300d Pract Diab Int October 2004 Vol. 21 No. 8 Copyright © 2004 John Wiley & Sons, Ltd.

TRAVEL LOG

Travel Log

The six-and-a-half million people livingin the Central American country of ElSalvador are faced with many chal-lenges, such as earthquakes, high sus-ceptibility to hurricanes, for example,1998’s Hurricane Mitch, and the after-math of a 12-year civil war whichended in 1992. Sustaining a familyproves difficult for many in El Salvador,especially for 48% of the populationwhich, according to a 1999 estimate,lives below the poverty line. Adding thecosts of diabetes treatment and sup-plies to this is economically cripplingfor many families.

Humanitarian aid projects are cer-tainly beneficial in such situations,though when tackling a challengesuch as diabetes, where those diagnosed require constant and con-sistent medical treatment, only a sus-tainable programme will suffice.Developing the means for permanentand substantial diabetes care is bothfeasible and, at this point, morallyobligatory.

ASADI, or Asociación Salvadoreñade Diabéticos, which is the nationaldiabetes association in El Salvador, isthe major provider of education andaid in the country. The developmentof a strong diabetes programme in ElSalvador can’t rest on the shouldersof one group alone. It will take a collaborative effort between the ASADI, other international organisa-tions, health care professionals,Government officials, and pharma-ceutical companies.

One step that needs to be taken isfor the Government of the Republic ofEl Salvador to develop a national dia-betes plan. There is currently a signif-icant lack of prioritisation of diabetesat the Legislative Assembly and theMinistry of Health. Though thischange will be internal, the necessityfor it can be demonstrated and high-lighted by international organisationssuch as the International DiabetesFederation, the World HealthOrganization, and the United Nations.An educational campaign from thesegroups, geared towards encouraging

the national governments of everycountry to prioritise diabetes on theirhealth care agendas will have a valu-able impact on diabetes policy andthe support national diabetes associ-ations need.

Training health care professionalsin El Salvador on diabetes and dia-betes treatment should be one edu-cational priority, because they haveaccess to large portions of the popu-lation and carry the weight of provid-ing medical care. In recent yearsNovo Nordisk has sponsored ASADIto provide educational seminars todoctors, people with diabetes andtheir families throughout the country.An expansion of this programme,which could be sponsored by otherpharmaceutical companies or run byhealth care providers from abroad,would help bring aid to areas outsidethe capital, closer to many in needwho are not able to afford the costs oftravel to a major clinic.

During my stay in El Salvador Ihad the opportunity to meet manychildren living with diabetes and learnfirst hand the specific challengesthey face in obtaining quality medical

treatment. One visit that stands out inmy mind was to the home of a youngboy named Vladimir. Originally therewere seven children in his family, fourwith diabetes. Because the familycan’t afford the exorbitant costs ofblood glucose monitoring devices orthe test strips, two of his older sib-lings have already passed away dueto complications, his older brother isblind, and Vladimir himself is facingkidney failure. Tearfully, he told mehow thankful he is to be alive.Because Novo Nordisk has loweredthe price of insulin in El Salvador so itwill be more widely available,Vladimir is able to live for now. But heis worried about the complicationsthat result from lack of blood glucosemanagement.

On his behalf, I carry a message:please help make diabetes manage-ment technology more affordable tothose in the developing world.

Clare RosenfeldMember of the Consultative Section on Childhood andAdolescent Diabetes for theInternational Diabetes Federation

Diabetes in El SalvadorNo. 2 in a four-part series of Practical Diabetes International Travel Log features looking at diabetes care inthe developing world

Clare Rosenfeld meets children with diabetes in El Salvador

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