People living with diabetes, like any other people, have essential needs that have to be met. Having a job is critical to providing the income to support basic needs even before we consider the financial support that is needed to access care. Employment, however, provides more than a source of income, it instils a sense of self-dependence, responsibility and discipline.
For people with diabetes, regular employment can create challenges. People living with the condition can be more prone to infections and other complications. Work can be a major source of stress, which increases insulin resistance and blood pressure in people with diabetes. It can also facilitate unhealthy habits, including eating unhealthy food, being too tired to exercise, or having difficulty sleeping.
Like workers with other forms of illness or disability, people with diabetes may require adjustments to the working environment to perform their responsibilities effectively and safely. According to the American Diabetes Association (ADA), “For workers with diabetes, employment discrimination can take many forms, but typically includes a failure to hire or promote you because of your diabetes, termination due to your diabetes, or a failure to provide you with reasonable accommodations that help you do your job.” The ADA goes on to explain these “reasonable accommodations” as referring to “the application or hiring process, the job itself or the way the job is done, the work environment that allows a person with disability to perform the essential functions of that job or enjoy equal employment opportunities.”
Reasonable accommodations must not cause undue hardships on the employer and can include:
Work can be a major source of stress, which increases insulin resistance and blood pressure in people with diabetes.
In Zimbabwe, there is no national policy on diabetes and no policies related to the condition in the workplace. The country has signed on to many international conventions on disability, including the United Nations Convention on the Rights of Persons with Disabilities, but none have been ratified or implemented nationally. Draft policies on disability exist but only refer to people with physical impairments. They do not include people with chronic conditions like diabetes.
Several people living with diabetes in Zimbabwe have told me they have experienced difficulties at work because of their condition. In the main, people with diabetes find it particularly difficult to balance the day-to-day demands of managing their diabetes – attention to diet, medication, rest, glucose monitoring and exercise etc., with the demands and deadlines, imposed by work. Many indicated that they had felt discriminated against or mistreated by employers and colleagues at least once during their working experience. One person indicated that work demands made it impossible for them to take the breaks and meals they needed.
People with diabetes are advised to eat meals around the same time each day, check blood glucose at certain times and exercise regularly. Irregular working hours can therefore be a problem. When shifts vary or working overtime is required, people with diabetes can forget to take their medication when they need to, which impacts their diabetes management.
Many of the people I spoke to mentioned that they were afraid of asking for “reasonable accommodations” in the workplace, even if their employer was informed of their condition. They did not want to sound unreasonable, bring unnecessary attention to themselves or were afraid of being treated differently. One person who works in the hotel industry told me that hotels deliberately avoid hiring people with diabetes because of the “stress” associated with the job. As a result, whenever they go for an interview, they do not mention their condition. This is not uncommon. With up to 90% of Zimbabwe’s population not officially employed and many employers not having the capacity to make reasonable accommodations for people with chronic conditions, many workers feel that they can be easily replaced if they appear too demanding.
Many people with diabetes I spoke to mentioned that they were afraid of asking for “reasonable accommodations” in the workplace.
Another complaint is that employers do not look out for people with diabetes, subjecting them to the same conditions as everyone else. For example, when workload causes employees to miss lunch and breaks, people with diabetes are not exempted. Some reported that money is deducted from their salary if they miss any time from work to manage their condition. One person reported that when COVID-19 cases were diagnosed the workplace, their employer made provisions for all pregnant women to work from home but left out people with diabetes, despite their vulnerability to the effects of the virus. Another person with diabetes who works in a hospital as a frontline worker, told me they were moved to a high-risk department during the peak of COVID-19 in Zimbabwe, despite explaining their condition to their supervisor.
Other people I spoke to had more positive accounts. A person who explained their condition to their employer and colleagues received understanding and support. They would be asked whether they had taken their insulin, warned about foods high in sugar and given time to recover when their blood glucose was too high or low. Another echoed the importance of being open about living with diabetes in the workplace. They provided general information and distributed leaflets about diabetes to colleagues and were “rewarded” with diabetes-friendly meals and refreshments.
To improve the experiences of people with diabetes in the workplace, the following measures are recommended:
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