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In DRC, a Local NGO Fights Diabetes Amid Natural Disasters, Civil Conflict

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DR Congo
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Direct Relief
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Association des Diabétiques du Congo educates people about diabetes prevention, nutrition, self-care, and management, and distributes medicine, donated by Merck KGaA via Direct Relief, to help people control the disease.

Growing up in what is now the Democratic Republic of Congo, Alfred Kakisingi witnessed many of his relatives enduring the impacts of diabetes. For those whose condition grew serious, the prognosis was grim. "Every time they send someone with diabetes to the hospital, the mindset is it looks like a death sentence," he says.

Decades later, despite the growing prevalence of diabetes in the DRC, the disease doesn't receive enough attention from the region's health providers, Kakisingi says. Hospitals and health care providers in the region feel "diabetes isn't a priority for them," he laments. People in the DRC often learn they have diabetes only when they begin to experience the disease's serious complications; untreated diabetes puts people at high risk of limb amputation, sight loss and premature death. Globally, around half of all adults with Type 2 diabetes are undiagnosed or unaware of their condition, according to the Lancet.

The World Health Organization has warned of a rapid increase in the related conditions of obesity, diabetes and hypertension in the DRC, in keeping with a similar trend in low- and middle-income countries around the globe. One in four residents of the DRC had hypertension in 2014, one of the highest rates in Africa, according to the WHO. Diabetes prevalence increased from 11.9% to 15.6% between 2010 and 2015 among workers at the DRC's Tenke Fungurume copper and cobalt mine, a longitudinal study of worker health records found.

TAKING ACTION

Kakisingi cofounded and runs an organization called Association des Diabétiques du Congo, or ADIC, which educates people in eastern DRC about diabetes prevention, nutrition, self-care, and management, and distributes medicine to help people control the disease. ADIC is based in the city of Goma along DRC's eastern border with Rwanda.

The DRC has experienced decades of turmoil, including wars and ethnic conflicts involving about 150 armed groups, sometimes spilling over from Rwanda; disease outbreaks of Ebola, cholera and Covid-19; and natural disasters including flooding. In May, tens of thousands of people fled their homes as the Mount Nyiragongo volcano erupted just 12 kilometers from Goma. The DRC had 5.2 million internally displaced persons in 2020, the largest IDP population in Africa, including 2 million newly displaced persons, according to UNHCR.

The civil conflict makes travel difficult and dangerous, so ADIC works with partners in towns and villages in eastern Congo to conduct training and get diabetes medicine to those who need it. It also operates an outpatient clinic in Goma, which treated 3,995 patients last year. When diabetes patients arrive, their blood sugar is checked and stabilized if needed. They are offered counseling on diabetes and how to manage it, and given a supply of medicine if available.

Direct Relief has partnered with Merck KGaA to donate and deliver diabetes medicine to ADIC for use with its local patients. Since 2019, Direct Relief has provided 3,222 pounds of Merck KGaA medicines to ADIC -- more than 350,771 defined daily doses of medication for diabetes and hypertension. The donations to ADIC are part of a larger program in which Merck KGaA has donated 20 million doses of its Glucophage medicines for Type 2 diabetes, plus over 10 million doses of its hypertension medicine Concor. (Merck KGaA, based in Darmstadt, Germany, is entirely separate from U.S.-based Merck & Co., though the two companies share historical roots.)

The support of diabetes patients in the DRC by Direct Relief and Merck KGaA comes amid a global movement to bring diabetes care to people in countries experiencing crisis. The movement includes the WHO Global Diabetes Compact, introduced in April 2021, which lays out a vision "to reduce the risk of diabetes and ensure that all people diagnosed with diabetes have access to quality care and treatment that is equitable, comprehensive and affordable."

"Diabetes is a global epidemic," according to the WHO's Global Diabetes Compact. Before COVID-19 emerged, more than 420 million people were living with diabetes worldwide -- 6 percent of the world's population, and four times more than in 1980, the report states. "This number is expected to rise to 570 million by 2030 and 700 million by 2045, rising most rapidly in low- and middle-income countries."

The WHO Global Diabetes Compact cited "a chronic lack of investment in diabetes prevention, early diagnosis, appropriate treatment and care," which "needs to be redressed without delay to reduce immense suffering among millions of people and mitigate preventable long-term social and economic costs to society."

In partnership with Life for a Child, Direct Relief has been donating supplies to ADIC to support its Type 1 diabetes patients since 2011. Since 2019, ADIC has been receiving donations of insulin and medicines for both Type 2 diabetes and cardiovascular disease, under Direct Relief's initiative with the International Diabetes Federation to support people with diabetes in countries experiencing crisis.

"Direct Relief's work is part of a very large push by advocacy organizations, policy organizations, the WHO and others to put diabetes and non-communicable diseases at the forefront in humanitarian and crisis settings, to provide care and access to medicines for people all over the globe that live in these situations," said Kelsey Grodzovsky, Program Manager for Global Programs at Direct Relief.

IMPROVING ACCESS TO QUALITY MEDICATIONS

The limited supply of diabetes medicine available in the DRC is often of low quality, Kakisingi said. Direct Relief provides ADIC with Merck KGaA's top-quality branded generic medication, including Glucophage and Glucovance (oral medications to control type 2 diabetes) and the hypertension medicine Concor. These are medications originally developed by Merck KGaA that are now off-patent.

"The benefits are enormous," Kakisingi said. "Direct Relief sends us medicine of top quality. Some of the doctors, when they see those products, they say they've never seen them before. Secondly, the product is sent so quickly. DR takes care of transportation and customs clearance costs, and this is a very big benefit."

Andre Musto, Senior Vice President, Head of Cardiovascular Metabolism & Endocrinology Franchise at Merck KGaA, Darmstadt, Germany, said, "Considering the current situation of undertreatment and limited access to medicines, we take our responsibility very seriously of developing and supporting diabetes treatment and education to address the current scenario and to help healthier generations to come. We are honored to continue our collaboration with Direct Relief and support their efforts and ultimately help patients in need."

Merck KGaA's medications have gone to countries in crisis around the world, including the Central African Republic, DRC, Republic of Congo, Ethiopia, Haiti, Syria and Zimbabwe, among others.

In 2020, Direct Relief provided diabetes products valued at hundreds of millions of dollars to underserved people with diabetes who were affected by disasters and emergencies in over 60 countries worldwide. Working closely with the three global insulin manufacturers, Direct Relief is now one of the world's largest humanitarian insulin providers. Direct Relief's distribution center is significantly expanding its refrigeration capacity to store cold-chain medicines (with space for up to 677 pallets of product), allowing increased support to people who require cold-chain therapies for diabetes, cancer, hemophilia, rare diseases, and other conditions.

Direct Relief's Rita Tshimanga provided translation support for this story.