Oswati – one of Tanzania’s children with diabetes

Oswati Mollel, 18 years old, was diagnosed with type 1 diabetes in August 2007.

Oswati Mollel is 18 years old. He lives with his Masai family in Tanzania’s Kilimanjaro region. In August 2007, he was diagnosed with type 1 diabetes. It was the second time in one month he was admitted to the very same hospital. The first time he was treated for malaria, but when he was re-admitted he was critically ill and spent two weeks in intensive care. Since then, Oswati has not returned to school.

While the inability to attend school remains a challenge for Oswati’s future, at least he has access to free insulin, diabetes education and care provided at the Kilimanjaro Christian Medical Centre (KCMC). Since June 2007, KCMC has run a project to support disadvantaged children with type 1 diabetes. They presently have 50 children supported under this program. “This has made an immense difference,” explains nurse and diabetes educator Ms. Sijah Mallya. “Earlier  many children died – now they are able to get free insulin and optimum diabetes care if they come to the clinic.”

Programme Coordinator of the World Diabetes Foundation, Mr. Ulrik Uldall Nielsen recently visited another site- the Bugando Referral Hospital where a similar initiative is being run under the project to help children with type 1 diabetes and he shared his impression with us. “A significant number of the children I spoke to were orphans and they all came from very poor families. There is little probability that any of them would have been alive today, many would have died even before a diagnosis was made and many others due to lack of access to insulin,” he says. 

Transport & culture

Despite the free insulin and care offered at the clinic, transportation is another challenge for Oswati. His home is 50 kilometres away from the clinic. He has to walk a long distance from his home to get to the main road, and wait for the bus coming from Arusha. The bus is often crowded, so he has to wait for the next one to come. Sometimes Oswati does not arrive at the clinic until 2 p.m. which is when the clinic closes. But understanding the seriousness of his condition, they usually attend him anyway.

Another barrier that Oswati faces, is the challenge related to his cultural heritage as a Masai. “It is difficult to convince a Masai to visit a clinic and even more so to come for follow-up visits,“ explains nurse Sijah Mallya. “Since we started, we have lost three Masai children. The Masai are a very strong tribe, and it is not easy to change their beliefs. So you need to invest extra time if you want to reach out to them. We try to advise them not to give their children any kind of herbal medicine, because as far as we know, there is no alternative to insulin,” she says.

As for the question of Oswati continuing school, nurse Sijah Mallya is eager to find someone to help him.  “His father is an old man and unable to provide for his schooling,” she explains. “And with the Masai tribe, if you do not go to school, you have to walk the cows. If Oswati walks the cows it will be difficult for him to control his diet and glucose levels, and walking barefoot is no good in his condition. Last year, he came to the hospital with a bad wound from walking the cows,” she explains. 

Diabetes nurse, Sr. Sijah Mallya (second from left) visits Oswati's home located 50 km from the Kilimanjaro Christian Medical Centre where Oswati receives diabetes care and medicine. 

Access to free care

At KCMC, Oswati is lucky to be part of the fundraising project supporting children from poor or disadvantaged background with free insulin and diabetes care. The project which is administered by the Tanzanian Diabetes Association supports children and youngsters with type 1 diabetes at five referral hospitals in urban and peri-urban areas of Tanzania. The estimated cost for supporting a child is USD 450 a year. In addition to the medicine and required equipment, the project also supports children's camps and purchase of refrigerators for the type 1 diabetes clinics as well as computers for updating of patient registries.

So far, the overall results of this fundraising project are positive. First of all, children survive longer and more children are being diagnosed early with diabetes. Acute complications such as diabetic ketoacidosis are now reduced significantly. This is partly due to improved diabetes management at the referral hospitals. The parents also increasingly recognise the importance of good glycaemic control, impact of diet and exercise on diabetes treatment. Although Oswati is not part of the statistics, 80% of children with diabetes are attending school and most of them have joined the secondary school.
Upon visiting the referral hospital in Bugando, also part of the project for children with type 1 diabetes, Mr. Ulrik Uldall Nielsen observed a striking number of children with type 1 diabetes. “Normally, when visiting diabetes clinics I find very few children with type 1 diabetes registered. However, the fundraiser programme has raised awareness of type 1 diabetes and shows that it is also a problem in a country like Tanzania. The generally low number of type 1 patients in many developing countries is probably more due to lack of diagnosis and treatment than to actual lower prevalence,” he concludes.

Action to support

Since 2003, the World Diabetes Foundation has supported the Tanzania Diabetes Association in establishing diabetes clinics within the existing health care facilities. More than 38 diabetes clinics have been established at all regional hospitals, with the support of different donors. Since 2007, five of these clinics offer specialized services for children with type 1 diabetes with the support from the World Diabetes Foundation’s fundraising programme.

Donations by Novo Nordisk employees, including Take Action fundraising initiatives, contributions from management and Novo Nordisk affiliates have raised nearly one million Danish kroner in support of the children's programme. “The fundraising projects facilitated by the World Diabetes Foundation offer a unique platform for individual Novo Nordisk employees to make a genuine difference, such as supporting the children in Tanzania with basic treatment, monitoring and educational activities that would otherwise be out of their reach. The enthusiasm and willingness of the employees to go the extra mile is truly admirable and a constant source of inspiration in our daily work,” says Ms. Benita Bertram, HR and Administration Manager of the World Diabetes Foundation.

Read more about the Fundraising project for children with diabetes in Tanzania