Social distress due to diabetes in low-income countries: a challenge 

This article was exclusively written for The European Sting by Ms. Thaïmye Joseph, a final year medical student, conducting his studies at Faculté de medecine et de pharmacie(UEH) in Haiti. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

According to scientists, Diabetes mellitus,  characterized by an abnormal carbohydrate metabolism leading to hyperglycemia, is a deleterious diagnosis. Regardless of the subtype which can be diabetes type 1 or type 2, this affection is a major concern and became, these last decades, a public health issue. WHO noticed an increase in diabetes cases from 108 million in 1980 to 422 million in 2014, with a faster prevalence  increase in low and middle income countries than in high-income countries. Furthermore, the mortality rate rose by 3% between 2010 and 2019.

It represents a challenge for health care providers not only because of the concerning mortality rate increase but also the various  life-threatening and invalidating complications (blindness, amputations, end-stage renal disease and so on) that come without an appropriate multidisciplinary treatment. Despite detailed guidelines, access to adequate professional guidance and medicine, the management of diabetes is far from perfect . As a matter of fact, the psychological and social impact of this disease is often underestimated particularly in low and middle income countries. 

In order to address this issue, we have to define the way this chronic disease can affect mental health. People living with diabetes  have to deal with increased risk of depression, anxiety and eating disorders which may lead to a condition called diabetes distress. This kind of distress is linked to a lot of factors such as ineffective patient counseling, education and lack of social support. To go further, patients, brave enough, to express themselves about their distress, experiment stigma and discrimination. The latter, beyond a psychological impact, also concerns basic social rights: health insurance restriction, discrimination at work and leisure activities,  instable financial situation.

In high income countries, scientists started including more and more social considerations in the general treatment of diabetes and assessing the patient effectively, trying to solve out disparities. However, in spite of their scientific advance, the battle is far from won. 

The question is how can healthcare providers address the aforementioned psychological and social impact in low-income countries such as Haiti when even citizens’ basic needs are not satisfied?
With a low budget allocated to health, the resources are mostly reserved to primary health care needs. A social coverage policy does not exist, thus, the patient, once diagnosed, has to face his own new reality.

In this context, healthcare providers, guided by their dedication, should use all disposal means in order to alleviate the patient distress. The first one is to continuously educate the patient on his condition and demystify all preconceived ideas that can lead to depression and anxiety and constantly assess the patient’s mental health. Small support groups can be created where daily problems will be debated. Moreover, private hospitals and clinics could build up a social fund to which diabetic patients could subscribe in order to help them cope with expenses caused by medications and unfortunate complications. Implementation of these simple measures would greatly hamper social conditions  of patients living  with diabetes. 

References 

Ramkisson S, Pillay BJ, Sibanda W. Social support and coping in adults with type 2 diabetes. Afr J Prm Health Care Fam Med. 2017;9(1), a1405. 

Felicia Hill-Briggs, Nancy E. Adler, Seth A. Berkowitz, Marshall H. Chin, Tiffany L. Gary-Webb, Ana Navas-Acien, Pamela L. Thornton, Debra Haire-Joshu; Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care 1 January 2021; 44 (1): 258–279.

About the author

Thaïmye Joseph is a final year medical student, conducting his studies at Faculté de medecine et de pharmacie(UEH) in Haiti. She’s a member of Association Haitienne des étudiants en médecine (AHEM) since 2018. Furthermore, she is determined, hard-working and goal-oriented aspirant surgeon. She keeps herself engaged in clinical research and looks forward to collaborate with other health organizations and improve the healthcare system.