My music. I love being able to listen to a song and remember certain parts of a trip.
I write to you with hopes that I can stir in you the concern I have with the public health concern of how widespread diabetes mellitus has become in Belize.
The National Struggle of Diabetes in Belize
A Letter of Concern
Dear Hon. Dean Barrow,
I write to you with hopes that I can stir in you the concern I have with the public health concern of how widespread diabetes mellitus has become in Belize.
The Public Health Problem
“My father was diagnosed with diabetes at the age of 32.
He was diagnosed with Type 2 diabetes to start with and in 2005, he underwent a bypass heart surgery and thereafter he was treated with insulin.
During the days of his heart bypass surgery his creatinine level was 3.5, above the normal range. Eventually around 2008 my father's blood sugar started falling down. The physician advised us to get his kidney function test and liver function test done.
Following the tests his reports revealed his creatinine level as six, hence he was diagnosed with CKD (Chronic Kidney Failure).
My mother started all the possible treatments one could think of. She consulted all the ayurvedic doctors, homeopathic doctors, acupunture and acupressure doctors. But after all these treatments his creatinine level just increased.
My dad's vision started to be affected and we had to rush him to a retina and glaucoma doctor. My father then was diagnosed with acute bleeding in his eye, cataract and diabetic retinopathy and glaucoma.
Things were getting worse and worse and there was no going back. The retina doctor said if we didn't get his left eye operated, it will shrink the eye. Unfortunately the surgery wasn't successful, as according to the retina surgeon his blood was too thin.
They couldn't put a lens, however they did remove the cataract. A little bit of vision that was left in his left eye was lost as well with the surgery and he was left in complete agony with the increased eye pressure which was 60mmHG and the normal range is 10-21mmHG, hence causing severe headaches.
His eyeball has been completely ruined and now somewhat grey in colour. The glaucoma and retina consultants have told us that he would never get his vision back in his left eye as his optic nerves are severely damaged.
My father is now on Haemodialysis three times a week and will need a kidney transplant soon. To see your near and dear ones suffer so much is heartbreaking.
Behind all his sufferings lies the one disease that is diabetes (a curse) which is a silent killer.”
This is a real account of a young woman named Ritu describing the suffering her father went through after being diagnosed with diabetes. This is just one story of one person with this disease, meanwhile there are millions suffering from diabetes every single day. Many Belizeans are well acquainted with diabetes. It was reported in 2009 in the study, Survey of Diabetes, Hypertension and Chronic Disease Risk Factors: Summary of Major Findings – Belize, 13.1% of the Belizean population over 20 has diabetes; with 17.6% of the women population over 20 years old having it. The remarkable thing is that these numbers include everyone over 20, but diabetes and hypertension prevalence increases with age. According to the World Health Organization, Belize ranks number 13 in the entire world for diabetes prevalence in their population. This disease is something that is not necessarily unique to Belize, but it is an issue that needs to be addressed in this country because it is a serious concern across the national Belizean population.
So why is this disease so prevalent in Belize? It is evident that diabetes rates are so high because little education, awareness, and preventative care are available to the Belizean public. The same study surveying diabetes in Belize found 77.5% of the Belizean population had less than 60 minutes of physical activity per week and that 33.2% of the study participants were found to suffer from obesity. This is astonishing when one considers that, according to the Center for Disease Control and Prevention (CDC), the current physical activity guideline for adults is 150 minutes of moderate intensity activity a week. The majority of Belize is over 90 minutes below the required amount of activity a week to help decrease the likelihood of developing diabetes.
