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Diabetes Care for Disadvantaged and Vulnerable

Living with diabetes is already hard as it is, more so if you happen to have this chronic condition while living on meager resources.

A poor diabetic would require medications, hospitalizations, regular check-ups, insulin (for type 1 diabetics), and other things to spend on aside from his family’s basic needs. Because of this, some diabetics forego medications just to sustain life’s basic needs.

Non-compliance to one’s prescribed medications and/or treatment increases a diabetic’s risk for complications like heart attack and stroke. And with the increasing prevalence of diabetes worldwide, attention and care should be given to the disadvantaged and vulnerable diabetics to help them survive and cope with their disease.

Department of Health (DOH)/ Philippine Coalition for the Prevention and Control of Non-Communicable Diseases (PCPCNCD)
Formally organized on April 14, 2004, PCPCNCD is composed of organizations that are committed to the prevention and control of non-communicable diseases. The Coalition is also the main organization that promotes the Healthy Lifestyle campaign of the government.

“We work in a more integrated manner. Our thrust here at the DOH, together with the PCPCNCD, is the prevention and control of risk factors,” says Ms. Frances Prescilla Cuevas, Chief Health Program Officer of PCPCNCD.

According to Ms. Cuevas, PCPCNCD’s thrust is to target or reduce the prevalence of the three major risk factors – physical in-activity, smoking and unhealthy diet. Reducing the prevalence of these risk factors likewise reduces the risk for the four major disease entities in the country today, which are cardiovascular disease, cancer, chronic obstructive pulmonary disease (COPD), and diabetes mellitus.

Healthy lifestyle. The group’s main strategy is the promotion of healthy lifestyle. The mag-HL (healthy lifestyle) campaign of the DOH had been particularly successful in instilling in the minds of the people the importance of a healthy lifestyle in the prevention of diseases.

The DOH also provides training for rural health workers, doctors and nurses in government hospitals in the provinces, down to the barrio health workers to be able to disseminate the government’s healthy lifestyle campaign.

Treatment guidelines. With regards to diabetes per se, PCPCNCD is working together with the diabetes specialty groups that are members of the Coalition in the creation of a common and more acceptable guidelines for the treatment and management of patients who already have diabetes. “All the members of the diabetes sector of the PCPCNCD will be the ones in-charge of formulating the guidelines,” says Ms. Cuevas. Among these diabetes organizations are the Philippine Diabetes Association (PDA), the Philippine Association of Diabetes Educators (PADE), the Institute for Studies on Diabetes Foundation, Inc. (ISDF) and the Philippine Center for Diabetes Education Foundation Inc. (PCDEF).

The guidelines, says Ms. Cuevas, will be especially useful for government doctors in the provinces and those in the rural health units. With the creation of a uniform guideline on the treatment and management of patients with diabetes, patients in rural communities are assured that they are getting the proper care and management of their diabetes.

Ms. Cuevas said that the project is still in the planning stage, but they are looking at having the draft of the guidelines ready by the end of 2006.

Fast food advocacy. Data from the DOH reports that 5 out of 10 Filipinos who eat out go to fastfood restaurants. This is the reason, says Ms. Cuevas, why they want to partner with fast-food companies in making food healthier for Filipinos.

“Our fast food advocacy program is really providing avenue for fast food companies to help in the drive of the government for healthier food choices – that is, making fast food healthier food,” Ms. Cuevas explains.
So far, PCPCNCD has partnered with several fast-food companies in this advocacy. Some, like Wendy’s, have already modified some of their food products and have offered healthier food options, reported Ms. Cuevas. Others like Jollibee and Goldilocks have already declared their intent to adhere to the healthier fast food advocacy.

Also on the pipeline are plans for a recognition program for a fast-food restaurant or an eating place that will mark them as healthy eating places; plus a food certification program that will put a seal to a food product marking it as a healthy food item.

Institute for Studies on Diabetes Foundation (ISDF) Inc.
Primarily an academic organization and as of now, the only school in the country that focuses on the study of diabetes alone, ISDF through the years has created programs geared towards helping poor diabetics.

Dr. Ricardo Fernando, founding chairman and president of ISDF enumerated some of ISDF’s projects that concern the poor diabetics, which include:

Workshops. ISDF holds at least four two-day workshops a year that educate doctors, nurses, dietitians, etc. on the care and management of patients with diabetes. The workshops are done in different parts of the Philippines, with the goal of providing health practitioners the basic knowledge on the management of diabetes to better care and provide medical attention to diabetics especially those living in rural communities where access to healthcare is poor.

Education and training. ISDF chooses doctor-scholars who undergo intensive training and education on diabetes management for free, with only the promise that after completion of the program, they will put up a diabetes clinic in the nearest center or government hospital. “We choose them (the scholars); they don’t come to us because they are bright but we choose them because we know they will benefit the people in the barrios,” says Dr. Fernando. ISDF graduates, according to Dr. Fernando, are also given the task upon completion of the program, to provide free services to the poor diabetics in their communities.

