Fighting an epidemic

Fighting an epidemic

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Diabetic eye disease is a complication of diabetes and is the world’s leading cause of avoidable blindness in the working age population.

By Emily Edwards
Photography by Darren James

Diabetes has become a rapidly escalating problem in low-income countries. In the Pacific, it is at one of the highest rates in the world, despite being uncommon only a generation ago.

Throughout the Pacific, diabetes and the devastating outcomes it can have, such as blindness, is often caused by a lack of healthy food choices which can be out of reach for people living in poverty, as well as a lack of awareness amongst Pacific people about what causes the disease.

The disease is having devastating repercussions on the population in the Pacific - it has been described as an epidemic. The below video shows the personal impact diabetes is having on just one person, 22 year old Clerence.

During our recent outreach to Vanuatu, our visiting team saw many diabetic eye disease cases. Clerence’s was one of the saddest. But The Fred Hollows Foundation NZ will be able to help and make a difference to her life.

When the team met Clerence at her home two months ago, she was sitting alone in the dark, in a wheelchair that once belonged to her father. She was not able to join a village celebration taking place next door to her home. But she was still smiling and welcoming, glad to see us.

Meet Clerence

Clerence has suffered from diabetes since she was a baby. As is often the case in Vanuatu, her condition was not diagnosed until many years after she was born. While she now takes insulin, she has been continuously affected by infections for which she has not always been able to afford to take antibiotics. Amongst the consequences have been two amputations, to remove her toes on both feet.

She also has dense cataracts, leaving her with seriously impaired vision. This is another symptom of her diabetes. The first symptoms were noticed when she was 10 and her condition was diagnosed, but her mother did not understand the link between diabetes and worsening vision.

"The hospital did an eye screening at her school. They said her sugar level was high... we had never heard of this before."

At this point, many things might have helped Clerence. For example, if she had been able to follow a healthier diet. Unfortunately, many of the foods that will help diabetics are very expensive in Vanuatu. Especially for a family without a breadwinner. (Clerence’s father died last year from diabetes, at 48 years old.)

"It's very expensive what they tell us to eat. Greens, brown bread, brown sugar, brown rice. Not too much white rice or bread."

Under-treated, her diabetes has led to a series of complications which has led to infections. When she has come to our outreaches, we have not been able to operate, because of these infections. For example, at our last outreach a year ago, an infected boil on her face meant once again we had to postpone her treatment.

Put simply this goes back to poverty. What’s more, this level of deprivation is frequently encountered in Vanuatu, where health facilities and services have been well below par. Diabetes is now so common across the Pacific that many patients and their families accept it as normal. Similarly, the conditions associated with this disease, such as diabetic eye disease.

We're working to make a difference

In six months the people of Vanuatu will no longer have to rely on our outreach visits to get eye care services. A Foundation-trained ni-Vanuatu eye doctor, Dr Kasso will be in place permanently. Clerence will be able to have an operation as soon as she is clear of her infection. This time she will not have to wait a year.

The return of Dr Kasso to Vanuatu will coincide with a much needed upgrade of the Port Vila National Eye Centre. This upgrade will enable us to take a more integrated approach to diabetic eye care.

All this has been made possible with your donations, and the impact will be life-changing for many.

That said, we know we must do more, and for that we will need your ongoing support.

Left: An ecstatic Dr Kasso stands on the building site of the upgrade and extension of the Port Vila National Eye Centre.

We will help Clerence as soon as possible and her overall health allows. However, it would have been so much better if the diabetes that led to her eye disease had been recognised and managed properly. Most of her current problems, including her cataracts, might have been avoided.

Clerence is just one of many who is affected by the epidemic of diabetes hitting the Pacific, as people are having to move away from the healthy foods that were the mainstays of their traditional diet. We believe the scale of diabetes within the Pacific requires a co-ordinated approach, involving governments, other key organisations and The Foundation.

Clerence outside her home with her mum Jeaneth.
Clerence outside her home with her mum Jeaneth.

This approach involves:

  • Raising awareness through targeted campaigns in the Pacific communities. Well-informed patients are more likely to come and see us earlier and manage their diabetes properly.

  • Helping to train local doctors and nurses to ensure early signs of diabetes are recognised and patient referral systems are strengthened.

  • Providing neccessary facilities and equipment. For example, we're extending and upgrading our eye clinic in Vanuatu to cater for the increasing number of patients with diabetic eye disease.

This is a large-scale undertaking that requires full-on commitment from our Pacific eye teams. It also requires the support of people like you, whose donations will make it possible to overcome this challenge.

With your help we can provide the solution. Without it we can’t, and people like Clerence will continue to suffer.

More about Clerence

When her symptoms were first noticed, her mother did not understand the problem.

“I just asked the teacher to move her closer to the blackboard.”

It was not until she was 16, when she suffered a major fall requiring surgery on her leg, that the full extent of her condition was recognised.

Diabetes caused her leg to become infected, requiring a long stay in hospital. Her eyesight had also worsened. But at least she was now taking insulin.

Her dense cataracts mean her vision is very compromised.

As she says, “It’s cloudy. I can tell someone is coming towards me. I can see an image, but I can’t tell who the person is.”

We believe it is a tragedy that we have not been able to operate on Clerence’s cataracts.

The two occasions she has come to an outreach, existing infections have prevented us from operating. But once these are resolved, our new permanent local eye doctor, Dr Kasso, will be able to operate.

Meanwhile she stays at home, unable to work or live the life of a normal 22-year-old. Her mother does not work either, having to care for her and her younger sister. Their lives depend on the generosity of their relatives and friends, and the meagre amount they earn selling fans at the local market.

This is the darkness of poverty and lack of understanding. Together, we can do something about it.

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