In addition to the lack of exercise, the diet of a typical Belizean is not conducive to living a long disease-free life. In the article titled “Health Implications of Food Patterns in Belize”, researchers found that 77% of the sample they used had consumed rice that day and the combination of rice and beans appeared in some form in 68% of the recalls. This sample also found that, concerning breakfast, commercial dry cereals were more commonly consumed than hot meals. Eggs were common for breakfast, while chicken and beef were common items at lunch and dinner. The most common eaten meal at lunchtime was found to be rice and beans and soda. At dinner, the most common meal pattern included tortillas and fruit juice. The most commonly consumed items for snacks were sodas and chips. Fruits such as apples, oranges, watermelon and bananas might be consumed as snacks, but it was found that chips, candies and cakes were almost an equivalent choice. The most common beverage choices were soda and punch, both very sugar filled. It is simple to see the lack vegetables and the over-consumption of fats, sugars, and simple carbohydrates in a typical Belizean diet. These types of food promote the development of diabetes.
The reason diabetes is so widespread in Belize clearly has to do with the lack of exercise and poor eating habits in the Belizean population, but the question remains: Why and what can be done about this epidemic? The largest reason why Belizeans consume what they do is related to how their food is a direct reflection of their culture. When thinking of any culture, many instantly think about how their customs transcend into their cuisine. Since gaining independence in 1981 from the British, Belize has developed a sense of identity through food and thereby has unintentionally developed a pronounced cuisine unique to Belize, influenced by Caribbean flavors and foods. The food Belizeans eat, although not the most healthy, is apart of their culture and asking the population to change what they eat is not only trying to change people’s daily habits, but also their ethnic identity.
Exercise is not a priority in the country for a multitude of reasons as well. As I read in many travel guides and witnessed firsthand, females that are overweight are preferred by the local men. When having excess body fat is seen as attractive and society is giving the message to Belizean females that this image is favored, they are more likely to put less emphasis on exercise. We see the effect of this with females having the highest obesity and diabetes rates in the country.
Furthermore, healthy foods like raw vegetables and natural fruit juices are not as prevalent in the typical Belizean household for a number of reasons besides their culture. Although fruits are fairly common, raw vegetables that are much lower in sugars are less available in the markets. Some vegetables are integrated into mixed and cooked dishes but raw vegetables are less common. This is likely related to a combination of cost, traditional meal patterns, and preparation time. People of Belize have easy access to inexpensive and canned foods that are easy to prepare, such as rice and refried beans, that spending time to prepare foods cooked with more expensive raw vegetables is very unappealing. It is clear that in order to convince Belizeans to eat better and live better, more than just telling them to do so needs to be done.
Understanding the Enemy
Diabetes mellitus is a disease that comes in two forms, type 1 and type 2. Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. This form of the disease is often inherited and therefore can rarely be prevented. Type 2 diabetes, formerly called adult-onset diabetes or non-insulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age—even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. The risk factors that increase the likelihood of being diagnosed with this disease range, many of which are very prevalent in the general Belizean population.
The factors that are known to increase a person’s chances of developing this disease, proven via scientific measures, include: genetics, diet, obesity, virus infections, age, emotional stress and smoking. When diabetes is known to run in the family for many generations then heredity plays a major role in the development of diabetes, especially type I. People who belong to a family background having history of diabetes are roughly 25% more prone to developing the disease. Furthermore, age is the commonest predisposing factor for diabetes. It has been observed that as one grows older, particularly above 45 years of age, the chances to develop diabetes are increased. There is little that can be done about these factors, but with consideration of the other factors, preventative care is still very feasible through education of healthy choices and promotion of living fit. (Little, 1991,14)
Obesity and diet are major factors responsible for causing type II diabetes and controlling type I diabetes. Consuming too much of simple carbohydrates, fats, and proteins are all harmful to the body. Consistently consuming too much food hampers the pancreas from performing its function of insulin secretion. Hence, with insufficient insulin secretion, the blood sugar level consistently rises, leading to diabetes mellitus. Obesity is another major factor causing diabetes mellitus. Excessive body weight as compared to the height of an individual, serves as a predisposing factor for diabetes mellitus as well. Due to an extra amount of fat in the body, insulin does not function properly in the body. Increased fat in the body also causes muscle and tissue cells to become resistant to insulin, leading to high blood sugar levels (hyperglycemia) and finally diabetes.
