Diabetes is probably not the first non-communicable disease that one would associate with Cambodia, but as tastes converge and dietary preferences change, so has the prevalence of disease in the kingdom.
According to the World Health Organisation, approximately 6 percent out of Cambodia’s 16.6 million people suffer from the disease. While this may seem good news to some, considering that the average global prevalence of diabetes currently stands at 8.5 percent, this is actually a cause for concern.
The number of diabetics are rising as quickly as the waistlines of Cambodians are expanding. Throughout the economic boom that followed the stability in the early 2000s, the number of overweight Cambodians has increased to 16.4 percent of the total population, and the number is expected to keep on rising – in both urban and rural areas.
According to research carried out by the Cambodian Diabetic Association, the prevalence rate is actually much higher among rural women between the ages of 40 and 45 as their workloads begin to decrease and their lifestyles become more sedentary.
The lack of awareness of the disease – which has acquired a rather benign-sounding name in Khmer
that translates to ‘sugar disease’ – compounded with poverty and accessibility issues, are among the factors that contribute to an often shorter lifespan among diabetics.
As the world marks the World Diabetes Day today, Khmer Times spoke to Maurits van Pelt, the director of the MoPoTsyo, a non-governmental organisation that provides much-needed care for diabetics in Cambodia, about the challenges in bringing the sweet and silent killer under control.
KT: As far as diseases go, diabetes is regarded as one of those silent killers. Unless an individual undergoes screening, sometimes the disease can remain ‘dormant’ without manifesting any serious symptoms. Is early detection still a problem in Cambodia?
Van Pelt: It is, and what many people don’t realise is that perceptions surrounding body image in Cambodia also play a role in making early detection a problem. The ideal body type is rather chubbier than what would be considered ideal by Western standards, so weight increases are generally not seen as a serious indicator of health, despite the fact that not all diabetics are overweight. This is a long-held stigma that still persists – not just in Cambodia, but also elsewhere in the world.
The problem doesn’t stop there. It simply isn’t enough for a patient to know they suffer from diabetes. Screening alone is not enough. People with diabetes need to learn how changing certain aspects of their lifestyle can actually help to bring their blood glucose levels (as well as blood pressure) under control.
There are simply isn’t enough awareness about the gravity of the disease, the complications that could result from the disease if it is left unchecked and uncontrolled. This is the real challenge for us.
KT: Is availability of the necessary medications, such as insulin, an issue?
Van Pelt: Yes, particularly in rural areas where accessibility remains an issue. Given the fact that a vial of insulin in Cambodia costs twice as much as the global average – a 10ml vial is $8 in the kingdom – plus whatever it costs to purchase the minimum of 15 syringes that they would need to administer the injections, it is way out of the reach of many rural Cambodians, many of whom are barely scraping by to make a living.
Another challenge for Cambodians who need to use insulin, is that they need to learn how to inject themselves every day with a special hypodermic syringe and needle. That is a skill they need for the rest of their lives. As such, getting diabetics in more rural areas to stick to the programme is yet another challenge that we have to face, especially in rural areas. It’s expensive and it can be seen as time-consuming.
KT: What is currently being done to encourage more diabetics to come forward to seek out
Van Pelt: Currently, MoPoTsyo is working with more than 14,000 diabetics through our peer-educator networks for diabetes in 17 operational districts – and this isn’t an easy task. Among 14,000-plus diabetics that have enrolled in our programme countrywide, there are only around 900 diabetics who are able to self-inject insulin. Through our peer-educator networks, we want to make sure our message gets across through without coming across as patronising. These educators are embedded within the communities, they are trained to perform early detection using blood glucose strips, and some even have basic medical training.
We are also working with the Ministry of Health to import basic medications for diabetics in bulk, which is hoped to bring down the prices of these much-needed medications. Right now they are distributed across 30 contracted pharmacy outlets, and we hope to expand the network to provide access to even more Cambodian in the future.