By Lauren Odderstol November 16, 2020 No matter where you live, we are all affected by disease. What you may not realize is how different diseases run rampant depending on the country where you live. The difference used to be stark depending on your country’s economic situation. People in lower-income countries tended to suffer from malnutrition and infectious diseases like tuberculosis while people in higher-income countries suffered from non-communicable (non-contagious) diseases, such as autoimmune, heart or other chronic diseases. Through globalization and other factors, disease spread has shifted so that many low and middle-income countries are dealing with a double burden of both communicable and non-communicable diseases. Add a global pandemic to the mix, and their situation becomes infinitely more complex. Diabetes is one non-communicable disease that is becoming more common in low and middle-income countries, including areas like refugee settlements. So, what causes diseases like diabetes to have a significant presence in places like refugee settlements? Type 1 diabetes is usually due to genetic defects and found mostly in children, leaving them without the ability to process sugar. If left undiagnosed, children are at risk of dying from Type 1, especially if there is a lack of available treatment. For Type 2 diabetes, traumatic experience, stress and diet are factors that can impact the body’s ability to process sugar in blood, particularly in adults. Both types are difficult to manage in a refugee context. What a person with diabetes living in a refugee settlement needs is support through health education and access to care. Medical Teams began serving refugees struggling with non-communicable diseases like diabetes in 2016. One of our main programs in Lebanon is training Syrian refugees to take care of their neighbors. We currently have over 120 Refugee Outreach Volunteers (ROVs) helping people with diseases like diabetes and hypertension. “It always breaks my heart to hear that some patients didn’t recognize their symptoms and have suffered for so long until they met the ROV who screened and referred them, and follows up,” said Samira Youssef, Medical Teams Lebanon Program Manager. Refugee settlements are far from health centers, hindering access to health care that is needed during diabetic emergencies. When trained volunteers are present in their community, people with diabetes have access to measure their blood glucose when they don’t feel well and access hospital referrals if the situation turns dire. Access to this type of care is the very thing that can help someone like Mazen, a young boy who was living with undiagnosed Type 1 diabetes in his refugee settlement. Mazen’s story Mazen with his father on their first visit to the hospital. Mazen’s father had to experience what every father fears. One day, his only son suddenly felt very ill and was not responding. Unsure of what to do, his father asked for help from his community Medical Teams Refugee Outreach Volunteer (ROV). The ROV quickly referred Mazen to a local pediatric hospital and took his blood glucose while they were waiting for their ride to arrive. His blood glucose measurement was very high, reaching 450 mg/dl on the first take. A random blood sugar reading over 200 mg/dl is enough to suggest a person may have diabetes. Mazen stayed three days in the hospital until his blood glucose level was back to normal. As soon as he got out of the hospital, he safely returned home, but his family was in a state of panic. How could his father care for his son? He could not afford insulin, diabetic strips or appropriate food – three things that would help maintain Mazen’s blood glucose at a normal level. In the days after returning home, their community ROV was doing regular home visits. He worked closely with Mazen’s father, educating him about the diet that his son must follow to help avoid another diabetic emergency. He told him that he did not have to worry – that Medical Teams will provide him with diabetic strips to measure and monitor Mazen’s blood glucose levels. Ten days after his time in the hospital, Mazen and his father have learned what to eat and what to avoid. He is back playing with his friends, and his father feels empowered – knowing how to respond to his child’s symptoms and who to call in case another emergency arises. Ten days after leaving the hospital, Mazen (red shirt, center) is feeling better and is healthy enough to play with his siblings and friends. “Managing diabetes in a child is difficult in the best of circumstances. I can’t imagine trying to do so without continuous access to medical care or medications,” said Bryna Bettis, Medical Teams Program Officer for Lebanon. Thankfully, children and other people with diabetes like Mazen don’t have to worry. They have access to the community health care, education and supplies needed to monitor their disease and live a healthier life. Co-written by Samira Youssef and Lauren Odderstol Find out more about how you can help children like Mazen here.