Diabetes is so widespread, especially in Belize, because people are making poor lifestyle choices and lack the knowledge of the long-term health implications their food choices have. Visiting the country myself very often, I witnessed this first hand. Through the organization ProWorld Service Corps, I was able to contribute to a health campaign where other undergraduate students and I traveled to different parts of the country for a week setting up clinics. The clinics were specific to testing for blood glucose levels, taking blood pressure and recording the height and weight of every individual that came to our set ups. Another component of our mission was to educate the local people about how to prevent diabetes. We taught children and adults alike what it meant to eat healthy. The response we received was astounding. I personally did not expect to meet adults who did not know what it meant to eat certain foods in moderation or not have any real idea about what a healthy meal consisted of. The children seemed to be able to recite facts like too much sugar can result in excessive weight gain and the importance of brushing one’s teeth, but these same children where the ones I saw spending every dime they had on sweets at the local convenience store.
When I stayed with a Belizean family in San Ignacio, Cayo, I got to witness how a typical Belizean dines for twelve days. There was never a lack of rice and every meal was accompanied by water mixed with an excess of sugar and artificial flavor. Tortilla was a part of every breakfast and only a minimum amount of vegetables were a part of each meal, and far from taking up half of the plate that is often recommended by nutritionists. I also witnessed all over the country that obesity was more prevalent in females compared to men and children. Never did I witness anyone exercising past doing work on their farms and the children playing outside.
Plan of Attack – Prevention
Prevention on a national level is about health promotion and education about the things a person needs to do to avoid falling victim to this disease. Preventing diabetes mellitus is primarily about promoting fit lifestyles and understanding the behavioral factors as to what is preventing Belizeans to live a healthier life. Prevention on the level of a single individual is about decreasing the intake of sugars and increasing the amount of exercise Belizeans do on a daily basis. The first, and fairly obvious, place to infiltrate health education is in the Belizean school system.
Although the Belizean education system is comprised of a partnership between the state and the church, there really should not be an objection to helping students live better lives and preventing an incurable disease. What to teach our youth is often debated, and the usefulness of certain subjects and curricula is often scrutinized, as should be. However, it is hard to not realize the importance of teaching the youth consistently throughout their school careers about living well. Topics such as what a well-balanced diet consists of and how much exercise a person should commit to everyday need to be common knowledge of all students. If students were taught the importance of living well, the social beliefs that carrying excess weight is ideal and eating well is not worth the extra few dollars would wither away. Students would grow up learning that it is cheaper to eat healthy and exercise now than spend hundreds and sometimes thousands on medical expenses related to neglecting these habits later. The youth are the future and teaching them the importance of preventative care is the most effective way of long lasting results of decreasing diabetes mellitus in Belize.
The other approach to preventing the growth of diabetes in Belize is to launch a national campaign educating and influencing adults to par take in better health choices. I am aware that some strides have been made to address this issue, as I witnessed little messages on Belizean diet coke bottles saying, “For your wellbeing walk 30 min. daily and keep smiling.” Something like this but more public and in a larger manner would help in raising awareness of preventative care of diabetes. Bringing in expert PR representatives who can design and help orchestrate such a project would be a step in reaching and teaching the masses. Components of this campaign would include billboards influencing adults to exercise more, urging vendors to make vegetables more available at local markets, and providing brochures on healthy living and eating at popular locations. Additionally, focusing on portion control versus changing their entire diet would help Belizeans maintain their cultural cuisine and be more prone to eat better. Another strategy would be to have these publicizing plans all have the same theme, such as having the same colours and/or characters presenting the messages, in order to have a broader effect. An example of this is the colour red for AIDS awareness. Whenever anything is related to AIDS, the colour red is present. Having that memory tag allows people to think about the issue more so and allows the message to be absorbed more effectively.
