Around the world we go, with our Global Diabetes Series, showcasing individuals grappling with this disease all over the planet. Today, we're proud to bring you a report from Cambodia -- one of ten countries in Southeast Asia, slightly smaller than Oklahoma, that lies between Thailand, Laos, Vietnam and the Gulf of Thailand. It's an interesting place, where half of the current population is younger than 15 years old (!)
A Guest Post by Piseth Kim
Hi Everyone. My name is Kim Y. Piseth, and you can call me Piseth (my first name). I am 24 years old living in Phnom Penh, the capital city of Cambodia. I recently graduated from the University of Cambodia in the field of Business Management. I live with my parents, one sister and one brother. I am the only child in the family with diabetes. Nowadays I work in a retail company as assistant operations manager. Aside from my professional work, I am involved in the activities of Cambodia Diabetes Association (CDA) and promoting awareness of diabetes in Cambodia. And it is my pleasure to share about my experience with diabetes.
I was diagnosed with type 1 diabetes while I was in university about five years ago. It started after I came back home from travels to the beach. I felt so exhausted and urinated quite often during that time.
I could not go to work or study for almost one month. During that period, I had been to the hospital for a medical checkup and ended up spending one week there. After checking my condition for that week, the doctor told me I had diabetes. It was such a shocking moment for me and my family as well. We could not believe that people as young as me could have diabetes! After we got educated and consultation from the doctor, we realized that it was type 1 diabetes. Then I still didn't believe that and I went to another hospital in Vietnam, but the result was still the same. From that time, I started injecting insulin with syringes twice or three times per day.
In the early years of my diabetes, it was a bit hard for me as my family tried to help, but we were not familiar yet with diabetes. Basically, everything changed. My family threw out all the sweet things in the kitchen and refrigerator. They treated me as "special condition person" and wouldn't allow me to do things they thought could harm my body.
And I was so scared to tell people around me that I have diabetes due to discrimination. I hadn't announced my diabetes to anyone except few of my close friends and my boss until after I attended the International Diabetes Federation's Young Leaders in Diabetes (YLD) training at the 2014 World Diabetes Congress in Melbourne.
Thanks to my boss and his family for treating me well, knowing about my condition! After Melbourne, I now dare to declare that I have diabetes with support from my friends with diabetes from around the world. The YLD training was different from what I expected, with everyone is so supportive to me and treating me well, while sometimes setting off an alarm to me on what I should and should not eat and do as well.
I've learned that for people with diabetes, it's important to have a good daily routine. I take two types of insulin: Insulatard (basal insulin), and Novo Rapid. I take 40 units of Insulatard in the morning plus 10 units of Novo Rapid and another 8 units of Insulatard plus 10 units of Novo Rapid in the evening. I test my blood glucose twice per day before taking insulin. An insulin pump is so expensive and we have no access to it, so I use both syringes and an insulin pen for the Novo Rapid to take my doses.
I add more Novo Rapid during the day if I eat something more than usual. For exercise, I just take a walk surrounding my block around 30 minutes after work, but it is not quite often enough. And for my medical check-ups, I visit my doctor every two or three months based on my available time and every four months to check my HBA1C.
It is very important for people with diabetes to check their A1C regularly; my last test result was 7.1 and my goal is to get it below 7.0.
As our public healthcare system is still limited, diabetes care is nothing special in Cambodia. Our healthcare service is very poor. We don't have any proper process for someone who wants to have a medical check and it takes a long time to see the doctor. Expense on medical supplies is another concern for the patients since the public hospital provides only free service charge on basic consultation. As for diabetes, we must go to see the doctor once every one or two months for a medical check. The diabetes patients need to pay all their own expenses, also for insulin or an A1c test, so we're often limited in our treatment based on what we can afford.
The same thing is true for glucose meters and test strips, based on how much you can afford for all these things. It is very difficult to find insulin pumps or continuous glucose monitoring systems in Cambodia due to the high cost. I am really not sure how many people use them in Cambodia since I have not found any of them yet.
It's not a problem for me to find the insulin as I live in the city but I am not quite sure for those living in the countryside or province. I can buy the insulin from the pharmacy used by my doctor and stock it in the refrigerator until my next visit to the doctor.
However, I sometimes struggle with my budget spending on these things, as one bottle of insulin costs about $13.00 USD with 50 test strips about $15.00 USD. With less support from the government for people with diabetes, I have to take on all these expenses for these medical supplies myself. Therefore, I need to reserve about 30% of my salary for my medical supply monthly.
Clearly, the biggest challenge of people with diabetes in Cambodia is the high expense of medical supplies. Most people consider diabetes to be a disease for rich people because they need to spend a lot for monthly monitoring. This is really true for me since I spend the majority of my income on that as well! This is want we really want to change so that everyone with diabetes can save their lives better even if they live in rural areas.
Thanks to IDF and Young Leaders Programme training for making me brave enough to declare to the world that I have diabetes, and become an advocate for change. Actually it was not as much of a problem as I supposed regarding diabetes discrimination in my neighborhood.
Fortunately, I found that I receive lots of support from people surrounding me, as they motivate me to be happy and continue to practice good health habits. Even at the workplace, everyone understands my condition and they assign only whatever tasks will not affect my diabetes in any negative way.
With all these experiences, I just hope that all people living with diabetes won't feel pressure, as it just requires us to pay additonal attention to our health; and then we still can do whatever we want to do. In the future, I also believe that people with diabetes in Cambodia will receive more support from the government in providing us the best possible healthcare support with better educated training.
For me, life with diabetes has definitely changed since I was selected as a representative for Cambodia in the Young Leaders in Diabetes in 2013. I started to become more active about diabetes with other YLD participants from around world, organizing activities related to promoting the awareness of diabetes in my country. And it does not stop here; I will do as much as possible to tell the whole world about what diabetes is and what people with diabetes really need and want.
Wow, thank you Piseth. We sure hope that more can be done to make diabetes care more affordable for you and your fellow Cambodians.