Living with diabetes in Rwanda

As a young woman living with type 1 diabetes, I have never been one to sit at home and let the world pass me by. Therefore, when the opportunity to study post-genocide reconstruction in Rwanda arose, I decided I wouldn’t miss it for the world. Raised in Hong Kong, Singapore, and the US, I have experienced diabetes care under three different medical systems. Everywhere I reside or travel, I aspire to learn how people live with diabetes.

Upon arrival in Rwanda’s capital, Kigali, I wanted to better understand the level of access to medicine and services, self-management techniques, and the perception of future prospects from those living with the condition. With the help of the Rwanda Diabetes Association (RDA), Marjorie’s Fund, and Dr. Etienne Amendezo, I was able to meet individuals living with diabetes in Kigali. Salama Umutoni, a 22-year-old female student at the University of Rwanda, was diagnosed with type 1 at age 13. Abdallah Murenzi is a businessman in his mid-30s who lives with type 2 diabetes. And Mariam Uwase, a 35-year-old nurse and mother of three, was diagnosed with gestational diabetes (GDM) during her second pregnancy. Together, these three individuals painted a picture of what life with diabetes in Kigali looks like.

Salama

Salama’s last HbA1c was 6.4%. She attributes her tight management to mentorship she has received from the RDA. However, living with diabetes has had its ups and downs. Salama admits, “It’s thanks to the RDA that I am taking insulin.” Upon diagnosis, her community pushed her to pursue traditional forms of treatment, as they were afraid of insulin’s long-term side effects. The RDA taught Salama that insulin is key to being healthy with type 1 diabetes; she asked RDA staff to intervene on her behalf to help her parents understand the importance of the medication. Now, she uses short-acting insulin and insulin glargine (long-acting), and injects two times per day. She also exercises often, and firmly believes that “what others can eat, I can eat.”

Abdallah

Abdallah was diagnosed in 2009. His father also has type 2 diabetes and Abdallah credits his family for their assistance. “My transition into life with diabetes was strongly supported by my family,” he says. For five years Abdallah had no diabetes complications, but in 2014 he began losing sensation in his fingers. Furthermore, 2016 was a trying year; due to work stress and other factors, his blood sugar averaged 200–300 mg/dL (11.1 – 16.7 mmol/L).  Abdallah’s doctor stepped in during 2017 and prescribed insulin glargine to complement his oral medication, vildagliptin. This year, his blood glucose is consistently between 100 and 120 mg/dL (5.6 – 6.7 mmol/L). Abdallah has yet to regain sensitivity in his hands but he is carefully monitoring his diabetes and exercising frequently to ensure other complications are avoided.

Mariam

Mariam was initially diagnosed with GDM in the 26th week of pregnancy with her second child. She managed her GDM with diet changes. It wasn’t until 2016 when she was pregnant with her third child that she was required to take insulin. Mariam was forced into an early delivery during her third pregnancy, as the fetus was not developing properly due to GDM-related complications. After her third child was born she was told that her diabetes would be gone, too. This turned out not to be the case, as she has subsequently developed type 2 diabetes. Now, she takes both gliclazide and vildagliptin on a daily basis and checks her blood sugar regularly. When asked about challenges, she acknowledges how, “diet changes are the hardest part of living with diabetes.” Thankfully, her children remain healthy.