We were delighted to bump into fellow person with diabetes (PWD) Mark Koekemoer, a 31-year-old diagnosed with type 1 as a teenager 16 years ago. A year ago, Mark created an online community called Rock Your Diabetes, and more recently, he's started a South African Twitter chat using the hashtag #DchatSA. He's on Twitter personally at @RockYourD.
WHAT DOES HE DO?
Take it away, Mark!
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A Guest Post by Mark Koekemoer
Firstly, let me just clear a few things up:
1. In South Africa, we do not live in huts.
2. There are no elephants or lions that roam freely in the streets or nearby said huts.
3. There ain't no barbecue like a braai. (South African "barbecue")
I mentioned the first two because I have heard far too many stories of people who actually believe this! South Africa is an incredible country, rich in natural resources and diverse cultures and a very popular destination for tourists. We have 11 official languages of which English is only the fifth most spoken home language. (We like to say "Howzit Bru?" for "How's it going?") South Africa has two capital cities: Cape Town and Pretoria.
I live in Cape Town, which is known as the "Mother City" and is a very trendy cosmopolitan city of about 3.7 million people. Not only is this a popular tourist destination because it's home to one of the seven natural wonders of the world, Table Mountain, but it's also the World Design Capital of 2014. This YouTube video gives a taste of the city, where you can even send your Facebook profile on holiday! We're about 1,500 kilometers (about 900 miles) from the executive capital of Pretoria, which is next to Johannesburg that is one of the world's largest gold mining centers and the commercial hub of South Africa. (It's also where the Diabetes South Africa non-profit org is based!)
At the age of 15, I was diagnosed with type 1 diabetes on the 31st of August 1996. At the time, I was at boarding school and after a few weeks of feeling really crappy and losing lots of weight, I took myself to the doctor for a checkup. Right there in the waiting room I read one of these medical pamphlets: "Have you lost weight? Struggling to concentrate? Feeling dehydrated?... Then you may have type 1 diabetes - inform your doctor of your symptoms..." Yes, yes, yes! I nodded to each of the questions, except the last one, which I couldn't relate to.
So I didn't tell my doctor about the pamphlet. I did, however, tell him all the symptoms I had. But for some reason, it just didn't click with him. In the end, I got booked off school for a week for "exhaustion and blurry vision." In the car on the way home, I smashed four litres (1 gallon) of soda water to quench my dehydration. But my mum knew better, and the next day I went for another check up. That's when I was diagnosed correctly. And the rest, as they say... is history.
My first years as a diabetic were spent on the back foot, always reacting to highs and lows and never understanding why my sugars were doing what they were and never taking time to understand diabetes. I never received proper education other than from my doctor, who was only ever interested in better control, even though he only prescribed me a sliding scale of insulin! In 2002, my life changed when I went into DKA. When that happened I realized how dangerous diabetes really was and made a decision there and then that I was going to take better care of myself. That day I shifted the control I had of my diabetes from outside of me (doctor dietician, parents) to inside, where I knew I COULD CHOOSE how I lived my life and made decisions to manage this disease. That's when I stopped living AGAINST my diabetes, and started living WITH it.
At first I struggled to find support in the local community, and even attended two type 2 diabetes support groups - what can I say - I was desperate! The South African Diabetes Association produced a magazine every so often, but this wasn't enough. I was on a mission to learn everything I could about diabetes and how to take better care of myself.
And that's when I turned to the Internet. I joined communities online and asked questions, engaged in conversations and bought books that were not available in SA from Amazon. I also attended webinars to learn all that I could.
In 2002, I started on a pump and for many years ate according to the Low GI diet; I enjoyed vegetables and whole grain foods, rarely ate poorly and learnt to carb count like a champ. I also became very interested in health and nutrition, and read everything I could on the topic. Then in November 2011, I started doing Crossfit and got introduced to the Paleo diet. And it all changed again. Eating "Paleo" means to essentially cut out refined carbs, sugar and gluten and choose real food in the form of vegetables, meats, healthy fats, nuts and seeds. Since I switched to a Paleo way of eating, my control and health has moved to a whole new level.
