Tanzania, Type 1 and Privilege

Here's the article I wrote for Type 1 International, an amazing organisation advocating for equal access to insulin and medical care. Visit the original on their website here Type 1 International

I am so lucky. I don’t think this is something that is written much here, but I am. Living here has made me realise this. Two years ago I was diagnosed with Type 1 diabetes. I had just accepted a teaching contract at an international school in Tanzania, quit my job and was moving out of my flat. I had a choice: continue with my plans to move to Tanzania, or not. Choice is the key-word. I choose to be here.

People in this country do not have much. The average income is about $750 per year. I cannot begin to understand their struggle. I live here as an “expatriate.” I don’t really understand that word, but basically, I am white, I have a job, I have medical insurance.

When I was diagnosed, I was living in Australia. I received incredible care and education. So much so, that I was able to take control of my diabetes and move overseas within six weeks. Not only did the diabetes education I receive give me the power to manage my condition independently, growing up in a developed country gave me the education and skills to understand my condition. I can read. I can access the internet. I can educate and inform myself. The place I was born is what has enabled me to manage type 1 while living in a developing country.

I moved here with two years’ worth of insulin, 1000s of needles, and boxes full of test strips, all funded by the Australian and New Zealand medical system. When I need a restock, my Tanzanian pharmacist orders what I want from overseas. I cash my receipts with my insurance, and I get reimbursed-for thousands of dollars. Every time I collect my order, I wonder how other T1s here survive.

That said, supplies are not easy. Over the counter, I can buy fairly cheap and nasty test strips and meters. These are great for an emergency, but I found them to be inaccurate. Instead I bulk order better models. This can take time, so I need to be organised. The pharmacist may have small quantities of Novorapid and Lantus, or it could take them a few days to order what I need. This means ensuring I keep my insulin in multiple places in case one lot gets damaged or stolen. Unfortunately my insurance will not cover me for a pump or a CGM, but what I have is so much better than most here.

Power, or lack thereof, is probably the biggest challenge. Again I am privileged. I have a house and workplace with some electricity and a fridge. Most people do not. Despite this, keeping my insulin and glucagon cool is a challenge. Facing daily 12 hour power cuts for 4 months, 7 days without power, I have become creative in keeping my insulin cool, and would now consider myself the expert on this.

For my first endocrinologist appointment here I visited the best hospital in town. It cost me $15 to see an excellent Kenyan endocrinologist plus $10 for my HbA1c blood test. This amount is equivalent two weeks income for the average Tanzanian. The waiting room was packed. I queued for a long, long time with lines of Type 2 diabetics desperate to see the doctor. He was frazzled yet professional when he saw me, and relived to see that I am an easy patient. I know my condition. A good HbA1c result, and off I went. The next time I wanted more, so I travelled to Kenya. I can afford to do this, but I know that others cannot. In Kenya, I had time with the endo, who was not under the immense pressure of the doctor in Tanzania. I had all the required checks that a dutiful diabetic should have. I travel to another country to see my endo, but I am the lucky one.

Emergency care scares me. I question if the hospitals here would know what to do with me in the case of a severe hypo, or a car crash. Still, I am lucky – I have glucagon at home and work. In an emergency my insurance will pay for me to be evacuated by air to world-class medical care in Nairobi. I wonder what happens to the Tanzanian Type 1s? I hate to think…

There are wonderful charities working here to get insulin to the needy. I want to learn more about them because they are so vital. Still, people shouldn’t have to be dependent on a charity. T1International is advocating for access to the essentials and hopes to support sustainable solutions in Tanzania as we learn more about the situation.

I just want to repeat that I am so lucky. I travel, I work, and I live an amazing life here. We go on safari, we camp with lions. We live in a beautiful house under the Acacia trees. There are days when I am so strong. There are days that T1 brings me to my knees, but I have a husband who helps me get back up again. For now, my diabetes is under control, so I can live here. When it isn’t, I can leave. No matter where I live in the world, I will have Type 1 diabetes; that makes me unlucky I suppose. But I have choice, I have education, and I have insulin. My heart aches for those that don’t.