The Diabetes Problem

So, a lot of this post is going to be about health care. Forgive me if this sounds like a medical journal.

The hospital is still the same as ever. We’re low on supplies and medicine, malaria is still rampant (more than ever actually since it’s rainy season), and all the hospital staff keeps pushing on and doing their best. But something I kind of touched on here, but didn’t get very in depth in, is the diabetes problem here. Type 1 and type 2 are both problems here in Sierra Leone, for similar yet different reasons.

Diabetes type 2 is prevalent in the elderly population and like the US, it’s primarily due to poor diet. Most of the foods eaten here are fried foods: fried rice, fried chicken, fried fish, fried casava leaves, fried everything. So, doctors recommend eating grilled chicken and fish instead of fried. But let’s face it, fried food is delicious! I’d rather have fried food over grilled any day of the week. But it just bites everybody later in life if that’s your primary meal. Now when you get diabetes type 2, or when find out you have diabetes type 1, you must manage your diet and watch your glucose levels. But that is hard, especially is Sierra Leone. You need insulin that needs to be refrigerated, and power outages are common. You must prick your finger before and after every meal and throughout the day and learn what you need to do for different levels of blood glucose counts. So patient education is very important. Clear communication is important. Making sure your patient truly understands is important.

The problem? Most people will say, “Oh yes, I understand” and even demonstrate that they understand. Then they go home and don’t do anything that was taught to them. Granted, that happens in the United States too. But in the United States, not managing your diabetes can get you a short stay in the hospital because we have so many resources to get a patient back to a healthier state. Here, it can lead to a lengthy stay in the hospital and, more than likely, death. We’ve had so many elderly patients admitted because of their unmanaged diabetes.

Every time these patients see me, they want me to be their nurse because I’m a foreigner and I’m white. They think that because I’m a foreigner and I’m white, I know more than any nurse from Sierra Leone. Which is simply not true. My education was different but that does not mean I know more. And I keep trying to tell people that. Plus, I’m not an appropriate choice for teaching these patients because I’m still learning Krio. I’m not proficient at all and to care effectively for my patients, I need to be able to teach them. So, I’m not a good choice for many patients and their families until I live here longer. It can be very frustrating for both our patients and for me. I want to help, but I’m just not capable of doing that yet.

But I’ll tell you what I can do. I can monitor vital and oxygen levels effectively so I can tell if a patient needs a higher level of care. I know when a patient is critical and needs immediate intervention. I can write handoff reports for the nurses on the next shift (and I try to write as clearly as I can because goodness knows the doctors don’t, seriously it’s like deciphering hieroglyphics). I can put a nasogastric tube down a patient’s nose and into their stomach. I got to do that the other day. It made me feel good that I could do a procedure for my fellow nurses.

I guess the point I’m trying to make here is that there is a huge need for nurses here because diseases and other health conditions are so prevalent here, but I’m not capable of delivering all the care that is needed yet and that can make me feel useless. I have a lot to learn, but I still help where I can and intend to learn what I can. I just need to be patient with myself.