  • Diabetes clubs. Charity patients who see ISDF-graduate doctors are organized into clubs of 20 to 60 members. These clubs are again organized into a formal group which is now called The Consortium of Government Diabetes Clinics (CGDC).
  • Lay fora. Every year, ISDF invites speakers from either government or private hospitals to speak on various topics in their annual lay forum. Previously spearheaded mainly by ISDF, this annual event is now handled by the CGDC.
  • Newsletter. ISDF also produces a quarterly publication called Scribblings, which contains valuable information, news, and articles on diabetes. Scribblings is distributed to doctors to help guide them in the management of their patients with diabetes.
  • Dispensary. The ISDF’s dispensary is for free, says Dr. Fernando. Poor diabetics can get certain medicines from the dispensary free of charge. They also offer discounts, and sometimes give free insulin and glucose meters to the really needy patients.
  • Rainbow Camp. Held annually, the rainbow camp is a summer camp that aims to educate and raise awareness among diabetic children on the management, treatment and prevention of complications in diabetes.

Aside from all these, ISDF also serves as the mother organization for other diabetes groups, including the Philippine Association of Diabetes Educators (PADE), which is composed of doctors, nurses, dietitians, etc.; the Association of Diabetes Nurse Educators of the Philippines (ADNEP), and the Philippine Society of Diabetologists (PSD) – all of which have programs that also benefit the disadvantaged and vulnerable diabetics.

Diacare Foundation
“Diacare is a group of type 1 diabetics formed by parents of these children. It was created with the primary objective of providing indigent diabetic patients with the care that they need like subsidy for insulin, and generally act as a support group for the patients and their families,” says Dr. Joey Miranda, president of Diacare.

When Diacare started, they got initial support from an NGO group in Australia that provided free insulin for all members of the foundation. Now, Diacare continues to help their members through self-sustenance. They involve their members in fundraising activities that can help sustain the members’ insulin needs.

Dr. Miranda relates that every time the group receives donations like free insulin from private donors, what they do is they sell the insulin to their members at a subsidized prize. He says that this way, they will be able to maintain funds that they can again use to buy additional insulin for their members. Dr. Miranda adds that selling insulin at a subsidized prize and not just giving them for free, will help Diacare members learn self-sustenance by being more an active participant in their fundraising activities for the whole group.

One of Diacare’s major programs is the annual Camp COPE,a summer camp for type 1 diabetic children and teens. During camp COPE children are taught the proper way of caring for themselves including proper monitoring of blood sugar, proper diet and nutrition and other pertinent information that can help them cope with their diabetes.

Concerted effort
Other groups like the Philippine Diabetes Association (PDA), the Philippine Center for Diabetes Education Foundation Inc. (PCDEF), and the Philippine Society of Endocrinology and Metabolism (PSEM) also have their own initiatives when it comes to helping the poor diabetics.

PDA’s Childhood Diabetes Council, for one, is involved in the Adopt a Child with Diabetes program of the International Diabetes Federation (IDF). The Childhood Diabetes Council receives funds through the IDF to support indigent children to maintain adequate diabetes care. Aside from the sponsorship, the program also involves diabetes education for the children and their families on the importance of maintaining a healthy lifestyle in the management of their diabetes.

PDA also comes out with a quarterly publication called Diabetes Watch, a magazine that aims to promote diabetes awareness and contains informative articles on diabetes management and prevention.

PCDEF, on the other hand, spearheads the annual Diabetes Awareness Week (DAW), together with PDA and PSEM. DAW’s main goal is “to promote awareness of diabetes through early detection and educational programs; and toprevent the onset and progression of complication through promotion of healthy lifestyle and mass screening program.” PCDEF also publishes the engaging newsletter Diabetes Leader.

Together with the PDA, PCDEF has also spearheaded the creation of the Working Group for the Study of Childhood Diabetes. According to the PCDEF website, the group has already embarked on a project to study the prevalence of type 1 diabetes in childhood and adolescence in Metro Manila. The project was geared towards the preparation of educational materials for childhood diabetes which was launched in different schools nationwide.

The PCDEF also conducts the yearly Intensive Training Course for Diabetes Educators whereby teams composed of nurses, nutritionists and physicians learn about various aspects of diabetes care for free. They then go back to their various institutions or communities to establish diabetes education clinics and teach patients and their families or caregivers on diabetes care. The PCDEF has just graduated its 18th batch of diabetes educators this year

Led by Dr. Augusto D. Litonjua, the PCDEF also formed the certifying body for diabetes educators in the country, the first of its kind in Asia. Its aim is to improve and standardize the quality of diabetes education in the Philippines. Yearly, the PCDEF also holds symposia on updates for the diabetes trainors in order for them to stay current on their knowledge of diabetes.

Diabetes care for all
Providing support and care for the disadvantaged and vulnerable diabetics require a concerted effort from various groups, individuals and the patients themselves.

Through active participation in all the efforts, activities, programs and projects of all the groups and organizations mentioned here, those with diabetes are assured that they can survive and cope with their diabetes.

Helping the disadvantaged and the vulnerable groups does not only mean giving them money to buy their medications and insulin. But more importantly, caring for the poor and disadvantaged diabetics starts with diabetes education and increasing awareness about the disease.

We likewise believe that through proper education and information, people with diabetes, even the disadvantaged (the elderly, children and ethnic groups) and the economically-challenged ones can live near normal lives and be productive individuals.

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