For those living with the condition, care is a complicated matrix of lifelong, regimented use of insulin, delivery devices, and blood glucose monitoring. Diabetes education and skilled health professionals are just as critical.

Reduced access to just one of those essential pillars of care – whether it’s the insulin, the delivery device, the monitoring equipment, education, or skilled care – can result in any number of potential complications. Nerve damage. Heart, kidney, and teeth problems. Blindness. Even death.

In low-resource settings, access to any of the above is more likely to be limited. With that in mind, it’s surprising that so much focus has been paid to insulin access, to the exclusion of other elements of diabetes care.

But a new study is changing that.

Published in the in World Journal of Diabetes by researchers at the Life for a Child (LFAC) Program at Diabetes NSW And ACT in Australia, the study looks at how likely people from low- and middle-income countries are to be able to access two essential elements of diabetes care: insulin delivery devices and a diagnostic blood test known as glycated hemoglobin (HbA1c) testing.

For the LFAC program, these aren’t just academic questions. For over 20 years, the program has been deeply involved in procuring and distributing type 1 diabetes medicines and supplies for children and adolescents.

Currently, LFAC supports 22,000 children and young children under the age of 26, in 43 countries and through 72 local health care partners, with insulin, syringes, blood glucose testing strips, and HbA1c testing and supplies.

Direct Relief has worked with LFAC for over 10 years, and currently arranges the transportation and delivery of the Program’s insulin, insulin syringes, and some blood glucose monitoring equipment to local healthcare partners. In 2019 alone, Direct Relief coordinated the delivery of 2 million insulin syringes and approximately 270,000 vials of insulin for the LFAC program.

When it comes to the study, findings were grim. Almost half of the public health systems surveyed did not provide any insulin syringes for people with type 1 diabetes – even though syringe usage was the most common method for administering insulin in more than 80% of the surveyed countries.

Many surveyed health centers could provide free or reduced-cost syringes for their patients – in large part due to private donations of supplies from LFAC and Direct Relief. However, the study also found that people who purchase these supplies from other sources, such as private retail pharmacies, can spend on average anywhere from $0.19 – $0.29 USD per syringe. That means the potential yearly cost could climb northwards of $400.00 for syringes alone – in countries where people often live on less than $3.20-$5.50 per day.

When it came to HbA1c testing, access wasn’t much better. The study found that, while more than 80% of centers did provide this testing for their patients, the costs could be prohibitive – an average of $9.34 per test at about a third of facilities. For those who sought testing from their country’s public health care system, costs could be even more significant – anywhere from $4 to $29 per test. In these settings, HbA1c testing is conducted 1 to 4 times per year – an annual cost of up to $116.

Even at those prices, access wasn’t a given – stockouts, maintenance, and limitations on staff training and refrigeration capacity were all reported to impact availability of the testing.

There are nearly half a billion people worldwide living with diabetes, according to the International Diabetes Federation. This figure is expected to increase dramatically – to almost 700 million people over the next 25 years. Almost 80% of these people live – and will most likely continue to live – in low- and middle-income countries, here the medicines and technologies needed to diagnose and manage diabetes are scarce, or prohibitively expensive.

As a result, people residing in these countries will bear a disproportionate burden of the estimated 4 million deaths or more that are attributable to diabetes each year. That makes this issue a major barrier to global health equity.

Approximately 90% of people with diabetes are thought to have type 2, which may be preventable, and can be managed effectively through early detection, education, social support, healthy lifestyle changes, and in some cases medication.

However, for those living with type 1 diabetes, including over a million children and adolescents, there is no evidence that the disease can be prevented. It can only be managed effectively, with continuous access to insulin, insulin delivery devices, and blood glucose testing, as well as education and social support.

Since 2011, the LFAC Program and Direct Relief have mobilized the delivery of nearly 7 million insulin syringes donated by BD for 10,000 children in 20 lower resourced countries.

The post When It’s Not Enough to Increase Access to Insulin appeared first on Direct Relief.

The medications were donated by Mylan and Ascend Laboratories, and the shipment was coordinated with Kurdistan Save the Children.

The infusion of medicine enables hospital staff to continue providing essential advanced cancer treatment services to patients.

In the semi-autonomous region of Iraqi Kurdistan, access to healthcare and medicine affordability remains a challenge for many.

The region is emerging from a tumultuous economic recession, which started in 2014.  Instability in the region was compounded in 2016 when conflicts in Iraq and Syria triggered a massive influx of internally displaced persons, or IDPs, and refugees into Iraqi Kurdistan. As of 2019, an estimated 2 million IDPs and refugees reside in Iraqi Kurdistan, further straining the region’s limited public resources.

In the public healthcare sector, budget cuts and increased patient load have led to a shortage of essential medicines needed to treat a wide array of health conditions. Patients already short on cash have had no other choice than to purchase their prescriptions from private pharmacies or healthcare providers; for many with chronic or life-threatening conditions, such as those with cancer, this untenable expense has driven many into poverty.

For the estimated 2,000 to 4,000 patients who are newly diagnosed with cancer in the region annually, approximately 3,000 are treated in Slemani at Hiwa Cancer Hospital. Many of those patients are documented IDPs and refugees in precarious financial situations.

Cancer in the Developing World

Cancer has become a leading cause of morbidity and mortality worldwide, with tens of millions diagnosed with the disease each year. That’s why reducing early death from the disease is one of the World Health Organization’s Sustainable Development Goals, which aims to reduce mortality from noncommunicable diseases including cancer by one-third by 2030.

While much of the disease burden is currently found in developed countries, 70 percent of all cancer deaths occur in low- and middle-income countries – signaling major equity gaps in cancer prevention, screening, diagnosis and treatment.

