Through vignettes from a diabetes education camp in the Philippines, I hope to convey the value of social support for youth with diabetes in resource-poor settings.
I am an Australian junior doctor and volunteer with Insulin For Life (IFL), a not-for-profit organisation that provides diabetes supplies to people with diabetes in disadvantaged regions, and supports locally organised diabetes camps. For the second time, I assisted at a camp organised by Sunshine Summer Camps held in May 2017 in Cebu, a densely populated island in the Philippines. Camp attendees and staff totaled 15 youth with diabetes aged 9-31 years, a few parents and guardians, diabetes educators, nurses and local volunteers.
The campers arrived in the facility auditorium with tables and chairs facing a podium and projector screen. There was little conversation and a nervous energy among the campers. A few ice-breaker games were provided to encourage campers to share a bit about themselves which helped to relax them, foster camaraderie and even generate a little laughter.
One of my roles was to test HbA1c which reflects average blood glucose over 3-months and is recommended 3-4 times a year, but is not affordable for the campers. A diabetes educator, translator and I tested each camper and explained their results to them and their carers. That evening, reviewing the results I was taken aback by the average HbA1c of 10.4%, which is ‘very poor’ , misses the broad target of 7% and puts individuals at a high risk for complications. All but one camper had results above the recommended target. I stared at the spreadsheet for a while, feeling uneasy, then shut my laptop and met the campers for dinner and games.
The next day I rose early to join the aerobics class. I watched a talented boy execute his steps with vigour and precision, albeit sporting a stern pout. He looked determined, putting into practice what he had learned the day before about the benefits of exercise. I wondered what was going through his mind and what his diagnosis meant for him. That afternoon, I chatted with campers about more than just numbers and was privileged to have many share their emotions.
A very quiet girl of 15 is striving to do her best in grade nine at school. She lives with her aunty and grandmother in a far-away village. Sometimes she plays with her cousins, but is otherwise alone. I asked her how she felt about having diabetes. “It hurts.” I asked her what she meant. She got quiet for a moment, then said one cousin told her she is a burden – the reason why the family has no money.
The dancer I had observed earlier is a skinny 21-year-old who could have passed for a boy in his early teens. He is the provider for his parents and four siblings with a minimum wage job at a fast-food outlet. He struggles to make ends meet and spends all his time at work. “My friends distanced themselves from me, and I feel very alone.” He had been fired from a previous job because of his diabetes which supposedly made him unreliable. He lied about having no medical conditions to get his current job, and fears being fired if they discover his diabetes. “I want to work hard to provide for my family and afford my diabetes (supplies). I think I might die if I work as hard as it is necessary to afford my diabetes. It’s a lose-lose.”
Other campers also told me of their social struggles, loneliness and the devastating emotional toll of being a burden on their family. However, all campers seemed to benefit from being in a room full of individuals like them where sharing, understanding, and support for diabetes was welcome. There was also a session in which campers were encouraged to talk or write about their emotions or express themselves through artwork. They learned they were not alone and that it was okay to feel sad sometimes. I became aware that friendships between the campers was growing. At dinner-time on the second night, campers were laughing, joking, singing and posing for photos.
On the final morning, the campers darted between team-challenge activities – splashing in the pool, scribbling down answers and wearing smiles that had grown considerably. It won’t be the HbA1c results that I remember years on, but the evolving friendships, the transformations I witnessed in campers, and what camps can offer children and young adults with diabetes.
Social support changes the attitude a person has towards their diabetes and is invaluable to their well-being. This is what a 12-year-old said when I asked
“Does anyone treat you differently because of your diabetes?”
“I am closer to my friends. My friends help me, they remind me to check my sugar. My parents have a hard time finding money, but I tell them every problem can be solved. I will work hard in school now and when I am old enough, I will be a doctor.”
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