Today we celebrate World Diabetes Day and are taking the opportunity to highlight the growing diabetes epidemic across the occupied Palestinian territories (oPt) – and the efforts St John is taking to tackle the condition alongside general healthcare providers.
The prevalence of diabetes in 25-64-year-olds in the oPt was 12.7% in 2010. This number is predicted to reach 20.8% in 2020 and 23.4% in 2030. If the most developed nations are struggling with tackling this condition – how does a state besieged with political turmoil and lack of investment such as the oPt fare?
In 2019 we concluded a year-long Rapid Assessment of Avoidable Blindness in the oPt, for those aged over 50. This report had a number of helpful findings, especially compared with a similar 2008 study conducted by St John of Jerusalem Eye Hospital Group (SJEHG).
Our 2019 study found that Diabetic Retinopathy (DR), a serious but manageable eye condition caused by diabetes, was one of the main causes of avoidable blindness in the oPt, causing almost 1 in 4 of all cases of avoidable blindness. A decade prior it only caused 8% of blindness. Shockingly in our study, more than 40% of people with diabetes either had never had an eye check-up or had not been checked more than two years prior to the survey. In a study conducted in 2012 into diabetes across the oPt, only 1 in 5 diabetic cases were controlled. What makes this clear is that diabetic services (both general and ophthalmic) are not keeping up with the demand caused by growing rates of diabetes across the country.
Despite the staggering numbers, DR was not a priority in the latest government Strategic National Health Plan (2017). There is no national integrated DR screening programme at the primary health care level or any plans to improve the capacity of health care providers to screen for DR. Compounding the problem here is an insufficient number of ophthalmologists.
Dr Nahed Mikki, who has project managed the most recent RAAB, explains the importance of these results:
The results of this study prove what we have suspected for some time – that rates of DR are growing alongside the increasing rates of diabetes across the oPt. It is clear that this condition is a growing issue for eye health in Palestinians. Luckily, on the back of the 2008 study, we have been developing robust diabetic retinopathy research, training and screening service across the oPt, so we are already off to a strong start in tackling the condition. What is necessary now is further investment across all levels to ensure this epidemic with the best possible resources we can gather.
Dr Nahed Mikki
So, what can be done? We have been focussed on tackling this issue for over a decade and found there are numerous challenges to tackling this condition in the oPt.
Due to the political permit system and other societal factors, it is absolutely vital that we increase accessibility to eye care in the region. To remedy this, we have been using portable cameras and mobile teams to target the most vulnerable and isolated villages and refugees camps across the oPt for screening services. Since 2012, these screening services have been provided across the West Bank and Gaza and in UNWRA refugee camps in Jordan in partnership and supported by the World Diabetes Foundation, CBM, The German Federal Ministry for Economic Cooperation and Development (BMZ), and the Fred Hollows Foundation (FHF).
In total, we have screened over 60,000 patients for the condition in specific DR-focussed projects. These are complemented by our screening services offered in our Mobile Outreach teams and hospitals and clinics.
We have also teamed up with the Ministry of Health and UNWRA to ensure our screening services are sustainable and comprehensive. By training general nurses at UNWRA camps and clinics on how to screen for the condition, and donating a fundus (DR-screening) camera for their use, we are expanding the scope of our services, in turn, they refer all patients presenting with DR our centres for the management of the condition. The teams at the camps work with our project managers to ensure every patient is supported along their treatment journey to receive the treatment they require.
Above all, education is a priority. As with all eye care issues, catching the condition early is imperative. We hope through our research, we will develop “best practice” approaches to educate both primary health care providers and those living with diabetes on how to monitor the condition.
We have come a long way since we set out to tackle this condition, but we have a long way to go. As the prevalence of Diabetes and DR continues to grow, so too must our services to combat it. Armed with research, highly trained professionals, and education, we may yet win the fight.