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South Sudan: bringing diabetes treatment home

28 Nov 2016

A muddy track branching off the main road connecting Agok town to Abyei leads to Wodchay village. Among the pathways of the village lies the home of Nyanjima Mayot. She is a calm, soft spoken 12-year-old girl with a broad smile. Her smile beams as she welcomes a team of medical personnel from the Médecins Sans Frontières hospital in Agok. The team of two, a training nurse and a nurse assistant, travelled more than ten kilometres to monitor their patient’s health. 

Nyanjima, the fifth child in a family of eight, is suffering from diabetes. One morning in 2013, Nyanjima collapsed while attending her classes at Ganga primary school in Abo-tok. She was quickly rushed to a nearby health facility, where she was given first aid and regained consciousness. Two days later, Nyanjima fainted again and her parents were advised to take her to the Médecins Sans Frontières hospital in Agok. “Nyanjima was diagnosed with insulin dependent diabetes mellitus, and we quickly put her on medication,”says Médecins Sans Frontières training nurse, Saviour Dombojena. 

“People came for treatment from villages and towns several days of travel away. Families were separated; others were forced to find extra accommodation in Agok. With the hard economic situation, it was just not sustainable for many of them.”

Type 1 diabetes requires daily injections of insulin, but the distance from Nyanjima’s home to the hospital meant that she could not come every day for medication. Her mother had no choice but to leave her siblings at home with their father, so she could take care of Nyanjima in Agok as she underwent her treatment. Nyanjima’s mother was the breadwinner of the family, and this task was now transferred to her father. But he struggled to take care of the family alone, and Nyanjima’s mother had to return home, leaving Nyanjima at a relative’s home in Agok town. Nyanjima was not happy in her new circumstances. She spent a large part of the day at the hospital.  She dropped out of school, she was missing her family, and was increasingly miserable. 

Nyanjima is one of many diabetes patients facing these difficulties. In order to make life easier for patients, the Médecins Sans Frontières team in Agok has introduced a home insulin programme. “People came for treatment from villages and towns several days of travel away,” says Dombojena. “Families were separated; others were forced to find extra accommodation in Agok. With the hard economic situation, it was just not sustainable for many of them.” The home insulin programme started in July 2015 after a study showed that some insulin can be kept safely without refrigeration for a certain period of time. This made a significant change in South Sudan, where temperatures can reach well above the mid-40s and keeping drugs at safe temperatures is a huge challenge as electricity is not available in many areas. Médecins Sans Frontières decided to train patients and their caretakers on how to administer the insulin so that they would no longer have to come to the hospital every day.

“We trained them how to use a glucometer (the medical device used to determine the approximate concentration of glucose in the blood), how to control their diet and how to inject themselves,” she continues. “Under medical supervision, they were then asked to demonstrate their theoretical and practical understanding of how to administer the insulin before they went home.” Médecins Sans Frontières provides free insulin, care and training. The diabetes patients come to the hospital once a month to pick up their insulin and undergo medical checkups. They are also advised to come to the hospital if they feel any unusual symptoms. Nineteen patients are now enrolled in the home treatment programme. For Nyanjima, this means that she could go back home to her family as she no longer had to go to the hospital for treatment every day. She is now able to safely administer the insulin by herself, under the oversight of her mother. Today Nyanjima is happy, living with her siblings and parents. She is back in school and she hopes to pursue her dream of becoming a medical doctor. “Many people in my village are suffering because of diseases,” says Nyanjima. “And I want to treat them,” she adds with enthusiasm.

The Médecins Sans Frontières Hospital in Agok is the only secondary health care facility in Abyei Administrative Area, serving a population of about 150,000 people.  Médecins Sans Frontières is currently running 17 regular medical projects throughout the country and in 2015 undertook close to a million medical consultations.