The diabetes time bomb is already upon us, and why is there so little information and community action to alleviate suffering?

I recently attended a free clinic, Dr Hemal Fernando has been running for over 21 years, every Saturday in Pamunugama, Sri Lanka, a coastal hamlet not 20km from Colombo.

What hit me hard was the reality that most of the patients have diabetes, (80%) and due to that are more prone to other illnesses, and make surgery and interventions more risky. Furthermore, I gathered that if this doctor does not provide the free medicines, which he purchases in the open market, (not medical representatives samples) these patients would forego treatment, as they will not purchase the needed medications averaging Rs1000 for a two week prescription fill!

Cause

The primary cause of this epidemic in Sri Lanka, is the increasingly sedentary lifestyle, where people still eat more than the requirement of starch, in the form primarily of polished rice three times a day, and the increasing consumption of flour, mainly in the form of bread, added to which the traditional sweet tooth results in unhealthy servings of sugar with their fluids, whether it is tea or fruit drinks, served sickly sweet.

No amount of pleading by the doctor seems to work on the patients, even though they are sick, to adopt a change to their dietary habits, in order to alleviate the symptoms and hopefully even reverse their condition.

In the doctor’s opinion, based on over 20 years of performing this service, the people are too poor to substitute starch for the needed protein of fish and meats, which is the alternative to over indulgence in rice, polished at that.

Before the patients are seen their fasting blood sugar is tested, so the doctor who has been treating most of them for a while will be able to gauge the level of medication required, after performing the other examinations himself, which include a modern gadget that checks the heart rate.

Among that sample of 80%, a quarter are under 50 years of age, and two of the cases, they had over 300 count, meaning they had to be referred for insulin injections, which they would have to purchase from outside, as the free healthcare system will not provide them that. He even had to negotiate with the pharmacists to try and give them the pens free of charge for them to purchase the units of insulin to inject themselves with in the stomach.

How can we take steps to reduce the incidence of Diabetes in the general population?

The doctor made an interesting observation to me, saying he had read that low birth weight babies are more prone to diabetes in older ages and so asked a mother who has many children the birth weight of her children to ascertain how one of them, who came today for treatment had such a high blood sugar count at his age of 42.

Of course the curse is the poor nutrition, the lack of education on nutrition at pre-school age, when one can be weaned into eating healthy, a lost cause once one is older. Every patient was asked to attempt to switch some carbs for proteins for a change to arrest the decent into Diabetes.

This is not to say that even the wealthy with access to the best medications, don’t get the disease, but they too are worried, but are hidebound in taking action, as they are educate and aware or older and none the wiser, further reinforcing my point that a more nutritious diet at an early age, something easier to do, is the need of the hour.

A less active lifestyle with many kitchen aides for work, leaves a disproportionate percentage of patients being women, who are more than likely to be overweight due to the over consumption of rice and the lack of awareness of the unnecessary level of food intake, when compared to their husbands, who are more active and therefore less obese, but for their alcohol intake, an issue I will not dwell on here.

Unless the state or the government take the moral high ground and give this war on Diabetes the importance it deserves, the problem will just get worse and have lasting effects on the population. The Easter Sunday bombings are a walk in the park compared to the thousands dying of complication arising from Diabetes. So why is this not given priority.

Politicians in Sri Lanka have not taken the steps to improve the health and wellness of our society. (building a hospital to get more votes is not a solution, just providing care) This, especially when they have to say to consume less rice, a staple grown in Sri Lanka. It is this signal priority that is not getting across to the people to change their food consumption habits away from starch, as they are more concerned about electoral fallout rather than the death of their patients.

For the record, Dr Fernando is a Board Certified Cardiologist of the USA & a FRCP from the UK, as well as being one of the youngest MDs (doctor of medicine as opposed to the MBBS which is the basic qualification of doctors in SL) when he passed that exam in Sri Lanka in 1966. He counts over 50 years of experience, in both Cardiology and Internal Medicine, and keeps his knowledge current by following the latest developments in the profession.

