The World Diabetes Foundation is an independent trust dedicated to the prevention and treatment of diabetes in low- and middle-income countries. Since 2002, the World Diabetes Foundation has provided 168 million EUR in funding to 572 partnership projects in 119 countries.
WDF’s 2023 fundraiser, Empowering Lebanese and refugee children and youth through sports to prevent NCDs, will be rolled out by GAME Lebanon, an international NGO working for social change through youth-led street sports and culture. GAME has been active in Lebanon since 2007.
The project will focus on strengthening access to public spaces for sports, addressing physical inactivity in children and youth in urban areas across Lebanon and nurturing participants’ life skills through training built around GAME’s Street Sports for Life Skills curriculum.
It will target Lebanese and refugee children and youth who live in disadvantaged urban communities and need to be more active in sports activities. It will also focus on increasing awareness about the importance of physical activity and healthy lifestyle within their local communities.
“Through this project, GAME aims to promote healthy living and proper nutrition among children in Lebanon,” says Lynn Hajj, GAME Lebanon Communications Coordinator. “It will increase the children’s weekly physical activities and provide a platform for delivering nutrition-based education to them, as well as their parents and caregivers.”
The project will take place over 18 months (2023 – 24).
Its targets include:
Situated on the eastern horn of Africa, Somaliland is an autonomous region that declared itself independent from Somalia in 1991. It has escaped much of the chaos and violence that plague Somalia, and has a working political system, government institutions, a police force and its own currency. Yet it is not internationally recognised, and its economy is still in its developing stage. As a result, poverty and unemployment are widespread.
WDF’s 2022 fundraiser project, Increasing awareness and providing diabetes care in vulnerable communities in Hargeisa, Somaliland, will increase diabetes awareness, build health care staff capacity, and prevent and treat diabetes in five of the country’s internally displaced populations.
The fundraiser project will be rolled out by the SOS Children’s Village (SOS CV), an international non-governmental organisation that has worked in Somaliland since 1999. It will focus on integrating diabetes into SOS CV's ongoing Family Strengthening Programming, which is working to improve overall living conditions for internally displaced families in Somaliland. SOS CV will collaborate closely with the Ministry of Health and Somaliland Diabetes and Hypertension Association on project implementation.
The fundraiser project will specifically target vulnerable families, women and people living with diabetes and in need of support. It also will arrange diabetes awareness raising sessions and training for community members, teachers and health workers. At national level, the project will contribute to the adaptation and implementation of WHO diabetes guidelines.
“The project will support many individuals – increasing their knowledge of diabetes and changing their lifestyle. It will also provide health professionals with knowledge and skills to manage patients suffering from the disease,” says Suleiman Ismail, National Programme Development Manager, SOS Children’s Villages in Somaliland.
“By doing this, lives will be saved and thus many children will be protected from losing their parental care.”
The project will take place over 18 months (2022-23). Its targets include:
Guatemala’s Sololá region, with its sparkling lake ringed by volcanoes, is exceptionally beautiful. But a hidden danger stalks the Maya people who live there.
Glucose tests conducted by Hospitalito Atitlán, WDF’s partner in the region, found that 15% of people tested had diabetes and 11% were pre-diabetic. More than 23% of the hospital’s patients are obese, and 43% are overweight.
Many factors contribute to this, according to Lyn Dickey, Hospitalito Atitlán’s Director of Development. Poverty and food insecurity have long challenged the region. Most residents speak only their maternal language - Tz’utujil, Kaqchikel or K’iche’ – and don’t understand the Spanish spoken by government and health authorities.
“Also, in this culture (as in many others), diabetes and other chronic diseases are largely accepted as the inevitable, ‘unlucky’ results of normal living. People do not accept that they have the power to control certain kinds of health outcomes.”
