How People with Diabetes in Developing Countries Cool Their Insulin
When it’s 100 degrees Fahrenheit and there’s no available refrigeration, the solutions are ingenious
My friend Jon recently returned from a research trip to Sierra Leone. He’s a graduate student in sociology at Boston University and was observing the work at a new clinic built to improve care for patients with chronic diseases like respiratory disease, cancer, and diabetes. The clinic, supported by the global health organization Partners In Health, is based in Kono District, a region with poor infrastructure, devastated by the civil war fought in the 90s and early 2000s over diamonds and other mineral resources.
While accompanying a nurse and a social worker from the clinic on their regular check-in visits to the rural villages surrounding Koidu, the capital of Kono District, Jon encountered a patient named Samuel. Samuel (whose name has been changed for privacy) is a trader and farmer, and also a Type 1 diabetic in his mid-30s. In order to live, he had to inject insulin every day.
Insulin is a protein and to maintain its potency, it must be kept at or below standard room temperature (20–25 C/68–77 F). If it gets too hot, it denatures, like egg-white in hot water, and becomes less effective. In regions where the temperature is regularly hotter than 25 C/77 F and where people live without refrigeration, this is a problem. Without reliable insulin to maintain healthy blood glucose levels, insulin-dependent patients can experience life-threatening complications like kidney damage and cardiovascular disease.
When Jon, the nurse, and the social worker went to check in on Samuel, he brought them out behind his house to a shallow hole covered with a piece of wood. At the bottom of the hole was a small clay pot and inside was the insulin, cool and vulnerable.
Approximately half a billion people worldwide live with Type 1 or Type 2 diabetes. A 2018 study in Diabetes Technology and Therapeutics estimates that about 150 to 200 million of them currently require insulin therapy. A 2016 study by the International Diabetes Federation (IDF) found that at least 33% of the diabetics who live in low- and middle-income countries are without home refrigeration…