My Observations

What’s more, he is the old school doctor with the training of merely using the stethoscope to diagnose most ailments, where today’s newly qualified physicians require a battery of tests, before they venture a diagnosis. That ability is worth its weight in Gold in a clinic such as this, at a church hall in the Shadow of a Church, where patient numbers demand quick diagnosis with minimal aids.

I told many of the patients that they are so fortunate to have an internationally renowned diagnostician attending to their needs, and has without any doubt both maintained their quality of life and provided basic health care, extending their productive and active lifestyles, for no charge. In short a gem in their midst, whose value will only be felt when he is no longer available to be of service.

Some patients have been regularly treated and medicines doled out for over 20 years, and personally vouch that the doctor is the reason they are alive today and are able to have fulfilling lives, the main reason for a person to live surely!

I recently wrote an piece on my social media page on the impending “Diabetes Time Bomb” expected to hit Sri Lanka as sure as day follows night, along with the link to an US article about how even Americans are foregoing treatment and hastening their life expectancy due to financial hardship, see below.

https://www.cdc.gov/nchs/products/databriefs/db349.htm

It was therefore both a godsend to witness the social peril I was talking about, and to share with my readers a lay man’s observations that people with far better knowledge and access to decision making should have made a long time ago.

PS Below are some of the comments I made on my Facebook page just three days ago (22^nd August) about the subject I have covered.

Let this information be a salutary lesson to all. In the US approx 18% of diabetics are skipping medications, primarily because of cost, and inevitably their lifespan reduction is the price they pay.

Sri Lanka is currently faced with a NCD issue of diabetes of epic proportions, and there is little mass communication between the citizens and their government about how we can control this time bomb. There are many reasons, but one main cause is the over consumption of rice instead of only eating one rice meal as was done in history, when it was more nutritious, organic and partially milled, leaving the nutrients intact.

Lifestyle and nutrition after instilling discipline is the most important part of pre-school education, as it is difficult to convince those who have got used to bad habits. It is time we put MOST of our educational resources (instead of the present ZERO) to pre-school education for all, so we can build a new generation of healthy humans, instead of the increasingly sick nation.

Why are we ignoring the most important aspect of life, the basics of nutrition, of healthy eating, so we can be sick less, and be aware of everything good and bad that we consume, and the state redirect resources to ensure clean air, clean food and clean water all of which contribute to healthy living?

Frankly the people have been conditioned to waste their time on a totally meaningless Presidential Election, where no one of any value will lead us, in all honesty, and instead march against what is important, a healthy lifestyle so fewer people suffer. When anyone asks you who do you think is going to contest, or win the election? Just say who cares they will all kill us before our time anyway, and change the conversation to the real priority of the nation, WELLNESS!

Just go to the newly built grand wings of the Polonnaruwa Base Hospital, with much increased beds and facilities. The patients are spread in mattresses in corridors for lack of space, implying that no amount of increased beds is going to ease the bed shortage. We are simply becoming a nation of sick people, reducing productivity and going in reverse. Shortly the Chinese will finish the massive new hospital being built there also as a gift from China, only to cure illness not to prevent it! Don't wait for the whole nation to be bedridden before we take action, let’s begin now, and learn from history how to grow, eat and enjoy alternative nutritious food sources, while effectively DITCHING RICE as we know it, that is simply enriching the Paddy Mafia and destroying both the farmer who grows it and the people who eat it.

Why are the people of Sri Lanka not told the facts about their rice eating habits? Who are we afraid of? Aren't the overflowing hospitals proof of the impending cataclysm? Tell me if any of the potential presidential candidates even cares of about this issue which should be on the top of the list, not bull shit security or foreign domination, which will happen anyway if we are all sick! It is the wellness program that all our voters should be evaluating not the crap that is played out in the media by the prospective candidates, all of whom are playing to the ignorant gallery, instead of educating the gallery to the facts of life