New factors are making the situation worse, she says. For example:
Kyrgyzstan has made strides in treating type 1 diabetes in recent years. Yet children and youth with type 1 diabetes in this central Asian country still face barriers ranging from stigma to interruptions in essential supplies. To improve their health outcomes, WDF’s 2020 fundraiser project will address four key aspects of their care:
WDF has worked with the UN Relief Works Agency for Palestine Refugees in the Near East (UNRWA) since 2002 to improve diabetes prevention and care in the agency’s health centres across the region.
WDF’s 2019 fundraiser project, Prevention and Management of Diabetic Foot for Refugees with Diabetes, will build on the learnings from this long-term partnership, with a special focus on preventing diabetic foot ulcers and, ultimately, amputations among Palestine refugees in Jordan through education, empowerment and capacity building of health staff.
“The burden of diabetes is continuously growing: each year we are seeing a 5% increase in patients with diabetes registered in UNRWA clinics, reaching more than 148,000 by the end of 2017,” explains Dr Yousef Shahin, Chief for Disease Prevention & Control at UNRWA and WDF’s partner on the project. “It is essential to ensure that diabetic foot is properly managed ahead of time to prevent the high cost of treating its complications and disabling effects.”
Nearly 17% of registered Palestine refugees worldwide live in 12 recognised UNRWA camps in Jordan. Their diabetes prevalence is higher than those in host countries, Dr Shahin says, noting that the diabetes rate in Jordan is 10.6% for those above 40 years of age, and 12.1% agency–wide.
“UNRWA faces challenges in diabetes care and diabetic foot care - patient self-empowerment and disease management are crucial,” Dr Shahin says. Health staff are largely generalists with heavy workloads, who often lack tools, equipment and time for patient education, he adds.
26 health centres strengthened
WDF’s 2019 fundraiser project will be rolled out at all 26 UNRWA health centres in Jordan. The project builds on learnings from past partnership projects WDF11-614, WDF14-898, WDF16-1406 and WDF10-555, a successful similar foot care project implemented in the West Bank and Gaza.
Its targets are:
On the lush green lawn of a colonial-era inn in Embu, Kenya, parents who recently met were sharing some deeply personal memories and fears.
“She was sick, sick, sick - we were moving between health facilities and we couldn't find the cause,” Jemima Mwihaki said.
Line Consolata Waita nodded. “My son was diagnosed when he was only 12 years old. He's my first one and is my heart. I thought – no, not that.”
“My son, he thought that after diagnosis he wouldn’t live 10 years,” Boniface Maina Muriithi said.
Nearby, their children –ranging in age from 5 years old to their early 20s – dribbled footballs, jumped rope, and exercised to the shrill thwwt of a facilitator’s whistle.
They were all participants in the Diabetes Youth Camp that took place from 24-27 January, 2020. Organised by the Kenya Diabetes Management and Information Centre (DMI) and Kenya’s Ministry of Health and supported by the World Diabetes Foundation, it was the latest camp providing Kenyan young people with diabetes and their parents new skills, support and not least hope.
A need to come together
The camps began in 2008, with the support of a WDF fundraiser project. Today, they are a central element of Kenya’s support for children and youth with type 1, with a focus on self-management. Newly diagnosed patients are sent to camp as soon as possible, and if healthcare workers are worried about a child, they may send him or her back to attend again. Initially, the camps were just for children, says Catherine Karekezi, Medical Director for DMI. In 2015, the concept was expanded to include parents. “We realised we were teaching children, but the parents were getting left behind. There's really a need for parents to come together and share their challenges. I think for them it was a big relief just to realise that the children can learn how to manage for themselves and they can have fun like any other child as long as they know what to do.” To encourage this independence, children and parents learn and sleep separately. At the January camp, the advantages of this were clear. In one room, parents listened intently to lessons about diabetes causes, treatment and complications, some with younger children drowsing on their laps. During an insulin lesson they injected themselves with empty syringes to check their technique; during a footcare session they examined each others’ feet. In another room, the children received a kid-friendly version of the same instruction. Here, the agenda included pre- and post-meal blood sugar measurements, insulin injections and discussions of the results. Regular breaks for song, dance and silliness kept energy levels high. For some parents and children, camp is the first time they have been apart since diagnosis. One important goal is to show that children with diabetes can become independent and grow up to live fulfilling lives, Ms Karekezi said. She recalled an incident from the January camp’s first night with a smile: “The parents of two small girls had been telling me about their concerns about letting their children be independent. And suddenly the girls ran in and said "Mom we've injected ourselves today and it doesn't hurt!” “The mothers were like, ‘Okay, you can do it? So I no longer have to inject you?’ And the girls said ‘Yeah, everybody here does it for themselves.’
