Diabetes shattering lives…as too many seek help too late

Sep 27, 2015 News

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By Desilon Daniels

“I would advise everybody to be more health conscious and to keep checking with a doctor because this is not an easy life. If this happens to you and you don’t try to overcome this, the grief alone would kill you.”

 
Each day, Ronald Greene prepares himself to swallow his pride because, from the moment he awakes, he needs help. From getting out of bed, to bathing, to dressing, and to getting around the house, Greene requires the help of someone else.
At the age of 42, having another person help you with even your most personal needs is not an easy thing. However, after losing a foot to diabetes in April, he admits that his options are limited.
I met Greene for our interview in his simple North Ruimveldt home on a quiet Sunday afternoon. When I arrived, he was sitting at the door in his wheelchair, watching people walk along the street. His missing left foot – with only a blackened stump as a reminder – was the first thing I noticed as I walked up the stairs.
Greene was more than willing to open up about his diabetes and right away he recounted how dizziness and blurred vision were the first signs that something was wrong.
“I just get up a morning to go to work and feel dizzy; I ain’t feel like myself. While working, I found myself seeing dark so I left, come home, lay down and found myself drinking a lot of water. I found myself getting hungry fast too. So, I end up at the hospital. They run some tests and say I got sugar, that I was diabetic,” Greene said. He explained that this diagnosis had come years ago and had not been a big surprise; his father had died from diabetes-related complications 30 years ago while his mother had died similarly 14 years ago.

Soon after his diagnosis, a deep-seated abscess grew on the back of his head. Though he was treated over time, Greene said that his previous symptoms persisted. He was unable to work at times and was hindered by a swollen left knee. He was eventually taken to the hospital in October 2014 and admitted. While he would have spent time in the hospital on previous occasions, these were usually short stints; this time, he spent 37 days.
“This whole one side,” he said, gesturing to his left, “End up getting weak.” He was eventually released but was so weakened that he could not even walk. Things worsened from there.
“I went back to the hospital and the foot was dark. They said that they could see what they could do but eventually the foot, like it start to suck me, and I start to pine away. I got so fine, I got so weak; I couldn’t even turn on the bed,” he recounted. He was told that while there was hope for his life, his foot would have to go.
“They told me that I would lose this foot and I had to mek up my mind because it wasn’t healing. They been treating it in the meantime but they told me I needed to come to a decision,” he said.
This decision, he explained, involved him either immediately removing his left foot or trying to save it. However, trying to save the foot could result in further spread and a larger area to amputate. He was given two weeks to make this life-changing decision.
“It was tears all the time; I did not want to lose my foot but the doctor spoke to me like his child, like I was his son. The nurses all spoke to me and my family too and they all told me that I would still have life,” he said. “It was hard to make that decision to lose my foot. At that time, I used to drive and thing and I was always moving. I was never in the house; I was always working. But, I had to make that decision to let my foot go.”

Not curable but treatable
“While diabetes is not a curable disease, it is certainly a treatable one,” says Dr. Kumar Sukhraj of the Georgetown Public Hospital’s Diabetic Foot Clinic. In fact, Sukhraj said, diabetes is a disease that is mostly preventable.
In Guyana, diabetes is the fourth leading cause of death and, according to the International Diabetes Federation, there were 61,800 cases of diabetes in Guyana in 2014. Diabetes is also a silent killer; it is estimated that more than 15,000 Guyanese are completely unaware that they suffer from the disease while more than 1,000 die from it each year.

Sukhraj explained that diabetes is a chronic condition in which one’s sugar or glucose levels are too high. Insulin, a hormone produced by the pancreas, is needed to regulate blood sugar levels. However, there are cases where the pancreas does not produce any insulin. This is Type I diabetes and usually occurs in children and young adults. With this type, diabetes is not preventable; even persons who employ healthy living strategies can develop Type I diabetes. In other cases, cells become resistant to the insulin produced, though the pancreas may be properly functioning. This is Type II diabetes and usually occurs in adults. With this type, diabetes is preventable; healthy eating, maintaining a healthy body weight, and exercise go a long way in preventing Type II diabetes.
Though Type I diabetes is not preventable, it is less common than Type II diabetes. Dr. Sukhraj therefore believes that diabetes figures in the country could be drastically cut if the right measures are put in place.
“Changing your lifestyle is key to avoiding diabetes or even when you already have it,” Sukhraj said. He noted that screening for diabetes is very easy, and takes only a minute. Without treatment, he added, the odds of dying from diabetes-related complications such as a heart attack, kidney failure, and infection are very high.
“From my experience, patients usually show up when complications begin to arise. There’s a problem with education…I hardly see people 40 years and above coming in for screening and they are in that at risk group. They might show up at an outreach and incidentally find out they have diabetes,” he said. He continued, “Generally, health is an aside to Guyanese people. The ideal thing is primary care, which entails prevention. Secondary care involves treatment while tertiary care is when we treat the complications.”
He added that about 60 percent of the persons diagnosed with diabetes return for follow up care but not all do. In fact, he said, some persons refuse to even acknowledge they have diabetes, even after they would have been diagnosed by a professional. Dr. Sukhraj emphasized that, even if the best facilities are available, they are pointless if the people do not access them.
“I just can’t imagine why people aren’t taking their health seriously; I just can’t. Generally, people are just lackadaisical. They take things for granted,” he said before continuing, “People also have a certain level of fear about their reality. I have patients who come and tell me not to tell them if their blood sugar is high but it’s important that people know so that they can manage it. I think it’s a cultural practice in Guyana; people don’t go to the doctor and they don’t see health as a priority issue. They’re just too caught up with life and do not realize there are other important things to consider.”

