Clutching identical notebooks, a group of Cambodians with diabetes
queues inside a small house off a dusty railroad track in the country's
capital, Phnom Penh. When they leave, their blood sugar level will be
inked on their hands and in their books to indicate how well they are
controlling the condition.
Every week, about 40 people from this slum community gather for blood glucose tests, counselling on diet and exercise, and to discuss the best ways to manage the disease. They are part of a peer education programme that could be the best way for them to change their lifestyles.
"In a clinical setting [patients] will just say, 'Yes, yes, yes' and then go away and continue with their normal life and nothing changes," says Maurits van Pelt, director of the MoPoTsyo patient information centre, a local NGO focusing on chronic disease.
"Here, those messages can be explored, because people have time. They can ask, and then resist, and then they can deal with that resistance as a group … you need an informal setting because it's all about behavioural change."
There is no doctor here. Instead, Meach Lina, 44, a peer educator who has received six weeks of training and is a diabetic, dispenses advice from home. But in Cambodia, where healthcare costs from disease often put families in long-term debt or poverty, peer education programmes can go a long way.
"I prefer coming here than to a private clinic. It costs less as I used to spend a lot of money on my treatment. But here, I also get advice from the counsellor, who tells me how to exercise and how to eat," says Saing Savoeurn, 66.
Lina makes appointments for Savoeurn to visit a doctor, as well as helping her to access low-cost generic drugs distributed through a revolving drug fund; after an initial capital investment, drug supplies are replenished with money collected from the sale of drugs. Patients are also offered affordable urine strips to keep track of their sugar levels at home.
"If you tell people in the west that people are doing this themselves they can't believe it … but I see this all as demystification. Giving people confidence [to] start to take matters into their own hands," Van Pelt says.
MoPoTsyo has trained more than 100 peer educators to help patients in Cambodia's rural areas and urban slums. It has 7,000 diabetic members in its network and estimates that about 500,000 people have self-screened for the disease since 2005 as a result of its programmes.
A study of rural Siemreap and suburban Kampong Cham found a surprisingly high prevalence of diabetes – 5% in Siem Reap, and 11% in Kampong Cham.
Peer educators typically counsel on nutrition and exercise. Photograph: Reuters
Every week, about 40 people from this slum community gather for blood glucose tests, counselling on diet and exercise, and to discuss the best ways to manage the disease. They are part of a peer education programme that could be the best way for them to change their lifestyles.
"In a clinical setting [patients] will just say, 'Yes, yes, yes' and then go away and continue with their normal life and nothing changes," says Maurits van Pelt, director of the MoPoTsyo patient information centre, a local NGO focusing on chronic disease.
"Here, those messages can be explored, because people have time. They can ask, and then resist, and then they can deal with that resistance as a group … you need an informal setting because it's all about behavioural change."
There is no doctor here. Instead, Meach Lina, 44, a peer educator who has received six weeks of training and is a diabetic, dispenses advice from home. But in Cambodia, where healthcare costs from disease often put families in long-term debt or poverty, peer education programmes can go a long way.
"I prefer coming here than to a private clinic. It costs less as I used to spend a lot of money on my treatment. But here, I also get advice from the counsellor, who tells me how to exercise and how to eat," says Saing Savoeurn, 66.
Lina makes appointments for Savoeurn to visit a doctor, as well as helping her to access low-cost generic drugs distributed through a revolving drug fund; after an initial capital investment, drug supplies are replenished with money collected from the sale of drugs. Patients are also offered affordable urine strips to keep track of their sugar levels at home.
"If you tell people in the west that people are doing this themselves they can't believe it … but I see this all as demystification. Giving people confidence [to] start to take matters into their own hands," Van Pelt says.
MoPoTsyo has trained more than 100 peer educators to help patients in Cambodia's rural areas and urban slums. It has 7,000 diabetic members in its network and estimates that about 500,000 people have self-screened for the disease since 2005 as a result of its programmes.
A study of rural Siemreap and suburban Kampong Cham found a surprisingly high prevalence of diabetes – 5% in Siem Reap, and 11% in Kampong Cham.
Peer educators typically counsel on nutrition and exercise. Photograph: Reuters
Like many developing countries, Cambodia faces an epidemic of
non-communicable diseases (NCD), with diabetes alone responsible for
more than 5,000 deaths last year. According to the World Health Organisation (WHO) (pdf), NCDs account for 46% of deaths in the country.
At the same time, the high costs (pdf) of accessing primary healthcare services are a significant barrier, especially since 80% of Cambodians live in rural areas. Community-based approaches to controlling NCDs could therefore provide a low-cost alternative if used in conjunction with the existing health system, according to Dr Hai-Rim Shin, head of NCDs for the western-Pacific region at the WHO.
"Peer education is helpful but it depends on the country context … many low- and middle-income countries don't have the health system to deal with this. That's why we also support community-level practitioners," says Shin.
Although peer education has long held a place in HIV-Aids prevention, its use in diabetes control is relatively new. The World Diabetes Foundation (WDF) supports peer educator networks in Jordan, Brazil and the Maldives, as well as Cambodia.
"It's something that is emerging, we are starting to see this in many countries where they don't have the healthcare capacity to deal with the disease," says Jamal Butt, the foundation's communications manager. He says WDF-sponsored projects have resulted in marked improvements and lifestyle changes for patients enrolled in community-based programmes.
According to Van Pelt, recent evaluations have found that about 70% of MoPoTsyo members were keeping their diabetes under control. An independent evaluation (pdf) also found significant improvements.
For Lina, however, it is obvious that her patients are more likely to listen to her than a doctor. "We are both simple people. It's easy for them to ask questions and get advice from me. They don't feel scared."
At the same time, the high costs (pdf) of accessing primary healthcare services are a significant barrier, especially since 80% of Cambodians live in rural areas. Community-based approaches to controlling NCDs could therefore provide a low-cost alternative if used in conjunction with the existing health system, according to Dr Hai-Rim Shin, head of NCDs for the western-Pacific region at the WHO.
"Peer education is helpful but it depends on the country context … many low- and middle-income countries don't have the health system to deal with this. That's why we also support community-level practitioners," says Shin.
Although peer education has long held a place in HIV-Aids prevention, its use in diabetes control is relatively new. The World Diabetes Foundation (WDF) supports peer educator networks in Jordan, Brazil and the Maldives, as well as Cambodia.
"It's something that is emerging, we are starting to see this in many countries where they don't have the healthcare capacity to deal with the disease," says Jamal Butt, the foundation's communications manager. He says WDF-sponsored projects have resulted in marked improvements and lifestyle changes for patients enrolled in community-based programmes.
According to Van Pelt, recent evaluations have found that about 70% of MoPoTsyo members were keeping their diabetes under control. An independent evaluation (pdf) also found significant improvements.
For Lina, however, it is obvious that her patients are more likely to listen to her than a doctor. "We are both simple people. It's easy for them to ask questions and get advice from me. They don't feel scared."
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