The Global Health Core’s very own, Palav Babaria, was recently featured in The New York Times in an opinion piece on the challenges often faced in treating Diabetes in Haiti.
Palav, who now works as a primary care physician at Oakland’s Highland Hospital, was once apart of UCSF, and our Global Health Core, as a Global Health Hospital Medicine Fellow (2012-2013).
The piece was co-written with Aisling O’Riordan, a doctor practicing in Dublin, Ireland who was working with Babaria at a Hospital in rural Haiti at the time. This hospital is able to provide healthcare services to Haitians thanks to the efforts of Partner’s in Health, with whom the Global Health Core works closely with.
In the article, they describe their experience through the story of Jean-Paul…
” JEAN-PAUL was 12 when he died. A diabetic, he might well have lived if not for a tragically simple problem, common in rural Haiti: the glucose test strips available did not match the only glucometer we had access to in our rudimentary district hospital.
We are doctors — one American, one Irish — who worked as volunteers at the town hospital in Haiti’s desperately poor central plateau last spring. On the storm-drenched night that Jean-Paul arrived at the emergency room, we rushed to him through corridors clattering as if glass were breaking, as rain pelted down and leaked through the tin roof, forming puddles and muddy rivulets on the floor.
Jean-Paul was lying on a gurney. He looked much younger than 12, his growth stunted by Type 1 diabetes and malnutrition. He was unconscious and breathing in grunts. His sticklike wrists barely had a pulse.
In any emergency room in the United States, doctors would have immediately inserted a breathing tube in his throat, resuscitated him and admitted him to intensive care. In rural Haiti, we had no such options.
His father, gripping the gurney, told us Jean-Paul had been sick for a few days; he hadn’t known Jean-Paul’s infection could drive his sugars dangerously high; if he’d had a glucometer, as most American diabetics do, he could have seen it for himself. The small devices measure blood sugar by reading a drop of blood on a test strip.
But while the local health center had a glucometer, it was out of test strips. And our district hospital didn’t have enough glucometers to give one to every patient. In any event, Jean-Paul’s family waited to make the expensive and time-consuming trip to our hospital, hoping their son’s illness would pass. They waited until he was so sick that they had no choice.
Jean-Paul’s first blood-sugar sample was too high to be read on the glucometer. He was already in diabetic ketoacidosis — a life-threatening complication of diabetes. The initial steps for treating it are simple: fluid and insulin. We injected him with insulin and flooded him with liter after liter of fluids, trying to pump life back into him.
American hospital protocols for diabetic ketoacidosis recommend conducting lab tests every two hours, monitoring sugars hourly and readjusting the insulin drips accordingly. Our lab lacked any of the tests usually used to monitor ketoacidosis. We had to make do with our 10 remaining glucose test strips, rationing them by calculating how many hours apart we could space our checks. If we used them all that night, what would we do the next day?
We examined him and re-examined him, monitoring his ragged breath and racing heart. But it was too late; Jean-Paul was beyond saving before he even reached us.
Today is World Diabetes Day, and we cannot help but remember his needless loss. Every day in Haiti, we encountered the problem that killed him: Manufacturers of glucometers would give them away like free candy, and sometimes a half dozen would be scattered across the hospital. But they were useless because the test strips were always out of stock.
Glucose test strips are a major source of the profit derived from diabetes testing supplies. Conglomerates like Roche, the leader of the $8 billion a year diabetes testing industry, have made these strips proprietary — in other words, each strip fits only into a specific machine. While glucose test strips cost pennies to make, the branded strips sell for 50 cents to one dollar per strip, and diabetics who depend on insulin typically use several strips per day.
In Haiti, we would sometimes deplete an entire box of 50 glucose strips on a single sick patient who required frequent monitoring. This precious box was often ordered months in advance; it took up to six months for the order to go from the district to Port-au-Prince, Haiti’s capital, and on to the United States, and then for the shipment to arrive in Haiti, clear customs and be transported from a central depot to a peripheral one and finally to our hospital. When a box ran out, we rarely knew when the next would arrive. And by that time, manufacturers might have changed their models, and stopped manufacturing strips for the glucometers we had.
For sites like ours, which rely on donated supplies, ensuring that glucometers and test strips are from the same model and manufacturer has been virtually impossible. That mismatch is often the missing lifeline for patients like Jean-Paul.
The solution is simple, and one that many diabetics have been urging for decades: Create universal test strips that will work in any available machine, in the same manner that USB cables can link nearly all brands of computers and devices. Universal test strips would lead to cheaper strips and increased availability. This would ensure that diabetic patients in places like rural Haiti could monitor their own blood sugars, and local clinics and hospitals could effectively screen for, diagnose and treat diabetes. Patients like Jean-Paul would know their sugars were too high because of an infection, and come in to the hospital before it was too late.
Instead, we watched as nurses disconnected Jean-Paul from the intravenous tubing that night and carefully pulled a sheet over him so his father could carry his body out of the hospital.”
This NY Times article can be found at: http://www.nytimes.com/2013/11/15/opinion/a-haitian-boys-needless-death.html
For more information about Partner’s in Health and their work in Haiti, check out their website at: http://www.pih.org/country/haiti