The silence of diabetes threatening the health of the African community

Abdirahman Obste, a Somali entrepreneur, never realized the intensity of diabetes in the African community until he became witness to it several years ago at his former downtown Chicago restaurant. Now owner of Simple Mobile on Broadway and Elmdale Street, he recalls the time a customer leapt over the counter to grab what he called an “inedible muffin.”

Abdirahman Obste at his mobile phone shop. (Photo by Makda Fessahaye)

The customer begged and pleaded for the muffin that was about to be thrown away. Obste refused as he did not want to endanger the man’s health. Little did he know, the man’s health was already in danger and, to his surprise, the man seized the muffin and ate it, only to sigh in relief.

“He told me that if he had not eaten it, he would have died,” Obste recalls. “That was my first experience with someone with diabetes. You don’t hear about it often because the community seems to be ashamed by it.”

Census failing unaccounted African communities

Diabetes, however, is nothing to be ashamed of as the Centers for Disease Control and Prevention estimates that 25.8 million people in America (8.3% of the total population) have diabetes. For non-Hispanic blacks, the rate is 12.6%, the highest among any racial and ethnic population in the United States. As for African immigrants and refugees, the CDC cluster African-Americans and African immigrants and refugees together in their data.

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This story is part of a unique collaboration with nine Chicago area ethnic news media exploring some of the health care options and risks for immigrants who live here. The stories were released in June 2011 by Extra (Hispanic), Reflejos (Hispanic),  Pinoy Newsmagazine (Filipino), Al Moustaqbal – Future newspaper (Arab), India Tribune, Korea Daily News, Draugas – The Lituanian World-wide Daily, Reklama (Russian) and the Urdu Times (Pakistani). Click here to access the other stories: Tobacco repackaged: Paan Parag and hookah and their unappreciated risks, Seeking closure after Chernobyl, Medical tourism lures Korean immigrants home, Lithuanian patients have a hard time letting go of the past, The silence of diabetes threatening the health of the African community, Promoting healthy eating from the ground up in Little Village’s Hispanic community, Community programs needed to fight obesity among Latinos, Filipino elders find “family” in caretakers, A look into the complexities of refugee and immigrant health care coverage, and Is the South Asian vegetarian diet bad for the immigrant heart?

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“There is no data to tell you the truth,” emphasizes Dr. Alvine Laure Siaka of African Health Action Corporation in Minneapolis, a community based organization that provides low cost or free health services to many African immigrants and refugees. Now one of few organizations in the U.S. specifically researching barriers to health care for diabetics within the African immigrant and refugee population, the AHA works extensively with these hard-to-reach populations.

When it’s time for policy to be made and eventually implemented, policymakers will have a difficult time to appropriately address the unique problem of diabetes in these African communities. However, such policies changes will  have to tackle the day -to-day issues that many already face.

Health pamphlets offered at the Pan African Association come in most common African languages, including French and Wolof.

Claire Mukundente, health interpreter at the Chicago Uptown Clinic and the Pan African Association, recollects the account of an African immigrant who lost her eyesight due to a lack of treatment. A personal history muddled with no medical exams and little knowledge of healthy dietary alternatives left little chance for the woman to prevent her blindness.

The woman went completely blind shortly after her diabetes diagnosis at the Chicago Uptown Clinic. “It was too late to do anything after she came in,” Mukundente says.

Diabetics can develop a condition known as diabetic retinopathy, a disease affecting the blood vessels of the eye, which can lead to impaired vision and blindness. Common symptoms of diabetes also include excessive urination, increased thirst and appetite, unusual weight loss, fatigue, and irritability.

On average, individuals diagnosed with diabetes do not experience complications until 15 years after being diagnosed. Complications often never arise, with good treatment and regularized protocols. However, the resulting complications from diabetes include kidney disease, amputations, blindness, and heart disease.

It’s not only the African community that is often left uninformed of the scope of the problem. Dr. Siaka’s current research focuses on the speed with which diabetes complications arise among African diabetics. From her recent study, African immigrants and refugees are experiencing complications within 2-3 years of being diagnosed with diabetes. With no type of data supporting the susceptibility of diabetes in the African community, it is difficult to convince people that what they may see as a taboo, is in fact affecting many of those around them.

“It’s shocking and these numbers aren’t showing up anywhere on any census data,” Dr. Siaka says.

“The census is crucial to our contacting and affecting the African community,” Alie Kabba director of the United African Organization confirms.

Dr. Siaka’s findings and final report is scheduled to be released in June. She hopes that her research will not only advocate a change in census reporting, but also shift the focus on the particular needs of each community.

