Growing up in the country, I frequently heard about people who had “sugar”. These references were generally muttered with a sad shake of the head and a sympathetic softening of the voice. For a long time, I never understood, and found it hard to imagine, why the possession of such a splendid commodity should occasion such grief, and should be voiced in such mournful tones, full of doom, gloom and despair. In those days, like any other child, I loved sugar and, given the opportunity and lack of parental supervision, would indulge myself hugely, particularly if some “Crix” crackers and butter happened to be handy.
What confused me even further was that one of the neighbours, a buxom lady named Esther, was reputed to have a “sweet” man who, it was said, used to visit her whenever her husband was at work. Having read “Hansel and Gretel”, and knowing that enormous edifices could be constructed entirely of confectionery, and also having read about other culinary curiosities like a “gingerbread man”, I easily assumed that Esther’s surreptitious suitor was composed entirely of sugar. Whenever I met her in the neighbourhood shop, buying “Crix” crackers and butter, I recognised a kindred spirit and knew exactly what she was doing.
Later I learnt that having “sugar” meant having diabetes. After the deaths of many of my relatives on both my mother’s and father’s side, and later of my wife’s family, I knew and appreciated why it was then, and continues to be now, an occasion for grief. Unfortunately, at the time, I never knew how bad and how widespread it was. In Trinidad, with a population of about 1.3 million, an estimated 143,000 persons or 13 per cent of the population have diabetes. In Jamaica from 1.3 per cent in 1960 the rate of those with Diabetes Mellitus (DM) rose to 17.9 per cent in 1995. In 2017, there were 35,600 cases of DM in Barbados. Across the region, the overall prevalence of DM is between 11 and 18 per cent. In addition to the high burden of the illness itself, there are also severe complications including renal failure, blindness, lower limb amputation, and premature death, chiefly through coronary heart disease and stroke.
Knowing that I am potentially a victim has given me cause for concern, particularly when I witness bad episodes, like the amputations suffered by my grandmother, aunt and close friends, and their subsequent sad and painful deaths. Unfortunately, for a while it did not completely change my behaviour. This is entirely consistent with human nature. Smokers know that smoking is dangerous to their health and they still continue to smoke. In fact, the dissonance caused by doing something that can harm us, whether cigarettes, drugs or alcohol, makes us reach out for more because of the instant emotional relief they provide. However, a “fix”, regardless of how quick it is, never fixes anything.
Why are we like that? Increasingly, people in the Caribbean are demonstrating a willingness to change their governments instead of their lifestyles and are doing the same with diabetes—swapping doctors or advice instead of their eating and drinking habits when they have the disease.
I remember my father’s family, all of whom were notorious for their consumption of alcohol (particularly over-proof “Puncheon” rum), were convinced that if they drank brandy it would help to cure their diabetes. Unfortunately, it just made their illness worse and more expensive.
There are many stories of people who go to the doctor for treatment for diabetes and, when given a diet sheet with what seems to them to be very paltry provisions, ask, “This medicine, doc, you want me to take it before or after meals?”
Sufferers from diabetes are always on the lookout and are constantly provided by the grapevine and false advertising with miraculous remedies. Like jungle predators they move from bush to bush, recommended herb to guaranteed grass, boiling, mashing, mixing, looking for the cure. Yet, you cannot blame them. Hope springs eternal in the human breast. We are always searching for the magic bullet, the instant cure, the miracle.
Health professionals, however, have to take a lot of the blame. For the most part they have a vested interest in illness rather than wellness. They dispense potions, prescriptions, pills and diet sheets without providing a context for understanding or a framework for managing the problems. They explain conditions like the diabetic foot or impotence after the fact rather than before, when it can be prevented. They are smooth operators in a world where no operation is smooth. They remain, for the most part, insensitive to the cultural context of the individual sufferer and the need to work within that context. They continue to threaten rather than persuade; to “cuss” rather than discuss.
We spend about 90 per cent or more of national health budgets on trying to cure the incurable and ignore prevention. We buy expensive equipment that can only help a few instead of spending time and money on health promotion.
There are three Es in public health—enforcement, engineering and education. When engineering in the form of the magic bullet does not exist, and enforcement is impossible, education must be the remedy and it has to be timed and provided when the person needs it most.
In both private and public clinics in the Caribbean, at least twice a week, the benches are occupied by people who, when they hear the word “Next”, or their names are called, shuffle painfully and patiently forward to receive their pills or their insulin injections. Most are losing or have lost their sight. Many have problems with their feet. The men are generally impotent. Had they known how much they had to lose and were in an informed, caring and supportive environment, they would most likely have done it differently.
I would also like to see the “labelling” changed. People should not be labelled with a disease. There should be no more “diabetics”. There should be only “people with diabetes”. This would help to keep the focus on the people and their needs rather than the disease. It will promote good health rather than pander morbidly to morbidity and mortality. And if Esther and her “sweet man” know what is good for them, they will go easy on the crackers and butter but will continue to exercise regularly.
Tony Deyal was last seen repeating a quip by the writer Jerome K. Jerome and thinking of his father’s family, “We drink to one another’s health, and spoil our own.”