More children are out there
Zachary Ndegwa, a project officer with the Kenyan Ministry of Health’s Division of NCDs, was also in Embu in January, teaching and offering support. The camps are an important part of Kenya’s larger diabetes response, he said. “We have about a 5000-10000 children with diabetes in Kenya. But our system is currently following only about 2000 or 2500. Meaning that the rest of the children are out there, some of them with severe malnutrition or severely wasted. They die in the wards because nobody knows that these children are lacking insulin.” The Ministry of Health is supporting health authorities in each of Kenya’s 47 counties to address this. More than 5,000 healthcare professionals have been trained, and a second edition of Kenya’s national diabetes guidelines was distributed in 2019. The camps are the next part of the equation. After participating in a camp, children and youth show improvements in growth and HbA1c levels, and decreases in hospital admissions, he said. “These camps have given us a big, big advantage in terms of improving diabetes care.”
Have you changed?
As the three-day camp drew to a close, Boniface shared some news: John had controlled his blood sugar levels all weekend – and was able to reduce his insulin dose as a result. “He was so excited, proud,” Boniface said, smiling in wonder. Then the parents gathered for their final agenda item: ‘The Diabetes Journey’. Doris W Macharia, a clinical officer at Embu Hospital, and her 23-year-old daughter Janice Wahome spoke about their emotions when Janice was diagnosed with type 1 – and what they have learned since. “As a parent, you have these fears – when she’s far from me, she might die – right?” she said. Her audience nodded. “As parents, let us support our child. Talk to them, and watch their sugars, but not too much – they have a life to live.” “Have you changed? Will you never be the same again?” she asked, waving to encompass the room, the weekend, the camp. The parents in the room laughed and responded as one – “Yes!”
Esperance Habinshuti is a 26-year old Kigali resident with big brown eyes and a slow, knowing smile. She also has type 1 diabetes, and spends much of her free time teaching others about the disease and how to manage it.
“When Esperence talks, people say, ‘When you speak about your disease, it almost sounds like fun,” says Crispin Gishoma, executive director of the Rwanda Diabetes Association (RDA).
Ms Habinshuti sends him an ironic smile. Having type 1 diabetes in Rwanda is definitely not fun, and they both know it. Managing the disease is a non-stop challenge, and the irregular insulin supplies, lack of understanding and stigma don’t help. But Mr Gishoma and his colleagues at RDA are working to change this, and dedicated young people like Ms Habinshuti are part of the plan.
The World Diabetes Foundation has been supporting the RDA since 2005. The first and second partnership projects provided badly needed diabetes training for healthcare professionals. This led to a dramatic increase in the number of young people diagnosed with type 1 diabetes – from 3 in 2003 to more than 1500 today. Before 2003, most children and young people suffering from type 1 were most likely to die within a year.
In 2017, the RDA and WDF launched a fundraiser project, Rwanda diabetes awareness and support, to provide additional help to this fast-growing and vulnerable group.
The project had three elements:
On a warm November day in Yangon, a neatly dressed 49-year-old woman sat stoically behind a wood and glass partition at University Hospital UM1, her legs outstretched in front of her. A nurse swabbed her left foot gently, cleaning the space around her recently amputated second toe. The woman cringed, but made no sound.
“She has pain,” acknowledged Moe Wint Aung, Professor in endocrinology in the Department of Endocrine. “We would like to give her some analgesic spray, but we have a shortage of this good material for pain.”