If census data fail to distinguish the difference between African-Americans and African immigrants and refugees, both communities and their unique needs will be overlooked.

“Culturally appropriate methods of health care need to be taken into consideration. Treatment isn’t the problem,” Dr. Siaka says. “It’s about how the treatment is presented.”

Lifestyle transitions prove detrimental to health

Currently, the United States Citizenship and Immigration Services provide a mandatory medical checkup for immigrants when they first enter the U.S. Maza Mangesha, a public health expert for 19 years at the Chicago Uptown Clinic, has seen many of these African refugees and immigrants come through the clinic’s doors for these mandatory checkups.

At the Pan African Association pictorial health guides offer advice to African immigrants and refugees transitioning from different eating habits and lifestyles. (Photo by Jeremy Intal)

“Most people didn’t have diabetes before they came for their checkup so something must be happening when they come to live here,” Mangesha says,  “but I’m not 100% sure what it is.”

Diabetes is often triggered by various risk factors such as obesity, family history, diets high in sugar and oil, and low physical activity. To Mangesha, cultural adjustment appears to be the main problem for African immigrants and refugees.

“People used to work in the farm or travel far to get food and other goods, but now most of them live a sedentary lifestyle, especially the older ones,” she says. “Most people just don’t move as much as they did before they came here.”

The rate of diabetes complications has left the African community perplexed and sometimes ashamed, but not helpless.  Organizations, such as the Pan African Association in the Edgewater neighborhood, offer free private health checkups and workshops for the surrounding community.

Elsa Woldegarima, health promoter at PAA, makes several house visits to clients to ensure that healthy choices are made while grocery shopping. Often served in large portions, traditional dishes are filled with unhealthy ingredients such as palm oil. She concedes that some traditional African foods such as fufu, a West African staple, or wot, Ethiopia’s national dish, provide a sense of attachment to people’s respective culture.

The shelves at this African specialty shop are lined with palm oil, a common unhealthy ingredient in traditional African dishes. (Photo by Jeremy Intal)

“But you cannot just rip someone away from what they know best, so we have to teach them to modify their dishes,” says Woldegarima.

A life without diabetes starts with prevention so community leaders like Dr. Erku Yimer, director of the Ethiopian Community Association, have focused their efforts to spread the word about living a healthy lifestyle through hosting workshops, providing pamphlets and organizing health fairs.

Diabetes is not a visibly noticeable disease like obesity and other health ailments so it presents a unique challenge for African immigrants and refugees in the U.S., a country known for its unhealthy diet. This allows for many to remain silent about their health issues.

The economics of diabetes

It’s no wonder why diabetes has attacked African immigrants and refugees at such high rates. As with many minorities, many African immigrants and refugees hold low paying jobs with prolonged work shifts. Little time is left to address their health concerns. Many African immigrants remain uninsured or under-insured, regardless of employment status.

Diabetes is not only a health issue. It’s an economic one, too. The CDC estimates that the cost of treating a patient with diabetes without complications is about $12,000 a year. With complications, the total goes up to $30,000 a year. For members of the African community who may often find themselves without insurance, treatment is not an option and neither is preventive care.

“Under-employment, not unemployment, is the problem,” Kabba says. Under-employment often means low paying jobs with no work-based insurance. Word-of-mouth can only go so far and the voice of a trusted, affordable doctor provided by a medical plan at work is irreplaceable.

Even without a doctor, common testers of blood sugar levels essential to determining food intake for diabetics are too expensive for individuals with low paying jobs. These testers are often covered by private or work-based health insurance.

Testers for blood sugar levels often range from $30 to $70. (Photo by Jeremy Intal)

Low cost health clinics do what they can to serve as the community’s band-aid solution. Cost effective resources such as the Chicago Uptown Clinic and the Touhy Health Clinic offer much needed support. Both Kabba and Woldegarima identify the difficulties faced by the African community in terms of transportation and the backlog  in the Cook County Health and Hospitals System. For African immigrants and refugees living on the city’s north side, these smaller, more convenient health clinics with shorter waiting periods offer some relief. “There’s still a wait, but the wait is shorter,” says Woldegarima. Prevention and treatement of diabetes is not as bleak as it may seem.

Locations such as the Chicago Uptown Clinic offer an affordable option for the surrounding community, charging patients based on a percentage of one’s income. Health interpreters are readily available at the clinics too. Resources like these help reassure African immigrants that they are not alone in their fight against diabetes, but the solution is not simple.

Community organizations are continue to break the silence about diabetes and spread as much information into the community as possible. “It’s a struggle,” Kabba says. “But that means there’s a lot we can still do.”

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