Ronald’s new approach
Greene  admitted that he had not given much thought to his health before he was diagnosed with diabetes. “I ain’t gon’ lie; at most I used to do some exercise by moving about; riding, walking, and stuff along those lines. But when it came to eating, I didn’t stifle myself or stifle ma conscience,” he said. “It was anything pass! So long as it was thing to eat, I eat but now I can’t go down that road.”
Even after he would have been warned years ago about his diabetes, Ronald shared that he did not take serious precautions. Instead, he led himself into a false sense of security since he had been healthy growing up.
“From the time I know myself, I never had no illness or nothing. Nothing ever really bother me to say I got to go in the hospital or them kind of things. I always growing agile, strong; the longest I ever spend in hospital is when I tek sick last year with the diabetes,” he said.
He added that he would go to see a doctor “every now and again” but only when he believed there was cause for concern. “I never really used to deh behind it like I am now. Now, if my head hut me too bad, I wan’ go the hospital.”
Though his trips to the doctor have considerably decreased in the months after losing his foot, Greene is still required to make regular visits. His medication also remains high, though not as high as it had been a few months ago.
“At that time I used to be using like 14 tablets a day: six in the morning, four at midday, and another four in the evening,” he shared. Now, his dosage is down to about five tablets a day.
Greene also had to make big shifts in his diet. He has cut down considerably on his salt and sugar intake and is constantly aware of what he puts into his body. Unable to cook, he depends on his sister to provide him with healthy meals.
This has been a drastic change from the way he lived his life, even up to a year ago. As a taxi driver, his meals had focused mainly on convenience rather than considerations for his health.
“I can’t even pick up food on the road like I used to. Now, I might have to buy an ‘Ital’ [Rastafarian food] or a vegetarian if I want to eat out. Before, I never used to eat Ital or anything like duh; I used to eat at all them cook shops,” he admitted with a chuckle. “I was chicken crazy back then so it’s hard to come off of it and bend your mind,” he added. However, Greene’s condition has one silver lining; his family has certainly become more health conscious after his amputation.

Complete dependency
However, Green’s adjustments go beyond fast food and medication; with the loss of an appendage, he also lost something important to him: his independence. This loss has been an amazingly difficult adjustment for him. In fact, he said, he still struggles to adjust.
He explained that after he would have had his surgery, it took him some time to regain strength in his body. He had become frail and weakened by the disease. “At first I couldn’t stand up ’cause the leg just couldn’t bear my weight. Finally now I can hop, hop a bit but I’m hopping and need help from people. But day by day I’m getting better,” he said.
He continued, “It’s hard ’cause every time I have to do something I got to call somebody to help me. You always got to have somebody around to help yuh and let me tell you, it does tell pon yuh.” He said he tries to remain positive but it is sometimes difficult to swallow his pride and ask for much needed help.
“I grow up very independent; I never liked asking people to do things for me so I always did things for myself. It’s hard now to condone with it and to be dependent on other people. Even to now it’s hard to depend on people,” he confessed. He admitted too that sometimes “teeth and tongue does bite”, but overall his family has been very supportive and willing to help.
Greene is on his way to regaining a bit of that independence through therapy sessions at the Ptolemy Reid Rehabilitation Centre on Carmichael Street. Through these sessions, Ronald is regaining strength in his legs and body and is learning how to use crutches.
Greene said that even before he gets to his therapy sessions, he receives a workout by trying to make it from his home to a vehicle. He, of course, requires the help of family and friends to complete such an everyday task.
Each week, for nearly two hours, Greene and his trainer work slowly on regaining his independence. This therapy will help Greene when the time comes for him to use a prosthetic foot, which can be heavy. He explained that the site of amputation will be ready for the prosthetic in a few months’ time.
Currently, his feelings on the prosthetic appendage are mixed; on one hand, he is excited to have at least a semblance of his life again. On the other, the cost of the prosthetic has been on his mind.
He explained that, since his amputation, he met persons who would have lost feet or entire legs to diabetes. From his interactions, he learnt that prosthetics can be expensive.
“So far, what I’m hearing from other people is that the prosthetic can be costly. I got only one of my pieces gone but there are people I know who got none and who using both false legs. One of the legs is about $300,000 they say.”
He continued, “I’ve got to prepare for that; it’s been almost a year and the time is getting closer for me to get my foot.” Nonetheless, he said, “When you go the clinic and you see the amount of people who lose a limb ’cause of diabetes, it’s really telling you something, especially when you see people with none. You still got to count yourself lucky.”
Greene also admitted that diabetes has been a financial drain on his family; unable to work – and unable to walk normally ever again – he is completely dependent on those who care for him. Each week, money is required for transportation to therapy, special meals and medication, as well as $25,000 for hired help.
“Diabetes is an expensive disease; it’s very strenuous. Sometimes I does sit down and think…” he says, his words trailing off. He pauses for a moment, struggling to contain tears. He finally speaks again, his words cracking.
I am sitting right beside him, but he is speaking so quietly now that I have to lean in to hear his next words.
“Sometimes I just sit down and think that I can’t do this. It’s just so hard,” he finally whispers.
We both pause for a moment, letting his words hang between us. Finally, I ask, “What advice would you want to give to anyone reading this?”
He does not even have to think about an answer; he takes a deep breath. His voice still quivers, but there is strength in his eyes. “I would advise everybody to be more health conscious and to keep checking with a doctor because this is not an easy life. If this happens to you and you don’t try to overcome this, the grief alone would kill you.”

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