Yet Professor Aung, her hospital colleagues and the patient, whose name is Ms Daw Aye Aye Than, agreed – Ms Daw Aye Aye Than had been lucky. She was referred to UM1’s diabetes clinic for insulin treatment, where a foot ulcer with gangrene was discovered. In the past, the diabetes clinic staff would have dealt with the ulcer as best they could. But thanks to WDF’s Myanmar fundraiser project, Ms Daw Aye Aye Than was able to visit a new diabetes foot clinic in the hospital, and receive immediate, effective care.
Prof Aung asked the patient a few questions, then turned to her visitors.
“Because she lives far away, she’s staying at the hospital for one or two months,” she said. “With luck, after that she can go back to work.”
Little focus on feet
Diabetes is one of the main health problems in Myanmar, according to the Myanmar Diabetes Association. A national STEPs survey supported by the WDF in 2014 found a diabetes prevalence of 10.5% among Myanmar adults, well above the global diabetes prevalence of 7.3%. Funds raised by the WDF 2016 are being used for diabetes foot care training, screening and awareness in three university hospitals in Yangon and Mandalay, Myanmar's two largest cities. “We started talking to WDF about diabetes care in Myanmar because there was no systematic diabetes foot care system in Myanmar,” explained Prof. Ko Ko, General Secretary of Myanmar Society of Endocrinology & Metabolism and Endocrinologist at UM2, WDF’s partner on the project. People with diabetes receive basic care at the local level, but there has traditionally been little focus on feet, he says. “Because of that, we’ve had a lot of amputations due to diabetes - amputations that can be prevented.” When Myanmar’s government established three new diabetes clinics in the country’s university hospitals in 2015, Prof Ko Ko saw an opportunity. “Our objective is to establish these three clinics, and then train doctors and nurses across the whole country,” he said. “Our initial aim is to train 450 HCP within 3 years. We’re also planning screening and public awareness about diabetes foot care.” WDF Programme Manager Hanne Strandgaard was among those who visited UM1 that November day. “All three clinics are going 100km per hour – systematic, routine diabetes foot care services are being provided,” she said. “A patient registry is in place, which will enable more comprehensive data on foot complications to be collected and disseminated. Informative and visible educational materials have been developed, and other hospitals are looking to copy this approach. This will be a success – we can be very proud of this project and our project partners.”
The tip of the iceberg
Challenges remain: Prof Aung would like more training for her staff, and is working to obtain more medical supplies for the new clinic. Awareness about the dangers of diabetic foot ulcers are still low, Myanmar lacks podiatrists, and there’s a lack of shoemakers producing appropriate footwear for people with diabetes and foot complications, Prof Ko Ko adds. Still, he and his staff are optimistic – and ambitious. “We’ll continue to educate HCPs, and teach patients to know their risks," he says. "We hope to reach people living in villages, provide screening in villages, and teach midwives to do screening. This is tip of the iceberg.”
Building on the momentum from 2014, the 5K@EASD community continued the fundraising effort at the Stockholm edition of the 5K@EASD. Through the purchase of runner shirts, participants raised €9,340 to directly benefit the World Diabetes Foundation project “Creating Basic Care Units for Diabetes Care in Peru.” This program aims to raise awareness about diabetes and its prevention, improve diabetes care, and prevent and treat foot complications.
Updated as of December 2016:
Since its launch in 2015, the Peru Project has rolled out eight primary care clinics in Piura and Lima -- twice the orginal target -- where it has trained more than 100 healthcare professionals, screened more than 1000 people and provided counseling and footcare services to nearly 1000 people since its launch in June 2015.
In 2014, participants at the 5K@EASD in Vienna raised €10,809 through the purchase of runner shirts. All proceeds directly benefited the World Diabetes Foundation project “Strengthening the Management of Diabetes in Children in Mali.” This initiative improved access to care for 250 children with Type 1 diabetes in Mali, Africa.