Eating low-carb has reduced my carb intake and therefore my insulin requirements. Having less insulin in my body means I'm more controlled (the law of small numbers by Dr. Bernstein) and can now climb a flight of stairs without going hypo. For the first time in 16 years, I feel like I actually have control of my diabetes. This change has truly empowered me, and although I am sure it will not work for everyone — I would really encourage you to just try it. Since changing my diet I have also switched back to pens, and now have better control than I even had in all my years of pumping. This was an added benefit of eating real food - the feeling of freedom when I finally took off my pump.
OK, enough about me.
Health Care in South Africa
In South Africa, you will find public and private health care. Public health care is offered free by the state and provides people with diabetes (PWDs) access to medication, treatment and education. However, resources come in pockets around the country, so in some areas there is good access to public health care and in some areas there is not. The public health sector is under severe pressure, and although nearly 40% of government expenditure is spent on health, it's expected to deliver services to nearly 80% of the county's population (about 40 million people!).
The private health care sector, on the other hand, is funded by its members and provides state-of-the-art medical aid coverage, depending on the plan. I have been fortunate to have had access to private health care since I was diagnosed with type 1 diabetes, and have never had a problem with getting medicine or consumables. Unfortunately, private health care is not affordable for the majority of South Africans and our government is now looking to introduce a National Health Insurance scheme that will provide better health care to all.
Sounds like we have that in common with the United States...
Stats on diabetes in South Africa aren't as well-documented as they are in the U.S., but some local community stats from the website Sweetlife show this:
- According to the International Diabetes Federation (IDF), the estimated number of people with diabetes in South Africa is around 840 000, but other studies say there may be as many as 1.5 million diabetics.
- The World Diabetes Foundation says that in developing countries (like South Africa), less than half of people with diabetes are diagnosed. Without diagnosis and treatment, complications from diabetes rise at an alarming rate. This same foundation says that 85% of those with diabetes in South Africa are undiagnosed!
- Most at risk of developing diabetes in South Africa are the black community because of rapid lifestyle and cultural changes, and people of Indian descent because of their hereditary genes and diet.
- 90% of people with diabetes in South Africa have type 2 diabetes; 10% have type 1 diabetes.
- In South Africa 1 in 5 people older than 35 have type 2 diabetes; more than 50% are unaware of this.
Diabetes Education in South Africa
In my opinion, diabetes education in South Africa still has a long way to go to be effective and truly transformative. We already have a number of institutions trying to make a difference, like the Youth With Diabetes organization that aims to educate and empower youth living with diabetes. We have a wide network of CDE's that work closely with medical aid companies to provide a support "team" for their clients with diabetes. Then of course we have the South African Diabetes Association that aims to raise funds and awareness for diabetes in South Africa. But this is still not enough. There are far too many efforts in different directions and I am hoping that in the near future we can bring these powers together to create a new platform for diabetes awareness, education and treatment.
We know the online community is where the magic is happening in the world of diabetes. In SA our DOC is still small, but this means there is lots of room for growth! I recently initiated the first diabetes Twitter chat hosted in South Africa (#dchatsa) and have started a blog at www.rockyourdiabetes.com, where I want to communicate tips and advice on how to live a life unbound WITH diabetes. I'm excited to be participating. We also participated in the Global WDD chat on the 14th November, and I hope to play a part in creating the next platform for diabetes education in our country.
It's All About Attitude
As I've blogged: Diabetes is hard. There's just so much to learn about how to manage it properly and then you never get to take a break either! But I believe with a curiosity to learn, an open mind and the right attitude - one can really live a life unbound with this disease. Having type 1 diabetes has taught me some valuable lessons and shaped me to be the person I am today - confident, healthy and fit, and I wouldn't have it any other way.
Thanks for the great work you're doing in the D-Community, Mark. We look forward to staying in touch as the newest D-Twitter chat evolves!