Kong Yam’s sight is failing. She has worked her whole life but now the mother-of-six struggles to complete everyday activities like making rice porridge for her grandson. She’s lost sight completely in her right eye, and the left is painful and blurry. This is because 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 increases the risk of developing diabetes, and in fact, the Khmer word for diabetes translates as ‘sugar disease’.
The numbers make for worrying reading. According to a recent risk factor survey, the proportion of overweight or obese Cambodians increased from 15 to 22 per cent from 2010 to 2016, while the number of people with raised blood sugar more than trebled from 2.9 to 9.6 per cent. 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 it was one of only 26 primary healthcare centers in the country trained to screen and treat diabetes and hypertension. For most people, diabetes goes undiagnosed until complications arise. Only 1.5 per cent of surveyed diabetics were on medication.
Even for those diagnosed and on treatment, the cost of medicine is a huge burden for many households. Kong Yam also has high blood pressure and spends around US$20 a month on medicines: over a third of her living costs. This figure will increase as she needs greater amounts of insulin to manage her condition.
And it’s not only diabetes that is growing. An unhealthy diet, lack of physical exercise, smoking, alcohol, and exposure to indoor and outdoor air pollution have exponentially increased rates of a group of diseases which together account for the largest share of deaths in Cambodia.
These are the ‘noncommunicable diseases’, or ‘NCDs’: cardiovascular diseases, respiratory diseases, and cancer, and diabetes. 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 shift gears to address the deadly NCD epidemic.
In Kampong Thom where Kong Yam lives, the German development organization GIZ, financed by the German government, has been working with the Ministry of Health (MoH), alongside WHO and other partners, to make essential NCD services more widely available at all levels of the health system.
This year 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 MoH 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 significant move, the German development bank KfW is investing US$4.5 million 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.
On a personal level, Kong Yam is also making changes. White rice is a staple for Cambodians, but she is trying to cut back as she knows that it causes her blood sugar to rise dramatically. Supporting her as she manages her condition is fellow diabetic Sar Lat, who has been trained by the NGO MoPoTsyo to work as a peer educator. She helps build Kong Yam’s confidence and gives practical advice on how to cope with diabetes.
Kong Yam hopes to manage her treatment without financial worries and would like the cost of medicines to fall.
This silent epidemic may have crept up on Cambodia, but now the country must strike an important balance. Even with increased access to services, Cambodia’s health system cannot solely treat its way out of this crisis. Cultivating an environment where people have the opportunity to make healthier choices and where disease prevention is prioritised is critical, so women like Kong Yam don’t develop diabetes in the first place.