Diabetes in India: Skills-Based Volunteering
Recently my friend D. Francine Kaufman, our Chief Medical Officer, contacted me to explain that Medtronic was piloting a skills-based volunteering program, Skills for Change. She asked if I would like to be part of a small global team travelling to Chennai, India for 3 weeks to focus on gestational and type 2 diabetes. I immediately jumped at the opportunity.
The premise of Skills for Change is that you can achieve many times the benefit over general volunteering by applying the talents of professionals in public companies, with stewardship from experienced nongovernmental organizations, to address public challenges in developing countries. It’s a win-win-win for the client, the company, and the employee.
This was an immersive experience. No fancy hotels or restaurants. I wouldn’t have wanted it any other way, because in so doing, we got a broader sense of the environment and context of diabetes in India. We experienced traffic, congestion, delays, bureaucracy, and sporadic access to electricity, air conditioning, Internet, and safe drinking water. Yes, we all got sick.
Here’s my “top ten” list of the challenges faced by people living with diabetes in India:
1. First you have to live: It can be difficult to gain access to basic needs: food, safe drinking water, and electricity.
2. Self-Pay: With health care costs largely borne by the individual, they pay for what they can afford.
3. Income and Inequality: India’s per capita income is nearly 50 times less than ours, making even test strips a luxury for many. This income is not distributed equally. This makes the challenges of diabetes very different for the urban middle class and the rural poor.
4. It’s hard to exercise: While many of us may not have a valid excuse for not exercising enough, I think people in India definitely have a bonafide challenge. As a runner, it was hard to find a place to run.
5. The food, while delicious, is not diabetes friendly: For the urban middle class in India, food is abundant, and loaded with carbs and fat. Plus it’s next to impossible to count the carbs in a curry.
6. Stress / Poor Work-Life Balance: For a myriad of reasons it can be very stressful to live in India. People often work very long hours, 6 days per week, with little time for relaxation or exercise.
7. Lack of paper: Per capita, we use 50 times more paper than Indians. Toilet paper is rare, and in the case of diabetes, writing paper for logs or educational material is scarce.
8. Travel Difficulties: It can take days to reach a diabetes clinic; traffic is brutal.
9. Collectivism: Strong cultural motivations for being part of the group. For people with diabetes, it can be difficult to eat differently or exercise differently.
10. Many Languages: It is difficult to develop and distribute communication material that everyone can understand when there are hundreds of different spoken languages across the country.
Five of us from Medtronic split into two teams. Mary and Maneesh worked with doctors in a semi-rural hospital, surveying caregivers of people with type 2 diabetes. They got to see first-hand the challenges faced by the rural poor: undernourishment, long hours at manual jobs, very low income, and poor literacy. Mridu, Margaret and I worked with researchers in a world-class urban diabetes center, data mining a very large electronic health record to improve methods for detection, diagnosis, treatment, and follow-up of gestational diabetes.
We also had a bit of time to explore. India is a wonderful, complex society. It overwhelms the senses. With multiple religions, sects, languages, races, cuisines, income levels, climates, etc., it would take a lifetime to experience the depth and breadth of India.
I have to say it was difficult to leave. The people we worked with were incredible, the need was unimaginable, the experience indelible. Thank you Medtronic for this unique opportunity to help make a difference.