unit at Nasser Institute Hospital is the only centre in Egypt that gives the patient a diabetic instructional session as part of medical examination," boasts Harb. Tests last all day, then a drug is supplied and the patient returns monthly for a follow-up. This service is subsidised by the state but still costs LE380. Those who can go to private clinics pay three times as much.

Since 1995 the NIDE institute has organised anti- diabetes campaigns, mainly in schools and the most populated districts in Greater Cairo. Lectures are also given at the institute's hall on regular basis

Risk of the disease is highest amongst those with a diabetic in the family or those over 50 or those who are over-weight. Dr Harb believes the increased number of sufferers is related to recent changes in lifestyle and the environment. The largely urban complaints of stress, high blood pressure and increased cholesterol add to the chance of becoming diabetic, said Harb.

Emtethal Sweifi, a nutrition consultant at the Nutrition Institute (NI), explains that exercising, losing weight, eating fresh vegetables and giving up smoking are vital factors in avoiding the disease.

Children can also suffer from diabetes. According to NIDE, children represent 10 per cent of the total number of diabetics in Egypt. A study conducted by Ain Shams and Cairo universities suggested that one in a thousand children has the disease. Children who have a diabetic mother are three per cent more likely to suffer the illness; if their father is diabetic, the rate rises to six per cent.

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