Diabetes in a humanitarian crisis: Atypical clinical presentations and challenges to clinical- and community-based management among Somalis in Ethiopia

ABSTRACT

This study was designed to better understand the clinical presentations and challenges of managing type-2 diabetes mellitus (T2DM) in a humanitarian crisis-affected population. Findings are based on a long-term ethnographic study of humanitarian response in eastern Ethiopia by the first author from 2008 to 2018, and in addition, a mixed-method case study of T2DM in July–August 2018. For the case study, the authors collected anthropometric, demographic, and biological data from 85 persons with T2DM diagnosis and 23 of their adult siblings. The team then conducted participant-observation and 28 ethnographic interviews with a purposive sample of patients, their siblings, and local health providers, policymakers, and aid workers. T2DM was characterised in this sample by progressive weight loss, weakness, lethargy, loss of teeth, and persistently high average blood glucose levels (HbA1c), at initial clinical presentation, and then in subsequent years, even while taking prescribed medications and/or insulin. Patients struggled to access medical care, refrigerate insulin, and follow dietary recommendations due to chronic food insecurity and long-term dependence on limited food aid rations. Local health providers who are trained and supplied mostly through humanitarian relief funding lack the education and resources to effectively help patients manage non-communicable chronic conditions.

KEYWORDS:

• Diabetes
• non-communicable diseases
• humanitarian assistance
• displacement
• pastoralists

Acknowledgements

We would like to thank the Somali Ethiopians with diabetes we spoke to, their loved ones, Bukhari Sheikh Aden at UNICEF in Jigjiga, Brook Tadesse in Dire Dawa, and Maxwell Hawla and Nichole Grossman in Washington, DC for their help supporting and carrying out this study. Finally we would also like to thank the Somali Regional Health Bureau, Jigjiga University, the Aysha woreda health office, and the administrators of Bilal Hospital in Ethiopia for their cooperation and support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Declaration of Interest Statement

The authors declare no conflicts of interest.

ORCID

Emily Mendenhall http://orcid.org/0000-0002-5826-1321

Additional information

Funding

This work was supported by internal faculty grants at American University and Georgetown University in the USA.