Tips for living in a developing country with T1

Wear it. 

Living in a developing country can be difficult; power and water cuts, poor roads, scary police, language barriers, new illnesses... The list goes on. Add to this managing a condition as demanding as T1 and you have yourself a challenge! I will be honest and admit that this has been the source of numerous breakdowns, tears and tantrums, however it is absolutely possible and can be done. The rewards certainly outweigh the difficulties.

Here is some advice for planning a move to the developing world if you have Type 1 diabetes.

Develop a relationship with a pharmacist
Ask around for advice on reliable pharmacists in your area. Many pharmacies sell medicine of dubious origin and offer questionable advice. Make sure you find someone reputable. Make this a priority within the first week of arriving, so that if you loose your supplies, you know where to go. Here in Tanzania, you don't often need a prescription for certain medicines. My pharmacist basically orders me what I want/need and trusts my judgement. Some pharmacists have told me certain supplies are not available, whereas my pharmacist, Mr Hussein, goes above and beyond to get me what I want or need, ordering from all over the world with minimal profit for him.

Develop a relationship with a doctor
Get to know a doctor. It doesn't really matter if they are en endocrinologist, you just need someone to complete your insurance paperwork.

Supplies 

Bulk supplies on hand. 

Bring bulk supplies from home first, this gives you time to settle in before you have to worry about ordering and sourcing new supplies. We carried a huge duffel sack full of insulin through 20 hours of flying and transfers, as well as bulk needs and test strips to get here. Scarily, not a single security check noticed, however carry your medical letter like your life-depends on it (which it does).

Type 2 diabetes is a huge problem in Africa, so here in Tanzania at least, glucose meters and test strips are readily available. However the models are limited so if you want something particular you need that magical pharmacist to order for you. Needles are widely available in pharmacies, however the shorter ones seem less common. I am on MDI, and my fast and long acting insulin is available in a few pharmacies here, if they have run out it can be here within 2-3 days.

Make sure you back up your supplies. You just never know what might happen from weather disasters, theft, road blocks, political interruptions... Have a plan incase you can't get home immediately, or if something happens to your supply at home. Have a back up supply of all your necessary supplies in your workplace as well as a small bundle at a friends house. Not all meter batteries are easy to find so pre-purchase when you have the chance so that you are ready before they run out.

In Tanzania, hypo supplies are readily available if you are willing to be flexible. Just keep in mind that in the heat some sweets melt all through your kit! Not ideal. I have found that soft toffees that are imported from the Middle-East cope well with the heat.

Always carry snacks and supplies with you, you never know what can happen. In Kenya recently there was a traffic jam that took cars three days to pass through!

Electricity

My lockable insulin fridge.

Insulin ideally needs to be refrigerated at 2 - 8 degrees celcius. This has probably been the biggest cause of anxiety since being here and as power cuts are regular and severe... We went three months with only a few hours per day. So keeping my insulin cool has been challenging! So much so, I have dedicated an entire page to it. Click here to read more.

Glucagen kit
Emergency medical services here are few and far between, so you need to have and provide your own glucagon. My pharmacist is able to order it from overseas for me. I keep one at home and one at work. Make sure a  selection of people around you are aware of it, where it's kept and what it's for.

Insurance
This is so important. Ensure your insurance provider covers you adequately. Ask a million questions. My employer provides insurance that has paid a premium for pre-existing conditions, so my diabetes is covered. Unfortunately medical devices such as pumps and CGMs are not included, but I can get what I need.

Medical ID and emergency contact

Emergency medical support is not going to be the same standard that many of us are used to. Better your chances and wear medical ID, as much as you might hate it. Even if your diabetes is well-controlled, factors out of your control such as road accidents are common, and the faster teams know about your condition the better. I also carry on me a comprehensive list of  emergency contacts as well as insurance ID. You don't want someone to whisk you off to the nearest dubious hospital when you have insurance to cover medical evacuation.

Learn about the local clinics and nearest hospitals
Here in Arusha the nearest large hospital is the Aga Khan Hospital in Nairobi. Only three hours away by car. People say this hospital rivals those in the UK and America. Just because it is Africa, does not mean that care isn't available. Make an informed decision as the results from a bit of research may surprise you.

Diet

Fresh, unprocessed food from the markets.  

I think that being here has been easier to manage my diet than it would be in developed countries, the lack of processed food and fast-food makes avoiding temptations much easier. While you can't always get all the trendy fad food like quinoa and macadamia oil, simple, wholesome, fresh food is readily available. See my post about eating new cuisines while travelling here (being written currently).

Tell people
People are kind. Tell the people around you. Their support will make a huge difference. Generally the local people understand illness and hardship, they get it. For them to see this little imperfection in you makes you seem much more relatable and your differences fewer.

Be independent and informed
When I was diagnosed I was so lucky to have a supportive medical team and family who encouraged me to carry on with my move to Tanzania. I am sure that there are many doctors and nurses out there who would have discouraged the move. Keep in mind this - people are conservative. A move to a developing country is seen as a crazy thing to do for most people, let alone for someone with a medical condition. Living here I have found that I am completely responsible for my condition, and that is somewhat liberating. I am able to manage by being independent, organised and well-informed.


Please note that this is purely based on my own observations/experience and opinions, and is in no way exhaustive. Please add your own ideas to the comments.