As populations continue to grow and age, and as data gathering in low-resource settings becomes more reliable, the majority of newly diagnosed cancer cases are expected to shift to countries with fewer resources.

And with health resources in these places already spread thin, it remains crucial to strengthen and assist local cancer care providers.

Targeting Treatment Across 35 Countries

Direct Relief has delivered approximately $106 million USD of oncology and adjunctive therapies to facilities providing cancer treatment across 35 countries since 2016. Direct Relief is also a member and implementing partner of the Union for International Cancer Control and its City Cancer Challenge Initiative, as well as the Global Coalition Against Cervical Cancer.

The post Donated Cancer Medication Bolsters Hospital in Iraqi Kurdistan appeared first on Direct Relief.

Diabetes ranks high among the world’s top non-communicable diseases adversely impacting the day-to-day health of nearly half a billion people and causing the premature death of millions annually. As is often the case with serious public health threats facing people around the world, it is those least equipped with resources, or access to resources, that shoulder most of the disease burden. And nearly 80 percent of all diabetics reside in low- and middle-income countries where the essential medicines and technologies needed to diagnose and effectively manage their disease are scarce or prohibitively expensive.

Throughout its 70-year history, Direct Relief has recognized this inequitable distribution of resources in the fight against the global burden of diseases, like diabetes, and remains committed to providing healthcare professionals in low-resource settings with the tools necessary to promote health. That’s why Direct Relief partnered with the Life for a Child Program in 2011. Since that time, approximately 10,000 children and young adults with Type 1 Diabetes across 21 countries received comprehensive and consistent access to high quality medical supplies, such as needles, syringes, blood glucose monitoring strips, lancets, and meters, generously donated by long-time corporate partners Becton, Dickinson and Company, as well as LifeScan, Inc.

Since July 2018, Direct Relief has been able to significantly scale up its longtime support of the Life for a Child program due to the construction of its new headquarters and distribution facility that now has the capacity to store large volumes of cold-chain medications, like insulin, in a compliant and temperature-controlled manner. The organization has now overseen the end-to-end supply chain for approximately 300,000 vials of insulin, as well as Hemoglobin A1c and Microalbumin testing cartridges, for the benefit of over 16,000 children with Type 1 diabetes across 30 countries. This support was made possible by key donations from Eli Lilly and Company.

Due to this expanded partnership, insulin has now been delivered – free of charge – into the hands of patients in hard to reach areas such as the Central African Republic, Democratic Republic of Congo, Eritrea, and Syria, where prolonged political and economic issues have made this life-saving medication virtually inaccessible for low-income patients. Direct Relief will continue its support annually well into the foreseeable future, supplying patients with consistent access to insulin, and other essential medical items to manage their diabetes.

For some groups, such as the Diabetes Palestine Association in Gaza, the delivery of insulin was especially critical.

According to Dr. Younis Abualnour, the Executive Director of Diabetes Palestine Association, prior to receiving their 4,500 vials, insulin had been absent from the Ministry of Health’s clinics for over six months. The shipment was delivered in coordination with the World Health Organization, and distribution commenced immediately, providing much-needed relief to the Association’s patients and families.

Since 2011, Direct Relief has delivered 146 shipments of essential diabetes medicines and supplies valued at $51.3 million to 46 healthcare providers in 35 countries under the Life for a Child program. Direct Relief remains committed to the mission of the program and will continue to provide these critical medical items to children and young adults born with Type 1 diabetes who would otherwise not have access to these supplies.

The post In More than 35 Countries, Insulin Reaches Children and Young Adults appeared first on Direct Relief.

Syria is no exception.

As the country’s 7-year conflict wages on and trauma-related injuries and deaths continue to mount, Syrians also are experiencing this epidemiological transition towards chronic disease.

One in 10 Syrians lives with diabetes, according to the World Health Organization, and diabetes now ranks among the top 10 causes of death and disability in the country.

Since the war began, many health centers specializing in diabetes treatment – and all insulin production centers – have been shut down, damaged or destroyed, creating acute shortages of this life-saving medication. Almost all insulin must now be imported, resulting in inflated prices and affordability issues for most diabetes patients, especially those who have been internally displaced.

To address insulin shortages in Syria, Direct Relief and the International Diabetes Federation’s Life for a Child program partnered with the Syrian American Medical Society to deliver approximately 15,500 vials insulin to more than 700 Syrians under the age of 26 with type 1 and 2 diabetes.

The delivery was made possible by a generous donation from Eli Lilly and comes as fighting throughout Syria has displaced thousands, many with co-morbid chronic diseases, into the northwestern directorates of Idleb and Hama.

For aid groups distributing insulin for free or at steeply reduced prices, logistical hurdles to importing and storing the medication must be overcome. These include keeping the medicine at a consistent temperature despite lengthy travel times and unreliable electricity.

Direct Relief ships temperature-sensitive medicines like insulin inside specialized packaging that maintains a constant temperature range between 35.6-46.4 degrees Fahrenheit for 120 hours. To ensure and verify that the cold-supply chain has been maintained throughout the transit process, temperature-data loggers are inserted into each package to record the internal temperature of the shipment every two minutes.

The latest shipment of insulin to Syria is part of a larger collaboration with the Life for a Child program, which aims to provide insulin, syringes, blood glucose monitoring equipment, test strips, HbA1c testing, and diabetes education to healthcare centers in 42 low and middle-income countries for the benefit of 18,000 children and young adults living with diabetes.

Since the start of the crisis in 2011, Direct Relief has delivered over 200 tons of medical aid valued at $100 million to approximately 30 healthcare organizations providing critical care to Syrians across eight countries – constituting one of the largest and longest-sustained emergency response efforts in Direct Relief’s 70-year history.

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