A success story where preventative measures were triumphant in decreasing the numbers of a disease that does not have a vaccine is the story of Senegal and its struggle against AIDS. Africa is known to have one of the highest AIDS cases in the world. In West Africa specifically the infection rates range from 3% to 10% of the population. The country of Senegal, however, is an exception to this pattern in West Africa, having the rate of HIV infection remaining between 1% and 1.6%. The article “From Government Policy to Community-Based Communication Strategies in Africa: Lessons from Senegal and Uganda,” from the Journal of Health Communications, explores this Senegalese exception. The article reports that “Senegal is the only country in the region to have a legislation regulating commercial sex, as a part of the control of STDs,” and that, “It can be affirmed without a doubt that the major factor that triggered the fight against AIDS in Senegal was the [government’s] absence of denial.” (115) The beginning of the fight against AIDS in Senegal began with the mass media becoming involved, followed by nonprofit organizations and community associations joining into the effort. These efforts were reinforced by the testimonials on television of two people living with HIV. Furthermore, many parliamentarians each took a course concerning the issues surrounding AIDS and the head of government has spoken out and acted in support of the fight against AIDS/HIV. Many of these efforts are inexpensive and focus on providing a united front by the government against this public health issue.
Belize is more than capable of doing what this African country has done so well: protect their citizens from a disease that leaves its victims in extreme suffering and often dead. Senegal has made this effort against AIDS, a disease that affects less than 2% of their population, so it is only understandable that something be done by a country who has a disease affecting more than 13% of their population. The launching of a nationwide campaign informing citizens about diabetes and infusing the education system with a multitude of health related topics are key in prevention. The key to effectively reaching the people of Belize is by the Belizean government. Who better to give the message of how to live healthy in Belize then the people Belizeans have elected to represent them? Foreign assistance from many different international agencies and governments, including the United States Peace Corps and the Canadian government, have all made attempts at changing the current nutrition and health status in Belize. Although aid from strong and powerful groups across the globe can help to make a step in the right direction, it is time the Belizean Ministry of Health and Education stop playing a supportive role in this fight and step up to be the forefront fighters in this battle.
This united front of the Belizean government would make a dramatic decrease in the prevalence of diabetes more than possible. Preventing the development of diabetes is fundamental in saving lives, improving the quality of life, and, in the long run, saving money.
Importance of Diabetes Prevention
The most important aspect of preventing diabetes is avoiding unnecessary pain and suffering of the Belizean people. A democracy has the obligation of providing the people what they want and the population of Belize wants to live long healthy lives. Prevention of diabetes is about promoting exercising, eating better and living the way the human body is intended to live. The numbers of diabetics in the current population would decrease but also future populations would be better off. When diabetes is known to run in the family, a person is 25% more likely to be genetically predisposed to the disease. Healthy populations are stronger populations that continue to grow and pass on the pride one should have to be Belizean.
Diabetes has taken too many Belizean lives, considering how many cases could have been prevented through better health choices. Helping to prevent the disease through education and public campaigns would work to allow citizens to dramatically decrease their likelihood of being diagnosed diabetic. Furthermore, helping to diagnose Belizeans through inexpensive or free testing would work to help citizens realize they have the disease and begin working towards helping themselves. Early diagnosis is key to surviving the disease and fighting off painful complications. Educating locals on treatments would be the final step of working to eliminate diabetes from Belize. Infusing natural remedies into the treatment plans of Belizean diabetics would help in making diabetic management more successful in the country as well.
It is clear education is the fundamental pillar in this entire battle against diabetes. Educating the people on how to prevent this disease, how to live with the disease and learning if they have the disease are key to making a real difference in this public health issue. It is my personal hope that the government, and people with the power to make national change, have learned what it takes to fight this battle and why it is important we do so with the utmost urgency.
Yours truly and sincerely,
Prabjot Kaur Batth