Economics of Managing Diabetes in Bolivia

Diabetes remains one of the major health care issues facing the US health care system affecting almost 8% of Americans and that number continues to increase as obesity increases. Two types of diabetes exist: Type 1 diabetes occurs primarily in children and young adults when the body's immune system destroys the pancreatic beta cells that produce insulin; this is about 5-10% of all diabetes cases; the rest are Type II that starts off with an inability of the body to utilize the insulin produced. Type I diabetes is caused by damage to the immune system although it is still unclear how and Type II is often associated with family history, older age, obesity, physical inactivity and impaired glucose metabolism. Although less prevalent, Type I tends to be more serious since it onsets at a young age and requires injections of insulin for life.

Right before New Year's, I flew down to Bolivia to begin work at a Diabetes education youth camp. I partnered with a US based organization, AYUDA, out of DC. I found them while reviewing the globalgiving.com site focused on international NGOs to which you could donate money. I noticed that AYUDA had a program starting in Bolivia in January and so I decided to send Kendra, the Director of Volunteers Programs, an e-mail to see if I could join them then. After a simple email and a quick phone call, and without asking for references, money, or my resume, Kendra invited me down. I just needed to get a flight there from Nicaragua and she would take care of my accommodations. I asked her much later why she invited me down to work with children on such blind faith, and she said that she just received a good vibe from our conversation. Good enough for me. I wish all my interviews could go that well. In the end though, I did take the time and recruited some funding from Medtronic to support the camp.

So, why Bolivia? The prevalence of Type I diabetes is not necessarily higher in Bolivia, but due to lack of funding, education, and supplies, Type I diabetes can be so costly as to result in death for many children. Ayuda focuses on Latin America and has partnered with the local NGOs Nino Feliz and Fundacion Vida Plena to host 2 youth camps in Bolivia. They have previously hosted camps in Ecuador for the past 8 years, and are starting a camp in the Dominican Republic later this year.

The camp with which I will work begins on Thursday and in the meantime, I have been working on community outreach efforts. To better understand diabetes in Bolivia and how it affects children and families, I went on 3 home visits one day. The three families were very different. I first met Naomi who was the oldest and most mature 8 yr old I have ever met. She took good care of her condition and the whole family changed their diet to accommodate her change in diet. At times during the visit, I felt like the parents just wanted an opportunity to voice out their frustrations with the school that doesn't understand or support her condition, the cost of supplies, and the lack of information and a support group for families. The family overall seemed well-informed and was interested in the Medtronic insulin pump that one of the volunteers used. Bolivia still does not have access to insulin pumps, but does use glucose monitors. This family received their glucose monitor from the NGO for free although they still have to pay $70 for each vial of rapid insulin Lispro.

The next family included 9 yr old Fabiana whose family seemed very well off based partly on their 4 well dressed toy dogs. Also, their bathroom was more elegant than any room in my house could ever be. Due to their economic status, they do not receive donations from the local NGO. Instead, her aunt who is also diabetic sends over her insulin from Spain. But the mom still has to pay almost a $1 for each blood sugar test strip. Her mom seemed most concerned with her daughter's inability to realize that she is low on blood sugar. I saw them again today, and apparently Fabiana did not wake-up because her blood sugar level was 21, very low, and so the family had to force some honey, I think, into her cheek. She is okay now. We plan to really educate Fabiana on the importance of checking her blood sugar levels and understanding how to best manage her condition at the camp.

The third family included Moises a very tall 14 yr old boy. He has such a laid back attitude and we immediately hit it off. He even IM's me during the day now. He receives all his supplies free of charge from Nino Feliz. He is very well educated and has no issues playing soccer because he takes care of his blood sugar levels and makes sure to take himself out if he isn't feeling well. Without the donations of the local NGOs, I'm not sure how his family could afford to treat his condition.


The cost of managing diabetes is outrageously high since the government does not provide any support. On average, for a month's supply of diabetes products, 1 vial of Regular (R) insulin (cheapest type) costs $20, 2 vials of NPH (baseline) insulin costs $40, using urine strips to measure blood sugar (not ideal) costs $7 otherwise a family would pay $60 for glucose meter strips assuming people only check 2x a day when they should check more. In total at $67 for the month for just basic supplies, this is about 80% of an average monthly salary for one person in Cochabamba, Bolivia. Some tricks of the trade to check blood sugar if you have no other means include peeing outside to see if ants come because there is sugar, or pissing in the hot exhaust pipe of a car to see if you can smell burnt sugar. I guess people have to get creative to survive. One older Boliviano I met obtains his supplies through medical insurance, but not everyone has this. Still, he pays the $1 for each blood sugar test strip and therefore at least $60 each month.

To better understand the needs of the families I also helped organize a focus group today that I will write about later since it is 1:30am for me.