Fieldset
Refugees and diabetes: "I was confronted by the challenges they face"

For some people escaping war or conflict, reaching safety does not necessarily mean their lives are out of danger. Nurse Joyce shares her experience of treating diabetes in refugee camps around the world.

Today I am thinking about a seven-year-old boy I met when I was working with Médecins Sans Frontières / Doctors Without Borders (MSF) in Greece.

This young boy was living with type 1 diabetes, a serious health condition that requires regular monitoring and treatment.

He and his family had made the dangerous trip from Afghanistan all the way to the Greek island of Lesbos. I was impressed that he had survived the journey. People living with type 1 diabetes can die as soon they lose their access to insulin. Without regular, appropriate treatment, they face serious risk of complications.

Caring for chronic diseases wasn’t the first thing I had in mind when I applied for MSF

He had been diagnosed four years prior and luckily, he and his parents were familiar with the disease, trying to manage it the best they could.

Emergency care

Caring for chronic diseases wasn’t the first thing I had in mind when I applied for MSF. As an emergency/intensive care nurse, my background was focussed on emergency care, which is what drew me to MSF, but I have found myself a part of medical teams treating chronic diseases in every assignment I’ve had.

This includes in refugee camps where I have worked with MSF, such as Moria on Lesbos, Bentiu in South Sudan, and Al Hol in Syria. In these settings, I have met people who have found themselves running out of insulin or without the means to measure their glucose levels.

I was confronted by the additional challenges they face. Imagine knowing insulin should be stored at cool, stable temperatures while living in a tent that can reach 50 degrees Celsius or drop below zero in winter.

Sometimes, the solutions can be pleasingly simple.

In my last assignment, I worked in Al Hol camp where the logistician and medical doctor in our team had developed special "home-based insulin coolers" as a storage solution. That is a fancy name, but really this solution was simply a glass pot with a cloth around. When you keep the cloth wet, the insulin will remain stable at an appropriate cool temperature even during blistering days in hot tents. This is a very practical, cheap solution and easily made locally.

But there are other factors that are harder to solve which present major challenges to people’s health. For example, insulin injections should be timed with food intake, but often we found people were depending on food distributions in camps which meant they did not have regular, consistent meals. Of course, this was not in their control.

Sometimes I also saw that patients had not been given enough information on diabetes management. For example, we had patients who were taking two doses of medication at once, rather than separately in the morning and evening. This can have serious consequences, causing cardiovascular disease, nerve damage, kidney failure or blindness.

A long-term impact

Still my mind wanders back to the seven-year-old boy in Moria camp. He was living in a container shared with 30 other people. He would come to our clinic for medical consultations with a paediatrician. They would measure his glucose levels, adjust the insulin dose and prescribe drugs and required medical equipment.

It wasn’t the kind of medical action I had anticipated when I joined MSF, but it has the same importance as emergency care

Before I finished my assignment in Greece, we managed to support the family to be transferred to another camp with slightly better living conditions. There, we supported the boy with a glucometer and regular follow-up consultations.

It wasn’t the kind of medical action I had anticipated when I joined MSF, but it has the same importance as emergency care. Through support and treatment, we made a difference in this young boy's and his family’s lives, directly and in the long-term.

This World Diabetes Day, I wonder where that little boy is – now nine years old – and hope he is in good health.

Top image shows Al-hol camp.