Heat needs to be turned up on diabetes awareness
You, the general public, remain in the dark about diabetes, even when it affects virtually every family on the island. In a recent Harris Poll carried out in the United States, as stated by Desmond Schatz, cancer and heart disease are perceived as more serious than diabetes. In the same poll, the majority of those interviewed feel that people with diabetes have themselves to blame.
On November 9, the Office of the Bermuda Chief Medical Officer sent out a memorandum to doctors about “the important information pertinent to Zika virus surveillance and testing in Bermuda”. It went on to say that this information is necessary for international reporting and to assure that control measures are implemented early by the public-health sector.
Bermuda has to make sure that it is able to report properly on a condition so far removed from its shores, and which poses virtually no fatal threat to its residents. Do you know that since 1980, the number of people with diabetes worldwide has gone up four times? More than 450 million people are now affected.
In Bermuda, accurate figures such as those, which the CMO wants my colleagues and I to keep about Zika, do not exist with reference to diabetes, and we are not asked to report these figures. However, it is safe to say that one in four of the Bermuda population has diabetes or prediabetes. How do we convince the Government and the people of Bermuda about the urgency that we face? Do we not have the same energy to mount the type of activism and advocacy for diabetes as has been done so well for HIV/Aids?
Why has the decline in the incidence of HIV/Aids been achieved, whereas the epidemic of diabetes remains unchecked? What can the diabetes community and the people of Bermuda learn from the HIV/Aids movement? The answer is simple. It began with an army of advocates who turned up the heat and took the HIV/Aids argument to 212°.
These advocates created a sense of urgency; they demanded changes and achieved incredible results in a few decades. At times, their methods at achieving these results were confrontational, but they did what was deemed necessary to get the attention of everyone: governments, the public, the scientists and corporations. One thing that they did not do, according to Schatz, the Professor and Associate Chairman of Paediatrics, Medical Director of the University of Florida Diabetes Institute and the Director of Clinical Research at the University of Florida, was “go quietly into the night”.
When I arrived in Bermuda nearly two decades ago, the stigma and blame, the denial and ignorance, the fear and isolation with regards to HIV/Aids led me to publish a small pamphlet with the help of the Department of Health. The aim was to remove the public concerns and myths about this disease. The campaign launched by the DoH was such that those with HIV/Aids were and are still treated free, and that has doused the raging wildfire that could have swept through this small island.
Let us compare this with one of the deadly effects that diabetes has wrought on this community in that same period. I refer to the uncontrollable wildfire of chronic kidney disease, which diabetes has been responsible for in that period. The dialysis unit at King Edward VII Memorial Hospital opens virtually around the clock every day of the year; no closure for Cup Match, America's Cup, Christmas or new year celebrations. To cope with this rise in end-stage kidney disease, the island now has an ambulatory peritoneal dialysis service, which goes to people's homes.
Bermuda needs an immediate transformational change in tackling this invisible epidemic. We need the following to achieve our goals: a sense of urgency, which means that everyone needs to be involved in setting forth a strategic vision on how to move forward. To move forward will require collaboration by everyone — healthcare professionals, the Government, and the public. We need to remove the barriers of blame and stigma attached to this disease, and this will involve thinking outside the box. November is just one month in the year. Why can we not think, publicise and educate about diabetes in the other 11 months?
I know that money does not cure every ill, but this is one situation where more funding is needed to make sure that the education about this disease and especially the drugs responsible for treating this disease are available free to all with diabetes. In Britain, persons with diabetes are not required to copay for drugs and other paraphernalia needed to manage this disease.
The basis of treatment still relies on drugs that have been around for a very long time and that are relatively inexpensive; the newer drugs, which are very expensive, are not always the first line of treatment.
The Bermuda Diabetes Association struggles every year to keep its head above the proverbial water. It is ill-funded, has no permanent office space, and is renting accommodation at present from the Blind Society on Beacon Street and the St John Ambulance building on Point Finger Road.
The association has always relied on and been grateful to many corporate donors who have helped to maintain some form of funding for its projects. It struggles to find any funding for diabetes education for the public. I cannot remember any Bermuda Government of whatever political philosophy allocating funds in its budget to promote this organisation, which was started decades ago by concerned parents and which has not had the place it rightfully deserves in the community.
Here is a fascinating story, which was told by my friend, Mr Schatz, and which may be myth or fact. It is a story of a 19th-century science experiment. As the story goes, researchers found that when they put a frog in a pan of boiling water, the frog immediately leapt out. However, in contrast, when they put a frog in cool water that was slowly heated, the frog just sat there not realising that it was being boiled to death. The results of the experiment are a good metaphor for what is required for transformational change. The frog in the cool water is analogous to complacency, which is the undoing of transformational change. In contrast, the frog put in the boiling water had that urgent sense of impending doom and does something about it; it acted, however bold that might have been.
I had mentioned the Zika virus “epidemic”. The immediacy of the Zika virus grabbed the world's attention just before the Olympic Games in Brazil this summer. Immediacy meant urgency and crisis, which meant proper attention and prioritisation. A few weeks before my June attendance at the 76th Scientific Sessions of the American Diabetes Association, the United States Senate approved a $1.1 billion compromise to combat Zika. How many people have had Zika diagnosed in the US and how many of them have had the same deadly effects that diabetes imposes on those who suffer from it? Diabetes, on the other hand, gets the equivalent of $3 per person, per year for those with this disease in the US.
Now is the time in Bermuda for advocacy at 212°, for education at 212°, for more funding at 212°. It is time for diabetes to become a visible disease, like those that have had that privilege for so many decades. Those diseases have not had the same deadly, wildfire effects that diabetes is capable of. It can unleash such fury so as to ravage this beautiful and relatively peaceful small island that I now call my home.
• Fémi Badà, MD is an age management medicine specialist and the former chairman of the Bermuda Diabetes Association