In the past, diabetes and so-called Lifestyle diseases was virtually unknown in Papua New Guinea. The village lifestyle offered us great health benefits as we had a high-fibre, low-fat diet and we lived very physically active daily lives.
In contrast to village lifestyles of our foremothers and fathers in the years gone by, we eat more fat, less fibre and we live a far less physically active day to day life. Furthermore we are “in over our heads” with the mental demands of the modern world which we are aspiring to be a part of. We are stretched as individuals, families, villages and as a country between two worlds. One, the modern, western, materialistic world, based on the so-called “free market economy” and the traditional world of our ancestors. This “stretching”, places a great stress on our minds, bodies, relationships and ultimately our health.
The current wave of Papua New Guinea unprecedented economic growth propels us into and while more and more citizens are enjoying the lifestyle that their new found wealth is bringing them we are seeing an explosion of “lifestyle” and chronic diseases like Diabetes, High Blood Pressure, Heart Problems, Strokes, Kidney Problems and other chronic illness such as Asthma and Chronic obstructive airway diseases and mental illnesses like depression and anxiety, and addiction to alcohol, drugs and gambling.
Often people with chronic illness become very confused as they get lost in follow up and from one doctor to another their treatment is changed sometimes on an ad hoc basis and lacking standardization based on Evidence Based Medicine. But thankfully Papua New Guinea has now released the first edition of the – Diabetes – Clinical Practice Guidelines. This will now lead to a more standardise management of diabetes and act as a catalyst for the establishment of proper diabetes and lifestyle clinics throughout the country.
According to a WHO 2005 Report, 80 % of chronic diseases occur in low- and middle-income countries (Like Papua New Guinea) and it is estimated that 7.1 million people will die annually as a result of elevated blood sugar levels.
The International Diabetes Association, predicts that between 2010– 2030 Type 2 diabetes will increase by a walloping 140% in PNG, from 76,709 in 2010 to 172,000 in 2030.
In the 1st Diabetes – Clinical Practice Guidelines for PNG, which was recently launched it states that: “Hospital statistics show that diabetes has increased since 1980. A pilot survey in a working population in Port Moresby in 2008 showed that 10% had a high blood sugar level with no symptoms of diabetes. The STEPs national prevalence study in 2008-9 (funded by WHO) showed that 14.4% of adults aged 15-64 years had a fasting blood sugar level of ≥ 6.1 mmol/L”. This is a serious problem and one which mainly affects our educated working class, urban dwellers”.
Many of these people do not even know that they have diabetes until they present with diabetes complications – which includes – kidney failure, heart attacks and stroke, erectile dysfunction etc.
The Port Moresby General Hospital, the biggest tertiary hospital in Papua New Guinea is not equipped with the necessary resources to be able to properly manage most of these complications and therefore it is very important that people take more responsibility in looking after our own health and do what they can to stay fit and healthy in order to prevent the development of these conditions in the first place and if they do happen to develop these conditions, delay the onset of their complications.
Prevention is better than cure!
Especially when there is no cure or the cure is very difficult attain due to lack of resources, such as is the case in PNG. For example a heart attack is caused by blockage of one or more of the arteries supplying the heart. This blockage is formed by long term damage to these arteries and the deposition of fat within their inner walls (atherosclerosis).
The treatment of such blockages involves special procedures and expertise which we do not have in PNG and are unlikely to have for many years to come. However, it is well accepted in the international medical community, that there are certain “modifiable risk factors” which places an individual at a higher risk of developing atherosclerosis and if these are recognized early and managed properly (“modified”), their risk of developing atherosclerosis and a heart attack and other cardiovascular illnesses can be markedly reduced. Some of the important modifiable risk factors include:
- Hypertension (High Blood Pressure)
- Diabetes Mellitus
We all know that regular exercise and a balanced healthy diet leads to a healthier self, but with conflicting commitments to work, family and traditional obligations, finding the time and motivation to do these things can be challenging, especially when trying to do so in isolation without the benefit of being part of a team. But we must also know that if we don’t find time for these things…we will have no choice but to make time for illness when it eventually comes.
Healthcare workers should work closely with individuals to initiate and maintain appropriate lifestyle changes through dietary and exercise programs with the focus on prevention and or delaying the onset of lifestyle diseases and or their complications. The lifestyle disease healthcare team and clinics should be a source for motivation for individuals. Easy to read written information about specific conditions should be available for individuals so they can be empowered with appropriate knowledge of their condition(s) in order to have a sense of control and a sense of “being able to do something” to help themselves.
Regular following-ups, based on the Diabetes Clinical Practice Guidelines should be done to assess progress, identify problem areas and make appropriate decisions on specific lifestyle or pharmaceutical treatment per the guidelines.
Some of the tests that need to be done on a regular basis as part of the long term care of people with diabetes and other lifestyle diseases include:
- Blood glucose levels
- HbA1c, Urinary Micro-albuminuria (important tests to assess glucose control and detecting early kidney problems.
- Lipids – Including cholesterol
- Blood pressure
- Body Mass Index (BMI) and waist circumference
- Foot examinations
- Eyes checks and organizing ophthalmologists review where appropriate.
- Nerve function – Monofilament test.