It is true that one cannot place a price on good health. However, all too often one must pay a price to receive health care and their level of care and disease management is dependent on the amount of that fee.

In January of 2008, I traveled to Belize, Central America for a nursing internship. During my time there, I interacted with many of the Belizeans. The nursing students were asked to design a presentation on diabetes that we would eventually present before we returned home. While preparing for the presentation, my fellow nursing students and I encountered difficulty in deciding the best way to present to the Belizean people, since it needed to be in a very simplistic format.

Initially, my attention was drawn to the dire need that these people have for education and assistance with diabetes mellitus self-care. This prompted me to initiate a research study for my next trip in May and June of 2009 that would reveal information about a person’s ability to care for oneself and their condition, and would also examine areas such as yearly income, family support systems, present knowledge about the prescribed diabetic diet, exercise, and medication regimen. I interviewed 41 Belizean diabetics, and found some vast differences in the ways they managed the disease when compared with the United States’ methods. It is truly amazing how the people of Belize use the little resources they have to manage such a difficult health condition.

Chronic diseases such as diabetes mellitus are on the rise. According to King et. al. (2007), it is estimated that the world’s diabetic population will rise from 135 million in 1995 to 300 million in 2025. Diabetes mellitus is also a chronic disease that can lead to complications over time, including coronary artery disease, cerebrovascular disease, retinopathy, nephropathy, and neuropathy. These complications can be prevented or minimized with adequate care. According to the World Health Organization (2003), in the country of Belize, diabetes mellitus is among the ten leading causes of mortality. Fifteen percent (15%) of the Belizean population between 15 and 64 years of age has at least one chronic disease related to diabetes mellitus. The foundation of management of diabetes mellitus and the prevention of complications include adequate diet, exercise, and medication. A person’s knowledge of this foundation of management may depend on particular aspects of their life, such as but not limited to their available resources, economic status, and educational level. According to a poverty assessment report of Belize conducted in the year 2002, 25.3% of households and 33.0% of individuals were noted as poor and these statistics were based on their expenditure on food and other items required for survival. This poverty rate and the lack of resources for survival further impact the prevalence of chronic diseases and complications of diseases, such as diabetes mellitus. Thus, this population is in great need of assistance and health education.

A lack of resources, particularly money and social support, can greatly impact how a person with diabetes mellitus can care for him or herself. The people of Belize live with very little resources. When they become ill, they are asked to live differently, in a more expensive way. As noted by a health care provider in Belize, it is not feasible for them to manage their disease the way they are asked. In the country of Belize, many diabetics are aware of the foods they should be eating, but simply cannot afford what they need. They are aware of the medication that should be taken, but are unable to obtain the medication. Most of these people rely on government and social support assistance to obtain food and medication, which in many cases is lacking.

A research study was initiated in Belize in late May and early June of 2009. Data collection took place during this time period. Several themes were noted and some of these are described as follows. In the United States, it is common for someone to spend at least $100.00 or more per week on groceries alone. However, in the diabetic population of Belize, a person typically receives a pension of $100 per month and this amount needs to be used for all of their expenses. They tend to purchase medication and related necessities first; thus, purchasing food is becomes the last item on their list.

It is also common for a diabetic who lives in Belize to choose between treatment options. Because of the lack of finances and resources, one can either purchase food or medications, but not both. Additionally, many diabetics in Belize are affected by other diseases, such as high cholesterol. In Belize, the cost of medication to lower cholesterol is approximately $100 per month and this medication cost is not covered by government funding. In this situation, the person is forced to choose between antihyperlipemic medication and other medical necessities, such as diabetic medications. One Belizean diabetic stated, “I am on disability because of all my health problems related to diabetes. I only make $40 per month from disability, so I have to choose whether I should buy the food I need or the medication I need for the month.”

Many diabetics in Belize do not measure their own blood glucose levels because they cannot afford they own glucometers. The strips needed for these glucometers are also very expensive. As an alternative to self-monitoring blood glucose, these diabetics visit clinics monthly to have their blood glucose levels checked. This inevitably means that these people have less control over possibly fluctuating blood glucose levels, placing him or her at a higher risk for complication of the disease.

For the diabetic Belizean, the ability to take care of oneself is not diminished by a lack of will. Rather, the lack of financial and social support impacts the risks associated with the disease. One Belizean notes, “I know how to take care of myself. The government doesn’t enable me to do it, though. Without that support, and if you don’t have family to support you, you are completely on your own.”

Prevention of the complications of diabetes mellitus is critical. Without proper management of this chronic disease, the person is placed at a much higher risk for complications. One overlooked issue is that in order for complications to be prevented, money and other sources of support are needed. Because of a lack of resources and support, diabetics in Belize cannot care for themselves in the most basic ways known to the United States. The most disturbing part about developing complications is that they are preventable with the proper treatment. In the United States, most individuals have options available and the resources needed. In Belize, they typically do not.

At the present time, enabling these people to care for themselves in the best way possible with the resources that they have is the most feasible and immediate way to more effectively manage diabetes care in Belize. For the future, further study and work needs to be done in the country of Belize to improve resource allocation, to prevent this life-threatening disease, and to help those who have diabetes mellitus so that they will not develop complications of the disease.

References

Haung, M.C. & Hung, C.H. (2007). Quality of life and its predictors for middle-aged and elderly
patients with type 2 diabetes mellitus. Journal of Nursing Research, 15(3), 193-200.

World Health Organization. (2003). Health Situation Analysis and Trends Summary. Retrieved
June 28, 2009, from http://www.paho.org/english/DD/AIS/cp_084.html