International donors have made big progress against high-profile diseases like HIV, TB and malaria. But Cambodian doctors say non-communicable diseases like diabetes and high blood pressure are on the rise and going untreated.
The last thing I expected to hear when I came to Cambodia to ask people about everyday diseases that don’t make world headlines was “I wish I had AIDS.”
But I’ve heard it from several people with diabetes and high blood pressure. And I’ve spent some time talking to an anthropologist named Chean Min. He did a remarkable study a few years ago where he asked 60 Cambodians with HIV or diabetes how they dealt with their illnesses.
The HIV patients had an easier time of it. They had readily available free health services, and free drugs. They also knew more about their condition than people with diabetes did.
The HIV advocacy community has a lot to be proud of for drawing funds to the disease. But what about people with diabetes? Like HIV, drugs are often needed–for life. And like untreated HIV, untreated diabetes will eventually kill. Untreated hypertension causes strokes and heart attacks. And there are no rehab facilities in Cambodia.
The folks I spoke to were lucky –they were getting help from two NGOs, MoPoTsyo and the Cambodian Diabetes Association. There are very few places in Cambodia to go for free or low-cost services for diabetes and hypertension.
That they were receiving care means two things. One is that they went out and sought care–about 30 to 50 percent of Cambodians with diabetes don’t even know they have it. They chalk whatever symptoms they have (fatigue, thirst, frequent urination, foot ulcers and more) to general bad health. If they do come in for treatment, it’s often when their organs have already suffered significant and irreversible damage. Hypertension is known even in the West as a silent killer.
The people at the clinics have a second bit of luck. They happen to live near clinics run by the NGOs. Most Cambodians don’t.
According to the Institute for Health Metrics and Evaluation, hypertension is the number one risk factor for disability and death around the world, beating out other health issues such as smoking and obesity. As for diabetes, high blood sugar checks in sixth.
But where are the programs to deal with hypertension and diabetes? There’s not much assistance from big international donors. The money goes to the big three–HIV, tuberculosis and malaria. No one in the non-communicable disease advocacy community wants to see that funding cut. What they’d like is additional money come into primary care services to help people with the everyday non-infectious conditions that are taken for granted in the West, where effective treatment is readily available.
The folks at MoPoTsyo and the Cambodian Diabetes Association are hoping that a recent UN pronouncement and a recent series about the importance of non-communicable diseases in the British medical journal The Lancet will bring some attention to the burden of noncommunicable diseases.
And so would the folks I met in rural Cambodia who told me they’d rather have HIV, because then their diabetes or high blood pressure wouldn’t necessarily lead to early death.