Beyond the ordinary

”My story is really an ordinary one,” Dr. Evariste Bouenizabila assures me at the end of our phone conversation. Ordinary or not, his ability to get things around him moving is extraordinary enough to tell the story of the man whose fingerprints are all over the recent diabetes care initiative in the Republic of Congo.

Dr. Evariste Bouenizabila (left) uses his expertise in diabetes to extend both knowledge and

care facilities in his home country, the Republic of Congo.

Born the same year as the Rep. of Congo became independent from France, the young Evariste studied medicine at the Faculty in the capital Brazzaville and finished his thesis in 1985, at that point aged 25. With no possibilities for specialisation in his home country, he went to France to do his doctorate and specialise in diabetology. In 1993 he returned to the Rep. of Congo for the first time, but landed in post-election turbulence and decided to go back to France again. The second time he returned to his country in 2003 he only intended to spend a few weeks to find his family whom he had not seen for years. But an encounter with a religious sister and former colleague made him change his plans.

Point of no return

“I had just arrived at the airport when I ran across a religious sister with whom I had worked for children with diabetes before the war. I wanted to greet her, but her reaction was one of rejection rather than welcome,” Dr. Evariste Bouenizabila tells. Before turning her back on him she said, “I refuse to say hello, doctor. It is not worth it because you will just disappear again. So I will rather say good bye.” With the war, there were no specialists left in the hospitals and most of the children with diabetes whom they had treated together had died in the meantime. “Here I was planning to spend two weeks vacation and then return to France. Meeting that sister was a wake-up call to me and for all the doubts I had had in my head whether to return to the Rep. of Congo or not, this was my point of no return. I knew, that I had to stay and create some kind of sensitisation for people with diabetes and be where people needed me. That was not in France but in my home country.”

The group of ten

“At the end of 2003 we held the first meeting in what later became the diabetes association, Diabaction. We were ten. I was the only doctor and the rest were people with diabetes. The first two years we had no board. Now we are three doctors and five nurses and we have more than 180 people with diabetes registered as members,” he explains. Dr. Evariste Bouenizabila is currently scientific president of the organisation.

The one-time membership fee to join Diabaction is 5,000 Congolese Franc (CDF) corresponding to Euro 7. The members have access to the facilities at the adjacent diabetes care centre, Diabcare, as well as a consultation every three months. Treatment is not free, but members get a 50% discount. They also benefit from a 40% discount on insulin from the internal pharmacy. And while a consultation at a public health centre costs 10,000 CDF, members of Diabaction get it for 6,000 CDF.

Along with sensitising people with diabetes, the most important role of Diabaction is to create awareness and sensitise the authorities. Since 2004 the organisation has celebrated World Diabetes Day and organised walks involving companies and churches. In 2004 and 2005 they screened a total of 3,000 people and found a 7% diabetes prevalence rate. With 60% of the Rep. of Congo’s well over three million inhabitants living in urban areas an increase in the diabetes prevalence could be expected. However, the exact prevalence rate remains unknown for another two or three years until a national survey has been finalised.

Although the prevalence rate found by Diabaction was not nationwide, the 7% prevalence still caught the attention of the Ministry of Health who now recognises the problem of diabetes. Diabetes has become an integrated part of the medical centres’ services and the Ministry of Health has put a fixed price on medicine and ensured cheaper insulin. In short, Diabaction has managed to change the face of diabetes in the Rep. of Congo. 

      
The Diabc@re centre

Diabaction has established a centre for diabetes treatment in the capital Brazzaville named Diabc@re. With more than 7,000 registered patients it is the main centre for diabetes treatment in the Rep. of Congo. The World Diabetes Foundation has among other things supported the centre with IT equipment enabling the digitalising of the patient registry. As a natural part of the project supported by the World Diabetes Foundation all staff at the centre have been trained in diabetes care.

In addition to funding from the World Diabetes Foundation, the centre has managed to also strengthen dental, foot and eye care including laser treatment through other funding sources. The centre has laboratory equipment to perform HbA1c testing at its disposal, and so far there is a high patient compliance even though the cost for a single test is approximately 15 Euro.

Last year alone, close to 4,000 patients sought consultations at the Diabc@re centre in Brazzaville. This is a considerable number in a country with an estimated 14,000 persons with diabetes. Reinforcing the capacities of the Diabc@re centre and creating more diabetes facilities will no doubt increase the number of patients diagnosed and treated.

Primary care is core

While one ambition is that of creating another three large diabetes facilities in the main cities of Pointe-Noire, Gamboma and Dolisie, primary care diabetes clinics in the rest of the country is core to creating access to care for all Congolese. The World Diabetes Foundation currently supports the replication of three Diabcare centres and has recently extended the project to also include primary care level care by establishing mini clinics in all districts of the country and train local health care staff.

“This follows the strategy for the entire African region of extending diabetes care to primary care level which will mean better access to information, earlier diagnoses and better referral systems. In three years time, we will have extended diabetes care at primary care level to the entire country,” Dr. Evariste Bouenizabila explains. Having formerly held the position as national programme officer at the WHO Regional Office for Africa, he has in-depth knowledge about the strategies for non-communicable diseases in Africa. And as current special advisor of non-communicable diseases in the Ministry of Health he continuously utilizes his knowledge and network.

Fulfilling a dream

Knowing that professional migration is a huge problem in the Rep. of Congo as in many other African countries, I ponder what makes Dr. Evariste Bouenizabila stay when so many of his compatriots leave. His reply is quite frank: “I am man of the field. I know that I could earn 20 times more by working in France, but I will rather be here where I can actually change things and improve peoples’ quality of life. Changing things is really what keeps me going,” he says.  “I guess, I always dreamt of doing something concrete and by working on the projects in Diabaction I feel that I fulfil that dream. I share my knowledge and experience with people who believe in me and the change I create in them is what motivates me most of all.”

To conclude, I chose to believe that Dr. E. Bouenizabila is not as ordinary as he wants me to believe. I would rather describe him as a humble and very capable person doing an extraordinary effort, in a difficult environment where it was easier to turn away: He chose to pick the gauntlet and face the challenge and in doing so he is transforming himself and the world around him. For this reason he stands out as our local champion.

/ By Brit Larsen, Communication Coordinator at the World Diabetes Foundation

The project currently supported by the World Diabetes Foundation in the Republic of Congo aims at strengthening the existing Diabcare centre in Brazzaville and establishing three new diabetes clinics in three other cities by 2012. Training of doctors, nurses and health care personnel in diabetes and management of risk factors for non-communicable diseases is part of the project. The project which has only run for a year is already ahead of schedule and has so far established 22 diabetes clinics at primary care level. In a recent addendum to the project, an extension has been given to extend primary care in all districts of the country.  

Read the project description