Kong Yam’s sight is failing. Having worked all her life, the mother-of-six now struggles to complete everyday activities like making rice porridge for her grandson.
Kong Yam suffers from Type 2 diabetes, and she’s one of hundreds of thousands affected by Cambodia’s invisible epidemic. This neglected public health crisis is closely linked to the rapid changes in Cambodian society.
As GDP expands, so do waistlines, with people consuming more processed foods and sugary drinks.
A high-sugar diet, lack of physical exercise, smoking and alcohol have increased the risk of developing diabetes. According to a recent risk factor survey, the proportion of overweight or obese Cambodians increased from 15 to 22 percent from 2010 to 2016, while the number of people with raised blood sugar more than tripled to almost ten percent. Raised fasting blood sugar is a strong indicator of diabetes.
Kong Yam was diagnosed relatively early, but she’s in the minority. After feeling tired, hungry, and urinating more than usual, she went to her local health center in Kampong Thom province, until recently one of only 26 primary healthcare centers in the country trained to screen and treat diabetes.
For most people, diabetes goes undiagnosed until complications arise; only 1.5 percent of surveyed diabetics were on medication. Even for those diagnosed and on treatment, the cost of medicine is a huge burden. For her blood pressure and diabetes medicines, Kong Yam spends around 20 US dollars a month - over a third of her living costs.
Traditionally, infectious diseases, maternal and child health issues, and malnutrition have been at the center of health initiatives. Now the public health system needs to focus on new epidemics: Cardiovascular diseases, respiratory diseases, cancer, and diabetes.
In Kampong Thom, where Kong Yam lives, German development cooperation has been working with the Ministry of Health, alongside WHO and other partners, to make essential services for diseases such as diabetes more widely available at all levels of the health system.
This year, the German development organization GIZ and WHO have increased financial and technical support to more than double the number of health centers trained to screen and treat diabetes and hypertension.
And, a new collaboration between GIZ and the Ministry of Health focusing on secondary care will see improvements to the infrastructure of specialized diabetes clinics in the public health sector, in addition to a new project to improve access to care for children with Type 1 diabetes in children.
In a further significant move, the German development bank KfW is investing six million US dollars in the public health system allowing a significant expansion of the number of districts in Cambodia offering quality screening and treatment services for diabetes, high blood pressure and cervical cancer.
Kong Yam is also making changes: She is trying to cut back white rice as she knows that it causes her blood sugar to rise dramatically and gets support from a trained fellow diabetic, who works as a peer educator and helps build Kong Yam’s confidence and shares practical advice.
Cambodia now must strike an important balance. Even with increased access to services, the health system cannot solely treat its way out of this crisis.
More work still needs to be done on disease prevention, by fostering an environment where people lead healthier lives, so women like Kong Yam don’t develop diabetes in the first place.